Fracture in Humeroradial Synostosis: Description of Two Clinical Cases / Fratura em sinostose rádio-umeral: Descrição de dois casos clínicos*

Abstract Synostosis is a generic term to indicate the union of two originally separated bones. At the elbow, humeroradial or longitudinal synostosis causes significant disability, which varies depending on hand function, elbow positioning, adjacent joints mobility and contralateral limb function. It is estimated that, to date, a little more than 150 patients have been described with this deformity, which is more common in subjects with deficient ulnar formation or affected by conditions such as Antley-Bixler and Hermann syndromes. The lack of the elbow joint, with the formation of a longer bone due to humerus-radius fusion, results in stiffness. As such, it is assumed that fractures in this topography are not uncommon. However, since synostosis is rare, this lesion was only described twice in the literature. We report two patients with a fracture of the single bone formed by a humeroradial synostosis and Bayne type-IV ulnar formation failure. Both patients were treated surgically with success. We emphasize the need for adequate treatment to not compromise the daily activities of patients who are adapted to their deformity, thus avoiding worsening the function of a previously affected limb.

Resumo Sinostose é um termo genérico utilizado para indicar a união de dois ossos originalmente separados. No cotovelo, a sinostose rádio-umeral ou longitudinal causa importante incapacidade, que varia a depender da função da mão, da posição do cotovelo, da mobilidade das articulações adjacentes e da função do membro contralateral. Estima-se que um pouco mais de 150 pacientes foram descritos até hoje com essa deformidade, sendo mais frequente em portadores de deficiência de formação ulnar ou podendo fazer parte de síndromes como de Antley-Bixler e de Hermann. Devidoàrigidezcausadapelaausênciadaarticulaçãodocotovelo,queresultana formação de um osso mais longo com a fusão do úmero no rádio, presume-se que fratura nessa topografia não seja incomum. No entanto, pela raridade dessa patologia, tal lesão apresenta apenas duas descrições prévias na literatura. Relatamos os casos de dois pacientes com fratura do osso único formado pela sinostose entre o úmero e o rádio portadores de falha de formação ulnar do tipo IV de Bayne. Ambos os pacientes foram tratados de forma cirúrgica e evoluíram bem. Salientamos a necessidade do tratamento adequado para não comprometer as atividades da vida de um paciente já adaptado à deformidade, evitando piorar a função de um membro já alterado.

Síndrome de Klippel-Feil en un lactante / Klippel-Feil syndrome in an infant

Se presenta el caso clínico de un lactante de 11 meses de edad, quien fue remitido a la consulta de Genética Clínica del Centro Provincial de Genética Médica de la provincia de Holguín, por presentar dismorfias faciales asociadas a retardo motor, cuello corto y disminución de movimientos. Se realizó interrogatorio, examen físico exhaustivo y estudios radiológicos de columna cervical, que mostraron la fusión de vértebras cervicales, lo cual permitió diagnosticar el síndrome de Klippel-Feil. Se proyectó habilitación con ejercicios para fortalecer los músculos paravertebrales y se brindó asesoramiento genético a la familia.

The case report of an 11 months infant is presented, who was referred to the Clinical Genetics Service of the Medical Genetics Provincial Center in Holguín province, due to facial dysmorphias associated with motor retardation, short neck and decreasing movements. Interrogation, exhaustive physical exam and radiological studies of cervical column were carried out that showed the fusion of cervical vertebras, which allowed to diagnose the Klippel-Feil syndrome. A qualification with exercises was projected to strengthen the paravertebral muscles and genetic advice to the family was provided.

