Generation of locomotor­like activity using monopolar intraspinal electrical microstimulation in rats.

Severe spinal cord injury (SCI) affects the ability of functional standing and walking. As the locomotor central pattern generator (CPG) in the lumbosacral spinal cord can generate a regulatory signal for movement, it is feasible to activate CPG neural network using intra-spinal micro-stimulation (ISMS) to induce alternating patterns. The present study identified two special sites with the ability to activate the CPG neural network that are symmetrical about the posterior median sulcus in the lumbosacral spinal cord by ISMS in adult rats. A reversal of flexion and extension can occur in an attempt to generate a stepping movement of the bilateral hindlimb by either reversing the pulse polarity of the stimulus or changing the special site. Therefore, locomotor-like activity can be restored with monopolar intraspinal electrical stimulation on either special site. To verify the motor function regeneration of the paralyzed hindlimbs, a four-week locomotor training with ISMS applied to the special site in the SCI + ISMS group (n=12) was performed. Evaluations of motor function recovery using behavior, kinematics and physiological analyses, were used to assess hindlimb function and the results showed the stimulation at one special site can promote significant functional recovery of the bilateral hindlimbs (P<0.05). The present study suggested that motor function of paralyzed bilateral hindlimbs can be restored with monopolar ISMS.

Central pattern generator network model for the alternating hind limb gait of rats based on the modified Van der Pol equation.

Herein, we employed a central pattern generator (CPG), a spinal cord neural network that regulates lower-limb gait during intra-spinal micro-stimulation (ISMS). Particularly, ISMS was used to determine the spatial distribution pattern of CPG sites in the spinal cord and the signal regulation pattern that induced the CPG network to produce coordinated actions. Based on the oscillation phenomenon of the single CPG neurons of Van der Pol (VDP) oscillators, a double-cell CPG neural network model was constructed to realise double lower limbs, six-joint modelling, the simulation of 12 neural circuits, the CPG loci characterising stimuli-inducing alternating movements and changes in polarity stimulation signals in rat hindlimbs, and leg-state change movements. The feasibility and effectiveness of the CPG neural network were verified by recording the electromyographic burst-release mode of the flexor and extensor muscles of the knee joints during CPG electrical stimulation. The results revealed that the output pattern of the CPG presented stable rhythm and coordination characteristics. The 12-neuron CPG model based on the improved VDP equation realised single-point control while significantly reducing the number of stimulation electrodes in the gait training of spinal cord injury patients. We believe that this study advances motor function recovery in rehabilitation medicine.

An incidental migrating intra-spinal bullet: the silent victim of celebratory gunfire.

BACKGROUND: Incidentally found intra-spinal bullets are extremely rare, and have never been reported in the literature. The aim of this study is to report a rare case of an asymptomatic migrating intra-spinal bullet, emphasizing the role of cultural context in history taking, and describing its surgical retrieval technique. CASE PRESENTATION: We discuss a case of a 10-years old boy with an incidentally discovered intra-spinal bullet opposite to the L5 vertebral level, who presented 3 months after the suspected initial insult. Following its migration to the L3/L4 level intraoperatively, the bullet was forced to spontaneously return to its preoperative position by reverse Trendelenburg Position, Valsalva maneuver and Intrathecal saline infusion, thus avoiding extending the previously performed laminectomy. CONCLUSION: The authors remind the readers that history is the cornerstone of the clinical practice, even in the most obscure cases. Many convoluted intra-operative situations could be resolved by utilizing basic anatomical and physiological principles.

Protocol paper: kainic acid excitotoxicity-induced spinal cord injury paraplegia in Sprague-Dawley rats.

