Accuracy of SPECT/CT fusion imaging in differential diagnosis of benign and malignant spinal lesions / 中国基层医药

Objective To analyze and discuss the clinical value of single photon emission computed tomography(SPECT)/CT fusion imaging in differentiating benign and malignant spinal lesions.Methods From January 2017 to January 2018,70 cases with benign and malignant spinal lesions in Shanxida Hospital were studied.SPECT/CT fusion imaging and SPECT examination were used to compare the diagnosis results between the two groups.Results After SPECT diagnosis,a total of 98 bone metastatic lesions were detected,including 10 false positive lesions,60 benign lesions and 28 false negative lesions.After SPECT/CT fusion imaging,there were 100 lesions,including 4 false positive lesions,59 benign lesions and 37 false negative lesions.In this study,a total of 145 lesions were found in 70 patients with benign and malignant spinal lesions,including 95 benign lesions and 50 malignant lesions.The specificity,sensitivity and accuracy of SPECT/CT fusion imaging [95.79％ (91/95),92.00％ (46/50),93.79％ (136/145)] were higher than those of the control group [82.11％ (78/95),64.00％ (32/50),and 82.76％ (120/145)],the differences were statistically significant (x2 =9.048,11.422,9.578,all P ＜0.05).Conclusion In the diagnosis of benign and malignant spinal diseases,SPECT/CT fusion imaging can accurately distinguish benign and malignant lesions,and clearly reflect the development of the disease,which lay a solid foundation for good treatment in the future.

Accuracy of SPECT/CT fusion imaging in differential diagnosis of benign and malignant spinal lesions / 中国基层医药

Objective@#To analyze and discuss the clinical value of single photon emission computed tomography(SPECT)/CT fusion imaging in differentiating benign and malignant spinal lesions.@*Methods@#From January 2017 to January 2018, 70 cases with benign and malignant spinal lesions in Shanxida Hospital were studied.SPECT/CT fusion imaging and SPECT examination were used to compare the diagnosis results between the two groups.@*Results@#After SPECT diagnosis, a total of 98 bone metastatic lesions were detected, including 10 false positive lesions, 60 benign lesions and 28 false negative lesions.After SPECT/CT fusion imaging, there were 100 lesions, including 4 false positive lesions, 59 benign lesions and 37 false negative lesions.In this study, a total of 145 lesions were found in 70 patients with benign and malignant spinal lesions, including 95 benign lesions and 50 malignant lesions.The specificity, sensitivity and accuracy of SPECT/CT fusion imaging [95.79%(91/95), 92.00%(46/50), 93.79%(136/145)] were higher than those of the control group [82.11%(78/95), 64.00%(32/50), and 82.76%(120/145)], the differences were statistically significant(χ2=9.048, 11.422, 9.578, all P<0.05).@*Conclusion@#In the diagnosis of benign and malignant spinal diseases, SPECT/CT fusion imaging can accurately distinguish benign and malignant lesions, and clearly reflect the development of the disease, which lay a solid foundation for good treatment in the future.

Fracturas inestables de la columna vertebral: presentación de una serie de casos / Vertebral column unstable fractures: presentation of a case series

INTRODUCCIÓN. Este trabajo se realizó debido a la alta incidencia de lesiones vertebrales por traumatismos, con lesión medular o sin ella, observada en cuerpo de guardia del Hospital Enrique Cabrera. El objetivo fue documentar una serie de pacientes tratados por fracturas vertebrales inestables y valorar además su evolución clínica. MÉTODOS. Se realizó un estudio prospectivo de intervención de 15 pacientes con fracturas vertebrales inestables, atendidos entre el 1990 y el 2001. A todos los pacientes se les realizó estudio radiológico simple pre y posoperatorio, anteroposterior y lateral. Se registró el cuadro clínico neurológico pre y posoperatorio según la clasificación de Frankel. RESULTADOS. Predominó el sexo masculino (86,6 por ciento) y la edad promedio fue de 35,2 años. El segmento vertebral más afectado fue el T12-L1 y los mecanismos de producción de las lesiones predominantes fueron las caídas de altura y los accidentes automovilísticos. Se operaron en total 10 pacientes; todos fueron instrumentados y a 5 se les realizó descompresión de los elementos nerviosos. Se usaron técnicas como la instrumentación de Luque, corpectomía transpedicular e instrumentación de Luque, Harrington-Luque y descompresión anterior con osteosíntesis AO. Se obtuvieron buenos resultados en 6 pacientes, regulares en 2 y malos, en otros 2 pacientes. Como complicaciones se registraron la lesión de la duramadre y sepsis del sitio operatorio en un caso, y rotura de una de las varillas del Luque en otro paciente. CONCLUSIONES. La descompresión medular y la estabilización espinal, lo más tempranamente posibles, continúan siendo una necesidad

