Amyotrophic cerebellar hypoplasia

Summary Lower motor neuron degeneration, cerebellar hypoplasia, atrophy of pons, olives, and cerebellum, sclerosis of thalamus and pallidum, and deficient myelination were found in a 2-months-old baby with laryngeal paralysis, mental retardation, progressive amyotrophy, and slow nerve conduction velocity. Such changes seem characteristic of an unusual syndrome previously referred to as cerebellar hypoplasia in Werdnig-Hoffmann disease, or anterior horn cell disease with pontocerebellar hypoplasia. Although the pathologic changes in lower motor neurons are indistinguishable from those in other cases of infantile spinal muscular atrophy, the consistent reproducibility of a complex pathologic pattern suggests that this is probably a manifestation of a separate disease process. The term amyotrophic cerebellar hypoplasia (ACH) is a convenient designation for the syndrome.Supported in part by National Institutes of Health grant no. RR75     

Clinico-Radio-Histopathological Correlation by C-Arm Image-Guided Biopsy in Spinal Tuberculosis

Background/Purpose of the StudyC-arm-guided biopsy is a safe and effective technique for evaluating TB spine and is useful in planning therapy. The purpose of this study was to find a correlation between clinically and radiologically suspected TB spine and C-arm image-guided biopsy-proven cases and to study the complications encountered.MethodsAfter evaluating the clinical, laboratory, X-ray and MRI findings, 92 patients with provisionally diagnosed tubercular spine were subjected to C-arm image-guided biopsy.ResultsAmong our 92 cases, histopathology was positive in 55 cases (59.78%). Out of these 55 histologically positive cases, CBNAAT was positive in 42 cases and negative in the rest 13 cases. Overall, among the 92 cases, CBNAAT was positive in 51(55.43%) of cases, and out of these, histopathology turned out to be positive in 42 of cases. Out of 41 cases with negative CBNAAT, histopathology was suggestive of tuberculosis in 13. The strength of agreement between CBNAAT and histopathology was statistically significant (p < 0.0001; kappa = 0.511). No complication such as bleeding, nerve/cord injury, infection, injury to aorta or pneumothorax was encountered during and after the C-arm biopsy in any case.ConclusionC-arm image-guided biopsy is reasonably accurate and should be used as a tool for diagnosis of TB spine. We recommend histopathological examination as a key component for the diagnosis of TB spine, as it is precise and consumes relatively shorter time. CBNAAT is more rapid but is not a substitute for histopathology for spine TB diagnosis.     

后路经椎间隙截骨的临床分型及应用

【摘要】 目的：介绍脊柱后路经椎间隙截骨术（trans-intervertebral space osteotomy,TIO）的技术理念、临床分型和应用策略。方法：根据TIO技术特点、手术操作过程中截骨切除范围所涉及的解剖结构,将其分为3大类型及2种扩大（+）型：围绕椎间盘及关节突关节为Ⅰ型,扩大至楔形切除椎间隙一侧终板为Ⅱ型（头尾双侧终板则为Ⅱ+型）。扩大至楔形切除椎间隙一侧椎弓根为Ⅲ型（双侧椎弓根则为Ⅲ+型）;收集2003年1月~2012年12月接受后路经椎间隙截骨术治疗的30例胸腰椎侧后凸畸形患者的临床资料,其中男12例,女18例,年龄29~69岁（51.4±10.4岁）。由5位脊柱外科医师先后对患者的临床资料进行独立评估与分型（间隔2周）,进行Kappa一致性检验以分析其可信度及可重复性。结果：30例患者中行Ⅰ型TIO 15例,Ⅱ型TIO 6例,Ⅱ+型TIO 3例,Ⅲ型TIO 4例,Ⅲ+型TIO 2例。观察者间一致性的Kappa系数0.806~0.953;观察者内一致性的Kappa系数为0.837~0.953,可信度及可重复性满意。结论：经椎间隙截骨临床分型实用可靠,可作为理论基础用于比较不同研究中经椎间隙截骨技术的手术效果,有利于指导脊柱侧后凸畸形的截骨矫形治疗。     

