MRI Characterization of Vascular Spinal Tumors.

STUDY DESIGN: Randomized trial. OBJECTIVE: This study described practical magnetic resonance imaging (MRI) characteristics to assist in the identification of these tumors including the corresponding statistics. SUMMARY OF BACKGROUND DATA: Identification of vascular spinal tumors using MRI allows the opportunity for angiography and preoperative embolization (PE) to improve outcomes and decrease hemorrhage. The MRI characterization reliability of these tumors has not been described. MATERIALS AND METHODS: A retrospective comparison of 40 patients, at a single institution, with known spinal tumors was conducted with 20 vascular versus 20 nonvascular cases (based on postoperative pathology). Randomized MRI T1 precontrast/postcontrast and T2 images of these tumors were blinded and reviewed by 7 spine surgeons and 5 musculoskeletal radiologists. Four criteria were reviewed: T2 hyperintensity, contrast enhancement, flow voids, and feeding vessels. The clinical relevance was evaluated by asking if the reviewer recommended PE. RESULTS: The specificity, sensitivity, and accuracy of each characteristic for surgeons were: T2 hyperintensity (65%, 85%, 75%), contrast enhancement (84%, 38%, 61%), flow voids (42%, 86%, 64%), and feeding vessels (35%, 90%, 63%). The results for the radiologists were: T2 hyperintensity (83%, 61%, 72%), contrast enhancement (87%, 32%, 60%), flow voids (44%, 93%, 69%), and feeding vessels (33%, 93%, 63%). Both the groups had low κ and intraclass correlation values. Review of angiography/PE recommendation showed that both surgeons and radiologists had a false-negative rate of 33%. CONCLUSIONS: Surgeons and radiologists have similar moderate accuracy of MRI vascularity identification. Radiologists have a higher sensitivity, but lower specificity. Even with simplified, straightforward criteria, the MRI characterization of vascular spinal tumors has low interobserver/intraobserver reliability with a false-negative rate for angiography/PE recommendation of 33%. Angiography may become more standard in the workup of spine tumors.

In vivo intra-articular negative pressure wound therapy effect on cartilage in a goat model.

This prospective, randomized, blinded pilot study determined if a difference was present in the histology and apoptotic rate of articular cartilage after application of a negative pressure wound therapy (NPWT) device to an uninjured joint surface compared to a control side using Capra hircus goats. The goats were euthanized at 3 or 7 days after surgery. The en bloc joint resection was divided into medial (direct sponge contact) and lateral compartments (no sponge contact; indirect NPWT). In the necropsied cartilage and menisci, there were no gross or histologic/morphometric differences identified by a blinded veterinary pathologist. The percentages of apoptotic and necrotic chondrocytes based on flow cytometry were not statistically different. This study demonstrated that there were no observable deleterious effects to uninjured cartilage from direct or indirect intra-articular NPWT placement. These data suggest that NPWT may be placed safely in an intra-articular position for up to 7 days. Further studies in humans are warranted.

Pediatric nonaccidental trauma thoracolumbar fracture-dislocation: posterior spinal fusion with pedicle screw fixation in an 8-month-old boy.

STUDY DESIGN: Case report of pedicle screw fixation in an infant with nonaccidental spine trauma. OBJECTIVE: To ensure awareness of nonaccidental pediatric spine trauma and describe a safe and effective method of treating a complex problem of thoracolumbar fracture-dislocation in an infant. SUMMARY OF BACKGROUND DATA: Nonaccidental pediatric spine trauma is rare, accounting for <1% of abuse. No previous cases of pedicle screw fixation have been described in a patient younger than 1 year of age. Prior treatment of this clinical entity has been treated with casts or wire-fixation. METHODS: An 8-month-old boy had a nonaccidental (also known as child abuse) traumatic T12-L1 fracture-dislocation. This was subsequently surgically corrected with posterior spinal fusion and instrumentation with pedicle screws. RESULTS: After surgery, the patient is doing well with no adverse effects from surgery. CONCLUSIONS: Although child abuse is a rare cause of spinal trauma, clinicians should do a full skeletal survey to ensure no other injuries are overlooked. Pedicle screw fixation can be used in infants with unstable traumatic spinal injuries, allowing earlier rehabilitation and return to normal activity level.

Latent foreign body synovitis.

The differential diagnosis for monoarticular arthritis is extensive. Patient omissions from the history can compound this broad diagnostic dilemma. A case report is presented of a 32-year-old female with an eight-month history of isolated right first metatarsophalangeal joint (MTPJ) pain, after exhaustive, non-specific diagnostic evaluation. An open biopsy was performed, and a 3.5 cm wooden foreign body, believed to be the result of an injury 18 years prior, was excised from the 1st MTP. Open biopsy may be required as an important part of the workup for definitive diagnosis of a foreign body synovitis. A discussion regarding the presentation, clinical and diagnostic findings follows.