Surgical Resection of Intermetatarsal Coalition of the Fourth and Fifth Founded in Long Distance Running / 대한스포츠의학회지

Intermetatarsal coalition (IC) is very rare; although few cases have been reported in foreign orthopedic journals, these have not originated in our country. We report the case of a 20-year-old man who complained of pain in the left forefoot only during long distance running (3 km). On examination, his foot shape, skin appearance, and gait were normal, with no plantar keratosis; however, the radiograph revealed coalition between the fourth and fifth metatarsals. Surgical excision was performed. In the histopathologic study, fibrous coalition was confirmed. This paper reports an uncommon case involving surgical excision of IC in the military service, involving active sport activity.

Osteotomía desrotadora para el tratamiento de la sinostosis congénita radiocubital proximal / Detracting osteotomy for the treatment of proximal radiocubital congenital synostosis

Generalidades: la sinostosis congénita radiocubital proximal se caracteriza por un déficit de segmentación entre el radio y el cúbito que forma un puente óseo o fibroso que limita la supinación y pronación del antebrazo. Objetivo: describir de la técnica quirúrgica de osteotomía desrotadora para el tratamiento de sinostosis congénita radiocubital proximal y los resultados obtenidos en los pacientes. Materiales y métodos: entre febrero de 2013 y junio de 2015 se realizó osteotomía desrotadora para el tratamiento de sinostosis congénita radiocubital proximal en el Hospital Pediátrico Docente "Baca Ortiz" a 7 niños con un total de 12 antebrazos; 5 bilaterales y 2 unilaterales derechos; con un promedio de edad de 5 años 3 meses. El promedio de seguimiento fue de 1 año 4 meses. Los resultados incluyen el grado de fijación de pronación de la deformidad, el rango de movimiento pre y postoperatorio de supinación y pronación. Resultados: se obtuvo 9 antebrazos (75%) con resultados excelentes, 2 (16.7%) con resultados buenos y 1 (8.3%) con resultado regular. Una ganancia de rango de movimiento de supinación en promedio de 50.8º y una reducción de rango de movimiento de pronación en promedio de 85.8º. Conclusiones: la osteotomía desrotadora es una técnica quirúrgica efectiva para tratar la sinostosis congénita radiocubital proximal. (AU)

Background: The Congenital Proximal Radioulnar Sinostosis is characterized by a lack of segmentation between the radio and ulna, which constitute a osseous bridge or fibrous union that borders the supination and pronation of the forearm. Objective: To describe the surgical technique of derotational osteotomy for the treatment of Congenital Proximal Radioulnar Sinostosis, as well as evaluate the observed results in patients. Materials and Methodology: from February 2013 to June 2015, an derotational osteotomy for the treatment of Congenital Proximal Radioulnar Sinostosis was applied on seven children, for a total of twelve forearms; five bilateral, and two right unilateral; with an age average of 5 years and 3 months. The average follow-up time was 1 year and four months. The results include the degree of fixation in pronation of the deformity, the range of pre and post surgical movement of supination and pronation. Results: We obtained nine foreams (75%) with excellent results, two (16.7%) with good results and one (8.3%) with regular results. A gain in the range of movement of supination, on average, of 50,8º, and a reduction in the range of movement of pronation, on average, of 85.8º. Conclusions: The derotational osteotomy is a surgical technique effective for the treatment of Congenital Proximal Radioulnar Sinostosis.(AU)

Craneosinostosis: Revisión de literatura / Craniosynostosis: Literature review

Las craneosinostosis consisten en el cierre prematuro parcial o total de una o más suturas craneales, con una incidencia de 1 de cada 1000 a 3000 nacidos vivos, con mayor prevalencia en varones. Dentro del contexto de las craneosinostosis primaria, la escafocefalia o craneosinostosis sagital es la forma más frecuente y conocida. Al presentarse en un período de vida donde el crecimiento cráneo cerebral es muy importante, ocasiona en los niños una deformidad craneal característica que debe ser corregida, ya que en caso contrario y al ser progresiva, la afectación estética puede ser muy indeseable; las alteraciones funcionales que se pueden presentar van desde aumento de la presión intracraneana, hasta convulsiones, entre otras. Se realizó una búsqueda en bases de datos como PUDMED, RIMA, MEDLINE, MEDSCAPE de revisiones de temas, guías de manejo, artículos y análisis estadísticos, en idioma inglés, donde se encontraron 1.469 referencias. Después de una primera mirada de los artículos a través de sus resúmenes comprendidos en el periodo de tiempo año 2000 a 2014, finalmente se seleccionaron 50 artículos en texto completo abarcando el tema en su totalidad que cumplían los requisitos de búsqueda.

