The Relationship between Neck Pain and Cervical Alignment in Young Female Nursing Staff

OBJECTIVE: Degenerative changes in the cervical spine are commonly accompanied by cervical kyphosis which can cause neck pain. This study examined the relationship between neck pain and cervical alignment. METHODS: A total of 323 female nursing staff from our hospital were enrolled. Sagittal radiographs of the cervical spine, Body Mass Index (BMI), Visual Analogue Scale (VAS) measures of neck and arm pain, Neck Disability Index (NDI) and the Short Form (36) Health Survey (SF-36 scores) were obtained and reviewed retrospectively. Global lordosis (GL) of the cervical spine was measured on radiograph images. Correlations between GL and questionnaire scores were investigated using the following three methods : 1) correlation between GL and questionnaire scores among the entire sample; 2) subgroup analysis of patients with "kyphosis (KYP) : GL scores0" on questionnaire measures; and 3) subgroup analysis of patients with pain vs. those without pain, on GL and questionnaire measures. RESULTS: There was no significant correlation between GL and any questionnaire measure. There was a significant difference between the mean GLs of the KYP and LOR groups, but there were no group differences in BMI, age or any questionnaire measures. There was no difference between the pain (n=92) and pain-free (n=231) groups in age, BMI or GL, but there were differences in neck, and arm pain, and physical function and NDI scores. CONCLUSIONS: Our data suggest that kyphotic deformity was not associated with neck pain.

Posterior Transarticular Atlanto-Axial Fixation with Perrin Screw

Posterior transarticular screw fixation is effective treatment method in cases of atlanto-axial instabilities. Various surgical procedures have been described for stabilization of unstable C1-C2 complex. The conventional management methods, either a Gallie or Brooks fusion technique, have limitations such as post-operative rigid bracing and relatively high rate of non-union. Since Magerl developed a technique for posterior transarticular screw placement at C1-C2 in 1979, Noel I. Perrin published modified technique for atlanto-axial instability using percutaneous drill guide system in 1995. This instrumentation system improved limitations of conventional fixation technique and reduced complications as well as shortening of operation times. Between May 1997 and February 1998, modification of this surgical approach with Perrin screw system was used in the treatment of 12 cases of atlantoaxial instability. Transarticular screw was placed in conjunction with bone graft wiring through the percutaneous working drill guide. The causes of the instabilities were rheumatoid arthritis(5 cases), traumatic injuries(4 cases), post operative instability(1 case), and non-union with immobilization(2 cases) and other cause. Patient age was ranged from 18 years to 70 years. Mean operation time was 145 min(110 to 225) with mean blood loss was 180 ml. Intraoperative complication was drill tip fracture in 1 case and screw pullout in 1 case postoperatively. Neurological or vascular injury were not observed there was neither radiologic instabilities nor spinal deformities. Neurologic and symptomatic status were improved in all operated cases.

Radiologic Location of Ventricular Tip and the Patency of Ventriculoperitoneal Shunt

Proximal cerebrospinal fluid shuntmalfunction due to ventricular catheter occlusion remains the most common sourceof the shunt problem. The position of the hole-bearing segment of the catheter affects the long term patency of the ventricular catheter of a cerebrospinalfluid shunt.Placementof thissegmentnear thechoroidplexus or injured ependyma increases the probability of obstruction. Accurate locationof ventriculoperitoneal(V-P)shunt tip inrelation to foramen Monro canbe well establishedby plain radiographyregardless of agesor sizes and shapes of head dueto the fact that foramen Monro tothe spatial matrix of the skull is constant. Of 147patients who underwentV-P shunt operations, 49(33.3%)patients had more thanone operations. Radiologicgradingof theventricularcatheterposition is compared betweensingle operatedgroup andreoperated group.Single operated group showed excellentin 33.6%, good41.8%, poor 24.4%of accuracy rateof catheter tip position. Incases ofreoperation, placement ofcatheter tipresulted in excellent 12.5%, good21.8%, and poor 65.6%.These results indicatethat accurate location of ventricular catheter tip affects favorably to the patency of V-P shunt.