BACKGROUND: Excitotoxicity-induced in vivo injury models are vital to reflect the pathophysiological features of acute spinal cord injury (SCI) in humans. The duration and concentration of chemical treatment controls the extent of neuronal cell damage. The extent of injury is explained in relation to locomotor and behavioural activity. Several SCI in vivo methods have been reported and studied extensively, particularly contusion, compression, and transection models. These models depict similar pathophysiology to that in humans but are extremely expensive (contusion) and require expertise (compression). Chemical excitotoxicity-induced SCI models are simple and easy while producing similar clinical manifestations. The kainic acid (KA) excitotoxicity model is a convenient, low-cost, and highly reproducible animal model of SCI in the laboratory. The basic impactor approximately cost between 10,000 and 20,000 USD, while the kainic acid only cost between 300 and 500 USD, which is quite cheap as compared to traditional SCI method. METHODS: In this study, 0.05 mM KA was administered at dose of 10 µL/100 g body weight, at a rate of 10 µL/min, to induce spinal injury by intra-spinal injection between the T12 and T13 thoracic vertebrae. In this protocol, detailed description of a dorsal laminectomy was explained to expose the spinal cord, following intra-spinal kainic acid administration at desired location. The dose, rate and technique to administer kainic acid were explained extensively to reflect a successful paraplegia and spinal cord injury in rats. The postoperative care and complication post injury of paraplegic laboratory animals were also explained, and necessary requirements to overcome these complications were also described to help researcher. RESULTS: This injury model produced impaired hind limb locomotor function with mild seizure. Hence this protocol will help researchers to induce spinal cord injury in laboratories at extremely low cost and also will help to determine the necessary supplies, methods for producing SCI in rats and treatments designed to mitigate post-injury impairment. CONCLUSIONS: Kainic acid intra-spinal injection at the concentration of 0.05 mM, and rate 10 µL/min, is an effective method create spinal injury in rats, however more potent concentrations of kainic acid need to be studied in order to create severe spinal injuries.

Spinal infection with intraspinal abscess or empyema and acute myelopathy: comparative analysis of diagnostics, therapy, complications and outcome in primary care.

INTRODUCTION: This study on pyogenic spinal infections with intraspinal epidural involvement (PSI +) compared the outcome of patients with spinal cord injury (SCI) to those without (noSCI) taking diagnostic algorithm, therapy, and complications into account. METHODS: Patients were enrolled in an ambispective study (2012-2017). Diagnostic and therapeutic algorithms, complications, and neurological outcome were analyzed descriptively. Survival was analyzed applying Kaplan-Meier method and Cox regression. RESULTS: In total, 134 patients with a median (IQR) age of 72 (61-79) years were analyzed. Baseline characteristics were similar between the SCI (n = 55) and noSCI (n = 79). A higher percentage of endocarditis (9% vs. 0%; p = 0.03) was detected in the noSCI group. The majority (81%) received combinatorial therapy including spinal surgery and antibiotic treatment. The surgery complication rate was 16%. At discharge, improvement in neurologic function was present in 27% of the SCI patients. Length of stay, duration of ventilation and the burden of disease-associated complications were significantly higher in the SCI group (e.g., urinary tract infection, pressure ulcers). Lethality risk factors were age (HR 1.09, 95% CI 1.02-1.16, p = 0.014), and empyema/abscess extension (≥ 3 infected spinal segments, HR 4.72, 95% CI 1.57-14.20, p = 0.006), dominating over additional effects of Charlson comorbidity index, SCI, and type of treatment. The overall lethality rate was 11%. CONCLUSION: PSI + are associated with higher in-hospital mortality, particularly when multiple spinal segments are involved. However, survival is similar with (SCI) or without myelopathy (noSCI). If SCI develops, the rate of disease complications is higher and early specialized SCI care might be substantial to reduce complication rates.

Efficacy of Minimally Invasive Trans-Sacral Canal Plasty between Patients with and without Failed Back Surgery Syndrome.

Background and Objectives: Clinicians are required to manage a growing number of elderly patients with several medical comorbidities, and invasive surgical treatments are sometimes not advisable for these patients. The aim of this study was to evaluate the efficacy of minimally invasive intraspinal canal treatment, trans-sacral canal plasty (TSCP), for patients with and without failed back surgery syndrome (FBSS). Materials and Methods: A multicenter analysis was conducted. TSCP was performed in patients with chronic low back pain and leg pain due to lumbar spinal disorders. An adhesiolysis by TSCP was carried out, then a mixture of steroid and local anesthesia was injected. Visual Analog Scales (VAS) for low back pain and leg pain, and complications were evaluated. Results: A total of 271 patients with a minimum 6-month follow-up were enrolled. There were 80 patients who had a history of previous lumbar spinal surgery (F group), and 191 patients without previous lumbar spinal surgery (N group). There were no significant differences in sex and age between the two groups. VAS scores for low back pain (N group/F group) preoperatively, immediately postoperatively, and 1 month, 3 months and 6 months postoperatively, were 51/52 mm, 24/26 mm, 33/34 mm, 30/36 mm, and 30/36 mm, respectively. VAS scores for leg pain were 69/67 mm, 28/27 mm, 39/41 mm, 36/43 mm, and 32/40 mm, respectively. Both VAS scores for low back pain and leg pain were significantly decreased from baseline to final follow-up in both groups (p < 0.01). However, VAS scores for leg pain at 3 months and 6 months postoperatively were significantly higher in F group (p < 0.05). There were three catheter breakages (2/3 in F group), and one dural tear in F group. Conclusions: TSCP significantly reduced both VAS scores for low back and leg pain in patients with and without FBSS. However, co-existence of intractable epidural adhesion might be associated with less improvement in FBSS.

