स्पाइन जर्नल

Study background: Heterotopic ossification (HO) is a well-known complication of cervical total disc replacement (CTDR), a successful alternative to cervical decompression and fusion for degenerative disc disease.

Objective: The aim of our study was to evaluate the incidence of HO in single and double-level Discover disc replacement, a relatively new type of artificial implants. Moreover, the related clinical and radiological outcomes and the possible influencing factors were analysed.

Methods: Twenty-six women and 39 men were retrospectively followed-up for 5 years. They consecutively underwent one or two-level cervical Discover arthroplasty. Clinical outcome was assessed using the visual analogue scale (VAS). The angular range of motion (ROM) was calculated with periodic dynamic X-rays. A Student’s t test was used to analyse the association between the occurrence of HO and various risk factors.

Results: Among the 65 patients enrolled, the overall incidence of HO was 7.69% and the mean follow-up was 63.29 ± 11.90 months. All the cases were diagnosed as Grade III or Grade IV. The mean VAS showed immediate postoperative improvements and the mean ROM was partially maintained. No displacement of the prostheses was detected.

Conclusions: During the 5-year follow-up period, the Discover cervical discs have provided optimal clinical outcomes showing a lower and tardive incidence of HO than other reported implants. Although a longer follow-up with a larger group of patients should be investigated, cervical arthroplasty can be still considered a safe and effective procedure in highly selected patients.

Introduction: Rhabdomyosarcoma is a highly aggressive and rapidly growing sarcoma with skeletal origin that occasionally appears in the spinal epidural space.

Method: We report a 20-year-old girl who presented with back pain, progressive paraparesis, and urinary retention. She had muscular weakness in her lower extremities and absent deep tendon reflex. An epidural dumbbell-shape mass at T3-T4 level was observed on MRI. The patient underwent T3-T5 hemilaminectomy.

Result: Histopathological examination Immunohistochemical staining confirmed the diagnosis of alveolar Rhabdomyosarcoma. She received radiotherapy and chemotherapy. The patient died 3 months after.

Conclusion: Primary spinal epidural RMS is an extremely rare and very aggressive tumor. The treatment should focus on extensive resection with intensive combination of radiotherapy and chemotherapy.

Intramedullary spinal tuberculoma is a rare form of central nervous system tuberculosis. We report a case in HIV infected patient with evidence of symptoms of systemic tuberculosis who presented with a history of progressive leg weakness, urinary urgency, and impotence. Thoracic MRI showed disseminated micronodular lesions. Abdominal MRI revealed ascitis, necrosed retroperitoneal adenopathies. Ascitis liquid acid-fast bacilli stainings and cultures were positive. MRI of the brain revealed multiple infracentimetric nodular lesions in the cerebral parenchyma and in cerebellar vermis. MRI of spinal cord revealed two intramedullary hyper intense lesions measuring 10 mm and 7 mm interesting the terminal cones. Gd-DTPA-enhanced MRI showed enhancement of the two intramedullary lesions. The lesion, was located in the cones medullaris. Antituberculous medication was instituted as soon as the diagnosis was made. Neurologic symptoms and signs slowly improved.

Study design: A case report of a patient with diffuse idiopathic skeletal hyperostosis (DISH) associated with ossification of posterior longitudinal ligament (OPLL) and dens hypertrophy resulting in spinal canal stenosis and progressive hemiplegia Objective: To demonstrate the excellent functional outcome following posterior spinal decompression and fusion. Methods: In December 2012, a 72-year-old male patient, who was diagnosed with hyperostosis of anterior and posterior longitudinal ligament 6 months ago, presented with rapidly increasing motor deficit of the left arm and unsecure gait pattern. X-rays, CT, and MRI diagnosed DISH and OPLL. Hyperintense signal in the C1 spinal cord on T2 weighted sequence was also observed. Patient underwent decompressive foraminotomy of foramen magnum and laminectomy of C1-C4 with Occiput – C5 fusion. Results: Neurological status and myelopathy improved to a great extent after surgical intervention. Conclusion: The current case demonstrates the scenario of DISH associated hemiplegia and the need for a posterior spinal decompression and fusion.

26 patients underwent decompression-stabilization procedures for their malignant spinal lesions. Fifteen were females and 11 males. Their average age was 60.6 years (range 18-73 years). These patients were classified according to extent of involvement of the spine. One column was involved in 1/26 (3.8%) case, two in 11/26 cases (42.3%) and three in 14/26 cases (53.8%). A posterior approach alone was done in 8/26 (30.8%) patients while a combined anterior and posterior approaches were done in 18/26 (69.2%) cases. A variety of posterior stabilization procedures were used. Out of 24 patients who were able to attend the follow-up 16 (66.7%) were able to walk, five (20.8%) were paraparetic, and 3 patients (12.5%) were paraplegic. Patients with combined approach showed higher percentage of neurologic improvement (62%) while patients with posterior approach showed only 35% improvement in their neurologic status. Accordingly results obtained from direct anterior approaches using corpectomy and anterior reconstruction of the anterior and middle columns have produced the best results in terms of neurological improvement. Almost all of our patients had 2 or 3 columns involvement but the results did not support the three columns theory where we could not correlate any significant results, regarding pre- or post-operative radiographic measurements (mechanical instability) and pre- or post-operative neurologic findings (neurologic instability), with the number of involved columns.

We present two cases of idiopathic spinal epidural lipomatosis. Case 1: A 77-year-old man experienced tightness in bilateral lower extremities and neurogenic claudication for 1 year. He was overweight with a body mass index of 30.8 kg/m2. Magnetic resonance imaging revealed extensive epidural lipomatosis of lumobsacral spine with significant constrictive compression of the thecal sac. Case 2: A 78-year-old man presented with low back pain along with progressive pain and numbness in the left lower extremity and neurogenic claudication for 6 months. He was diabetic with body mass index of 25.6 kg/m2. Magnetic resonance imaging demonstrated circumferential compression of the thecal sac due to increased epidural fat tissue at the L4 level. We suggest that spinal epidural lipomatosis should be considered in the differential diagnoses when patients with neurological symptoms have conditions relating to hyperinsulinism such as obesity and exogenous steroid administration