INTRODUCTION: Present paper was conducted due to the high incidence of traumatic vertebral lesions with medullary lesion or not present in patients seen in the Emergency Department of "Enrique Cabrera" Hospital. The aim of present paper was to verify a series of patients with unstable vertebral fractures and also to assess its clinical course. METHODS: An interventional prospective study was conducted in 15 patients presenting with unstable vertebral factures from 1990 to 2001. All patients underwent a lateral and preoperative and postoperative routine radiological study. According the Frankel's classification the preoperative and postoperative clinical picture was registered. RESULTS: There was a male sex predominance (86.6 percent) and mean age was of 35,2 years. The more involved vertebral segment was the T12-L1 and the mechanisms causing the predominant lesions were the height falls and the road accidents. Ten patients were operated on; in all there was instrumentation and in five we used decompression of nervous elements, as well as the Luque instrumentation, transpedicular corpectomy and Luque instrumentation, Harrington-Luque and anterior decompression with AO osteosynthesis. In six patients we achieved good results, regular in two and poor in other two patients. As complication were registered the dura mater and sepsis in the operative site in a case and a rupture in one of the Luque wires in other patient. CONCLUSIONS: Early medullary decompression and spinal stabilization are very necessary

INTRODUCTION. Ce travail est dû à la haute incidence de lésions vertébrales traumatiques, avec lésion médullaire ou pas, trouvée au Service d'urgence de l'hôpital « Enrique Cabrera ». Le but de ce travail a été d'examiner une serie de patients atteints des fractures vertébrales instables, et d'évaluer aussi leur évolution clinique.MÉTHODES. Une étude prospective d'intervention de 15 patients atteints de fractures vertébrales instables, traités entre 1990 et 2001, a été réalisée. Tous les patients ont subi des examens radiologiques simples pré et postopératoires, antéro-postérieurs et latéraux. Un tableau clinique neurologique pré et postopératoire a été créé d'après la classification de Frankel.RÉSULTATS. La prédominance du sexe masculin a été significative (86,6%), et l'âge moyen a été 35,2 ans. Le segment vertébral T12-L1 a été le plus lésé, et les lésions ont été notamment causées par des chutes et des accidents de route. Un total de 10 patients ont été opérés; tous ont été appareillés, et cinq ont subi une décompression nerveuse. Les techniques utilisées ont été l'instrumentation de Luque, la corpectomie transpédiculaire et l'instrumentation de Luque, d'Harrington-Luque et la décompression antérieure à ostéosynthèse AO. On a obtenu des résultats satisfaisants chez 6 patients, des résultats passables chez 2, et des résultats desfavorables chez les autres 2 patients. Parmi les complications on a rencontré la lésion de la dure-mère et l'infection du site opératoire dans un cas, et la rupture d'une des tiges de Luque dans un autre cas.CONCLUSIONS. La décompression médullaire et la stabilisation spinale, réalisées le plus tôt que possible, continuent à être une nécessité

Lesiones intramedulares que simulan tumor / Spinal cord lesions that mimic neoplasms

Objetivo. Analizar las características clínicas y neurorradiológicas de las distintas lesiones intramedulares con la finalidad de poder diferenciar las lesiones no-tumorales de las tumorales y reservar la exploración quirúrgica sólo para aquellos pacientes sin diagnósticoy con sintomatología rápidamente progresiva. Material y métodos. Se revisaron las historias clínicas de 44 pacientes operados consecutivamente con diagnóstico presuntivo de tumor intramedular entre enero de 1988 y diciembre de 2007. No se incluyeron en el análisis los tumores bulbomedulares ni los del cono y filum ni tampoco los lipomas, teratomas y quistes dermoides.Resultados. Se identificaron 4 pacientes (9.1%), 3 masculinos y 1 femenino, con edad media de 9 años, que presentaban deterioro neurológico progresivo e IRM espinal compatible con tumor intramedular. El resultado histopatológico confirmó en los cuatro casos lesiones no tumorales: infiltrado inflamatorio inespecífico, edema, micosis y gliosis respectivamente.Conclusiones. El minucioso análisis clínico, de laboratorio y el estudio de las imágenes en IRM puede ayudar a la correcta distinción entre tumores y lesiones no-tumorales evitando la exploración quirúrgica que sólo está justificada en los casos muy dudososacompañados de rápido deterioro neurológico funcional del paciente.

