A Rare Course of Scoliosis Associated with Chiari Malformation and Syringomyelia

Spinal deformity is an important clinical manifestation of Chiari I malformation (CM-I) and syringomyelia. Here we report the result of an 8-year follow-up of a 13-year-old girl with severe scoliosis associated with Chiari malformation and a large syringomyelia. The patient presented at our hospital at the age of 13 with a 68° scoliosis. Magnetic resonance imaging showed Chiari malformation and a large syringomyelia. Neurosurgical treatment involved foramen magnum decompression and partial C1 laminectomy, but the scoliosis still progressed. We present the first case report of a rare course of scoliosis in a patient with CM-I and a large syringomyelia

Computer-assisted Minimally Invasive Posterior Lumbar Interbody Fusion without C-arm Fluoroscopy

Computer-assisted spinal surgery is becoming more common; however, this is the first technical report to describe the technique of minimally invasive spinal posterior lumbar interbody fusion (MIS-PLIF) without using C-arm fluoroscopy. The authors report 2 years of follow-up of a 49-year-old female patient with L4 degenerative spondylolisthesis. The patient suffered from low back pain and intermittent claudication for more than 6 years. The authors performed computer-assisted MIS-PLIF without C-arm fluoroscopy. Instead, O-arm® navigation, the use of which reduces radiation exposure to patients as well as others in the operating room, was employed. Surgery was successful, and correct lumbar alignment was maintained. She had neither neurological deficits nor low back pain at her 12-month final follow-up. In conclusion, computer-assisted MIS-PLIF without C-arm fluoroscopy is a useful technique that reduces radiation exposure to the surgeon and operating room staff

Cervical Spine Osteoradionecrosis

Osteoradionecrosis (ORN), a well-known complication of radiotherapy in the mandibular bone, is very rare in the cervical spine. The authors report the result of a 3-year follow-up of a 63-year-old female patient with ORN of the cervical spine. The patient had a history of laryngeal carcinoma and was treated with chemotherapy and radiation therapy with a total of 120 Gy. Eight years later, she developed acute, severe neck pain due to cervical spine necrosis. The authors performed vascularized fibular bone graft and posterior pedicle screw fixation to reconstruct her cervical spine. The patient was successfully treated with surgery, and cervical alignment was preserved. She had neither neurological deficits nor severe neck pain at her final follow-up 3 years later. Delaying treatment of ORN may be life threatening, so the early diagnosis of this condition is important for patients who receive radiotherapy. Otolaryngologists and spine surgeons should understand this potential complication to speed diagnosis and treatment as early as possible

Minimally Invasive Surgery for Unstable Pelvic Ring Fractures: Transiliac Rod and Screw Fixation

Pelvic fractures occur with high-energy trauma, and the patient’s clinical status is unstable. Although a number of surgical methods for unstable pelvic fractures are available, none can achieve strong fixation with minimal invasiveness. We describe a surgical transiliac rod and screw fixation (TIF) procedure that provides minimally invasive fixation using a spinal implant for unstable pelvic ring fractures, and we retrospectively analyzed the procedure’s outcomes in 27 patients with type B or C1 fractures (based on the AO/ATO classification system). Small skin incisions are made above the posterior superior iliac spines on both sides. The ilium is partially resected, and two iliac screws are inserted on each side. The spinous process of the sacral spine is then shaved, and the iliac screws are connected to 2 rods, one placed caudal to the other. Corrective manipulation is performed at the fracture site, and the rods are connected with connectors. Favorable fracture reduction, defined as a rating of ‘excellent’ or ‘good,’ was achieved in 77.8% of the patients. Transiliac rod and screw fixation (TIF) will be a useful therapeutic option for unstable pelvic ring fractures

Segmental Pedicle Screw Fixation for a Scoliosis Patient with Post-laminectomy and Post-irradiation Thoracic Kyphoscoliosis of Spinal Astrocytoma

Spinal deformity is an important clinical manifestation after surgery for spinal cord tumors. One-third of patients who receive laminectomies and irradiation of the spinal column develop scoliosis, kyphosis, or kyphoscoliosis. Recent reports indicate good results after scoliosis surgery using segmental pedicle screws and a navigation system, but these reported studies have not included surgery for post-laminectomy kyphosis. Hooks and wires are ineffective in such patients who undergo laminectomy, and there are also high perioperative risks with insertion of pedicle screws because landmarks have been lost. Here, we report on the 5-year follow-up of a 13-year-old male patient with post-laminectomy and post-irradiation thoracic kyphoscoliosis after surgical treatment of spinal astrocytoma. Posterior segmental pedicle screw fixation was performed safely using a computer-assisted technique. The authors present the first case report for treatment of this condition using a navigation system

