Comparative study of radiography,CT and MRI of benign spinal lesions associated with invasive signs / 实用放射学杂志

Objective To investigate the aggressive signs of benign spinal lesions appearing on medical imaging and their impact on diagnosis.Methods 139 cases of benign spinal lesions with aggressive signs confirmed by pathology of needle aspiration or surgery were reviewed,including 18 cases of osteoblastoma(OB),12 cases of aneurysmal bone cyst(ABC),14 cases of osteoenchondroma (OC),19 cases of Langerhans cell histiocytosis (LCH),15 cases of hemangioma (HA),34 cases of tuberculous spondylitis (TS),and 27 cases of pyogenic spondylitis (PS).All patients underwent radiography,119 cases CT plain scan,75 cases MRI scan,and 57 cases performed all the three imaging modalities.The aggressive signs,including bulging of posterior margin of the vertebral body,pathological compression fractures,ill-defined boundary,abnormal soft tissue mass,bone marrow and soft tissue edema were showed.The benign and malignant misdiagnosis rate,the consistent rate of diagnosis with pathology were statistically analysed.Results Bulging of posterior margin of the vertebral body were found in 2 cases of OB,1 case ABC,3 cases LCH,1 case OC,6 cases HA,6 cases TS,2 cases PS.Pathological compression fracture were found in 6 cases of OB,10 cases ABC,16 cases LCH,4 cases HA,21 cases TS,16 cases PS.Ill defined boundary were found in 3 cases of OB,8 cases HA,34 cases TS,27 cases PS.The abnormal soft tissue around spine were found in 6 cases of OB,2 cases ABC,15 cases LCH,10 cases TS,15 cases PS.Bone marrow and soft tissue edema were found in 5 cases of OB,4 cases ABC,10 cases LCH,4 cases HA,30 cases TS,27 cases PS.For benign and malignant misdiagnosis rate,MRI was better than CT(P＜ 0.05).For accuracy of the consistent rate with pathology,CT was better than MRI(P＜0.05).The integrated application of the three imaging methods could significantly improve diagnostic accuracy (P＜0.05).Conclusion The imaging features benign spinal lesions are various,which may be associated with aggressive signs.A comprehensive method combined with three kinds of imaging methods,is a simple and feasible way to avoid the misdiagnosis.

Role of MRI spine in evaluation of cases of neurotrophic arthropathy

Introduction: A neurotrophic joint (also known as a Charcot joint) refers to a progressive degenerative/ destructive joint disorder in patients with abnormal pain sensation and proprioception. A substantial number of neurotrophic joints are caused secondary to lesions of the spine. Many a times the patient does not give any history indicating a spine lesion. Hence MRI scan of Spine should be made a part of the investigations in every case of neurotrophic joint. Aims and objectives: To study the incidence of Spinal lesions as a primary causative factor behind a neurotrophic joint and to study the efficacy of MRI spine exam in correctly diagnosing Spinal lesions in patients presenting with a neurotrophic joint. Materials and methods: This study was conducted in the Radiology department of Dhiraj general Hospital. 20 patients presenting with neurotrophic joint/joints but giving no history suggestive of an underlying spinal pathology were evaluated by MRI spine. Results: Out of 20 patients presenting with neurotrophic joint who were evaluated by MRI spine, only 12 scans revealed a spinal pathology secondary to which the patient had developed neuropathic change of the affected joint. Conclusion: Onset of joint neuropathy is usually insidious. If this pathological process continues unchecked, it can result in joint deformity, ulceration and/or super infection, loss of function, and in the worst-case scenario, amputation or death. Early identification of joint changes is the best way to limit morbidity and for that early diagnosis of any underlying pathology is important. MRI spine is a sensitive tool to detect any lesion of the spine. It helps to accurately diagnose a variety of spinal lesions and tells about its exact size, extent and severity and thereby contributes immensely in the management of a neurotrophic joint.