MRI of the intraspinal nerve roots in patients with chronic inflammatory neuropathies: abnormalities correlate with clinical phenotypes.

OBJECTIVE: Chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN) are caused by inflammatory changes of peripheral nerves. It is unknown if the intra-spinal roots are also affected. This MRI study systematically visualized intra-spinal nerve roots, i.e., the ventral and dorsal roots, in patients with CIDP, MMN and motor neuron disease (MND). METHODS: We performed a cross-sectional study in 40 patients with CIDP, 27 with MMN and 34 with MND. All patients underwent an MRI scan of the cervical intra-spinal roots. We systematically measured intra-spinal nerve root sizes bilaterally in the transversal plane at C5, C6 and C7 level. We calculated mean nerve root sizes and compared them between study groups and between different clinical phenotypes using a univariate general linear model. RESULTS: Patients with MMN and CIDP with a motor phenotype had thicker ventral roots compared to patients with CIDP with a sensorimotor phenotype (p = 0.012), while patients with CIDP with a sensory phenotype had thicker dorsal roots compared to patients with a sensorimotor phenotype (p = 0.001) and with MND (p = 0.004). CONCLUSION: We here show changes in the morphology of intra-spinal nerve roots in patients with chronic inflammatory neuropathies, compatible with their clinical phenotype.

Protocol paper: kainic acid excitotoxicity-induced spinal cord injury paraplegia in Sprague-Dawley rats

BACKGROUND: Excitotoxicity-induced in vivo injury models are vital to reflect the pathophysiological features of acute spinal cord injury (SCI) in humans. The duration and concentration of chemical treatment controls the extent of neuronal cell damage. The extent of injury is explained in relation to locomotor and behavioural activity. Several SCI in vivo methods have been reported and studied extensively, particularly contusion, compression, and transection models. These models depict similar pathophysiology to that in humans but are extremely expensive (contusion) and require expertise (compression). Chemical excitotoxicity-induced SCI models are simple and easy while producing similar clinical manifestations. The kainic acid (KA) excitotoxicity model is a convenient, low-cost, and highly reproducible animal model of SCI in the laboratory. The basic impactor approximately cost between 10,000 and 20,000 USD, while the kainic acid only cost between 300 and 500 USD, which is quite cheap as compared to traditional SCI method. METHODS: In this study, 0.05 mM KA was administered at dose of 10 µL/100 g body weight, at a rate of 10 µL/min, to induce spinal injury by intra-spinal injection between the T12 and T13 thoracic vertebrae. In this protocol, detailed description of a dorsal laminectomy was explained to expose the spinal cord, following intra-spinal kainic acid administration at desired location. The dose, rate and technique to administer kainic acid were explained extensively to reflect a successful paraplegia and spinal cord injury in rats. The postoperative care and complication post injury of paraplegic laboratory animals were also explained, and necessary requirements to overcome these complications were also described to help researcher. RESULTS: This injury model produced impaired hind limb locomotor function with mild seizure. Hence this protocol will help researchers to induce spinal cord injury in laboratories at extremely low cost and also will help to determine the necessary supplies, methods for producing SCI in rats and treatments designed to mitigate post-injury impairment. CONCLUSIONS: Kainic acid intra-spinal injection at the concentration of 0.05 mM, and rate 10 µL/min, is an effective method create spinal injury in rats, however more potent concentrations of kainic acid need to be studied in order to create severe spinal injuries.

The First Algorithm Calculating Cement Injection Volumes in Patients with Spine Metastases Treated with Percutaneous Vertebroplasty.

