Classification of symptomatic osteoporotic compression fractures of the thoracic and lumbar spine.

The pathophysiology of osteoporotic compression fractures is different from those occurring secondary to traumatic spinal injury, and currently, there is no classification suitable for symptomatic osteoporotic compression fractures treated by percutaneous vertebroplasty. We propose a new classification based on the radiological appearance in the subacute or chronic stage of the clinical presentation of these fractures. They are classified by the authors based on observations and measurements from preoperative and postoperative dynamic lateral radiographs. Compression fractures are divided into two types. Type I is a compression fracture involving the anterior column only. Type II is a fracture involving both the anterior and middle column. Each type is divided into two groups: fractures with union and those with non-union. Type II compression fractures have a higher incidence of non-union than type I (p<0.05). In both type I and II non-union groups, fractures achieve greater increase in vertebral body height after vertebroplasty than both type I and type II union group fractures (p<0.05). In both non-union groups, fractures achieved a greater reduction of kyphotic angle post-vertebroplasty than type I and II union group fractures (p<0.05). Further clinical follow-up of these patients will confirm and extend this classification.     

全椎体切除治疗合并脊髓压迫的症状性脊柱血管瘤

目的探讨和评价全椎体切除椎问植骨椎体重建及后路椎弓根螺钉固定,治疗合并脊髓压迫的症状性脊柱血管瘤的疗效及应用价值。方法自2002年7月至2006年5月,我院收治6例症状性脊柱血管瘤患者,均为男性,其中慢性压迫性脊髓功能障碍5例,急性压迫性脊髓功能障碍1例。病变累及的椎体为T4 1例,T5 1例,T6 1例,T8 1例,T10 1例,T8-9 1例。应用全椎体切除椎间植骨椎体重建及后路椎弓根螺钉固定技术。结果术中和术后无脊髓、神经根及血管损伤等并发症发生,4例术前行动脉栓塞术的患者术中失血850～1100ml,2例术前未行动脉栓塞患者术中失血分别为1500ml和2100ml。术后3d至1．5个月神经功能全部恢复。术后随访2．1—5年（平均3．4年）,随访期间未见肿瘤复发,植骨均融合,内固定未见松动断裂,全部患者无后遗症,均恢复正常工作学习。结论全椎体切除椎间植骨椎体重建及后路椎弓根螺钉固定技术可安全应用于合并脊髓压迫的症状性脊柱血管瘤患者,并能够取得长期满意的疗效。     

一期前后入路全脊椎切除治疗胸椎骨巨细胞瘤

目的 探讨一期前后联合入路全脊椎切除并脊柱稳定性重建治疗胸椎骨巨细胞瘤的疗效.方法 回顾性分析本院自2001年3月至2007年6月采用一期前后联合入路全脊椎切除及脊柱稳定性重建治疗9例胸椎骨巨细胞瘤患者.结果 术中无死亡病例,无脊髓医源性损伤等并发症发生.所有患者术后获20-52个月(平均29.6个月)随访,术后患者背部疼痛及放射性疼痛基本缓解,8例有神经压迫症状的患者均有不同程度改善.1例患者术后6个月复发,给予放射治疗.影像学复查内固定物固定良好,无脊柱失稳及假关节发生.结论 一期前后联合入路全脊椎切除及脊柱稳定性重建治疗胸椎骨巨细胞瘤可以根治性切除肿瘤,降低肿瘤局部复发的危险,是一种可行且有效的外科治疗技术.     

一期前后入路全脊椎切除治疗胸椎骨巨细胞瘤

目的 探讨一期前后联合入路全脊椎切除并脊柱稳定性重建治疗胸椎骨巨细胞瘤的疗效.方法 回顾性分析本院自2001年3月至2007年6月采用一期前后联合入路全脊椎切除及脊柱稳定性重建治疗9例胸椎骨巨细胞瘤患者.结果 术中无死亡病例,无脊髓医源性损伤等并发症发生.所有患者术后获20-52个月(平均29.6个月)随访,术后患者背部疼痛及放射性疼痛基本缓解,8例有神经压迫症状的患者均有不同程度改善.1例患者术后6个月复发,给予放射治疗.影像学复查内固定物固定良好,无脊柱失稳及假关节发生.结论 一期前后联合入路全脊椎切除及脊柱稳定性重建治疗胸椎骨巨细胞瘤可以根治性切除肿瘤,降低肿瘤局部复发的危险,是一种可行且有效的外科治疗技术.     

