Giant schwannoma of the cauda equina with dural ectasia: a case report.

We describe a rare case of giant cauda equina tumor in the upper lumbar spine with dural ectasia in the lumbosacral region. This patient had a long history of acromegaly due to pituitary adenoma, for which bromocriptine was administered. The cauda equina tumor was surgically resected en bloc and proved to be a benign schwannoma. Postoperatively, with the exception of the left L5 dermatome, sensory disturbance decreased markedly and motor function slowly improved. Although resection of a giant schwannoma of the cauda equina often sacrifices other cauda equina spinal nerves involved by the tumor, neurological deterioration was not observed in the case presented.

Asymmetry of premotor time in the back muscles of adolescent idiopathic scoliosis.

STUDY DESIGN: In 38 patients with adolescent idiopathic scoliosis (AIS), the correlation between left and right differences in premotor time (D-PMT) of back muscle and clinical findings were analyzed. OBJECTIVE: To investigate the clinical relevance of back muscle D-PMT in AIS. SUMMARY OF BACKGROUND DATA: There have been numerous studies investigating back muscle asymmetry of AIS by EMG, but to date, no studies have measured D-PMT in back muscles. MATERIALS AND METHODS: D-PMT in the back muscles measured in a similar manner as that in the extremity muscles was assessed in 10 nonscoliotic teenaged girls and 38 AIS patients. The correlation between back muscle D-PMT and four factors (age, Risser sign, Cobb angle, and progression of deformity) was investigated. RESULTS: The D-PMT values of back muscle at all levels in the control group were within +/-5 ms, but those in 20 of the 38 AIS patients were more than 5 ms. D-PMT at the lower-end vertebra level was strongly correlated with progression of deformity, but not with age, Risser sign, and Cobb angle. All five patients with D-PMT of more than 10 ms at the lower-end vertebra level had progressive deformity. CONCLUSIONS: D-PMT in back muscle at the lower end vertebra level in AIS correlated closely to the progression of scoliotic deformity, thus suggesting that this phenomenon is associated with the progression in AIS.

Spinal wedge osteotomy by a single posterior approach for correction of severe and rigid kyphosis or kyphoscoliosis.

STUDY DESIGN: Seven patients with severe angular kyphotic deformity of the spine were treated by circumferential spinal wedge osteotomy using a single posterior approach. OBJECTIVE: To evaluate the surgical outcomes for seven patients with severe angular kyphosis or kyphoscoliosis treated by spinal wedge osteotomy. SUMMARY OF BACKGROUND DATA: Excellent surgical outcomes have been reported for procedures such as hemivertebra excision, vertebral body resection, and spinal osteotomy for angular kyphosis or kyphoscoliosis. However, the safety and efficacy of these procedures for severe and rigid deformities have not been established. METHODS: The surgical procedure involves circumferential exposure of the apex vertebra to the anterior aspect using a single posterior approach. Sparing only the spinal cord, the surgeon performs circumferential wedge bone resection, closure, correction, and stabilization by instrumentation while monitoring the spinal cord. Seven patients (3 kyphotics and 4 kyphoscoliotics) treated by this procedure were evaluated for a minimum of 2 years. Underlying conditions comprised five cases of congenital deformity with hemivertebrae and two cases of skeletal dysplasias. The mean age at surgery was 16.5 years, and the mean follow-up period was 6.9 years. RESULTS: Before surgery, the mean kyphotic curve was 105.4 degrees (range, 68-150 degrees ), and the mean scoliotic curve was 85.3 degrees (range, 60-132 degrees ). After surgery, the curves averaged 48.9 degrees and 40 degrees, respectively, yielding corrections of 52.9% and 54.9%. The mean posterior trunk shift in global sagittal balance was 21 mm before surgery, becoming 3 mm after surgery. Progressive spinal cord dysfunction had developed in three patients before surgery. In all three, postoperative neurologic improvement was observed. Postoperative complications consisted of transient, unilateral leg paresis in two patients. No incidents of infection or pseudarthrosis were observed. CONCLUSIONS: Spinal wedge osteotomy by the single posterior approach is a reliable and safe surgical technique for correcting severe rigid angular kyphosis or kyphoscoliosis.