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Eighty-seven patients with acute (n = 70) or chronic (n = 17) head injuries were prospectively studied with magnetic resonance (MR) imaging and computed tomography (CT) to characterize the frequency and nature of traumatic brain stem injury (BSI). Forty-eight traumatic lesions were identified in 36 patients. Of 36 patients, 35 had neurologic findings that corroborated the radiographic impression of BSI. T1- and T2-weighted MR images demonstrated a significantly higher number of lesions than did CT. Patients with BSI had a significantly higher frequency of corpus callosum and diffuse axonal "shear" lesions. The number of cortical contusions and extraaxial hematomas was similar in both groups. The mean Glasgow Coma Scale (GCS) scores at admission were significantly lower in patients with evidence of BSI on MR images. Patients with primary BSI had lower initial GCS scores, a longer duration of coma, more diffuse axonal "shear" lesions, and a higher frequency of corpus callosum injury than patients with secondary BSI. The location of primary and secondary lesions was significantly different. Overall, MR imaging was more helpful than CT in detecting, localizing, and characterizing BSI.

Eleven patients with ankylosing spondylitis and traumatic fracture/dislocation of the spine were identified in a retrospective review of all cases of cervical spine injury treated on the neurosurgical service over a 10-year period. Injury was most often secondary to minor trauma or a motor-vehicle accident, and the level of vertebral involvement was most frequently between C-5 and T-1. Neurological symptoms at presentation ranged from neck pain alone to complete loss of function distal to the level of injury. Initial routine treatment consisted of axial traction for realignment with the minimal weight needed to accomplish this, taking into account the flexion deformity. All patients underwent pluridirectional tomography and/or computerized tomography to delineate the exact sites of injury. Three patients died shortly after admission due to pulmonary complications. The remaining eight patients underwent early posterior stabilization and mobilization in a halo or cervicothoracic brace to achieve fusion. Neurological improvement was achieved in six of these eight cases. The experience described here supports the initiation of axial traction as initial therapy for cervical injuries followed by early surgical stabilization in patients with ankylosing spondylitis. The difficulty of maintaining spinal alignment and the devastating pulmonary problems attendant on conservative management may be obviated by early fusion.

Pathological overgrowth of the epidural fat in the spine has been described and reported nearly exclusively in patients either with Cushing's syndrome or on chronic intake of glucocorticoids for a variety of clinical disorders. The authors report four patients with documented spinal lipomatosis (three pathologically and one radiologically). Only one of these patients received corticosteroids, and none had an underlying endocrinological abnormality. All four patients were adult males with a mean age at onset of symptoms of 43 years (range from 18 to 60 years). The symptoms ranged from simple neurogenic claudication and radicular pain to frank myelopathy. Myelography followed by computerized tomography were instrumental in the diagnosis of the first three patients; the fourth was diagnosed by magnetic resonance imaging. The thoracic spine was involved in two cases and the lumbosacral area in the other two. The different treatment modalities were tailored according to the symptomatology of the patients. These included weight reduction of an overweight patient with minimal neurological findings in one case and decompressive laminectomy and fat debulking to achieve adequate cord decompression in the remaining three cases. Two patients improved significantly, the condition of one stabilized, and the fourth required a second decompression at other spinal levels. The various modalities of treatment and their potential complications are discussed.