一期前后入路全脊椎切除治疗胸椎骨巨细胞瘤

目的 探讨一期前后联合入路全脊椎切除并脊柱稳定性重建治疗胸椎骨巨细胞瘤的疗效.方法 回顾性分析本院自2001年3月至2007年6月采用一期前后联合入路全脊椎切除及脊柱稳定性重建治疗9例胸椎骨巨细胞瘤患者.结果 术中无死亡病例,无脊髓医源性损伤等并发症发生.所有患者术后获20-52个月(平均29.6个月)随访,术后患者背部疼痛及放射性疼痛基本缓解,8例有神经压迫症状的患者均有不同程度改善.1例患者术后6个月复发,给予放射治疗.影像学复查内固定物固定良好,无脊柱失稳及假关节发生.结论 一期前后联合入路全脊椎切除及脊柱稳定性重建治疗胸椎骨巨细胞瘤可以根治性切除肿瘤,降低肿瘤局部复发的危险,是一种可行且有效的外科治疗技术.     

Chordoma of the lumbar spine: a case report

Chordomas are rare tumors and they may arise anywhere along the spinal column and clival bone. The vast majority of tumors are found at skull base and sacrum. Chordomas involving the lumbar spine are rare. Approximately 6% of spinal chordomas originate in the lumbar vertebrae. We report a case of this chordoma arising from the lumbar vertebra.     

Synovial cysts of the lumbar spine

Background and purposeSynovial cysts of the spine occur most frequently in the lumbosacral region. Methods of treatment vary, but in cases of chronic pain or neurological deficits surgical intervention is undertaken. The aim of this paper is to present indications, surgical technique and efficacy of surgical treatment in patients with synovial cyst of the spinal canal.Material and methodsThe retrospective analysis included 11 patients, aged from 47 to 72 years, treated at the Department of Neurosurgery and Neurotraumatology, Poznan University of Medical Sciences, between 2004 and 2009. The length of medical history ranged from 2 months to 6 years. Conservative treatment applied before surgery was not effective. Neurological examination revealed unilateral or bilateral sciatica, superficial sensory disturbance or lower limb paresis.ResultsSynovial cysts were located mainly at the L4-L5 level (9 cases). Magnetic resonance imaging (MRI) of the spine was performed in all patients and showed the cystic lesion attached to the intervertebral joint. Surgical treatment consisted of a unilateral fenestration using microsurgical techniques in most cases. Back pain relief was observed in 9 cases. In 10 patients, symptoms of sciatica disappeared. Neurological deficits disappeared in 5 patients.ConclusionsSurgical treatment of spinal synovial cysts is safe, effective and ensures a long-lasting effect. Surgical treatment is indicated in patients in whom the clinical symptoms correlate with the presence of synovial cyst in imaging studies and do not resolve after conservative treatment.     

Partial spondylectomy: modification for lateralized malignant spinal column tumors of the cervical or lumbosacral spine.

Total en bloc spondylectomy is a useful technique in treating primary and secondary spinal malignancies, but requires extensive instrumentation to achieve difficult fusions, and requires extensive exposure of neurovascular structures that poses additional risk of nerve root and vascular injury. More limited resections may reduce these risks, especially in the cervical or lumbosacral spine. We report a technique used in two patients with lateralized primary vertebral tumors of the cervical or lumbosacral spine where tumor removal was achieved through a partial spondylectomy. The advantages of a partial spondylectomy included: (i) avoidance of injuring contralateral neurovascular structures during exposure; and (ii) supplementation of instrumentation by additional fixation at the level of spondylectomy. Partial spondylectomy can be an alternative to total en bloc spondylectomy in properly selected patients with lateralized encapsulated malignant spinal tumors and may be performed in the cervical or lumbosacral spinal regions.     

