Thoracic neurenteric cyst in an adult: case report.

OBJECTIVE AND IMPORTANCE: Neurenteric cysts are very rare (particularly in the adult age group) congenital intraspinal cysts of endodermal origin. The patient described was a 48-year-old man who was diagnosed as having an isolated thoracic neurenteric cyst at the T5-T6 level, without a mediastinal enterogenous cyst. Radiological studies demonstrated multiple anterior vertebral column abnormalities. CLINICAL PRESENTATION: The patient presented with a long history of mild midback pain. During the 2 years preceding admission, his midback pain worsened and he experienced right intercostal pain in the midthoracic area. Several months before admission, he noticed right lower extremity weakness, which led him to undergo neurological evaluation and radiological studies. INTERVENTION: Thoracic spine x-rays revealed marked thoracic scoliosis and multiple vertebral abnormalities. Magnetic resonance imaging and myelography revealed an intradural extramedullary cystic mass at the T5-T6 level, severely compressing the spinal cord from the ventral side. Thoracic laminectomy was performed and the cystic lesion was completely removed, with disconnection of the ventral tract. CONCLUSION: This is an unusual presentation, at this age, of a congenital intraspinal cyst in the thoracic area. Such cysts must investigated for early diagnosis and treatment. A neurenteric cyst should be suspected particularly if the cyst is associated with anterior vertebral column abnormalities.

Neurologic outcome of early versus late surgery for cervical spinal cord injury.

STUDY DESIGN: A prospective analysis evaluating neurologic outcome after early versus late surgery for cervical spinal cord trauma. OBJECTIVES: The study was conducted to determine whether neurologic and functional outcome is improved in traumatic cervical spinal cord-injured patients (C3-T1, American Spinal Injury Association grades A-D) who had early surgery (<72 hours after spinal cord injury) compared with those patients who had late surgery (>5 days after spinal cord injury). SUMMARY OF BACKGROUND DATA: There is considerable controversy as to the appropriate timing of surgical decompression and stabilization for cervical spinal cord trauma. There have been numerous retrospective studies, but no prospective studies, to determine whether neurologic outcome is best after early versus late surgical treatment for cervical spinal cord injury. METHODS: Patients meeting appropriate inclusion criteria were randomized to an early (<72 hours after spinal cord injury) or late (>5 days after spinal cord injury) surgical treatment protocol. The neurologic and functional outcomes were recorded from the acute hospital admission to the most recent follow-up. RESULTS: Comparison of the two groups showed no significant difference in length of acute postoperative intensive care stay, length of inpatient rehabilitation, or improvement in American Spinal Injury Association grade or motor score between early (mean, 1.8 days) versus late (mean, 16.8 days) surgery. CONCLUSIONS: The results of this study reveal no significant neurologic benefit when cervical spinal cord decompression after trauma is performed less than 72 hours after injury (mean, 1.8 days) as opposed to waiting longer than 5 days (mean, 16.8 days).