Remote medulla ablongata ventral acute subarachnoid hemorrhage following cervical spinal surgery: A case report

IntroductionThe incidence of remote intracranial hemorrhage (RICH) in patients during spinal surgery is rare and the detailed mechanism remains unclear.Presentation of caseA 55-year-old man had undergone cervical discectomy and fusion at C5–6 and C6–7 due to herniated disc and secondary spinal canal stenosis. He had severe headache 20 h postoperatively and his drain output increased from 100 to 350 mL in the second 10 h after surgery. Computed tomography (CT) and magnetic resonance imaging (MRI) were performed and he was diagnosed with acute subarachnoid hemorrhage in the ventral medulla oblongata. The drainage tube was quickly removed. Infusion of hypertonic saline was used to reduce intracranial pressure and nimodipine prevented vasospasm around the brainstem. The patient made a gradual, satisfactory recovery with conservative treatment.DiscussionThe most likely pathomechanism leading to RICH is venous bleeding due to rapid leak of a large amount of cerebral spinal fluid (CSF) after spinal surgery. If the patient has a headache or neurological complaints after spinal surgery, immediate imaging is recommended to confirm the diagnosis. Treatment depends on the amount and location of intracranial hemorrhage.ConclusionRICH is a serious but rare complication of spinal surgery and cerebellar hemorrhage is the most common. The most important pathomechanism leading to RICH after spinal surgery is venous bleeding due to rapid leak of a large amount of CSF. Timely CT is necessary to exclude RICH. Treatment of RICH depends on the size of the intracranial hematoma and the patient’s symptoms.     

Vertebral level of the ending of the spinal cord and its relationship to the length of the vertebral column in Northern Turkish neonates

Summary Racial and sex differences in the level of ending of the spinal cord of the adult have been reported. It is lower in Africans and in females. Since such differences may affect even fetuses and newborns we aimed to study in Northern Turkish neonates. The study was made on 40 full-term newborn still-births (23 male, 17 female). In all cases, the length of the vertebral column, the length of the spinal cord and the body weight were measured and the vertebral level of ending of the spinal cord was noted. It was found that the termination of the spinal cord varied from the first lumbar to the second sacral vertebra, with a mean level between L2 and L3. In female neonates, it was observed that the spinal cord ended at a slightly lower level (0.2 vertebra) than in males. Our findings approximately agreed with those of Barson [2] who studied neonates in England and of Jit and Charnalia [5] in North India. However, we found that the spinal cord ended one and half vertebrae lower in Northern Turkish neonates than in South African and South Indian subjects. The correlations between body-weight and length of the spinal cord, weight and length of the vertebral column, length of the spinal cord and length of vertebral column, length of the vertebral column and level of ending of the cord were statistically highly significant for males, females and both sexes together (p<0.001). The longer the vertebral column, the higher the termination of the spinal cord.

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Niveau vertébral de la terminaison de la moelle épinière et sa relation avec la longueur de la colonne vertébrale chez le nouveau-né en Turquie du Nord

