Thrombosis of Left Common Iliac Artery Following Anterior Lumbar Interbody Fusion: Case Report and Review of Literatures

We report on a case of thrombosis of the left common iliac artery following anterior lumbar interbody fusion (ALIF) of L4-5 in a 79-year-old man with no previous medical problems, including peripheral vascular disease. After completing the ALIF procedure, the surgeon could not feel the pulsation of the left dorsalis pedis artery, and the oxygen saturation (SaO2) had fallen below 90% from pulse oxymetry on the left great toe. Thrombectomy was successfully performed after confirming the thrombus in the left common iliac artery using Computed Tomography (CT) angiography. Thrombosis of the common iliac artery is very rare following ALIF. However, delayed diagnosis can lead to disastrous outcome. Although elderly patients have no cardio-vascular disease or vessel calcification in pre-op evaluation, the possibility of a complication involving L4-5 should be considered.

Dynamic Lumbar Spinal Stenosis : The Usefulness of Axial Loaded MRI in Preoperative Evaluation

Two cases of dynamic lumbar spinal stenosis were identified by the authors using axial loaded magnetic resonance image (MRI). In both cases, the patients presented with neurogenic claudication but MRI in decumbency showed no definite pathologic condition associated with their symptoms. In contrast, axial loaded MRI demonstrated constrictive spinal stenosis and a significantly decreased dural sac caused by epidural fat buckling and thickening of the ligamentum flavum in both cases. In the second case, a more prominent disc protrusion was also demonstrated compared with decumbent MRI. After decompressive surgery, both patients had satisfactory outcomes. Axial loaded MRI can therefore give decisive information in dynamic spinal disorders by allowing simulation of an upright position.

CT-Guided Percutaneous Vertebroplasty in the Treatment of an Upper Thoracic Compression Fracture

Percutaneous vertebroplasty (PVP) has been used to relieve pain and to prevent further collapse of the vertebral body in patients with an osteoporotic compression fracture. The most commonly affected site for the use of PVP is the thoracolumbar junction. There are few reports that have described on the usefulness of PVP in the treatment of a high thoracic compression fracture. We report a case of an upper thoracic compression fracture that was treated with computed tomography (CT)-guided PVP. It was possible to obtain easy access to the narrow thoracic pedicle and it was also possible to monitor continuously the proper volume of polymethylmethacrylate employed, under CT guidance.

Myxopapillary Ependymoma of Filum Terminale Mimicking Nerve Sheath Tumor

Myxopapillary ependymoma is a distinctive subtype of glioma that occurs almost exclusively in the conus medullaris and filum terminale. Though magnetic resonance(MR) imaging is an effective diagnostic tool for the diagnosis of these tumors, there are no definite correlations between the preoperative radiological images and histopathologic findings. A 30-year-old man with low back pain and leg pain was presented. MR images demonstrated a well-defined intradural extramedullary mass at the L3-4 with strong homogenous enhancement. Based on radiological features, our tentative diagnosis was a nerve sheath tumor. However, the histopathologic report confirmed it as myxopapillary ependymoma.