The craniosynostosis consist of full or partial premature closure of one or more cranial sutures, with an incidence of 1 in 1000 3000 live births, with higher prevalence in males. Within the context of primary craniosynostosis, sagittal craniosynostosis scaphocephaly or is the most common and known form. To occur over a period of life where growth cranium is very important causes in children a characteristic skull deformity should be corrected, since otherwise and being progressive, aesthetic involvement can be very undesirable; functional alterations that may occur include increased intracranial pressure, seizures and others. A search was conducted in databases such as PUBMED, RIMA, MEDLINE, Medscape reviews issues, management guides, articles and statistical analysis, in english, where they found 1,469 references. After a first look at the articles through their summaries included in the period 2000 to 2014, finally 50 articles were selected in full text covering the subject fully meeting the conditions search.

Genetic Syndromes Associated with Craniosynostosis

Craniosynostosis is defined as the premature fusion of one or more of the cranial sutures. It leads not only to secondary distortion of skull shape but to various complications including neurologic, ophthalmic and respiratory dysfunction. Craniosynostosis is very heterogeneous in terms of its causes, presentation, and management. Both environmental factors and genetic factors are associated with development of craniosynostosis. Nonsyndromic craniosynostosis accounts for more than 70% of all cases. Syndromic craniosynostosis with a certain genetic cause is more likely to involve multiple sutures or bilateral coronal sutures. FGFR2, FGFR3, FGFR1, TWIST1 and EFNB1 genes are major causative genes of genetic syndromes associated with craniosynostosis. Although most of syndromic craniosynostosis show autosomal dominant inheritance, approximately half of patients are de novo cases. Apert syndrome, Pfeiffer syndrome, Crouzon syndrome, and Antley-Bixler syndrome are related to mutations in FGFR family (especially in FGFR2), and mutations in FGFRs can be overlapped between different syndromes. Saethre-Chotzen syndrome, Muenke syndrome, and craniofrontonasal syndrome are representative disorders showing isolated coronal suture involvement. Compared to the other types of craniosynostosis, single gene mutations can be more frequently detected, in one-third of coronal synostosis patients. Molecular diagnosis can be helpful to provide adequate genetic counseling and guidance for patients with syndromic craniosynostosis.

Unilateral Talonavicular Coalition: A Case Report / 대한족부족관절학회지

Tarsal coalition is an abnormal union between two or more bones of the hind- and mid-feet, which can occur at various rates from cartilaginous to osseous union. Talonavicular coalition is reported less frequently than calcaneonavicular or talocalcaneal coalition and has been associated with various abnormalities, including symphalangism, clinodactyly, ray anomaly, clubfoot, other tarsal coalitions, and a ball-and-socket ankle joint. Patients with talonavicular coalitions are usually asymptomatic and rarely require surgical treatment. We review the literature and report on a case of 59-year-old male patient with talonavicular coalition.