PURPOSE: This study aims to develop an algorithm to predict cement injection volumes in patients with spine metastases treated with percutaneous vertebroplasty (PVP). Risk factors were also analyzed for intra-spinal canal cement leakages. PATIENTS AND METHODS: A retrospective analysis of 584 vertebrae in 251 patients. Patients and vertebrae were divided into three groups based on grades of tumor invasion to the spinal cord. Patients with the complete posterior wall of vertebrae were classified into group A, patients without the complete posterior wall of vertebrae but with normal Dural sac were classified into group B, and patients with deformation of the Dural sac but without neurological symptom were classified into group C. We systematically reviewed demographic data, clinical parameters, radiology features, and cement leakages among the three groups. The multiple linear regressions were used to screen potential risk factors and develop the algorithm to predict injected cement volumes in vertebrae. Significant factors were included in the algorithm. Potential risk factors for intra-spinal canal cement leakage were analyzed using the multiple logistic regressions. RESULTS: In the study, 17.1% (100/584) of vertebrae occurred cement leakages. Vertebrae in group C (28.6%, 8/28) had the highest cement leakage rate than patients in group A (14.4%, 61/424) and B (23.5%, 31/132) (P=0.014). Vertebrae in group C (14.3%, 4/28) were also more prone to intra-spinal canal leakages (P=0.003). The multiple logistic analysis showed that the Bilsky scale was significantly associated with intra-spinal canal cement leakages (P<0.001). The multiple linear regression analysis showed that intercept (P<0.001), treated vertebrae level (P<0.001), cortical osteolytic destruction in posterior wall (P<0.001), and Bilsky scale (P=0.014) were significant and those variables were included in the algorithm. The algorithm was Y=3.1627－0.8677×treated vertebrae level－0.6182×cortical osteolytic destruction in the posterior wall－0.2819×Bilsky scale. CONCLUSION: An algorithm is proposed and can be used to calculate cement injection volumes in spine metastases treated with PVP. This algorithm can facilitate surgical planning and guide cement injections. Bilsky scale is an independent risk factor for intra-spinal canal cement leakages. We do not recommend PVP treated in patients with a Bilsky scale of 2 and 3 mainly due to a high rate of intra-spinal canal cement leakages.

Intraspinal Iliac Venous Stent Migration with Lumbar Nerve Root Compression.

BACKGROUND: Venous stenting is a common treatment for chronic peripheral venous disease. The most frequent complications caused by this technique are stent misplacement and intracardiac or intravascular stent migration. In this publication, we will describe the first case of an intraspinal stent misplacement leading to lumbar nerve root compression. CASE DESCRIPTION: Our patient was a 20-year-old woman with a bilateral pulmonary embolism caused by a right common iliac vein thrombosis and a severe compression of the left common iliac vein by the right common iliac artery (May-Thurner or Cockett syndrome). She underwent an endovascular stenting of the left iliac vein. A few days later, she reported some pain in the right L5 radicular and showed signs of hypoesthesia of the left leg and of paresis of the left extensor hallucis longus muscle. A lumbar computed tomography scan showed a stent misplacement into the spinal canal through the left L5 foramen with nerve root compression. She underwent a surgical removal of the stent through a unilateral L5-S1 laminarthrectomy. The postoperative follow-up showed a complete clinical recovery and a control lumbar computed tomography scan confirmed the L5 nerve root decompression. CONCLUSIONS: The intraspinal misplacement of a venous stent is a rare complication that may cause nerve root injury. It requires a prompt treatment. Surgically removing the stent by a posterior approach seems to be a simple and safe therapeutic option.

Abnormalities associated with congenital scoliosis in high-altitude geographic regions.