Thoracic Myelopathy Caused by Multiple Ossified Ligamentum flavum Combined with Ossification of the Posterior Longitudinal Ligament

The authors report a case of thoracic myelopathy caused by multiple ossification of the ligamentum flavum(OLF) combined with ossification of the posterior longitudinal ligament(OPLL). A 52-year-old man had progressive motor weakness and numbness in the lower extremities. Diagnosis was made from the MR imaging that provided useful information about the multiple lesions in the lower cervical and upper thoracic area and about the degree of spinal cord compression. The surgical approach consisted of two stages: Posterior decompression for OLF(first stage) and anterior decompression for OPLL, followed by interbody fusion(second stage). The patient had satisfactory improvement after surgical intervention.

A Case of Neuroendocrine Carcinoma in Anterior Cranial Fossa

Neuroendocrine tumors are heterogeneous and potentially aggressive, and they must be distinguished from classic carcinoid tumors as the tumors share histologic features with their counterparts that occur in the lung, such as oat cell and intermediate cell carcinomas. Histopathologically, the oat cell neuroendocrine carcinoma displays itself in sheets, cord and rib-bons of small hyperchromatic, undifferentiated cells with very scanty cytoplasm. The intermediate cell is slightly larger than the oat cell and has more abundant cytoplasm. The authors report a case of a 52-year old patient with neuroendocrine carcinoma that occurred at the anterior cranial fossa extending into the nasal cavity. The patient presented with recurrent meningitis and seizure. Histological examination of the nasal biopsy tumor specimen confirmed neuroendocrine carcinoma, afterwhich the patient treated with a 4300 rad radiation therapy. Magnetic resonance imaging taken 2 years later showed an enlargement of the tumor mass at the anterior cranial fossa, and the patient was operated for removal of the intracranial tumor. The nasal cavity defect was reconstructed using rotation galeal flap technique.

Extramedullary Plsasmacytoma Developed in the Thoracic Epidural Space: Case Report

Spinal cord compression associated with plasma cell neoplasm is observed always in the patients suffering from the multiple myeloma or solitary plasmacytoma that occur in the marrow of the spine. Authors report a rare case of extramedullary plasmacytoma forming a mass in the epidural space of the thoracic spine. In 70 year old woman with paraplegia, MRI of the thoracic spine indicated a presence of epidural mass at the 2nd to 8th thoracic vertebrae. There was no abnormal bony changes in the spine on plain X-ray and MRI. Total removal of the epidural mass was performed by posterior approach. Histopathologic examination including immunohistochemical stain showed the plasma cell neoplasm producing IgM and kappa light chain. Cancer workup after operation including bone marrow study and whole body simple radiologic studies supported the diagnosis of extramedullary plasmacytoma.

Effects of Insulin, 2-Deoxyglucose and Dichloroacetate on Acute Focal Cerebral Ischemia in Rats

Hyperglycemia has been reported to worsen the tolerance of the brain to ischemia, and it has therefore been recommended that patient undergoing neurosurgical procedures not receive glucose-containing solutions. Since ischemic events lead to increased lactate production and accumulation and hence neuronal damage, the present study was designed to test the effect of insulin-induced hypoglycemia and decreased lactate by 2-Deoxyglucose and Dichloroacetate on focal cerebral ischemia in rats. Although the pre and post-ischemic blood glucose levels of control group and Dichloroacetate group showed no change, the blood glucose level of 2-Deoxyglucose group showed a significant increase(p=0.001), and insulim group a significant decrease(p=0.004). The reducing effects on the infarct zone in these three treated groups were found with statistical significance. As compared with control group, the tissue lactate levels of treated groups were decreased in both infarct zone and border zone but these data did not show statistical significance. From these observations, it is suggested that reduction of lactate production and accumulation could be beneficial by affording neuronal protection in ischemic tissues.

Intramedullary Neurilemmoma in Conus Medullaris

A case of intramedullary neurilemmoma embedded within the conus medullaris of spinal cord and presumably extending over its surface, is reported. Published reports of these rare lesions and possible mechanisms of their origin are reviewed. The treatment of choice for these rare lesions is thought to be laminectomy and resection and intraoperative frozen section diagnosis is considered essential. Importance of operative removal is emphasized.