Physiological Changes and Clinical Implications of Syndromic Craniosynostosis

Syndromic craniosynostosis has severe cranial stenosis and deformity, combined with hypoplastic maxillary bone and other developmental skeletal lesions. Among these various lesions, upper air way obstruction by hypoplastic maxillary bone could be the first life-threatening condition after birth. Aggressive cranial vault expansion for severely deformed cranial vaults due to multiple synostoses is necessary even in infancy, to normalize the intracranial pressure. Fronto-orbital advancement (FOA) is recommended for patients with hypoplastic anterior part of cranium induced by bicoronal and/or metopic synostoses, and posterior cranial vault expansion is recommended for those with flattening of the posterior part of the cranium by lambdoid synostosis. Although sufficient spontaneous reshaping of the cranium can be expected by expansive cranioplasty, keeping the cranial bone flap expanded sufficiently is often difficult when the initial expansion is performed during infancy. So far distraction osteogenesis (DO) is the only method to make it possible and to provide low rates of re-expansion of the cranial vault. DO is quite beneficial for both FOA and posterior cranial vault expansion, compared with the conventional methods. Associated hydrocephalus and chronic tonsillar herniation due to lambdoid synostosis can be surgically treatable. Abnormal venous drainages from the intracranial space and air way obstruction should be always considered at any surgical procedures. Neurosurgeons have to know well about the managements not only of the deformed cranial vault and the associated brain lesions but also of other multiple skeletal lesions associated with syndromic craniosynostosis, to improve treatment outcome.

Congenital Multiple Metatarsal Synostoses with Proximal Phalangeal Deformities of the Foot

No abstract available.

Two cases of Antley-Bixler syndrome caused by mutations in different genes, FGFR2 and POR

Antley-Bixler syndrome (ABS) is a rare form of syndromic craniosynostosis with additional systemic synostosis, including radiohumeral or radioulnar synostosis. Another characteristic feature of ABS is mid-facial hypoplasia that leads to airway narrowing after birth. ABS is associated with mutations in the FGFR2 and POR genes. Patients with POR mutations present with either skeletal manifestations or congenital adrenal hyperplasia with ambiguous genitalia. We report here two cases of ABS caused by mutations in FGFR2 and POR. Although the patients had craniosynostosis and radiohumeral synostosis in common and cranioplasty was performed in both cases, the male with POR mutations showed an elevated level of 17α-hydroxyprogesterone during newborn screening and was diagnosed with congenital adrenal hyperplasia by adrenocorticotropic hormone stimulation. This patient has been treated with hydrocortisone and fludrocortisone. He had no ambiguous genitalia but had bilateral cryptorchidism. On the other hand, the female with the FGFR2 mutation showed severe clinical manifestations: upper airway narrowing leading to tracheostomy, kyphosis of the cervical spine, and coccyx deformity. ABS shows locus heterogeneity, and mutations in two different genes can cause similar craniofacial and skeletal phenotypes. Because the long-term outcomes and inheritance patterns of the disease differ markedly, depending on the causative mutation, early molecular genetic testing is helpful.

Sindrome de Crouzon: Revisión de tema y reporte de caso / Crouzon's Syndrome: Review of the literature and case report

Síndrome de Crouzon es una sinostosis craneofacial congénita caracterizada por el cierre prematuro intrauterino de las suturas coronal, sagital y lambdoidea lo que pro- duce un crecimiento anormal del cráneo, hipoplasia maxilar y asimetría facial. Se reporta el caso de una niña de cinco años de edad con Síndrome de Crouzon, quien consulta el servicio de Odontología Pediá- trica de la Escuela de Odontología de la Universidad del Valle (Cali, Colombia). Se destaca el abordaje multidisciplinario y el manejo ortopédico pre-quirúrgico, colocan - do un dispositivo intraoral fijo de expansión controlada con tornillo tipo Hyrax junto a una máscara facial de protracción maxilar como terapéutica previa a cirugía en mono- block y avance con distractor osteogénico

Crouzon's Syndrome: Congenital cranios- ynostosis characterised by the premature in-utero closure of the coronal, sagittal, and lambdoid sutures. It produces an abnormal growth of the cranium, hypoplasia of the jaw, and facial asimmetry. The case of a five year old girl with Crouzon Syndrome is presented; she consulted the service of Paediatric Dentistry at School of Dentistry of Universidad del Valle (Cali, Colombia). This work highlights the multidisciplinary approach and the orthopaedic pre-surgical management performed, it involved an intraoral fixed device for controlled expan - sion with a Hyrax type screw and a facial mask for maxillary protraction as treatment before surgery. The surgery was performed in mono-block and advancement with an osteogenic distactor was done.