PURPOSE: To assess the different characteristics of congenital scoliosis between low-altitude geographic regions and high-altitude geographic regions in Chinese population and discuss the role of hypoxia on those differences. METHODS: A total of 120 patients with congenital scoliosis who underwent surgical treatment in our Hospital between January 2009 and October 2017 were identified. Complete data were reviewed, including medical records, X-ray, CT, and MRI pre-operatively. According to the patient's birthplace, they were divided into low-altitude geographic regions (low group) and high-altitude geographic regions (high group). Characteristics of vertebral deformities, rib deformities, and intra-spinal malformations in two groups were analyzed. RESULTS: A total of 397 segments of vertebral deformities were involved in the two groups, of which 136 were involved in high group and 261 in low group. The average segments involved were 4.5 and 2.9, respectively, in two groups. 63.3% patients in high group have rib deformities, which is significantly higher than that of low group (41.1%); and the proportion of patients with complex rib deformities in high group was also higher than that in low group (57.9% VS 24.3%). The incidence of CS associated with intra-spinal malformations in low group was 38.9%, which was similar to those reported previously; however, the incidence of that in high group was 63%, significantly higher than previous reports. CONCLUSION: Our results suggested that CS patients in high-altitude geographic regions might tend to have higher proportion and more severe of rib deformities, and also be more likely to accompany with intra-spinal malformations. So we supposed that hypoxia not only aggravated the proportion and severity of rib deformities, but also affected the development of spinal cord in humans.

Involvement of Neuropeptide Y in Post-Incisional Nociception in Rats.

BACKGROUND: Neuropeptide Y (NPY) is abundantly distributed in the mammalian nervous system. Its role in nociception arising from inflammatory and neuropathic pain conditions has been elucidated. However, its involvement in post-incisional nociception, particularly at the spinal cord level, is relatively unknown. PURPOSE: Management of postoperative pain is suboptimal. Evaluation of changes at the spinal level could facilitate better understanding of neural mechanisms underlying this type of pain. METHODS: Rats were subjected to hind paw incision and spatiotemporal pattern of NPY expression in the dorsal horn was investigated by immunohistochemistry. Next, rats were implanted with intrathecal catheters using previously standardized procedure. NPY was injected into the intrathecal space by an indwelling catheter and behavioral assessment of nociception was performed. RESULTS: Higher expression of NPY was observed in the superficial laminae of the dorsal horn. After incision, specific changes were observed like an abrupt decrease at 3 h after incision, which could be correlated with the intense nociception at this time. In contrast to morphine administration, which attenuated all 3 behavioral parameters of nociception, NPY decreased guarding behavior and thermal hyperalgesia during the acute phase. CONCLUSIONS: NPY is extensively expressed in the superficial laminae of the spinal cord and exhibit marked changes after incision. Nociception is also decreased after its administration. Hence, it is likely involved in post-incisional nociception. This information could have clinical relevance.

Microsurgery of intra-spinal tumor via the quadrant pathway / 西安交通大学学报(医学版)

Objective To investigate the indications,surgical principles and advantages and disadvantages of microsurgery of intra-spinal tumor via the quadrant pathway.Methods We made a retrospective analysis of the clinical data of patients with spinal canal tumors treated via the quadrant pathway from October 2014 to July 201 5. Results Totally 1 6 patients were included.Their tumors were fully removed by microscopic resection,in which there were three epidural cases,twelve subdural extra-medullar cases,and one intra-medullar case.In terms of stage,there were three cases of cervical segment (C3 - C7 ),four cases of thoracic (T1 - T10 ),nine cases of thoracic and lumbar ones (T1 1 - S2 ). In pathology, there were nine cases of neurilemmoma, two cases of neurofibroma,four cases of meningeal tumor and one case of neuroepithelial cyst.The postoperative symptoms and signs of the patients were significantly improved,and no recurrence or complications occurred in the follow-up 2-10 months.Conclusion Quadrant pathway can be used in removing spinal epidural and subdural tumor,which is shorter than two vertebral segments in length,and the cross-sectional area is less than 2/3 of the spinal cord. However,surgery with extensive adhesion and intra-medullary lesions should be performed carefully,and the surgical techniques are more demanding and a longer learning curve is needed.

