Intradural extra-arachnoid lumbar disc herniation is a rare disease. Few MRI findings have been reported. We experienced an intradural extra-arachnoid lumbar disc herniation. We reviewed the preoperative MRI findings. Lumbar spine T2-weighted sagittal MRI showed that one line of the ventral dura was divided into two by a disc herniation. We speculated that the two lines comprised the dura and arachnoid and that a disc herniation existed between them. We believe that division of the ventral dural line on T2-weighted sagittal images is a characteristic finding of intradural extra-arachnoid lumbar disc herniation. The division of ventral dural line seemed to be a “Y,” and, thus, we called it the “Y sign.” The “Y sign” may be useful for diagnosing intradural extra-arachnoid lumbar disc herniation.
Spontaneous thoracic spinal subarachnoid hemorrhage is rare, and thus no useful radiological findings for preoperative diagnosis have been reported. We experienced a patient with spontaneous thoracic spinal subarachnoid hemorrhage. A 37-year-old female presented with sudden-onset paraplegia and numbness in the trunk and bilateral lower extremities. The patient had no past history of trauma, lumbar puncture and bleeding disorder. T2-weighted sagittal magnetic resonance imaging (MRI) of the cervical and thoracic spines showed a mass occupied in the ventral space of spinal cord that was dorsally shifted. The mass extended from C6 to Th6 levels, with its largest size at Th2 level. Thoracic spine T2-weighted sagittal and axial MRI showed that the mass compressed spinal cord and was located in the intradural space. There was no spinal cord tumor and no spinal vascular malformation around the mass. Brain computed tomography (CT) showed a high-density area in the subarachnoid space, indicating the possibility of subarachnoid hemorrhage. Brain MRI showed no ruptured aneurysm. The patient was diagnosed as a spontaneous thoracic spinal subarachnoid hemorrhage and emergency surgery was selected. We performed right-side hemilaminectomy at Th1-Th6 and opened dura mater and arachnoid membrane. Hematoma was found in the ventral space of spinal cord and was removed. One year after surgery, numbness in the trunk and bilateral lower extremities had disappeared but paraplegia remained unchanged. Thoracic spine T2-weighted MRI confirmed no hematoma but showed a newly formed intradural cyst. Preoperative combination of brain CT and thoracic MRI is useful to diagnose thoracic spinal subarachnoid hemorrhage.
A case of ossification of transverse ligament of atlas (TLA) is reported. A 76-year-old female suffered from a transverse type myelopathy was successfully treated by posterior decompression. Dynamic lateral plain radiographs showed irreducible atlantoaxial subluxation (AAS). A computed tomogram revealed ossified mass compatible to ossification of TLA. Coalition of the atlantooccipital joints and osteoarthritis of the atlantoaxial joints with degenerated dens was also revealed. Magnetic resonance imaging showed compressed spinal cord at C1 level by the ossification of TLA and AAS. We suggest a mechanism of ossification of TLA as follows: hypertrophied dens and stress to the atlantoaxial joints caused by coalition of atlantooccipital joints could make forward shift of atlas leading to irreducible AAS, and continuous tension given to TLA from irreducible AAS would result in hypertrophied and ossification of TLA.
Staphylococcus aureusPyogenic spondylitis is a common infectious disease caused by various microorganisms. It is difficult to predict the infecting microorganism at the time of initiation of treatment. Pneumonia is generally clarified into community or hospital-acquired types based on where the infection was acquired, and the infecting microorganisms are different for each type. We retrospectively analyzed 20 cases of pyogenic spondylitis treated in our hospital and categorized the cases into community and hospital-acquired types. We also identified the infecting microorganisms and the rate of sepsis in each type. There were 12 cases of community-acquired and 8 of hospital-acquired infection. The major infecting microorganisms responsible for the community-acquired type were Gram-positive cocci, and those responsible for the hospital-acquired type were methicillin-resistant Staphylococcus aureus and Gram-negative bacilli. The rate of sepsis was significantly different for both groups: 16% for the community-acquired type and 75% for the hospital-acquired type. The classification of pyogenic spondylitis based on where the infection was acquired may be useful for predicting which microorganisms are responsible for the disease.
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