Introduction: A retrospective review was performed to evaluate clinical symptoms and the alignment of cervical spine for patients who underwent a cervical total disc replacement (C-TDR).
Methods: 10 patients underwent a single-level C-TDR. Their JOA score, EQ5D, EQ-VAS, range of motion (ROM), segmental lordosis, and C2-C7 angle were evaluated at preoperation and at 6 months postoperation.
Results: JOA score, EQ5D, and EQ-VAS, ROM, and segmental lordosis were significantly improved at 6 months compared with the preoperative state though C2-C7 angle did not change significantly.
Conclusions: C-TDR increases the local lordosis but does not affect the global lordosis of the cervical spine at 6 months postoperation.
Introduction: Adult spinal deformity surgery has become popular in recent years, and the incidence of proximal junctional kyphosis as post-surgical complication has increased. In this study, we focused on postoperative changes of the fixed upper anteversion in adult spinal deformity surgery and investigated the relationship with various spine parameters, including cervical spine alignment.
Methods: We assessed 24 patients (mean age, 73.2 years; 5 men, 19 women) who corrected adult spinal deformity by fixing from pelvis to middle or lower thoracic vertebra, between December 2013 and February 2018 at our hospital. Various spinal parameters from the standing whole spine X-rays at the time of before operation, immediately after operation, and 1 year after operation (e.g., PI, PT, SS, LL, SVA, TK, T1slope, C2-7 angle, C2-7SVA) were measured. The patients were divided into two groups based on their surgical outcome: Group A is the patients whose fixed upper end tilt angle increased by more than 5° from immediately after surgery to 1 year after surgery and Group B is those in whom there was no such increase.
Results: The results demonstrated a significant difference in the preoperative fixed upper end anteversion between Group A and B. However, there was no significant difference in the fixed upper anteversion immediately after the operation.
Conclusions: The results suggest that, in cases with greater preoperative fixed upper end tilt angle, despite surgical correction of the inclination, the fixed upper end tilt angle might increase again in the post-surgical period, thereby increasing the possibility of proximal junctional kyphosis occurrence.
The authors performed a cyst-subarachnoid shunt for symptomatic sacral perineal cyst.
Case Report: We treated a case of symptomatic sacral perineal cyst in a 44-year-old woman who had left-sided sciatica and urinary disturbance. Magnetic resonance Imaging (MRI), myelography and enhanced Computed Tomography (CT) of the cyst showed a cystic lesion in the sacral area which was compressing the dural sac. The contrast medium revealed that the cyst was communicated with the subarachnoid space. A cyst-subarachnoid shunt tube was set to equalize the cerebrospinal fluid pressure between the cephalad dural sac and the cyst.
Conclusions: After surgery, the patient had an uneventful postoperative course, and neurological improvement was obtained immediately.
Introduction: Solitary fibrous tumor (SFT) that mainly arise in the pleura, is rarely occurs in the spinal canal. Until now, 41 cases of SFTs arised in the spinal canal have been reported, 16 cases of which were intramedullary SFTs. Here, we reported a case of intramedullary SFT in the thoracic spine and review the literature.
Case Report: A-47-year-old female complained gait disturbance and right lower leg numbness for 4 years. Intramedullary tumor was observed at Th2-Th3 level on MRI. The tumor showed isointensity on T1-weighted images, and hypointensity on T2-weighted images. It was homogeneously enhanced by gadolinium. Tumor resection with Th1-Th3 laminectomy was performed. Histopathological findings showed spindle-shaped cells proliferated irregularly with collagen fibers. Immunohistochemical staining revealed CD34 positive, and EMA, S-100 protein and GFAP were negative, so the diagnosis was SFT. After 3 months, she can walk without any aid. Six months after surgery, MRI showed no obvious recurrence of SFT.
Discussion: SFT is a mesenchymal tumor that was first reported as a localized pleural tumor in 1931, and was later reported to occur systemically. Since 1996, 41 cases of SFTs occurring in the spinal canal have been reported, and we analyzed these papers. The male-female ratio was 1.28:1 and the average age of onset was 51.1 years (17-83 years). Tumors occurred in 34.1% at the cervical level, 61.0% in the thoracic level, and 9.8% in the lumbar level. Tumor localization was 22.2% epidural, 33.3% intradural-extramedullary, and 36.1% intramedullary. On MRI findings, 78.6% of cases showed iso to hypo-intensity on T1-weighted images and iso to hypo-intensity on T2-weighted images. In gadolinium imaging, 80% were homogeneously contrasted. Immunohistochemical staining of SFTs shows positive for CD34 and negative for S-100 protein, GFAP, EMA, SMA and desmin. Differential diagnosis includes astrocytoma, ependymoma, hemangioblastoma, meningioma and schwannoma. A malignant case of SFTs occurring in the central nervous system is reported to be 5.8%, It has been reported that the recurrence rate of spinal SFTs was 14.8% in the case of total surgical removal and 80% in the case of partial removal.
Conclusion: We reported a rare case of SFT arise from spinal cord. Diagnosis should be done using MRI. Although most cases of SFTs are benign, recurrence cases and malignant cases have been also reported. Therefore, surgical total resection and careful long-term follow-up are important in treating SFTs of the spine.
Introduction: Chondrodysplasia punctata (CDP) is a skeletal dysplasia characterized by stippled epiphyses during infancy. Although spinal deformities have been noted in CDP patients, there are few reports for the development and management of early onset scoliosis. We report about two cases of scoliosis with CDP have treated for long term.
Case Report: Two cases are also female of Conradi-Hünermann type CDP with early onset scoliosis. One case with moderate but flexible scoliosis was performed cast and brace treatment for 6 years from the age of 4, and anterior-posterior final fusion was performed when she was 10 years old. The other case with significant kyphoscoliosis was performed growth sparing surgery for 6 years from the age of 8 and posterior final fusion was performed when she was 14 years old.
Conclusion: Both cases could be avoid from early spinal fusion surgery and kept growth during treatment before the final spinal fusion surgery.