Clinical study of acute spinal spontaneous hematoma / 中华急诊医学杂志

Objective To evaluate the etiology, pathogenesis, clinical manifestation, imaging features, treatments and factors related to prognosis of acute spinal spontaneous hematoma.Methods The clinical data of 38 patients with acute spinal hematoma treated in our hospital from 2011 till now were analyzed retrospectively.Duration of follow-up was 6 months.The factors influencing the prognosis were analyzed.Results Acute epidural hematomas (n=29) were much more common than subdural (n=5), subarachnoid (n=1) and intramedullary (n=3).Most hematomas were located in the cervical and thoracic vertebra regions.The etiology of acute spinal spontaneous hematoma was unknown in most patients.Twenty-nine patients were dealt with surgical intervention and 9 patients were treated conservatively.After 6-month follow up, recovery rate measured by JOA score in patients of spinal injury ASIA level A and B was (51.26 ±38.97), and level C, D and E was (80.33 ±25.83), P<0.05.Recovery rate in patients with hematoma discovered in less then 24 hours treated with surgical decompression was (64.79 ±36.10), and that in those with hematoma present over 24 hours was (34.54 ±30.17), P<0.05.Conclusions Acute spinal hematoma always caused by unknown etiology, and usually manifests itself in a sudden onset of pain and neurological deficits.The early diagnosis mainly depends on MRI.Patients presenting with severe neurologic dysfunction or showing signs of progressive deficit should have immediate surgical intervention. The status of neurological deficits before surgery and the length of interval between onset and surgical intervention are associated with recovery.

Radiculopathy due to spontaneous facetal cyst hemorrhage.

Facetal cysts are usually encountered as incidental radiological findings in spinal imaging studies. Only rarely can neurological symptoms be attributed to them. These cysts are lined by vascularized synovial tissue. There are few reports in literature of hemorrhagic transformation in these cysts with sudden increase in size precipitating symptoms acutely. We report one such case where the existence of a hitherto undiagnosed cyst was unmasked by the haemorrhage. There is a need to be aware of this complication in patients with untreated or incidentally diagnosed cysts so that any sudden neurological deterioration can be dealt with promptly.

Retained Intraspinal Bullet: A Rare Case in a Visitor to Malaysia - A Case Report

Firearm injuries to the spine commonly present with acute neurology caused by direct penetration or indirectly from concussive effects of bullet impact on the vertebral column. We report a case of delayed neurologic presentation of retained intra-spinal bullet in a 42 year-old African who had chronic low back pain and sciatica with a past history of gunshot injury to the spine and radiograph revealed a bullet at the L4-5 disc level. Intra-operative exploration showed a fibrous mass around the bullet compressing on the L4 existing nerve root and L5 traversing nerve root. Removal of the retained bullet resulted in a good clinical outcome with complete resolution of symptoms.

Pneumorrhachis, pneumomediastinum, pneumopericardium and subcutaneous emphysema as complications of bronchial asthma.

Pneumorrhachis (PR), or epidural emphysema, denotes the presence of air in the spinal epidural space. It can be associated with a variety of etiologies, including trauma; recent iatrogenic manipulations during surgical, anesthesiological and diagnostic interventions; malignancy and its associated therapy. It usually represents an asymptomatic epiphenomenon but also can be symptomatic by itself as well as by its underlying pathology. The pathogenesis and etiology of PR are varied and can sometimes be a diagnostic challenge. As such, there are no standard guidelines for the management of symptomatic PR, and its treatment is often individualized. Frequently, multidisciplinary approach and regimes are required for its management. PR associated with bronchial asthma is extremely rare, and only very few cases are reported in the literature. Here, we report a case of a 17-year-old Saudi male patient who is a known case of bronchial asthma; he presented with extensive subcutaneous emphysema, pneumomediastinum, pneumopericardium and pneumorrhachis as complications of an acute exacerbation of his primary ailment.

Lesiones intramedulares que simulan tumor / Spinal cord lesions that mimic neoplasms

Objetivo. Analizar las características clínicas y neurorradiológicas de las distintas lesiones intramedulares con la finalidad de poder diferenciar las lesiones no-tumorales de las tumorales y reservar la exploración quirúrgica sólo para aquellos pacientes sin diagnósticoy con sintomatología rápidamente progresiva. Material y métodos. Se revisaron las historias clínicas de 44 pacientes operados consecutivamente con diagnóstico presuntivo de tumor intramedular entre enero de 1988 y diciembre de 2007. No se incluyeron en el análisis los tumores bulbomedulares ni los del cono y filum ni tampoco los lipomas, teratomas y quistes dermoides.Resultados. Se identificaron 4 pacientes (9.1%), 3 masculinos y 1 femenino, con edad media de 9 años, que presentaban deterioro neurológico progresivo e IRM espinal compatible con tumor intramedular. El resultado histopatológico confirmó en los cuatro casos lesiones no tumorales: infiltrado inflamatorio inespecífico, edema, micosis y gliosis respectivamente.Conclusiones. El minucioso análisis clínico, de laboratorio y el estudio de las imágenes en IRM puede ayudar a la correcta distinción entre tumores y lesiones no-tumorales evitando la exploración quirúrgica que sólo está justificada en los casos muy dudososacompañados de rápido deterioro neurológico funcional del paciente.(AU)