Image-guided surgery and craniofacial applications: mastering the unseen / 대한악안면성형재건외과학회지

Image-guided surgery potentially enhances intraoperative safety and outcomes in a variety of craniomaxillofacial procedures. We explore the efficiency of one intraoperative navigation system in a single complex craniofacial case, review the initial and recurring costs, and estimate the added cost (e.g., additional setup time, registration). We discuss the potential challenges and benefits of utilizing image-guided surgery in our specific case and its benefits in terms of educational and teaching purposes and compare this with traditional osteotomies that rely on a surgeon's thorough understanding of anatomy coupled with tactile feedback to blindly guide the osteotome during surgery. A 13-year-old presented with untreated syndromic multi-suture synostosis, brachycephaly, severe exorbitism, and midface hypoplasia. For now, initial costs are high, recurring costs are relatively low, and there are perceived benefits of imaged-guided surgery as an excellent teaching tool for visualizing difficult and often unseen anatomy through computerized software and multi-planar real-time images.

Radiological Assessment of the Effect of Congenital C3-4 Synostosis on Adjacent Segments

STUDY DESIGN: Retrospective case series. PURPOSE: To assess the effect of non-kyphotic aligned congenital C3-4 synostosis on the adjacent segment in 10 patients. OVERVIEW OF LITERATURE: In the cervical spine, fusion disease at the adjacent motion segments may be a risk factor for potential neurological compromise and death. METHODS: Radiograms of 10 patients 13 to 69 years of age presenting with neck/shoulder discomfort or pain with or without trauma history were examined. C3-4 synostosis was found incidentally in all patients on routine examination radiographs of cervical spine. RESULTS: Adjacent segment disease (ASD) was not found in the three patients younger than 39 years of age. Five of the 10 (50%) patients, including a 67-year-old man, did not develop spondylosis in any of the cervical mobile segments. Spondylosis was observed only in the caudal 1-2 mobile segments in the remaining five patients. The youngest was a 40-year-old male who had spondylosis in the two caudal mobile segments (C4-5 and C5-6). Spondylosis was limited to the two close caudal mobile segments and was not in the cranial segments. Flaring of the lower part of synostotic vertebra associated with advanced narrowed degenerate disc was evident in five patients. CONCLUSIONS: Mobile segment spondylosis in the individuals with congenital monosegment C3-4 synostosis over age of 40 years may be a natural manifestation of aging and is not solely an adjacent segment disease directly and fully related with congenital C3-4 synostosis.

An iatrogenic proximal radioulnar synostosis: a case report and review of literature / 中华创伤杂志(英文版)

The most common cause of proximal radioulnar synostosis in adults is traumatic, usually after forearm fractures. Disabling complications are mainly loss of rotatory movements of the forearm. Various surgical procedures have been described in the literature to end up in forearm synostosis as a complication. We here presented a rare case of proximal forearm synostosis following a common but improper surgical technique for an olecranon fracture complicated by implant infection. The synostosis was treated by resection and fascia lata interposition graft.

Anterior Cervical Discectomy and Fusion Using a Double Cylindrical Cage versus an Anterior Cervical Plating System with Iliac Crest Autografts for the Treatment of Cervical Degenerative Disc Disease

