स्पाइन जर्नल

Meningiomas of the spinal axis have been identified from C1 to as distal as the sacrum. Their clinical presentation varies greatly based on their location. Meningiomas situated in the atlanto-axial region may present similarly to some meningiomas of the craniocervical junction, while some of the more distal spinal axis meningiomas are discovered as a result of chronic back pain. Surgical resection remains the mainstay of treatment, although advancements in radiosurgery have led to increased utilization as a primary or adjuvant therapy. Angiography also plays a critical role in surgical planning and may be utilized for preoperative embolization of hypervascular meningiomas.

Study design: A case report describing the development of vertebral deformities associated with dysplastic spondylolisthesis that was managed conservatively until skeletal maturity was achieved.

Objective: To describe development of wedging and rounding vertebral deformities.

Summary of Background Data: There are no reports of preschool children with dysplastic spondylolisthesis that were managed conservatively until skeletal maturity.

Methods: A 5-year-old girl presented with a postural deformity associated with congenital scoliosis and dysplastic spondylolisthesis. Surgery was performed for scoliosis at the age of 13 years, but spondylolisthesis was managed conservatively up to skeletal maturity.

Results: The wedging of the L5 body and the rounding of the sacrum progressed during her growth period, and no progression was observed thereafter. The slippage progressed gradually during and after her growth period, and posterior lumbar interbody fusion was performed at the age of 21 years.

Conclusion: We speculate that the slippage associated with dysplastic spondylolisthesis occurs at the growth plate, and vertebral deformities are the results rather than the causative factors of the slippage as observed in the case of slippage associated with isthmic spondylolisthesis.

Objective: For the management of whiplash-associated disorders the use of patient oriented disability questionnaires are of uppermost importance. The Australian whiplash disability questionnaire has a high content, face and constructs validity, and an excellent short- and medium-term reproducibility. However, until now no German version of this questionnaire is available.

Aim: A cross-cultural adaptation of the whiplash disability questionnaire for a German-speaking population with ensured retention of psychometric properties such as validity and reliability of the translated version.

Settings: Acute and chronic settings.

Subject: A total of 75 patients (67 acute/8 chronic) and a control group of 177 asymptomatic volunteers were analyzed.

Interventions: All participants completed the translated 13-item questionnaire as well as documented their current health state on a visual analog scale (VAShealth) and a general disability questionnaire (EQ-5D) for comparison. For test-retest reliability assessment 16 chronic patients and 25 healthy persons completed the questionnaire twice with an interval of 2 weeks.

Main measures: Construct and concurrent validity and test-retest reliability.

Results : The translated version showed no floor or ceiling effects, a high internal consistency (Cronbach’s alpha=0.95) and a very good inter-item correlation (rho=0.926). The concurrent validity testing using EQ-5D score as the reference showed a significant correlation to the whiplash disability questionnaire (overall rho=0.838, acute patients rho=0.749, chronic patients rho=0.876; p<0.001 each) and to the VAShealth (overall rho=-0.74, acute patients rho=-0.66, chronic patients rho=-0.65; p<0.001 each). The intra-class coefficient (0.969) indicated high short term reproducibility.

Discussion : The German version of the whiplash disability questionnaire is valid and reliable as outcome measure for acute and chronic study settings.

The authors report the case of a 24-year-old man who presented with sudden onset quadriplegia while doing a bench press in the supine position. He had a history of cervical disc herniation at the C6/7 level. Plain x-rays showed no spinal fracture and no spinal canal stenosis. MRI revealed a C6/7 disc herniation that severely compressed the spinal cord. Physical exam showed complete spinal cord injury below C8 level. Urgent C6/7 anterior decompression and fusion using hydroxyapatite (HA) was performed. A large, sequestrated herniation mass into the spinal canal was removed. His neurological deficits improved gradually after surgery. Over 3 years postoperatively, he can walk by himself without crutches, though he has slight motor weakness of left finger and foot, paresthesia below C8 on the right, and slight bladder disturbance.

Many cases of cervical spinal cord injury caused by sporting injury have been reported. Those cases generally accompanied high energy trauma such as fracture dislocations. This case did not involve any large cervical motion before injury or any spinal fracture. This very important case shows the possibility of a spinal cord injury in supine position without high energy trauma. Patients with cervical disc herniation should be counseled about the risk of participating in sports, including those without significant neck motion.

Background context: The correlation of idiopathic scoliosis and cavus foot has been previously reported. This has been ascribed to possible lesions related to muscular imbalance influenced by the central nervous system.

Purpose: Our study goal is to assess and compare the rate of pes cavus in children with and without scoliosis.

Study design: Prospective, cross-sectional; Case-control study.

Patient sample: 81 subjects, 42 healthy children matched for age and gender with 39 children with idiopathic scoliosis.

Outcome measures: Clinical examination of the trunk and the feet, radiological assessment of the spine. The statistical analysis was performed using SPSS package.

Methods: Children were examined from a school-screening program at the physical medicine and rehabilitation department in the university hospital of Douéra, in Algiers. A number of measurements were assessed including the trunk asymmetry in standing forward bend followed by the Cobb angle in upright spine radiography and the footprints analysis under weight-bearing on the podoscope (mirror table).

Results: There is a statistically significant difference of pes cavus rate in children without idiopathic scoliosis and those with idiopathic scoliosis. Comparing 55.8% to 33.3% we found Chi-square=4.174 with P=0.043.

Conclusions: In our small sample, the significant difference between pes cavus in children without and with idiopathic scoliosis was noted, as it has been elsewhere reported. The percentage of cavus foot was traced higher in the healthy children than it is in the moderate scoliosis curves studied.

Abstract Study background: Although cervical pedicle screw method is the most stable instrumentation, which is useful for reconstruction of unstable or deformed cervical spine, to insert cervical pedicle screw accurately is sometimes challenging at the risk of the neurovascular injuries due to the anatomical features of cervical pedicles. The purpose of this study is to introduce our Screw Guide Template (SGT) system developed to insert mid-cervical pedicle screws accurately and safely with less risk. Method: Preoperatively, the bone image on CT was analyzed by the multiplanar imaging software and then the trajectory and the depth of the screws were designed three-dimensionally. Three types of transparent templates were created for each lamina: location template, drill guide template and screw guide template. During the operations, after engaging the templates directly with the laminae, three steps; drilling, tapping, and screwing were performed with each template. The screws were inserted accurately as we planned, which was confirmed by postoperative CT. Case presentation: Three cases underwent posterior spinal fusion surgeries with mid-cervical pedicle screw insertion using the SGT system. The location of all screws were perfectly matched the trajectory planned preoperatively in Case 1 and 2. While, the improper templates engagement due to inadequate par spinal muscle retraction lead to the mal-positions of two screws in Case 3. Conclusion: We demonstrated the availability of the SGT system as intraoperative screw navigation for cervical pedicle screw insertion in mid-cervical spine. Proper engaging templates and adequate muscles traction play an important role for the SGT system through the procedure.

Meningiomas are tumors originating from the meninges of the brain and spine that are typically benign. Mass-effect and traction of nearby structures resulting in neurological sequelae often predicates surgical resection. Vital structures are unavoidably encountered en route to craniocervical junction meningiomas, posing a significant surgical challenge. The clinical presentation varies based on neoplasm size and location. Resection techniques also vary based on individual anatomy and the required exposure.