Giant schwannoma of the lumbar spine. A case report

Giant “invasive” schwannomas of the spine occur occasionally, most frequently in the lumbar region. We present the case of a 46-year-old woman with giant “invasive” schwannoma of the lumbar spine, with a 12-year history of illness. The tumour originated in the vertebral canal and passed through the paraspinal muscles and retroperitoneal area to the abdominal cavity. The part of the tumour which was in the abdominal cavity was removed by means of laparotomy during the first operation. In the second one, the remaining part of the tumour was removed completely from the vertebral canal and retroperitoneal area through posterior-lateral access. The spine was stabilized with metal implants. Histological examination revealed cellular schwannoma. During the follow-up the pain resolved while paresis of the right quadriceps muscle of the thigh was still present.Cellular schwannoma is a benign form of schwannoma, but it may cause a local recurrence if not removed completely.     

Two-level total en bloc lumbar spondylectomy with dural resection for metastatic renal cell carcinoma.

Only five reports of multilevel spondylectomy for tumor have been reported in the literature, mostly in the thoracic spine. We report a successful two-level spondylectomy with en bloc dural resection in a patient with metastatic renal carcinoma to the L3 and L4 vertebrae.     

Sudden hypotonic paraparesis caused by tophaceous gout of the lumbar spine.

Gouty arthritis of the axial skeleton is rare, and neurological complications due to spinal cord or nerve root compression secondary to tophaceous deposits have been seldom reported. We describe a patient with chronic gouty arthritis who developed an acute paraparesis caused by tophaceous cauda equina compression. Surgical removal of the mass resulted in complete recovery.     

不同融合方式对腰椎生物力学的影响

背景：腰椎融合已广泛应用于腰椎疾患,但腰椎融合后对邻近节段的影响尚存争议,不同融合方式的节段稳定性及对邻近节段的影响尚不清楚。 目的：利用动物模型研究腰椎融合节段生物力学稳定性及相邻上节段的生物力学特点。 方法：将新西兰大白兔随机分为前路椎体间融合组(切除L5~6椎间盘,终板去皮质化,自体髂骨移植)、后外侧融合组(L5~6双侧横突去皮质化后自体髂骨移植)、环状融合组(先行前路椎体间融合,1周后作后外侧融合)、对照组(不作手术)。术后12周处取标本作影像学检查、手触测试、生物力学测试。对融合标本分别施加屈伸,左右侧弯,左右旋转6个方向的纯力矩,比较不同融合方式融合节段的稳定性及邻近节段运动范围。 结果与结论：与对照组比较,前路椎体间融合组、环状融合组、后外侧融合组L5~6节段屈曲活动度分别下降86.24%(P < 0.05),88.74%(P < 0.05),73.10%(P < 0.05),融合节段近上节段L4~5屈曲运动范围分别增加52.22%(P < 0.05),55.89%(P < 0.05),27.11%(P < 0.05)。说明3种融合方式均显著提高融合节段稳定性,环状融合提供的节段稳定性最高,后外侧融合提供的节段稳定性最低。3种融合方式均使融合节段邻近上节段运动范围显著增加。前路椎体间融合,360°融合使邻近上节段屈曲运动范围增加无统计学差异。后外侧融合使邻近上节段屈曲运动范围增加最少。     

Ependymal cyst in the lumbar spine associated with cauda equina compression.

There are many reports of extradural ependymal cysts in the literature; however, reports of intradural ependymal cysts are very rare and there has been no prior mention of an ependymal cyst originating from the filum terminale. In this report we present the case of a 31-year-old woman with an ependymal cyst that caused cauda equina compression, and discuss the clinical profile of the case in terms of symptoms, diagnostic images, pathohistological findings, and surgical procedures. To our knowledge, this is the first report of an ependymal cyst that caused cauda equina compression. The cyst was successfully treated by excision of the cyst during careful intraoperative monitoring to prevent neurological damage to the conus medullaris and cauda equina.