Diffusion weighting improved the sensitivity of imaging in cervical spondylotic myelopathy.

Study Design. Six spinal solitary osteochondromas.Objectives. To evaluate the course of spinal cord compression after surgery, and the risk of local recurrence and malignant transformation, based on the present series and cases reported in the literature.Summary of Background Data. Spinal cord compression by a solitary osteochondroma is rare. Little is known concerning neurologic improvement after decompression of the spinal cord or the risk of recurrence or malignant transformation of spinal solitary osteochondroma, because most of the cases reported are isolated.Methods. Clinical history, plain radiographs, pathologic features, computed tomographic studies, and magnetic resonance imaging were reviewed. Five patients underwent long-term follow-up physical examination and computed tomography for an average of 6 years (range, 2-12 years) after surgical treatment. The literature was reviewed for solitary osteochondroma with spinal cord compromise, recurrent solitary osteochondroma, or solitary osteochondroma in the process of sarcomatous transformation.Results. In the present study, two of the six patients experienced spinal cord compromise. Neurologic deficits improved after surgery. None of the patients had local recurrence or malignant transformation at follow-up observation. Including these two patients, the authors found 62 cases of solitary osteochondroma with spinal cord compromise in the literature. Overall, three patients died, eight did not improve, and 48 (81%) experienced regression of the neurologic deficit after surgical decompression. Among the 150 cases of solitary osteochondroma the authors found in the literature, there were six cases (4%) of local recurrence and four cases (2.7%) of malignant transformation.Conclusions. Surgical treatment improves neurologic deficit in more than 80% of cases of spinal cord compromise caused by solitary osteochondroma. The risk of recurrence or sarcomatous transformation justifies clinical and radiologic follow-up review.

This is the first reported series of PD patients undergoing posterior spinal fusion from T2 to the sacrum for major deformities. This study indicates that good correction of sagittal and frontal balance enables good clinical and radiologic results that remain stable over time even when complications occur.

The posterior and anterior longitudinal ligaments of the lumbar spine appear on magnetic resonance (MR) images as thin lines of very low signal intensity in all spin-echo sequences. They cover the periphery of the outer fibers of the anulus fibrosus on sagittal images. The lumbar spine of 17 patients with 19 disk herniations was prospectively evaluated with MR imaging, and these findings were correlated with surgical findings. At surgery the posterior ligament was found to be disrupted in eight cases and intact in 11. Absence of a low-signal peripheral line around the herniated nucleus pulposus (HNP) was the most reliable sign of ligament rupture (no false-negative or false-positive findings). The peripheral line appeared to be interrupted in four cases, two of which were falsely positive. The two false-positive cases were related to a chemical shift artifact between epidural fat and the HNP. Presence of a normal and continuous peripheral line outlining the HNP excluded ligament disruption. The overall sensitivity for detecting disruption was 100%, and the specificity was 78%.

Complete vertebrectomy and spinal shortening can be used in the acute phase to manage thoracic spine fracture-dislocations.

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A case description and a review of the literature. To report a case of deformity secondary to cervical vertebral osteoradionecrosis (ORN) associated with severe wound complications and review the pertinent medical literature. The incidence of deformity after ORN is rare and its association with extensive damage of soft tissues makes surgical treatment difficult. The spine surgeon should be aware of this to adapt the evaluation and surgery and be prepared to manage the numerous potential complications. A case of post-irradiation symptomatic kyphosis involving ORN of C5-C6 is reported. Failure of the anterior approach surgery was observed, and the secondary course was marked by the development of substantial cutaneous necrosis associated with severe and extensive post-irradiation cutaneous and muscular atrophy. Failure of the anterior approach surgery justified the use of posterior stabilization. Secondary destabilization of the posterior fixation at the cervico-thoracic junction required extension of the osteosynthesis to the middle thoracic region. Extensive posterior stabilization permitted obtaining reliable mechanical control of the radio-induced kyphosis with a 3-year follow-up. Wound freshening and covering with well-vascularized tissue was used to fill dead spaces and helped prevent soft-tissue complications after revision surgery. Radio-induced kyphotic deformity is an important entity. Surgeons should be aware of the complications that can lead to further deformity. Corrective procedures are also at high risk for mechanical, atrophic and infectious complications. Surgical repair strategies should be based on thorough comprehension and work-up of the disorder.

The prevalence of scoliosis in our population is higher than those of idiopathic scoliosis; Risser grade 3 or above, lumbar fracture and a single fracture seem to account for more severe coronal deformation.