We investigated lordotic alignment and posterior migration of the spinal cord following en bloc open-door laminoplasty for cervical myelopathy. Fifty-five patients (32 men and 23 women) were studied, with an average follow-up of 2.4 years. Radiological examination included evaluation of lordosis of the cervical spine and spinal cord, degree of enlargement of bony spinal canal, and the magnitude of posterior cord migration. We also correlated these changes with neurological improvement. Postoperatively, there was an average of 5% loss of cervical spine lordosis (P > 0.01) on radiographs and 12% reduction in the lordotic alignment of the spinal cord (P > 0.05) on magnetic resonance imaging. Postoperatively, the size of the bony spinal canal increased by 48%. Posterior cord migration showed a significant correlation with the preoperative cervical spine and spinal cord lordosis (P < 0.05). Thirty-seven (67%) patients with neurological improvement exceeding 50% showed significant posterior cord migration following laminoplasty compared with those demonstrating less than 50% improvement (P = 0.01). Our results suggest that a significant neurological improvement is associated with posterior cord migration after cervical laminoplasty.
JapanThis report reviews our experience with spinal decompression for posterior limbus vertebral lesions or osteocartilaginous vertebral corner defects in the lumbar spine in 29 children and young adults. There were 19 male and 10 female patients with a mean age of 16.5 years (range, 9 to 24 years). Twenty-four patients were involved with various athletic activities.Clinical presentation included low back pain with a variable degree of radiculopathy in 25 patients and a cauda equina syndrome in four. The level of the affected spinal area was LJ-2 in one patient, L2-3 in one, L3-4 in seven, L4-5 in 17, and L5-S I in three. The preoperative imaging workup showed lateralised 'non-calcified' or 'calcified' limbus vertebral defects in 13 patients and centrally displaced lesions in 16 patients. All patients underwent posterior spinal decompression with a slightly extended laminotomy, except for three patients who had a subsequent posterolateral fusion. All of the patients consequently returned to practice their favourite preoperative sport and lifestyle, but five discontinued their previous sports. We suggest that patients with posterior limbus vertebral lesions require careful diagnosis and therapy that are different from those with an ordinary lumbar disc herniation.
The degree of DNA-instability as revealed by the immunohistochemical staining with anti-single-stranded DNA antibody after acid hydrolysis (DNA-instability test) was used as a marker of malignancy. This was applied to benign (4 osteochondroma and 4 enchondroma cases), border-line (23 bone giant cell tumor, BGCT cases), and malignant (6 chondrosarcoma and 6 osteosarcoma cases) neoplastic lesions. The expression of tumor oncogene, c-myc was detected immunohistochemically.Proliferative activity was evaluated by PCNA-immunohistochemistry, and the quantitative analysis of the number, mean area, mean total area, the largest area, and maximum shape-irregularity of AgNORs in a nucleus were performed for all these cases. The results for 19 BGCT (82.6%) cases, 6 chondrosarcoma cases (100%), and 6 osteosarcoma cases (100%) were positive with the DNA-instability test, indicating their malignancy. All benign tumor cases were negative with the DNA-instability test.Reflecting the malignant character, all chondrosarcoma cases, all osteosarcoma cases and the BGCT cases positive with the DNA-instability test showed statistically higher values of PCNA-index; and all AgNORsparameters in comparison to those for benign tumor cases, and c-myc was positive for 66.7%, and 26.3%, of them, respectively. But these values for BGCT with positive and negative DNA-instability test results showed no statistically meaningful differences. All the BGCT cases negative with DNA-instability test were negative for cmyc expression.Among the BGCT cases positive with DNA-instability test, 18 cases (94.7%) showed cortical bone destruction by computed tomography (CT), and 5 cases (26.3%) showed extra-osseous expansion. No such radiographic changes were detected among the BGCT cases negative with DNAinstability test. Among 18 BGCT cases with cortical bone destruction, 5 cases (27.8%) showed tumor recurrences, and 2 cases (11.1 %) showed lung metastases.These results indicate that the majority of BGCT cases are malignant and the detection of cortical bone destruction by CT is a sensitive clinical marker to detect them.
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