Résumé Selon la race et le sexe, les différences de niveau de la terminaison de la moelle épinière ont été rapportées chez l'adulte. Elle est plus basse chez les Africains et chez les femmes. Dès lors il se peut qu'il existe déjà des différences raciales et selon le sexe, chez le foetus et le nouveau-né. Nous nous proposons d'étudier une population de nouveau-nés du Nord de la Turquie. Cette étude est faite à partir de 40 nouveau-nés à terme, décèdes (23 garçons et 17 filles). Chez tous ces nouveau-nés, la longueur de la colonne vertébrale, la longueur de la moelle épinière et le poids ont été mesurés. Le niveau vertébral de la terminaison de la moelle épinière variait entre la première vertèbre lombaire et la deuxième vertèbre sacrée. Le niveau moyen de cette terminaison était situé entre L2 et L3. Chez les filles nouveau-nés, il était observé que la moelle épinière se terminait légèrement plus bas (0,2 vertèbre) que chez les garçons nouveaunés. Nos observations rejoignent celles de Barson [2] qui étudia des nouveaunés d'Angleterre et celles de Jit et Charnalia [5] qui étudièrent des nouveau-nés du Nord de l'Inde. Cependant, nous avons trouvé que la moelle épinière se terminait une vertèbre et demie plus bas chez les nouveau-nés de la Turquie du Nord que chez les nouveau-nés d'Afrique du Sud et d'Inde du Sud. La corrélation entre le poids des spécimens et la longueur de la moelle épinière; le poids et la longueur de la colonne vertébrale, la longueur de la moelle épinière et la longueur de la colonne vertébrale, la longueur de la colonne vertébrale et le niveau vertébral de la terminaison de la moelle épinière parmi les garçons, les filles, et dans les deux sexes, étaient statistiquement très significatifs (p<0.001). Plus la colonne vertébrale était longue, plus haute était située la terminaison de la moelle épinière.

     

国人男性椎管的测量与观察

本文对广西出土的113例男性干燥椎骨的椎孔,进行了矢径、横径的测量和形态观察。椎孔的矢、横径在壮族(30例),汉族(57例)间无显著差异(P>0.05)。在C_(3～6)椎骨水平,推管的矢径和形态与脊髓的外形不一致,矢径于该处形成生理性狭窄,以C_4处为最小(12.92mm)。除C_1外,椎管的形态可分为4型:Ⅰ型圆型;Ⅱ型三角型;Ⅲ型过渡型;Ⅳ型不整型。 C_(1,2)椎管的形状为圆型,向下至C_6,通过半圆形逐步过渡到三角形(C_6占81.31％);再向下至T_6,三角形通过蛤形和多边形又逐渐过渡为圆形(T_6占84.76％);再向下至L_5,又通过蛤形逐渐过渡为三角型(L_5占99％)。从L_3至L_5,三角形椎孔有逐步通过钟形向三叶形过渡的趋势。三叶形腰椎管占5.02％。本文结果支持Eisenstein的观点,认为三叶形结构是一种普通的、非病理性的现象,与年龄增长、骨赘或椎孔狭窄无关,这或许是一种正常的发育性变异。     

Reduction and stabilization of lumbar and thoracolumbar spine fractures with Louis' plates and internal fixator: a comparative study

Summary In this retrospective study, 28 patients who presented isolated fractures from T11 to L4 were surgically treated using a posterior approach. The fractures were reduced and stabilized in half of the cases with Louis' plates and in the other half with an internal fixator. Twelve patients had partial neurological deficits on admission. They were reviewed after a mean period of 24 months from time of injury, and 10 months after implant removal. The kyphosis of the fractured vertebral body was measured, and showed a mean value of 18° before surgery and 10.3° at the last visit. The regional statics of the spine were also studied. The residual mobility of the fixated and neighbouring spinal units was assessed, comparing long segment fixation (plates) with short segment fixation (internal fixator). The residual mobility of the adjacent, non-fixed segments was significantly better when the internal fixator had been used than with the Louis' plates. Of the 12 patients with neurological involvement, 11 had increased their Frankel score by one grade. Results were evaluated by clinical parameters (pain, neurological deficit, occupational disability); scores were as follows: 32% good, 57% satisfactory and 11% poor. There was no significant difference in clinical score between the two treatment modalities.     

The R-zero line: a new kinematic concept of the lumbar spine

Summary A new kinematic concept is described that relates to the notion that the lumbar spine behaves as a complete structure. This concept is called the R-zero line and represents kinematically the neutral position of the lumbar spine between anteflexion and retroflexion. The clinical significance of this parameter is evaluated in normal individuals and in patients with a symptomatic herniated disc at L4–5, with a symptomatic herniated disc at L5–S1, and with spondylolysis/spondylolisthesis. The results of this study show that the R-zero line has a characteristic configuration in all four test groups.