Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 53, Issue 2
Displaying 1-15 of 15 articles from this issue
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Original Articles
  • Prospective Assessment of Pain and Functional Status After Percutaneous Vertebral Body-Perforation Procedure for Treatment of Vertebral Compression Fractures
    Makoto YAMADA, Kunio YOKOYAMA, Masahiro KAWANISHI, Hidekazu TANAKA, Yu ...
    2013 Volume 53 Issue 2 Pages 71-76
    Published: 2013
    Released on J-STAGE: February 25, 2013
    DOIhttps://doi.org/10.2176/nmc.53.71
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    Percutaneous vertebral body perforation is a new technique for treating painful vertebral compression fractures (VCFs). We prospectively evaluated this treatment in 45 consecutive patients with 63 VCFs treated at our hospital between September and December 2009. In all patients, long-term conservative treatment had failed to achieve pain relief, resulting in reduced changes in activities of daily living (ADL). We evaluated visual analogue scale (VAS) scores for pain before and after vertebral body perforation as well as in the chronic phase, changes in ADL, whether recipients would recommend this treatment, and complications. The mean VAS score improved from 6.9 ± 1.9 before surgery to 3.6 ± 2.9 immediately after surgery, and to 2.5 ± 2.1 at 3 months. ADL was improved in 27 patients, and walking became possible in 16 of 24 patients who had been unable to walk. Nearly two-thirds of patients would strongly recommend this treatment to others. The analgesic effect of vertebral body perforation was significantly lower in patients with than in those without vertebral pseudarthrosis before surgery. Only 1 patient suffered a new fracture during the 3-month period after surgery, but there were no perioperative complications. Vertebral body perforation for painful VCFs can achieve early improvement of ADL due to the analgesic effect in carefully selected patients and is a safe treatment with a low frequency of complications.
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  • Incidental Detection of Thyroid Nodules at Magnetic Resonance Imaging of the Cervical Spine
    Kyongsong KIM, Naoya EMOTO, Masahiro MISHINA, Susumu OKADA, Toyohiko I ...
    2013 Volume 53 Issue 2 Pages 77-81
    Published: 2013
    Released on J-STAGE: February 25, 2013
    DOIhttps://doi.org/10.2176/nmc.53.77
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    The incidental detection of thyroid lesions in patients undergoing magnetic resonance (MR) imaging of the cervical spine was prospectively evaluated on 389 MR images. Sagittal images extended from the cranio-cervical junction to the upper thoracic level, and axial images from C3-4 to C7-T1 intervertebral levels. Twenty patients (5.1%) had a total of 26 thyroid nodules. Eighteen patients presented with a single dominant nodule, of whom 2 had a multinodular gland with a single dominant nodule (one had 3 and the other had 5 nodules). Two patients had diffusely enlarged gland without a dominant nodule. The mean size of the nodules was 11.6 mm. One thyroid nodule was detected at the C5-6 intervertebral level, 14 at the C6-7, and 11 at the C7-T1. T2-weighted imaging was more useful than T1-weighted imaging for the detection of thyroid nodules because of the hyperintense versus isointense appearance of the lesions. Thyroid carcinoma was identified at surgery in one patient. The detection rate was low compared with computed tomography with contrast medium and ultrasonography. Our results suggest that MR imaging has limited value for the detection of thyroid lesions and that the presence of such lesions cannot be denied based only on MR imaging of the cervical spine. However, asymptomatic thyroid lesions, including thyroid cancer, can be identified on MR images of the cervical spine, so we recommend that evaluation of these images should consider such lesions.
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  • Shoulder Traction Device for Enhanced Conventional Fluoroscopy During Cervical Spine Operations
    Abdullah MARANGOZ, Cengiz COKLUK, Enis KURUOGLU, Keramettin AYDIN, Adn ...
    2013 Volume 53 Issue 2 Pages 82-84
    Published: 2013
    Released on J-STAGE: February 25, 2013
    DOIhttps://doi.org/10.2176/nmc.53.82
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    Conventional biplanar fluoroscopic imaging of the cervical spine is commonly used during cervical spinal surgery. We designed an intraoperative traction device to prevent shoulder superimposition on the cervical fluoroscopic imaging. During surgery at the stage of fluoroscopic examination, an operator can apply traction via the traction band of the device. This device is safe and easy to use, and can be preoperatively fitted to patients. Fluoroscopic images obtained with the new traction device were definitely superior compared with images obtained without the traction device. This device may be useful in cases with difficult fluoroscopic imagination of the lower cervical spine.