Objective. To analyze the clinic and neuro-imaging characteristicsof the intra spinal lesions in order to differentiate the non-neoplasticlesions from neoplastic lesions and to spare surgical exploration only for non-diagnosed patients with rapid deterioration. Materials and method. Fourty-four medical charts of patientsoperated on spinal cord lesions between January 1988 and December 2007 have been analyzed. Results. In four patients (3 male, 1 female – mean age: 9 years)who were operated with diagnosis of intra-spinal tumor, their lesions turned out to be non-neoplastic: non-specific inflammation, edema, mycosis and gliosis, respectively. Conclusions. The thorough clinical and laboratory investigation together with the study of the imaging can help distinguishbetween non-neoplastic lesions from neoplastic lesions in order to avoid surgical exploration which is only suitable in very doubtful cases with rapid deterioration.

Recurrent Intramedullary Neurenteric Cyst of the Spine

Neurenteric cysts are developmental cysts derived from embryonic endodermal layers. Fewer than 100 have been reported in which there were no associated bone or soft-tissue malformations and only six among those cases showed intramedullary location in the literatures. The authors report a 16-year-old young man with a thoracic intramedullary neurenteric cyst which presented with symptoms of axillary pain and paraparesis. The magnetic resonance imaging showed intramedullary mass extended from level of T3 to T7. There was no associated bone or soft-tissue anomaly. This cyst was partially excised and marupialized into subarachnoid space. The pathological findings were compatible with neurenteric cyst. Nine months later, the cyst recurred and at second operation, cyst wall was removed completely.

Ascending pathways of skin and deep information projecting to the ventral posterior lateral nucleus of thalamus in the cat / 全日本鍼灸学会雑誌

In acupuncture, the typical sensation induced by insertion of a needle into the muscle that called “De Qi” is essential to induce acupuncture analgesia. The effect of acupuncture analgesia may depend on the deep afferents rather than to the cutaneous ones at the acupuncture point. The ascending pathways conveying these skin and deep afferents project to the ventral posterior lateral nucleus (VPL) of thalamus, one of the thalamic relay nuclei projected to the cerebral cortex, were examined by spinal cord lesion at the cervical level with observation of the responses evoked by electrical stimulation applied selectively to the skin and deep tissues.<BR>Neuronal discharges were recorded extracellularly from the VPL using the multimicroelectrode technique. After spontaneous neuronal activities were recorded, the receptive fields and characteristics were determined by applying some kinds of mechanical stimulation to the receptive field. The skin and deep structures were then selectively stimulated using a pair of stainless steel needles and insulated needles except for tips. Units were classified for skin units, deep units, and skin-deep units according to the responses to the electrical stimulation. Responses were elicited in some neurons following to both skin and deep stimuli. The latency of response elicited by electrical stimulation applied to the deep structure was slightly shorter than that of the skin structure. The recording sites for deep units were located more rostrally in the dorsal region of the VPL than that for the skin units.<BR>The afferents of some skin-deep neurons from both skin and deep structures were ascended through different pathways in the spinal cord. The skin and deep afferents were found to converge at the thalamic level.

Clinical Analysis of Patients with Thoraco-lumbar Spinal Lesions Managed by Vertebrectomy, Interbody Fusion and Stabilization using Kaneda Device

Among the 98 patients who underwent operations for thoracolumbar spinal lesions from May 1989 to September 1994, the authors performed clinical analysis of 72 patients who were followed-up for more than 12 months. There were 52 cases of trauma, 18 cases of tuberculous spondylitis, and 2 cases of metastatic tumor. After partial or toal vertebrectomy, interbody fusion was performed using autogenous iliac bone or autogenous ribs which were taken while approaching the thoracic spine, and stabilized using Kaneda devices. Complete neural decompression was possible under direct vision in all cases. Neurologic deficits improved to an average of 1.7 grades using a modified Frankel scale. Patients with tuberculous spondylitis did not show recurrence or any evidence of increased risk of secondary infection caused by instrumentation. Loosening or breakdown of instruments occurred in 4 patients, and spinal deformity in 7 patients, but reoperation was not needed in any of these patients. By anterior decompression, interbody fusion and stabilization using Kaneda device in thoracolumbar spinal lesions, we could obtain satisfactory neurologic improvement as well as immediate firm stability and high fusion rate involving only a minimum(usually two) number of motion segments as compared with the posterior approach.