Gout is a common metabolic disease characterized by the development of arthritis and nephropathy related to the deposition of monosodium urate crystals within the joints, periarticular tissues, skin and kidneys. Tophus formation seen around the spinal column is very rare, while occurrences of spinal gout tophus without systemic gout disease are much more unique. In our study, we report a spinal gout case that presented with right sciatica without previous history of systemic gout disease.

The highest dorsal rootlet density is at the T1 segment of the spinal cord, can be easily distinguished visually, and may be a useful surgical landmark. The DREZs in T6-7 segments are longest, while these two segments have the least number of rootlets. Because the dorsolateral tract is remarkably narrow and the dorsal horn is exceedingly deep, DREZ surgery at the thoracic level may be difficult and risky for the dorsal column and corticospinal tract. Acquaintance with the microanatomy of the DREZ in the thoracic spinal cord is crucial to DREZ surgery.

Study DesignRetrospective case series.PurposeThe objectives of this study were to determine and discuss the surgical planning of patients who underwent operations following diagnoses of thoracal and lumbar spinal schwannomas. We also aimed to discuss the application of unilateral hemilaminectomy for the microsurgery of schwannomas.Overview of LiteratureSchwannomas are located in different regions and sites. These differences require several surgical approaches. Unilateral laminectomy without stabilization of the spine provides a more minimally invasive removal of the tumor.MethodsIn this retrospective study, 15 patients with spinal schwannomas were evaluated with regards to age, sex, onset history, neurological findings, tumor locations, McCormick scale, surgical procedure, and operational results. The lateral approach provides exposure of intradural structures and posterior paraspinal regions. Extensions of tumors cause problem for the surgeon in terms of approach, resectability of the tumor, and stability of the spine. Gross total resection was achieved in all cases, and none of the patients necessary required a fusion procedure.ResultsFive patients were males and 10 were females. The age interval was 29-65 years. The tumor was located in the lumbar region in 9 patients, in the thoracic region in 2 patients, and in the thoracolumbar junction in 4 patients. The intradural lesions were removed by laminectomy and the extradural lesions were resected with hemilaminectomy. The paramedian route was used to explore the extraspinal part of the tumor. Costotransversectomy was for the thoracic region. Subtotal resection was performed in 1 patient. Patient symptoms recovered gradually in the postoperative period.ConclusionsResection of giant schwannomas is challenging and usually requires a different approach. We describe the complete resection of complex dumbbell or paraspinal schwannomas of the thoracic and lumbar spine by unilateral hemilaminectomy.

Segments of the spinal cord generally do not correspond to the respective vertebral level and there are many anatomical variations in terms of the segment and the level of vertebra. The aim of this study is to investigate the variations and levels of lumbar and sacral spinal cord segments with reference to the axilla of the T11, T12, and L1 spinal nerve roots and adjacent vertebrae. Morphometric measurements were made on 16 formalin fixed adult cadaveric spinal cords. We observed termination of the spinal cord between the axilla of the L1 and L2 spinal nerve roots in 15 specimens (93.8%). In all cadavers the emergence of the T11, T12, and the L1 spinal nerve roots was at the level of the lower one-third of the same vertebral body. In 15 specimens (93.8%), the beginning of the lumbar spinal cord segment was found to be above the T11 spinal nerve root axilla and corresponded to the upper one-third of the T11 vertebral body. The beginning of the sacral spinal cord segment occurred above the L1 spinal nerve root axilla and corresponded to the upper one-third of the L1 vertebral body. The results of this study showed that when the conus medullaris is located at the L1-L2 level, the beginning of the lumbar spinal cord segment always corresponds to the body of T11 vertebra. This study provides detailed information about the correspondence of the spinal cord segments with reference to the axilla of the spinal nerve roots.