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  • Anterior Cervical Interbody Fusion Using Polyetheretherketone Cage Filled With Autologous and Synthetic Bone Graft Substrates for Cervical Spondylosis: Comparative Analysis Between PolyBone® and Iliac Bone
    Jin Hoon PARK, Sung Woo ROH
    2013 Volume 53 Issue 2 Pages 85-90
    Published: 2013
    Released on J-STAGE: February 25, 2013
    DOIhttps://doi.org/10.2176/nmc.53.85
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    Clinical and radiological outcomes of cervical interbody fusion using a polyetheretherketone cage filled with PolyBone® (Kyungwon Medical Co., Ltd., Seoul, Korea), beta-tricalcium phosphate material, and autologous iliac bone were retrospectively compared in 47 patients who underwent anterior cervical discectomy and fusion (ACDF) between January 2007 and April 2008. Of these, 23 received iliac bone grafts and 24 received PolyBone. Numeric rating scale and neck disability index were used for clinical outcome assessments. Cervical radiography was performed immediately postoperatively, and at 1, 3, 6, 12, and 24 months postoperatively. Computed tomography (CT) was performed at 12 and 24 months postoperatively. Change in segmental lordosis, disk height, and fusion were compared at 12 and 24 months postoperatively. Clinical outcomes were similar between both groups. CT and radiography at 12 months showed that fusion had occurred in 22 patients in the iliac bone group and in 19 in the PolyBone recipients. Fusion was also identified in 22 patients in both iliac bone and PolyBone groups at 24 months postoperatively. The clinical outcomes of ACDF using PolyBone and iliac bone were similar, with similar cervical interbody fusion rates at 24 months postoperatively. However, the time taken for fusion was apparently longer in the PolyBone group.
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  • Prevalence of Spinal Meningeal Cyst in the Sacrum
    Satoshi TANI, Yuichi HATA, Satoru TOCHIGI, Hiroki OHASHI, Akira ISOSHI ...
    2013 Volume 53 Issue 2 Pages 91-94
    Published: 2013
    Released on J-STAGE: February 25, 2013
    DOIhttps://doi.org/10.2176/nmc.53.91
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    Spinal meningeal cysts in the sacrum (SMC) are known to be occasionally symptomatic with low back pain as well as leg pain, but no distinct prevalence of this pathological entity including asymptomatic lesions has been described. This prospective study investigated the prevalence of SMCs based on magnetic resonance (MR) myelography in 102 consecutive Japanese women with gynecological problems, who underwent pelvic conventional MR imaging. Ten of 102 patients were suspected of being positive for SMC (9.8%), but pseudo-positive findings were possible. A high probability of positive SMC was found in 7/102 (6.9%). MR myelography was better to detect SMCs than conventional MR imaging. Multiplicity and female preponderance may be other features of SMC. The speculated prevalence of SMCs in Japanese females ranged from 6.9% to 9.8%.
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  • Synovial Cysts of the Lumbar Spine
    —Pathological Considerations and Surgical Strategy—
    Mario GANAU, Franco ENNAS, Giulia BELLISANO, Laura GANAU, Rossano AMBU ...
    2013 Volume 53 Issue 2 Pages 95-102
    Published: 2013
    Released on J-STAGE: February 25, 2013
    DOIhttps://doi.org/10.2176/nmc.53.95
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    Symptomatic lumbar synovial cysts (LSCs) are a rare cause of degenerative narrowing of the spinal canal, with thecal sac or nerve root compression. True synovial cysts have a thick wall lined by synovial cells, containing granulation tissue, numerous histiocytes, and giant cells. In contrast, pseudo-cysts lack specialized epithelium, have a collagenous capsule filled with myxoid material, and may be classified into ganglion cysts, originating from periarticular fibrous tissues, and ligamentous cysts, arising from the ligamentum flavum or even from the posterior longitudinal ligament. Here we present the surgical series of the Chair of Neurosurgery at the University of Cagliari (Italy) including a total of 17 LSCs. Surgical technique consisted of facet sparing excision of LSC, achieved by simple hemilaminectomy/laminectomy, and diagnosis was always confirmed by histological specimen examination, which detected the typical synovial epithelium, the intracystic presence of hemosiderin, histiocytes, and calcifications. Further immunohistochemical investigation revealed positive staining for cytokeratin: CK5, CK6, and AE1/AE3. Clinically, our cohort experienced rapid and complete resolution of symptoms, without perioperative complications, or recurrence of cysts or vertebral instability at a median follow up of 28 months, when the MacNab score was generally excellent. A review of the literature, retrieving articles published from 1973, collected a total of 101 articles concerning all the cases of LSC scientifically described to date. Both clinical and histological findings described in our study support the theory of degenerative microtraumatic pathogenesis of synovial cysts.
