European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Case Reports
Asymptomatic thoracic Pantopaque cyst mimicking an intradural extramedullary lipoma on MR images.
Oil-based contrast media such as Pantopaque have not used for imaging for several decades, but because these contrast media have an extremely low clearance rate, the remnant contrast media or residual sequelae of these materials may be encountered in the clinical field. ⋯ Intraspinal masses showing metal-like density in X-ray or computed tomography but in MRI showing only lipoma or cystic lesions, not metallic characteristics, the differential diagnosis should include iophendylate (Pantopaque) cyst. Oil-based contrast medium is believed to have the potential to make a syrinx formation via arachnoiditis, which can lead to severe neurologic deteriorations, so even if the patients do not represent with an acute neurologic deficit, surgical total removal of remnant material without leaking should be considered.
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To report a complication of airway obstruction during spinal deformity correction surgery in Duchenne muscular dystrophy (DMD) patient, due to lordoscoliosis, airway malacia, and prone surgical positioning, which was rectified by changing the position of the patient and surgery was successfully completed. ⋯ Lordoscoliosis and airway malacia in a patient with DMD can lead to occlusion of the tracheobronchial lumen when the patient is in the prone position. Changing the patient's position from prone to semi-lateral can be of help to reverse this airway obstruction and complete the surgery. Pedicular screw insertion can be safely and effectively carried out in this position using free-hand technique.
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Spinal stenosis at the C2-3 segment is a rare occurrence, and when it occurs myelopathy infrequently results. Furthermore, only a handful of cases involving congenital abnormalities of the posterior arch of the axis have been described resulting in cervical myelopathy many of which described simultaneous congenital abnormalities at adjacent levels and none of which identified ossification of the posterior longitudinal ligament (OPLL) at the same level. We report a case of a previously undescribed combination of abnormalities at the C2-3 segment resulting in clinical myelopathy. ⋯ Deficiencies in the posterior arch of the axis are rare and have not previously been reported in conjunction with OPLL. Advanced imaging is helpful to define the abnormality and site of compression. In the setting of a progressive neurological dysfunction, surgical decompression and stabilization is a reasonable intervention and can be associated with neurological and symptomatic improvement.
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To investigate the effects on evoked thalamic neuronal activity of application of notochordal cells and chondrocyte-like cells derived from nucleus pulposus (NP) onto a dorsal root ganglion (DRG) and to compare these effects with a previously reported increased thalamic activity induced by NP. ⋯ Separate exposure of the DRG to the two NP-derived cell populations induced different effects on evoked thalamic activity, but none of the tested cell samples induced an increase in neuronal activity similar to that previously observed with NP. This indicates a high complexity of the interaction between NP and nervous tissue.
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Case Reports
Anatomical changes in occipitalization: is there an increased risk during the standard posterior approach?
The purpose of this study was to examine the anatomic changes in a case of occipitalization of the atlas. ⋯ In our case, occipitalization considerably changed the anatomy of the upper cervical spine and craniocervical junction. Special care must be taken when using the posterior approach to avoid neurovascular injury in cases with occipitalization.