OBJECTIVE: Anterior cervical discectomy and fusion (ACDF) is often complicated by subsidence, pseudoarthrosis, kyphosis, and graft donor site morbidities. To decrease the occurrence of these complications, various types of cages have been developed. We designed this retrospective study to analyze and compare the efficacy and outcomes of ACDF using double cylindrical cages (DCC) (BK Medical, Seoul, Korea) versus an anterior cervical plating system with autogenous iliac crest grafts. METHODS: Forty-eight patients were treated with autograft and plating (plate group), and 48 with DCC group from October 2007 to October 2011. We analyzed construct length, cervical lordotic curvarture, the thickness of the prevertebral soft tissue, segmental instability, and clinical outcomes. RESULTS: There were no significant differences between the two groups with regard to the decrease in construct length or cervical lodortic curvature at the 3-, 6-, and 12-month follow-ups. The prevertebral soft tissue was thinner in the DCC group than the plate group immediately after surgery and at the 3-, 6-, and 12-month follow-ups. The difference in interspinous distance on flexion-extension was shorter in the plate group than the DCC group at the 3- and 6-month follow-ups. However, there was no significant difference in this distance between the two groups at the 12-month follow-up. CONCLUSION: A double cylindrical cage is a good alternative for fusion in patients with cervical degenerative diseases; the surgical method is relatively simple, allows good synostosis, has less associated prevertebral soft tissue swelling, and complications associated with autografting can be avoided.

Radiographic Assessment of Effect of Congenital Monosegment Synostosis of Lower Cervical Spine between C2-C6 on Adjacent Mobile Segments

STUDY DESIGN: A prospective radiographic study of cervical spine with congenital monosegment fusion. PURPOSE: To evaluate the effect of cervical synostosis on adjacent segments and the vertebral morphology. OVERVIEW OF LITERATURE: There are numerous clinical studies of adjacent segment disease (ASD) after monosegment surgical fusion. However, there was no report on ASD in the cervical spine with congenital monosegment synostosis. METHODS: Radiograms of 52 patients, aged 5 to 90 years, with congenital monosegment synostosis (CMS) between C2 and C6, who complained of neck/shoulder discomfort or pain were studied. 51 were normally aligned and one was kyphotically aligned. RESULTS: Spondylosis was not found in the patients below 35 years of age. Only 12 out of 24 patients with normally aligned C2-3 synostosis had spondylosis in 19 more caudal segments, and only one at C3-4. A patient with kyphotic C2-3 had spondylolysis at C3-4. In 8 patients with C3-4 synostosis, spondylosis was found in only 9 caudal segments (4 at C4-5, 4 at C5-6, and 1 at C6-7). The caudate C4-5 disc was the most liable to degenerate in comparison with other caudate segments. Caudal corporal flaring and inwaisting of the synostotic vertebra were the features that were the most evident. In 2 of 9 C4-5 and 7 out of 10 C5-6 synostosis patients, spondylosis was found at the two adjacent cephalad and caudate segments, respectively. Only corporal inwaisting without flaring was found. In all cases, spondylosis was confined to the adjacent segments. More advanced spondylosis was found in the immediate caudal segment than the cephalad one. CONCLUSIONS: It is concluded that spondylosis at the mobile segments in a synostotic spine is thought to be a fusion-related pathology rather than solely age-related disc degeneration. Those data suggested that CMS definitely precipitated the disc degeneration in the adjacent segments.

Effectiveness of Helmet Cranial Remodeling in Older Infants with Positional Plagiocephaly

BACKGROUND: Management of positional plagiocephaly by wearing a cranial molding helmet has become a matter of growing medical interest. Some research studies reported that starting helmet therapy early (age 5 to 6 months) is important and leads to a significantly better outcome in a shorter treatment time. The aim of the present study was to evaluate the effectiveness of cranial remodeling treatment with wearing helmet for older infants (> or =18 months). METHODS: We conducted a retrospective study of 27 infants with positional plagiocephaly without synostosis, who were started from 2008 to 2012. Every child underwent a computerized tomography (CT) before starting helmet therapy to exclude synostosis of the cranial sutures and had CT performed once again after satisfactory completion of therapy. Anthropometric measurements were taken on using spreading calipers in every child. The treatment effect was compared using cranial vault asymmetry (CVA) and the cranial vault asymmetry index (CVAI), which were obtained from diagonal measurements before and after therapy. RESULTS: The discrepancy of CVA and CVAI of all the patients significantly decreased after cranial molding helmet treatment in older infants (> or =18 months) 7.6 mm from 15.6 mm to 8 mm and 4.51% from 9.42% to 4.91%. Six patients had confirmed successful outcome, and all subjects were good compliance patients. The treatment lasted an average of 16.4 months, was well tolerated, and had no complication. Additionally, the rate of the successful treatment (final CVA < or =5 mm) significantly decreased when the wearing time per was shorter. CONCLUSION: This study showed that treatment by cranial remodeling orthosis was effective if the patient could wear the helmet longer and treatment duration was somewhat longer than in younger patients, well tolerated in older infants and had no morbidity. This therapeutic option is available and indicated in these older infants before other cranial remodeling surgery.