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Case Reports
  • Transformation From Asymptomatic to Symptomatic of Lower Cervical Spinal Dural Arteriovenous Fistula
    —Case Report—
    Toru SASAMORI, Kazutoshi HIDA, Takeshi ASANO, Toshiya OSANAI, Syunsuke ...
    2013 Volume 53 Issue 2 Pages 103-106
    Published: 2013
    Released on J-STAGE: February 25, 2013
    DOIhttps://doi.org/10.2176/nmc.53.103
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    A 60-year-old woman presented with a spinal dural arteriovenous fistula (SDAVF) located in the lower cervical region, which had been asymptomatic for 56 months after the initial detection. She underwent embolization of the SDAVF when she became symptomatic, but her neurological recovery was only partial. Cervical SDAVF is rare but sometimes discovered in an asymptomatic state. The natural history and validity of preventive treatment for asymptomatic SDAVF have not been fully established. Her unfavorable outcome demonstrates the potential advantages of adequate treatment at an early stage even for asymptomatic SDAVF.
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  • Spinal Dural Arteriovenous Fistula With Lipomyelodysplasia
    —Case Report—
    Masayuki SATO, Tomoji TAKIGAWA, Masanari SHIIGAI, Goichiro TAMURA, Tom ...
    2013 Volume 53 Issue 2 Pages 107-109
    Published: 2013
    Released on J-STAGE: February 25, 2013
    DOIhttps://doi.org/10.2176/nmc.53.107
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    A 72-year-old man presented with a very rare case of spinal dural arteriovenous fistula (AVF) with lipomyelodysplasia manifesting as progressive paraparesis and bladder dysfunction. Magnetic resonance imaging revealed a spinal lipoma associated with tethered cord and spinal cord swelling with dilated perimedullary veins. Embolization of the spinal dural AVF was successfully performed, and is an optional treatment for coexisting spinal dural AVF and lipomyelocele in adults.
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  • Conus Medullaris-Cauda Arteriovenous Malformation and Klippel-Trenaunay Syndrome: What is the Treatment Goal?
    —Case Report—
    Donatella SGUBIN, Ryuichi KANAI, Francesco DI PAOLA, Alessandro PERIN, ...
    2013 Volume 53 Issue 2 Pages 110-114
    Published: 2013
    Released on J-STAGE: February 25, 2013
    DOIhttps://doi.org/10.2176/nmc.53.110
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    A 29-year-old man with Klippel-Trenaunay syndrome (KTS) presented with a symptomatic conus medullaris-cauda arteriovenous malformation (AVM) manifesting as back and right limb pain, which abruptly worsened with the onset of right limb weakness and urinary retention. He was treated by multisession endovascular embolization resulting in improved neurological status. KTS is a sporadic disease with unknown etiology, but genetic susceptibility may lead to the over-expression of angiogenic factors and increased angiogenesis. KTS may be exceptionally associated with slow-flow spinal AVM, but there is no consensus about the optimal treatment for these symptomatic lesions. Embolization treatment may represent a safe option to minimize complications and possibly improve the neurological status in patients with spinal AVM associated with KTS, if one or both legs are already impaired by hypertrophy or other vascular malformations. Genetic analysis may reveal an underlying angiogenesis change, so closer follow up might be indicated in selected patients.
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  • Syringomyelia Associated With Paget Disease of the Skull
    —Case Report—
    Satoshi HORI, Masanori KURIMOTO, Kimiko UMEMURA, Hideo HAMADA, Seiya N ...
    2013 Volume 53 Issue 2 Pages 115-118
    Published: 2013
    Released on J-STAGE: February 25, 2013
    DOIhttps://doi.org/10.2176/nmc.53.115
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    A 38-year-old man presented with a rare case of syringomyelia associated with Paget disease of the skull. Syringosubarachnoid (SS) shunting was performed. We speculate that deformation of the skull secondary to Paget disease caused narrowing of the foramen magnum with progressive impairment of the cerebrospinal fluid circulation, which led to syringomyelia and neurological symptoms. SS shunting is safe, effective, and technically simple, so may be a useful initial treatment for syringomyelia associated with Paget disease of the skull.
