Cordoma en la articulación facetaria de C4: reporte de caso / Chordoma in C4 Facet Joint: A Case Report

Los cordomas son tumores óseos primarios, poco frecuentes, derivados de remanentes no diferenciados de la notocorda. Por su origen histológico, suelen ubicarse en la línea media del esqueleto axial, y los lugares de presentación más frecuentes son la base del cráneo y la columna. Se caracterizan por presentar un crecimiento lento, por lo que tienden a ser clínicamente silenciosos hasta alcanzar tamaños que causan manifestaciones que varían según el sitio de presentación; sin embargo, tienen alta agresividad y recurrencia local. El tratamiento es quirúrgico e, idealmente, se busca una resección completa de la lesión. El artículo presenta el caso de un hombre de 20 años de edad, quien desarrolló un cordoma en la articulación facetaría superior izquierda de C4, que es una localización rara.

Chordoma are rare primar? bone tumours derived from non'difieren tiated remains of the notochord. Due to their histological origina, the most common site of presentation is on the mid'line of the axial skeleton, with a distribution that is most frequent on the sacral bone, skull base and mobile spine. These tumours have a slow growth rate, which means that symptoms occur when the size of the mass causes different manifestations according to its site of presentation. Howeveti they have aggressive behaviour with high rates of local recurrence. Ideal treatment is based on surgical block removal if possible. This article presents the case of a 20' year'old male patient with diagnosis of a chordoma on the leít superior facetar? articulation of C4.

Finite Element Analysis for Comparison of Spinous Process Osteotomies Technique with Conventional Laminectomy as Lumbar Decompression Procedure

PURPOSE: The purpose of this study was to evaluate and compare the biomechanical behavior of the lumbar spine after posterior decompression with the spinous process osteotomy (SPiO) technique or the conventional laminectomy (CL) technique using a finite element (FE) model. MATERIALS AND METHODS: Three validated lumbar FE models (L2-5) which represented intact spine and two decompression models using SPiO and CL techniques at the L3-4 segment were developed. In each model, the ranges of motion, the maximal von Mises stress of the annulus fibrosus, and the intradiscal pressures at the index segment (L3-4) and adjacent segments (L2-3 and L4-5) under 7.5 Nm moments were analyzed. Facet contact forces were also compared among three models under the extension and torsion moments. RESULTS: Compared to the intact model, the CL and SPiO models had increased range of motion and annulus stress at both the index segment (L3-4) and the adjacent segments under flexion and torsion. However, the SPiO model demonstrated a reduced range of motion and annulus stress than the CL model. Both CL and SPiO models had an increase of facet contact force at the L3-4 segment under the torsion moment compared to that of the intact model. Under the extension moment, however, three models demonstrated a similar facet contact force even at the L3-4 model. CONCLUSION: Both decompression methods lead to postoperative segmental instability compared to the intact model. However, SPiO technique leads to better segmental stability compared to the CL technique.

Relationship of Facet Tropism with Degeneration and Stability of Functional Spinal Unit

PURPOSE: The authors investigated the effect of lumbar facet tropism (FT) on intervertebral disc degeneration (DD), facet joint degeneration (FJD), and segmental translational motion. MATERIALS AND METHODS: Using kinetic MRI (KMRI), lumbar FT, which was defined as a difference in symmetry of more than 7degrees between the orientations of the facet joints, was investigated in 900 functional spinal units (300 subjects) in flexion, neutral, and extension postures. Each segment at L3-L4, L4-L5, and L5-S1 was assessed based on the extent of DD (grade I-V) and FJD (grade 1-4). According to the presence of FT, they were classified into two groups; one with FT and one with facet symmetry. For each group, demographics, DD, FJD and translational segmental motion were compared. RESULTS: The incidence of FT was 34.5% at L3-L4, 35.1% at L4-L5, and 35.2% at L5-S1. Age and gender did not show any significant relationship with FT. Additionally, no correlation was observed between DD and FT. FT, however, wasfound to be associated with a higher incidence of highly degenerated facet joints at L4-L5 when compared to patients without FT (p < 0.01). Finally, FT was not observed to have any effects upon translational segmental motion. CONCLUSION: No significant correlation was observed between lumbar FT and DD or translational segmental motion. However, FT was shown to be associated significantly with the presence of high grades of FJD at L4-L5. This suggests that at active sites of segmental motion, FT may predispose to the development of facet joint degeneration.

The relationship of facet tropism to lumbar disc herniation.

SUMMARY OF BACKGROUND DATA: The association between the facet tropism and the development of lumbar disc herniation has been studied; however the results remain controversial. OBJECTIVE: To determine the association between the facet tropism and the development of lumbar disc herniation. STUDY DESIGN: A cross-sectional study. MATERIAL AND METHOD: MRI of 34 patients with lumbar disc herniation was evaluated. Two orthopedic surgeons measured facet joint angle and determined the degenerative status of L3-4, L4-5, and L5-SI. Facet tropism was defined as the difference between the angle of the right and left facet more than 5 degrees. RESULTS: The average difference of facet joint angle of HNP group was higher than normal group in the same level. There was no statistically significant correlation between the facet tropism and lumbar disc herniation. CONCLUSION: These results do not indicate any relationship between the facet tropism and lumbar disc herniation.

The orientation of facet joints and transverse articular dimension in degenerative spondylolisthesis.

OBJECTIVES: To determine whether the orientation of facet joints, facet tropism and transverse articular dimension could play a role in degenerative spondylolisthesis. MATERIAL AND METHOD: MRI study of L4-5 level of twenty degenerative spondylolisthesis and age-matched twenty control group were included. The orientation of facet joints, transverse articular dimension (TAD) and cosine facet orientation of TAD were measured with two independent observers. RESULTS: The facet orientation of more than 43 degrees and cosine facet orientation of TAD less than 7.4 were statistically significant for developing degenerative spondylolisthesis (p < 0.05). CONCLUSION: The facet orientation of degenerative spondylolisthesis patients was more sagittal orientation than the the control group, and the cosine facet orientation of TAD was also less than the control group.

Back Pain related to denegerative facet joint disease as sequally of long instrumentation and short fusion in thoracolumbar fracture

The aim of this study is to evaluate the degeneration of facets in unfused segments immobilized by Harrington rods and Hartshill rectangle plate fixation and to see how often back pain develop after treatment with this method. A total of 58 patients with thoracolumbar fractures were treated with long-fix and short fuse technique. Harrington rods and Hartshill plates are removed an average of 18 months after initial surgery. Every case showed solid fusion during implant removed exploration. All cases were followed for a minimum of 5 years. radiological studies were performed to evaluate the degeneration of the facet joints. Back pain was found in 22 patients [38%] the degeneration of infused facets was visualized in 12 patients [2%] by roentgenograms. Increased activity in the instrumented spine by bone scan examination also was noted in [24] patients: six cases [10%] were at infused area, 2 at fused area and 7% at fused and infused areas. In conclusion degeneration in the immobilized and infused segments after long fix and short fuse was rarely seen clinically after long-term follow-up. Back pain was experienced in only [38%] of the patients that seldom required treatment