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Objective: The spinal cord extends from the foramen magnum to the sacrum in the human fetus at the beginning of the 2 nd quarter. However, the medullary cone is located at or above the level of the second lumbar vertebra at birth. The objective is to determine the difference between the rates of longitudinal growth of the spinal cord and the spine in human fetuses from the 13 th to the 22 nd week of gestation (WoG) using magnetic resonance imaging (MRI). Methods: Descriptive observational cross-sectional study of 24 stillbirths (13 ♂, 11 ♀), between the 13 th and 22 nd WoG, using spinal MRI. We recorded spine and spinal cord lengths in millimeters from the foramen magnum to the coccyx for the former and to the medullary cone for the latter. We identified the position of the medullary cone according to vertebral level and its correlation with the gestational age and the literature. Results: The spinal cord increased in length from 50 to 93 mm, the spine from 57 to 137 mm, and the medullary cone rose from S1 to L2. The rate of growth was 1.2 mm/day for the spine and 0.6 mm/day for the spinal cord. Conclusions: Discordance in the rate of normal longitudinal growth of the spine and spinal cord caused the medullary cone to rise from S1 level to L2 in the second trimester of pregnancy. These results allow an understanding of normal development and certain congenital malformations. Level of evidence IV; Case series. RESUMO Objetivo: A medula espinhal (ME) estende-se desde o forame magno até o sacro no feto humano no início do 2º trimestre. No entanto, ao nascimento, o cone medular localiza-se no nível da segunda vértebra lombar ou acima. O objetivo é determinar as diferenças na taxa de crescimento longitudinal da ME e da coluna vertebral (CV) em fetos humanos da 13 a à 22 a semana de gestação (SG) por meio de ressonância magnética (RM). Métodos: Estudo observacional transversal descritivo em 24 natimortos (13 ♂, 11 ♀), com idades entre 13ª e 22ª SG, por RM da CV. O comprimento da CV e da ME foi registrado em milímetros, desde o forame magno até o cóccix na CV e até o cone na ME. Identificou-se a posição do cone de acordo com o nível vertebral, sua correlação com a idade gestacional e com literatura.Resultados: O comprimento da ME aumentou de 50 para 93 mm, a CV de 57 para 137 mm e o cone medular subiu de S1 para L2. O ritmo de crescimento foi de 1,2 mm/dia para a CV e de 0,6 mm/dia para a ME. Conclusões: A discordância no ritmo do crescimento longitudinal normal da CV e da ME fez com que o cone medular subisse do nível de S1 até L2 no segundo trimestre de gravidez. Os resultados permitem compreender o desenvolvimento normal e certas malformações congênitas. Nível de evidência IV; Série de casos. Descritores: Desenvolvimento Fetal; Coluna Vertebral; Medula Espinal. RESUMENObjetivo: La médula espinal (ME) se extiende desde el foramen magnum hasta el sacro en el feto humano al inicio del 2º trimestre. Sin embargo, el cono medular se ubica a nivel de la segunda vertebral lumbar o por encima en el momento del nacimiento. El ...

We report four new cases of chordoma of "the mobile spine", all at the L2 level. Diagnosis was often delayed due to predominantly nonspecific low back symptoms; however, neurological involvement is more frequent than in chordoma with a sacrococcygeal localization. No pathognomonic images have been described for any imaging modality, and differential diagnosis should include metastases, chondrosarcoma, and giant-cell tumor. Histopathological analysis can be performed on CT-guided puncture biopsy samples, but a high level of suspicion must be present and, if there is any doubt, immunohistochemical studies should be carried out. Despite being the treatment of choice, complete tumor resection by a double-approach spondylectomy is barely feasible at the L2 level.

Objective: Spastic cerebral palsy (sCP) is a cause of early onset scoliosis, although there are no data on its prevalence. Our objective was to determine the prevalence of early onset neuromuscular spinal deformities (SD) in severely compromised children with sCP. Methods: Cross-sectional quantitative, observational, exploratory, and descriptive study. Review of clinical records. Inclusion criteria: age 2 to 5 years, sCP, level V of the GMFCS, residents in our province. X-ray blind reading by 2 observers. The Student t test was used for parametric data and the chi-square test for non-parametric data. Level of statistical significance: p < 0.05. Results: Thirty-eight cases of 158 registered were included. Average age: 3 years 7 months (2 years – 5 years 2 months). Sex: 21 male/17 female. The predominant etiologies were perinatal: 21 (55.3%), and the prevalent nutritional status was eutrophic: 28 cases (73.7%). SD was very frequent: 32 patients (84.2%) without statistical differences between sexes; there were 20 kyphoscoliosis, 1 lordoscoliosis, 6 scoliosis, 5 hyperkyphosis. Mean angular values: 23.9° (10°- 50°) for the frontal plane deformities and 58° (9°- 92º) for the sagittal deformities. Seventeen patients (44.7%) had average pelvic obliquity of 15° (2°- 30°) without differences in patients with and without SD. There was no association between SD and etiology, digestive disorders, seizures, nutritional status, hip excentration, or limb deformities. Conclusions: The prevalence of SD in children up to 5 years old with severe sCP is high: 84.2% (32/38 cases). The orthopedic profile is children with sCP of any etiology at GMFCS level V, with multiple disabilities and independently of associated limb deformities. Level of evidence I; Diagnostic Studies - Investigating a Diagnostic Test: Testing of previously developed diagnostic criteria on consecutive patients (with universally applied reference “gold” standard).

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Objective: Selective dorsal rhizotomy (SDR) used for spasticity treatment could worsen or develop spinal deformities. Our goal is to describe spinal deformities seen in patients with cerebral palsy (CP) after being treated by SDR. Methods: Retrospective study of patients operated on (SDR) between January/1999 and June/2012. Inclusion criteria: spinal Rx before SDR surgery, spinography, and assessment at follow-up. We evaluated several factors emphasizing level and type of SDR approach, spinal deformity and its treatment, final Risser, and follow-up duration. Results: We found 7 patients (6 males): mean age at SDR 7.56 years (4.08-11.16). Mean follow-up: 6.64 years (2.16-13), final age: 14.32 years (7.5-19). No patient had previous deformity. GMFCS: 2 patients level IV, 2 level III, 3 level II. Initial walking status: 2 community walkers, 2 household walkers, 2 functional walkers, 1 not ambulant, at the follow-up, 3 patients improved, and 4 kept their status. We found 4 TL/L laminotomies, 2 L/LS laminectomies, and 1 thoracic laminectomy. Six spinal deformities were observed: 2 sagittal, 3 mixed, and 1 scoliosis. There was no association among the type of deformity, final gait status, topographic type, GMFCS, age, or SDR approach. Three patients had surgery indication for spinal deformity at skeletal maturity, while those patients with smaller deformities were still immature (Risser 0 to 2/3) although with progressive curves. Conclusions: After SDR, patients should be periodically evaluated until they reach Risser 5. The development of a deformity does not compromise functional results but adds morbidity because it may require surgical treatment.