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  • Congenital Absence of the Lumbar Facet Joint Associated With Bilateral Spondylolysis of the Fifth Lumbar Vertebra
    —Case Report—
    Zhuo WANG, Toshihiko SAKAKIBARA, Yuichi KASAI
    2013 Volume 53 Issue 2 Pages 118-121
    Published: 2013
    Released on J-STAGE: February 25, 2013
    DOIhttps://doi.org/10.2176/nmc.53.118
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    A 14-year-old boy presented with a rare case of congenital absence of lumbar facet joint manifesting as low back pain. Physical examination showed no neurological or hematologic abnormalities. Radiography revealed absence of a facet joint on the right side of L4-5. Computed tomography and three-dimensional computed tomography revealed absence of the facet joint on the right side of L4-5 and spondylolysis on both sides of L5. Pain subsided after conservative treatment. This is an extremely rare case of congenital absence of lumbar facet joint associated with bilateral spondylolysis.
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  • Surgical Treatment of Scaphocephaly With Sinus Pericranii
    —Case Report—
    Tomomi KIMIWADA, Toshiaki HAYASHI, Takehiko SANADA, Reizo SHIRANE, Tei ...
    2013 Volume 53 Issue 2 Pages 121-125
    Published: 2013
    Released on J-STAGE: February 25, 2013
    DOIhttps://doi.org/10.2176/nmc.53.121
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    A 1-year-old female was admitted with a subcutaneous, pulsatile soft mass in the midline parietal region, and abnormal head shape. Fundus examination showed papilledema, suggesting elevated intracranial pressure. Radiological findings showed sagittal suture craniosynostosis with sinus pericranii. Magnetic resonance venography showed that the drainage through the sinus pericranii was not essential for the venous outflow from the brain. The patient underwent surgical resection of the sinus pericranii and total cranial remodeling. Ligation of the stalk-like orifice attached to the superior sagittal sinus with resection of the sinus pericranii and total cranial reconstruction were performed concurrently. The postoperative course was uneventful, and her papilledema resolved. No recurrence of the sinus pericranii has occurred for 3 years. This case describes a unique one-staged operation to treat sinus pericranii with sagittal suture craniosynostosis.
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  • Atlantoaxial Intraspinal Juxtafacet Cyst
    —Case Report—
    Tetsuro SAMESHIMA, Keita SHIBAHASHI, Toshiki NOZAKI, Atsuya AKABANE, A ...
    2013 Volume 53 Issue 2 Pages 125-128
    Published: 2013
    Released on J-STAGE: February 25, 2013
    DOIhttps://doi.org/10.2176/nmc.53.125
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    A 69-year-old man presented with progressive paralysis of the right arm and leg with a past history of metastatic rectal cancer. Magnetic resonance imaging showed a cystic mass lesion posterior to the odontoid process. Under a preoperative diagnosis of intradural extramedullary tumor, partial transcondylectomy and C1 hemilaminectomy were performed, and the cyst was removed through a transdural approach, decompressing the medulla oblongata and the cervical spinal cord. The histological diagnosis was juxtafacet cyst (ganglion cyst). An atlantoaxial intraspinal juxtafacet cyst at the level of the odontoid process is extremely rare. In our case, the cyst was removed using a posterior approach, resulting in rapid improvement in symptoms.
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  • Thoracolumbar Extradural Arachnoid Cyst
    —Three Surgical Case Reports—
    Masato TOMII, Junichi MIZUNO, Masaaki TAKEDA, Tadao MATSUSHIMA, Yasuno ...
    2013 Volume 53 Issue 2 Pages 129-133
    Published: 2013
    Released on J-STAGE: February 25, 2013
    DOIhttps://doi.org/10.2176/nmc.53.129
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    Three cases of symptomatic extradural arachnoid cyst were treated by surgery. Total excision of the cyst followed by tight closure of the fistula by suture was achieved in all 3 cases. Surgery improved the neurological deficits but urinary incontinence persisted in all three patients. Obliteration of the fistula is considered to be important at surgery from the etiological perspective of the cyst. There are many surgical options, but surgical removal of the cyst and obliteration of the communication usually leads to prompt improvement in neurological deficits. Instability, malalignment, and worsening scoliosis are well-recognized postoperative complications of excessive laminotomy, but the exposure should be wide enough to cover the cyst completely at the operation. Wide exposure of the entire cyst is preferable to avoid missing the fistula and to identify any adhesions or fistula between the cyst and the dura. Identification of the fistula location based on preoperative imaging studies is also important.
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Editorial Committee
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