Radiation Exposure to the Hand of a Spinal Interventionalist during Fluoroscopically Guided Procedures

STUDY DESIGN: Prospective study. PURPOSE: During fluoroscopically guided spinal procedure, the hands of spinal surgeons are placed close to the field of radiation and may be exposed to ionizing radiation. This study directly measured the radiation exposure to the hand of a spinal interventionalist during fluoroscopically guided procedures. OVERVIEW OF LITERATURE: Fluoroscopically guided spinal procedures have been reported to be a cause for concern due to the radiation exposure to which their operators are exposed. METHODS: This prospective study evaluated the radiation exposure of the hand of one spinal interventionalist during 52 consecutive fluoroscopic spinal procedures over a 3-month period. The interventionalist wore three real-time dosimeters secured to the right forearm, under the lead apron over the chest, and outside the lead apron over the chest. Additionally, one radiophotoluminescence glass dosimeter was placed under the lead apron over the left chest and one ring radiophotoluminescence glass dosimeter was worn on the right thumb. The duration of exposure and radiation dose were measured for each procedure. RESULTS: The average radiation exposure dose per procedure was 14.9 µSv, 125.6 µSv, and 200.1 µSv, inside the lead apron over the chest, outside the lead apron over the chest, and on the right forearm, respectively. Over the 3-month period, the protected radiophotoluminescence glass dosimeter over the left chest recorded less than the minimum reportable dose, whereas the radiophotoluminescence glass ring dosimeter recorded 368 mSv for the thumb. CONCLUSIONS: Our findings indicated that the cumulative radiation dose measured at the dominant hand may exceed the annual dose limit specified by the International Commission on Radiological Protection. Spinal interventionalists should take special care to limit the duration of fluoroscopy and radiation exposure.

Compression Myelopathy due to Proliferative Changes around C2 Pars Defects without Instability

We report a case with compression myelopathy due to proliferative changes around the C2 pars defects without instability. A 69-year-old man presented with progressive clumsy hands and spastic gait. Plain radiographs showed bilateral spondylolysis (pars defects) at C2 and fusion between C2 and C3 spinous processes. Dynamic views revealed mobility through the pars defects, but there was no apparent instability. Computed tomography showed proliferative changes at the pars defects, which protruded into spinal canal. On magnetic resonance imaging, the spinal cord was compressed and intramedullary high signal change was found. A diagnosis of compression myelopathy due to proliferative changes around the C2 pars defects was made. We performed posterior decompression. Postoperatively, symptoms have been alleviated and images revealed sufficient decompression and no apparent instability. In patients with the cervical spondylolysis, myelopathy caused by instability or slippage have been periodically reported. The present case involving C2 spondylolysis is extremely rare.

Vacuum Phenomenon of the Sacroiliac Joint: Correlation with Sacropelvic Morphology

STUDY DESIGN: A radiologic study of sacropelvic morphology and vacuum phenomenon of sacroiliac joint in subjects unrelated to low back pain. PURPOSE: The aim of this study is to describe the relationship between sacropelvic morphology and vacuum phenomenon of the sacroiliac joint. OVERVIEW OF LITERATURE: Lumbopelvic alignment and sacropelvic morphology are associated with the pathomechanisms of various spinal disorders. The vacuum phenomena of the sacroiliac joint (SJVP) are often observed in clinical practice, but the relationships between these phenomena and sacropelvic morphology have not been investigated. This study examined the prevalence of SJVP in computed tomography (CT) images and the relationship between sacropelvic morphology and SJVP. METHODS: We analyzed multiplanar CT images of 93 subjects (59 men, 34 women). Pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and lumbar lordosis (LL) were measured using the three-dimensional reconstruction method. The prevalence of SJVP in multiplanar CT images were reviewed. Roland-Morris Disability Questionnaire (RDQ) scores and the modified Japanese Orthopedic Association (JOA) score, which focuses on subjective symptoms and restriction of activities of daily living, were also obtained from all the subjects. RESULTS: Thirty-six of the 93 subjects had SJVP (39%), with marked female predominance (91% women, 8.5% men). Men with SJVP had significantly lower PI than men without SJVP (35.1° vs. 46.3°, p<0.05). There was no correlation between SJVP and the modified JOA or RDQ scores. CONCLUSIONS: These data suggest that differences in sacropelvic morphology can influence the biomechanical environment and contribute to SJVP in men. Presence of SJVP did not affect JOA or RDQ scores.

Complete Resolution of a Case of Calcific Tendinitis of the Longus Colli with Conservative Treatment

Acute calcific tendinitis of the longuscolli is a self-limiting inflammatory condition caused by calcium hydroxyapatite deposition in the longuscolli tendon. Although several case reports have described its radiological presentation, few reports provide detailed chronological accounts through symptomatic and radiologic resolution. A 59-year-old woman presented with severe neck pain and stiffness of a few days duration as well as moderate discomfort when swallowing. Lateral radiographs revealed a large calcium deposit anterior to the C1.C2 joint and swelling of the prevertebral soft tissue from C1 to C5. CT and magnetic resonance imaging showed fluid in the retropharyngeal gap.A soft collar and non-steroidal anti-inflammatory drug were prescribed, without antibiotics. At 4 months after presentation, the calcium deposit and all symptoms had resolved completely. Although this disease is comparatively rare, physicians should keep it in mind when a patient presents with acute severe neck pain.

Hemorrhagic Facet Cyst in the Lumbar Spine Causing Contralateral Leg Symptoms: A Case Report

Here we present a case of hemorrhagic lumbar facet cyst presenting with progressive radiculopathy only on the contralateral side. If a patient has previous back pain or neuropathy for several months and then suddenly deteriorates, hemorrhagic facet cyst of the lumbar spine should be part of the differential diagnosis. However, as in the present case, we should be aware that there is a possibility of a contralateral lesion.

MRI Changes of the Spinal Subdural Space after Lumbar Spine Surgeries: Report of Two Cases

Although magnetic resonance imaging (MRI) is frequently used to assess the lumbar spine, there are few reports in the medical literature that have evaluated using MRI immediately following spinal surgery. Furthermore, descriptions of the subdural changes after lumbar spine surgery are also infrequent. In this paper, we present two cases with subdural change seen on MRI immediately after lumbar surgery. Both the patients had mild symptoms that resolved spontaneously, and the follow-up MRI scans showed resolution of the subdural changes. Subdural changes should be considered as one of the possible causes of unexpected symptoms in patients following lumbar spinal surgery.