Multiple Cervical Spinous Process Fractures in a Novice Golf Player

Avulsion of spinous process, also called Clay-shoveler's fracture, is most prevalent among those engaged in hard physical labor. To the best of the author's knowledge, only one case of multiple spinous process fractures of the upper thoracic spine in a novice golfer has been reported. A 45-year-old female presented with intractable posterior neck pain. The patient experienced a sharp, sudden pain on the neck while swinging a golf club, immediately after the club head struck the ground. Dynamic cervical radiographic findings were C6 and C7 spinous process fractures. Magnetic resonance imaging revealed C6 and C7 spinous process fractures without spinal cord pathology. The patient was treated with pain medications and cervical bracing. The patient's pain gradually improved. The injury mechanism was speculated to be similar to Clay-shoveler's fracture. Lower cervical spinous process fractures can be associated with a golf swing. If the patient complains of long lasting neck pain and has a history of golf activity, further study should be conducted to rule out lower cervical spinous fracture.

Posterior Atlantoaxial Fixation with a Combination of Pedicle Screws and a Laminar Screw in the Axis for a Unilateral High-riding Vertebral Artery

A vertebral artery (VA) injury presents a difficult problem in atlantoaxial fixation. Recent technical reports described posterior C2 fixation using bilateral, crossing C2 laminar screws. The translaminar screw technique has the advantages of producing little risk of VA injury and the unconstrained screw placement. In addition, biomechanical studies have demonstrated the potential of the translaminar screw technique to provide a firmer construct that is equivalent to methods currently used. We report the successful treatment of C1-2 instability with a left-side high-riding VA. Because of the potential risk of VA injury, we performed a posterior C1-2 fixation with a combination of pedicle screws and a laminar screw in C2. We first placed bilateral C1 lateral mass screws and a right-side C2 pedicle screw. However, placement of the left- side C2 pedicle screw was technically difficult due to a narrow isthmus and pedicle. A laminar screw was inserted instead and authors believe that this posterior C1-C2 fixation with a combination of pedicle screws and a laminar screw in C2 can be a useful alternative technique for the treatment of C1-C2 instability in the presence of a unilateral high-riding VA.

Bcl-2 and Bax Expression and Ki-67 Proliferative Index in Astrocytic Tumors: in Relation to Prognosis

OBJECTIVE: We report a retrospective investigation of the prognostic value of bcl-2 and bax expression, and Ki-67 proliferative index in 42 astrocytic tumors. METHODS: We classified the astrocytic tumors and reviewed the clinical information and survival time. The sections were taken from surgically resected paraffin-embedded tissue and performed immunohistochemical stains for bcl-2, bax and Ki-67. RESULTS: The immunohistochemical stain for bcl-2 revealed a positivity in only two(4.76%) among forty-two cases. The immunostain for bax was positive in 35 cases(83.3%). However, the correlation between bcl-2 & bax expression and age, sex, tumor location, size, and histologic grade was not found. By Kaplan-Meier analysis, bcl-2 & bax expression and survival time in astrocytic tumors was no significance in log rank test(p>0.05). There were prognostic values between Ki-67 LI and histologic grade and between Ki-67 LI and survival time, respectively(p<0.05). CONCLUSION: Bcl-2 and bax are not significant, whereas Ki-67 LI is suggested as a significant prognostic factor, associated with histologic grade and survival time of astrocytic tumors.

A Case of Spinal Cord Compression Caused by Rhabdomyosarcoma of the Mediastinum Associated with Type I Neurofibromatosis(NF Type I)

A 12-years-old female admitted to the hospital with the complaint of pain on the right upper chest area which persisted about 1 month prior to admission. Cafe-au-lait spots of various size laying on a whole body and freckling on the axilla were found on physical examination. A huge mass was found on the plain chest X-ray and on chest MRI. The mass encroached thoracic spine, posterior rib, back muscles, and then into the neural canal and compressed thoracic spinal cord. On the 5th day of hospitalization, the patient complained tingling on the both legs and 2 days later, monoparesis on the right leg. Open thoracotomy and decompressive laminectomy was done to remove mass. Pathologic reports confirmed rhabdomyosarcoma, embryonal type.

Clinical Usefulness of MR FLAIR Image in Mild Head Injuries

OBJECTIVES: MR fluid-attenuated inversion recovery(FLAIR) image uses paired long inversion time and relaxation time that nulls the signal from CSF. With nulling of the CSF long echo time readout could be used to increase T2-weighting, hence improving the conspicuousness of most tissue lesions without the deleterious effects of CSF artifact seen on T2 weighted sequence. We examed the usefulness of FALIR image in the diagnosis of mild head injury. METHODS: A total of 38 patients with mild head injury were examined by FLAIR image. We compared those images with CT scan and T1, T2-weighted images. Careful observation of MR images were done by two well-trained neuroradiologists. Each image was compared for conspicuousness and detectability of traumatic lesions might have shown abnormal signal intensities. The Wilcoxon signed ranks test was used for statistical evaluation. RESULTS: The FLAIR image was significantly more sensitive than those of other images(p<0.001). T2 FFE(Fast Field Echo) image was more useful for detection of small petechial hemorrhages. CONCLUSION: FLAIR image is considered to be more sensitive than those of conventional MR images in the evaluation of mild head injuries.