Imaging in neurofibromatosis type 1: An original research article with focus on spinal lesions

Background: Neurocutaneous syndromes encompass a group of disorders that affect the embryonic ectodermal plate, which includes the central and peripheral nervous systems, as well as the overlying skin. Materials and methods: All patients were known case of neurofibromatosis type 1. All patients for this study had undergone MRI whole spine with brain screening. Conventional radiographs were also taken when and where needed after taking informed consent. Results: In our study we found that 15 (60%) patients having lumbar neurofibromas, 7 (28%) patients having cervical neurofibromas, 2 (8%) patients having thoracic neurofibromas and 1 (4%) patients having sacral neurofibromas. Conclusion: MRI allows non-invasive detection of spinal neurofibromas and helps determine intrdural or extradural origin and their relationship to the neural foramina, spinal canal, and thecal sac and spinal cord. The target sign (bright on T2, with dark collagen centrally) is highly suggestive of a peripheral neurofibroma on MRI.

Primary Intracranial Ewing's Sarcoma (Peripheral Primitive Neuroectodermal Tumour of Parietal Bone) with Spinal and Pelvic Metastasis in a Young Female Child: Rare Case Report and Review

Introduction The Peripheral Primitive Neuroectodermal Tumour (pPNET)/Ewing's sarcoma family tumor (ESFT) group is a recently redefined term which includes all small round cell tumors of bone, soft tissue, and nerve with a common neuroectodermal origin. These highly aggressive pediatric soft tissue tumors occur less frequently in the craniospinal axis. Primary cranial lesion associated with spinal and pelvic metastasis is a rare presentation. Clinical Presentation A 9-year old girl was hospitalized with features of progressive increase in intracranial pressure with quadriparesis. The patient had ⅘ quadriparesis with bilateral papilledema. Brain MRI showed a large, hetero intense, contrast enhancing right parietal bony lesion infiltrating the dura with mass effect over the brain. Brain CT showed bony expansion and multiple calvarial lytic lesions. MRI cervical spine revealed collapsed fourth cervical vertebral body with extensive paravertebral and paraspinal soft tissue components with cord compression. Metastatic workup revealed a lytic lesion in the left iliac bone and left lung. The patient underwent a surgically challenging C4 corpectomy with cage fixation followed by craniotomy and excision of parietal bony lesion with titanium mesh cranioplasty in the same sitting. Histopathology revealed pPNET and was confirmed by CD99 positivity. Conclusion This rare multiple site tumor presentation was carefully planned and effectively managed by a combined single-stage surgical approach involving total excision of primary parietal bone and metastatic cervical spine tumors with primary titanium mesh cranioplasty and cervical spine stabilization, followed with radiotherapy and chemotherapy, which resulted in good recovery and improved the overall prognosis for the patient.

Introdução O grupo 'tumor neuroectodérmico primitivo periférico (pPNET) / tumor da família dos sarcomas de Ewing (ESFT)' é um termo recentemente redefinido o qual inclui todos as pequenas arredondadas células de tumor ósseo, tecidos moles e nervos com origem neuroectodérmica comum. Estes tumores pediátricos de tecido mole altamente agressivos ocorrem com menor frequência no eixo cranioespinal. Lesões primárias do crânio associadas a metástase espinhal e pélvica são raras. Relato de Caso Criança de 9 anos de idade hospitalizada com fraturas e pressão intracraniana crescente com quadriparesia. A paciente teve ⅘ de quadriparesia com papiledema bilateral. RM do cérebro por contraste mostrou uma lesão óssea parietal direita extensa e hétero-intensa infiltrando a dura-máter com efeito maciço sobre o cérebro. TC do cérebro mostrou expansão óssea e múltiplas lesões líticas na calota craniana. RM da espinha cervical revelou colapso da quarta vertebra cervical com componentes paravertebral e paraespinal de tecido mole com compressão da medula. Workup metastático revelou uma lesão lítica no ilíaco esquerdo e pulmão esquerdo. A paciente foi submetida a difícil corpectomia da C4 com fixação de cage seguida de craniotomia e excisão da lesão parietal óssea com cranioplastia com malha de titânio na mesma posição. Histopatologia revelou pPNET, confirmada por positividade de CD99. Conclusão Este raro caso com apresentação de múltiplos tumores foi cuidadosamente planejado e eficazmente conduzido por acessos cirúrgicos combinados em fase única envolvendo excisão total do osso parietal primário e tumores metastáticos da espinhal cervical com cranioplastia com malha de titânio e estabilização da espinha cervical, seguida de radioterapia e quimioterapia, resultando em boa recuperação e melhora no prognóstico geral da paciente.