Objective. To analyze the clinic and neuro-imaging characteristicsof the intra spinal lesions in order to differentiate the non-neoplasticlesions from neoplastic lesions and to spare surgical exploration only for non-diagnosed patients with rapid deterioration. Materials and method. Fourty-four medical charts of patientsoperated on spinal cord lesions between January 1988 and December 2007 have been analyzed. Results. In four patients (3 male, 1 female ¹ mean age: 9 years)who were operated with diagnosis of intra-spinal tumor, their lesions turned out to be non-neoplastic: non-specific inflammation, edema, mycosis and gliosis, respectively. Conclusions. The thorough clinical and laboratory investigation together with the study of the imaging can help distinguishbetween non-neoplastic lesions from neoplastic lesions in order to avoid surgical exploration which is only suitable in very doubtful cases with rapid deterioration.(AU)

Lesiones intramedulares que simulan tumor / Spinal cord lesions that mimic neoplasms

Objetivo. Analizar las características clínicas y neurorradiológicas de las distintas lesiones intramedulares con la finalidad de poder diferenciar las lesiones no-tumorales de las tumorales y reservar la exploración quirúrgica sólo para aquellos pacientes sin diagnósticoy con sintomatología rápidamente progresiva. Material y métodos. Se revisaron las historias clínicas de 44 pacientes operados consecutivamente con diagnóstico presuntivo de tumor intramedular entre enero de 1988 y diciembre de 2007. No se incluyeron en el análisis los tumores bulbomedulares ni los del cono y filum ni tampoco los lipomas, teratomas y quistes dermoides.Resultados. Se identificaron 4 pacientes (9.1%), 3 masculinos y 1 femenino, con edad media de 9 años, que presentaban deterioro neurológico progresivo e IRM espinal compatible con tumor intramedular. El resultado histopatológico confirmó en los cuatro casos lesiones no tumorales: infiltrado inflamatorio inespecífico, edema, micosis y gliosis respectivamente.Conclusiones. El minucioso análisis clínico, de laboratorio y el estudio de las imágenes en IRM puede ayudar a la correcta distinción entre tumores y lesiones no-tumorales evitando la exploración quirúrgica que sólo está justificada en los casos muy dudososacompañados de rápido deterioro neurológico funcional del paciente.

Objective. To analyze the clinic and neuro-imaging characteristicsof the intra spinal lesions in order to differentiate the non-neoplasticlesions from neoplastic lesions and to spare surgical exploration only for non-diagnosed patients with rapid deterioration. Materials and method. Fourty-four medical charts of patientsoperated on spinal cord lesions between January 1988 and December 2007 have been analyzed. Results. In four patients (3 male, 1 female – mean age: 9 years)who were operated with diagnosis of intra-spinal tumor, their lesions turned out to be non-neoplastic: non-specific inflammation, edema, mycosis and gliosis, respectively. Conclusions. The thorough clinical and laboratory investigation together with the study of the imaging can help distinguishbetween non-neoplastic lesions from neoplastic lesions in order to avoid surgical exploration which is only suitable in very doubtful cases with rapid deterioration.

Microsurgical Treatment of Recurrent Intra-spinal Canal Tumors / 中国医师杂志

Objective To explore the microneurosurgical treatment of recurrent intra-spinal canal tumors. Methods The clinical data on the microsurgical parameters, operative procedures, operative efficacy and post-operative complications of 16 cases with recurrent intra-spinal canal tumors from June 1993 to June 2002 were reviewed retrospectively. Results Under the operative microscope, the tumors were totally removed in 10 cases, subtotally in 4 cases, and partially in 2 cases. Fllowed up from 5 months to 8 years, 11 cases recovered well, 4 cases suffered from moderate disability, and 1 case died. Preoperative CT or MRI scan, knowledge of the anatomy and structures, and skillful operative techinique all were important to microsurgical treatment of recurrent intra-spinal canal tumors. Conclusion Once diagnosis of recurrent intra-spinal canal tumors, the operative treatment is effective. Radiation therapy for the malignant tumors or incompletely removed recurrent tumors is necessary.