We discuss cervical radiculopathy cases and consider the selection of anterior cervical surgery or posterior cervical surgery based on the lesion site and pathology. Lesions causing radiculopathy include anterior elements, such as disc herniation and intervertebral bony spurs, and posterior elements, including facet hypertrophy, thickened yellow ligament, and periarticular fibrous tissue. At the point of the lesion sites, we also must take into account the anatomical situation. Finally, we show the surgical strategy for cervical radiculopathy in our institutes and simultaneously describe the postoperative complications of anterior cervical surgery, as artificial disc replacement surgery will increase in the near future in Japan.
Background : 3-dimensional (3D) multi-fusion medical imaging for neurosurgical planning is a newly developing technique, in which images taken from different radiological modality are superimposed and reconstructed to a high-resolution 3D image. The aim of this study is to describe our experience with this technique while applying it to spinal disorders and to discuss its usefulness and operational issues.
Methods : The patients who underwent surgery for any spinal disorders using 3D multi-fusion medical imaging for preoperative neurosurgical planning at our institution between 2015 and 2018 were included in the study. These images were described using a medical workstation, which had broad utility, by radiation technologists and a neurosurgeon. Patients characteristics, required time, usefulness for pre-surgical planning, and encountered issues were analyzed.
Results : Thirty-three patients were included in this study. Mean age of the patients was 57.5±18.5 years. The underlying pathophysiologic disorders included various diseases, specifically spinal tumors for 20 patients. Two and 3 radiological modalities were incorporated in 26 and 7 patients, respectively. Mean required time for turning off the image was 95 minutes. The 3D image provided less useful information for pre-surgical simulation in the case of common neurospinal degenerative disorders, such as cervical or lumbar disc herniation. On the other hand, in cases of rare pathophysiological conditions, especially diseases that affect the craniovertebral junction or adhesive arachnoiditis, novel information provided from 3D fusion image helped surgeons to raise spatial cognition. However, as reciprocal deviation between each radiological modality was an insoluble problem, additional attempts to make the deviation smaller was needed.
Conclusions : We presented our experience with the use of 3D multi-fusion medical imaging for neurosurgical planning in the area of spinal disorders and discussed its usefulness and operational issues. This technique might make the surgery much easier for surgeons by raising their spatial ability. However, the reciprocal deviation between each radiological modality is an unsolvable issue. Therefore, this technique must be operated based on this characteristic feature in cases with spinal disorders.
A 53-year-old woman who suffered from pain on the right side of the neck, motor weakness of the right upper extremity, and clumsy finger movements for three months visited our outpatient clinic. Cervical magnetic resonance imaging (MRI) scan revealed a disc herniation at the right side of C2/3 level with compression of the spinal cord. There was no ossification of the posterior longitudinal ligament and mild osteophyte formation of vertebral bone. Resection of the herniated disc was performed via a postero-lateral transdural approach with C2 and C3 hemilaminectomy. After the surgery, the clinical symptoms improved remarkably without cerebrospinal fluid leakage. Postoperative MRI scan demonstrated that the herniated disc was successfully removed and the spinal cord was decompressed sufficiently. The incidence of C2/3 disc herniation is very rare. There are several approaches for removal of the herniated disc ; however, no consensus exists with regard to the most appropriate approach. In our case, we applied the postero-lateral transdural approach because the disc herniation was located laterally. The transdural approach has been shown to be advantageous in these respects.
Spinal epidural angiolipomas are rare benign tumors that generally induce slow progressive cord compression and are commonly found in the thoracic region. Only about 170 cases have been reported. Here, we report two cases of spinal epidural angiolipomas.
Case 1 : A 54-year-old woman underwent total hysterectomy under general and epidural anesthesia in the gynecology department. She experienced weakness in both the lower limbs after the operation. Paralysis improved with medical treatment but numbness in the lower limbs remained. Magnetic resonance imaging (MRI) scan revealed an epidural tumor at the Th11-12 levels. Tumor resection was performed, and the pathological diagnosis was indicative of angiolipoma.
Case 2 : A 74-year-old woman initiated medical treatment with prednisolone for rheumatoid arthritis 4 months before admission to our hospital. She began to experience weakness of both the lower limbs, which gradually worsened. MRI scan revealed an epidural tumor at the Th3-5 levels. The patient underwent a laminectomy for gross total excision of the lesion. The tumor was pathologically diagnosed as an angiolipoma. After surgery, paraplegia gradually improved.
Spinal epidural angiolipomas are rare causes of myelopathy, but prompt surgical resection can result in favorable functional outcomes.