Posterior Lumbar Interbody Fusion Using Laminar Bone and Titanium Block / 대한척추외과학회지

STUDY DESIGN: A retrospective study to analyze the results of posterior lumbar interbody fusion, using laminar bone and titanium block, with pedicle screw instrumentation. OBJECTIVES: To evaluate the clinical and radiological results of posterior lumbar interbody fusion, using laminar bone and titanium block, with pedicle screw instrumentation. SUMMARY OF LITERATURE REVIEW: Several studies have demonstrated the results of posterior lumbar interbody fusion, there has been no report on our method. MATERIALS AND METHODS: From March 2001 to May 2002, seventeen patients were treated by posterior lumbar interbody fusion, using laminar bone block, from spinous process and titanium block. All patients were clinically followed up over 12 months. The mean age of the patients and follow-up were 58 years and 15 months, respectively. The clinical results were evaluated by Kim's criteria and radiological union, and the subsidence of disc space and change of the lordotic curve were assessed by a simple Xray. RESULTS: The satisfactory clinical result and radiological union rates were 83.3 and 90.4%, respectively. The mean subsidence of the disc space and change of the lordotic curve were 0.8 mm and 1.6 degrees, respectively. There was one complication of a wrong insertion of the pedicle screw to the disc space. CONCLUSION: Posterior lumbar interbody fusion using laminar bone and titanium block showed an acceptable radiological union rate and clinical results. This could be a good alternative method for obtaining initial stability and bony union without taking a bone graft from the posterior ilium in various spinal lesions.

Interbody Fusion using Iliac Crest Allograft in Global Spinal Fusion / 대한정형외과학회잡지

PURPOSE: To analyze the efficacy of iliac tricortical allograft (Tutoplast (r) ) as an anterior load sharing construct in global fusion consisting of interbody fusion, transpedicular screw fixation and posterolateral fusion. MATERIALS METHODS: We followed up 40 levels in 27 patients who had undergone interbody fusion using iliac tricortical allograft (Tutoplast (r) ) and added transpedicular screw fixation and poterolateral fusion from Dec. 1995 to Dec. 1996. They were followed up for more than 2 years. The disease entities included 11 patients with spondylolisthesis, 8 patients with spinal stenosis with lumbar intervertebral discs herniation, 6 patients with degenerative lumbar kyphoscoliosis and 2 patients with pseudoarthrosis. Anterior interbody fusion was performed in 11 cases and posterior lumbar interbody fusion in 16 cases. RESULTS: The radiological union rate of interbody fusion was 90% (36/40) , and collapsed union was 7.5% (3/40) ranging from 11% to 28% collapses of initial graft height. The non-union occurred at level 1, which showed radiolucent line on host-graft interface but did not reveal instability on stress views. The radiologic union rate of the posterolateral fusion was 100%. Complications such as metal failure and infection were not noted. Satisfactory clinical results were 88.9%. CONCLUSION: Iliac tricortical allograft was a good substitute for an anterior load sharing construct in interbody fusion combined with transpedicular screw fixation and posterolateral fusion.

