Journal of spinal disorders
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Corticosteroid injections into the spinal epidural space are frequently used to effect a relief of back pain and associated radicular extremity symptoms. Spinal epidural lipomatosis has been documented after the use of systemic corticosteroid therapy. This case report documents the development of epidural lipomatosis after the administration of multiple epidural steroid injections. The development and subsequent resolution after discontinuation of the steroid injections are demonstrated with serial magnetic resonance imaging.
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Anterior instrumentation is recommended to correct idiopathic thoracolumbar or lumbar scoliosis through short fusion within the major curve. Only a few reports exist of anterior surgical correction for thoracic scoliosis. This study assessed the results of Zielke instrumentation for thoracic curve and analyzed the three-dimensional correction of deformity, especially correction of the uninstrumented compensatory curve. ⋯ The hump angle measured using a topographic body scanner decreased from 12.8 degrees +/- 4.5 degrees to 8.4 degrees +/- 4.3 degrees after surgery (p = 0.0001). Of the three patients in whom the rod broke up, only one showed a correction loss of 10 degrees; however, bony fusion was obtained. Anterior short fusion for thoracic scoliosis appears to offer significant correction, stabilization, and spontaneous correction of the compensatory lumbar curve without limiting lumbar motion.
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The morphologic characteristics of the cervicothoracic junction from C6 to T2 were examined. Gross dissection and cryomicrotomy was performed on 13 fresh cadavers. Four healthy volunteers underwent magnetic resonance imaging. ⋯ The coronal angulation of the exiting nerve was 64.83 for C7, 79.83 for C8, and 90.33 for T1 nerve roots based on coronal magnetic resonance imaging. Finally, gross dissection during the anterior approach to the cervicothoracic junction revealed that this approach was extensible, allowing access to the anterior aspect of the cervicothoracic spine. Associated vital structures must be protected, such as the arch of aorta, common carotid artery, innominate vein, thoracic duct, recurrent laryngeal nerve, stellate ganglion, trachea, and esophagus.
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A case of cervical intramedullary sarcoidosis and its uncommon magnetic resonance imaging with contrast medium are reported. Spinal cord sarcoidosis is very rare. It is difficult to diagnose intramedullary sarcoidosis without a previous diagnosis of systemic sarcoidosis or other apparent symptom. ⋯ Subsequent pathologic examination of the biopsied specimens revealed spinal cord sarcoidosis. After surgery, steroid therapy was performed, but the patient's symptoms hardly improved. Even if imaging study and intraoperative frozen section show neoplasm, the first surgery should be limited to decompressing the cord and biopsy in cases of suspected sarcoidosis.
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To study the functional outcomes of patients with cervical herniated intervertebral discs with radiculopathy but without signs of cervical myelopathy using a retrospective cohort study design. The patients were retrospectively identified by chart reviews. Inclusion criteria were (a) cervical radiculopathy with defined neurological disturbances (sensory disorder, reflex abnormalities, and motor weakness); (b) a spinal computed tomograph scan or magnetic resonance image demonstrating neuroradiologic abnormalities (soft or hard disc); and (c) completion of conservative physical and pharmacological treatment. ⋯ Patients with a herniated cervical intervertebral disc with radiculopathy can be treated conservatively with good results, although a residual intermittent neck pain syndrome often persists. The patients in the SUG, who initially showed more severe and long-lasting neurological disturbances, were improved at the time of examination, although with more marked residual disorders. Surgery is indicated only when appropriate conservative treatment for a reasonable time has failed.