Effectiveness of Helmet Cranial Remodeling in Older Infants with Positional Plagiocephaly

BACKGROUND: Management of positional plagiocephaly by wearing a cranial molding helmet has become a matter of growing medical interest. Some research studies reported that starting helmet therapy early (age 5 to 6 months) is important and leads to a significantly better outcome in a shorter treatment time. The aim of the present study was to evaluate the effectiveness of cranial remodeling treatment with wearing helmet for older infants (> or =18 months). METHODS: We conducted a retrospective study of 27 infants with positional plagiocephaly without synostosis, who were started from 2008 to 2012. Every child underwent a computerized tomography (CT) before starting helmet therapy to exclude synostosis of the cranial sutures and had CT performed once again after satisfactory completion of therapy. Anthropometric measurements were taken on using spreading calipers in every child. The treatment effect was compared using cranial vault asymmetry (CVA) and the cranial vault asymmetry index (CVAI), which were obtained from diagonal measurements before and after therapy. RESULTS: The discrepancy of CVA and CVAI of all the patients significantly decreased after cranial molding helmet treatment in older infants (> or =18 months) 7.6 mm from 15.6 mm to 8 mm and 4.51% from 9.42% to 4.91%. Six patients had confirmed successful outcome, and all subjects were good compliance patients. The treatment lasted an average of 16.4 months, was well tolerated, and had no complication. Additionally, the rate of the successful treatment (final CVA < or =5 mm) significantly decreased when the wearing time per was shorter. CONCLUSION: This study showed that treatment by cranial remodeling orthosis was effective if the patient could wear the helmet longer and treatment duration was somewhat longer than in younger patients, well tolerated in older infants and had no morbidity. This therapeutic option is available and indicated in these older infants before other cranial remodeling surgery.

Atraumatic Spinal Interdural Hamatoma: A Case Report

STUDY DESIGN: A case report. OBJECTIVES: To investigate the outcomes of recapping laminoplasty for the treatment of atraumatic spinal interdural hematoma. SUMMARY OF LITERATURE REVIEW: There are several causes for a spinal hematoma. The occurrence of spinal hematoma is rare; in particular, the ones arising atraumaticaly are considered extremely rare. MATERIALS AND METHODS: We studied a 33 year old male patient without any known risk factor. Magnetic resonance image has revealed an intraspinal epidural cyst compressing on the spinal nerve. After performing recapping laminoplasty, followed by partial excision of dura mater and resection of hematoma, we were able to observe another layer of dura mater, confirming the location of hematoma within two epidural layers, i.e., an interdural hematoma. RESULTS: Performing recapping laminoplasty is a more effective and less invasive procedure for removing cyst than conventionally used laminectomy. Patients were found to have synostosis after three months post-op, and they have exhibited neither lumbosacral pain nor lower limb motor weakness after six months follow-up. There were no recurrences or complications reported on our study. CONCLUSION: There are a few reported cases of atraumatic spinal interdural hematoma. Our study shows that performing pars osteotomy with recapping laminoplasty yield good clinical outcome for the treatment of atraumatic spinal interdural hematoma.