Posterior Lumbar Interbody Fusion using Laminar Bone Block / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study analyzing the results of posterior lumbar interbody fusion(PLIF) using laminar bone block and pedicle screw instrumentation. OBJECTIVES: To analyse the clinical and radiological results of PLIF using laminar bone block to evaluate whether this method is clinically valuable. MATERIALS AND METHODS: From March 1997 to February 1998, twenty three patients were treated by PLIF using bone block obtained from spinous process, facets and lamina. All of the patient were followed up over 12 months clinically. The mean age was 49 years and mean follow-up was 13.6 months. The clinical results were evaluated by Kim's criteria and adiological union, subsidence of disc space and change of lordotic curve were assessed by simple X-ray. RESULTS: The satisfactory clinical result rate was 82.6% and radiological union rate was 92.3%. The mean subsidence of disc space and change of lordotic curve were 2.0 mm and 2.2 degrees. There were four complications : two minimal dural tear, one pedicle screw breakage and one superficial infection. CONCLUSION: PLIF using laminar bone block showed acceptable radiological union rate and clinical results. It could be a good alternative to obtain bony union without taking bone graft from the posterior ilium in various spinal lesions.

Survivorship Analysis of Pedicle Screw Fixation / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study analyzing survivorship of pedicle screw fixation in various spinal lesions. OBJECTIVES: To determine the survivorship of pedicle screw fixation and to assess the risk factors for the death of system. SUMMARY OF LITERATURE REVIEW: The previous reports of ten years survival rate of pedicle screw instruments was about eighty percent and the factors which influenced were bone quality, strength of instruments, design of instruments and compliance of patients. MATERIALS AND METHODS: Three hundred and thirty-eight patients(178 males and 160 females), treated by pedicle screw fixation from May 1988 to Dec. 1997, were analysed. Follow-up averaged 26.8months(3 to 116 months). The survival rates according to spinal lesions which caused spinal fixation, types of instruments, level of fusion and methods of fusion were predicted by life table method. The criteria of death were 1)breakage of screw or rod 2)gross bending of screw >5 degree 3)screw pullout and 4)dissociation of rod-screw coupling mechanism. RESULTS: Death of instrumentation was identified in twenty-six patients(7.7%). Of the 1,827 screws used, forty-three screws(2.4%) in twenty patients had broken(28) or bent(15). Thirty-nine Cotrel-Dubousset screws(3.5%) and four Diapason screws(1.6%) had involved. Four patients showed pullout of screws and two had dissociation of rod and screw. There was no rod broken. Life table calculations predicted the survivorship of instrumentation would be 88.7% at 10 years of follow-up. Single segment fixation showed higher survival rate than more than three segments fixation(93.3% vs 83.4%). Fracture had the lowest survival rate(78.3%). Screw failure was not influenced by the method of fusion. Suspected causes of death were collapse of disc space(12 patients), increased kyphosis(6), forceful reduction of fracture(3), infection(2), nonunion(2) and trauma(1). CONCLUSIONS: Ten year survival rate of pedicle screw fixaion was 88.7%. The survival rate was influenced by 1)number of fixed segments 2)cause of fixation .

Clinical Analysis of Anterior Interbody Fusion Using Kaneda Device in Unstable Thoracolumbar Spinal Lesions(Long Term Follow-up Results)

Recently anterior spinal device(Kaneda device) for the treatment of the unstable spine has been used. We have experienced 33 patients of the unstable thoracolumbar spine, which were composed of 24 cases with burst fracture, 1 case with kyphotic angulation, and 8 patients with tuberculous spondylitis. These 33 patients were treated with and one stage anterior operation consisting of anterior decompression by vertebrectomy and diskectomies, and interbody fusion using autogenous ribs or iliac bone realigment and stabilization with Kaneda device. No patient showed neurologic deterioration after surgery. Follow-up periodes was 6 months to 2.5 years. The anterior spinal instrumentation with Kaneda deviced affored enough stability to enable early ambulation with good aligment and solid fusion.