Factors Predicting Clinical Impairment after Surgery for Cervical Spinal Schwannoma

Cervical spinal schwannoma is benign, and outcomes after surgical resection are generally excellent. A surgical dilemma sometimes arises as to whether to perform total tumor removal, which carries a risk of sacrificing the nerve root, or subtotal removal, where the risk can be tumor recurrence. The purpose of this study was to identify factors with the potential to predict clinical impairment after surgery for cervical spinal schwannomas. Thirty cases of cervical schwannomas treated surgically in our institute were retrospectively reviewed;initial symptoms, tumor location, Eden classification, surgical method, functional outcome, and tumor recurrence were investigated. All permanent motor deficits were the result of resecting functionally relevant nerve roots (i.e., C5-8). The rate of permanent sensory deficit was 11% after C1-4 nerve root resection, and 67% after C5-8 nerve root resection. Permanent neurological deficits occurred in 14% of patients younger than 40 years and 38% of those older than 40. Dumbbell tumors were associated with the need for total or ventral nerve root transection, as well as with a high incidence of tumor recurrence. The incidence of permanent neurological deficit was significantly higher in patients undergoing C5-8 nerve root resection, and tended to be higher in those over 40

Chiari Type I Malformation Caused by Craniometaphyseal Dysplasia

Craniometaphyseal dysplasia is a rare genetic condition characterized by progressive thickening of bones in the skull and metaphyseal abnormalities in the long bones. This disorder often causes progressively symptomatic cranial nerve compression, but in rare cases foramen magnum stenosis may lead to quadriplegia. Chiari I malformation with craniometaphyseal dysplasia is extremely rare. The authors report on a 25-year-old woman with myelopathy due to Chiari I malformation along with craniometaphyseal dysplasia. There are only four previous case reports of this condition. The authors present here the fifth case report of this rare condition and summarize its characteristics

Venous Thromboembolism in Patients with Acute Thoracolumbar Spinal Cord Injury

Venous thromboembolism (VTE) is a major complication in patients with acute spinal cord injury. There are few reports of VTE with acute thoracolumbar spinal cord injury (TLSCI). We assessed the incidence of VTE with acute TLSCI using color Doppler ultrasonography. We retrospectively assessed 75 patients with acute TLSCI (T1 to L1). All patients were surgically treated. VTE of the lower extremity and pelvis was assessed using color Doppler ultrasound regardless of whether symptoms were present. This retrospective study included patients who were assessed between 6 and 10 days (mean 8.1 days) after injury. VTE was detected in 27 of the 75 patients (35.7%) with or without paralysis. Of the 13 patients who had complete motor paralysis, 8 (62%) had VTE; of the 31 patients with incomplete motor paralysis, 10 (32%) had VTE, and of the 31 patients without motor paralysis, 9 (29%) had VTE. Among the patients with TLSCI, those with VTE had a significantly higher mean age than those without. The incidence of VTE in TLSCI patients is not related to the severity of paralysis in a Japanese population. The incidence appears to be related primarily to age

Multipotent Neurotrophic Effects of Hepatocyte Growth Factor in Spinal Cord Injury

Spinal cord injury (SCI) results in neural tissue loss and so far untreatable functional impairment. In addition, at the initial injury site, inflammation induces secondary damage, and glial scar formation occurs to limit inflammation-mediated tissue damage. Consequently, it obstructs neural regeneration. Many studies have been conducted in the field of SCI; however, no satisfactory treatment has been established to date. Hepatocyte growth factor (HGF) is one of the neurotrophic growth factors and has been listed as a candidate medicine for SCI treatment. The highlighted effects of HGF on neural regeneration are associated with its anti-inflammatory and anti-fibrotic activities. Moreover, HGF exerts positive effects on transplanted stem cell differentiation into neurons. This paper reviews the mechanisms underlying the therapeutic effects of HGF in SCI recovery, and introduces recent advances in the clinical applications of HGF therapy

Biomechanical Comparison of Posterior Fixation Using Spinal Instrumentation and Conventional Posterior Plate Fixation in Unstable Vertical Sacral Fracture

Vertical sacral fracture is one of the most difficult fractures to treat. Posterior fixation using spinal dual rods is a novel method for treating this fracture, but its biomechanical strength has not yet been reported. The aim of this study was to evaluate the biomechanical strength produced by posterior fixation using spinal instrumentation. Sacral fractures were created in eight pelvic bone models and classified into a posterior plate fixation group [P group, n＝4] and a spinal instrumentation group [R group, n＝4]. The biomechanical strength was tested by pushing down on the S1 vertebra from the top. The mean maximum loads were 1,057.4 N and 1,489.4 N in the P and R groups, respectively (p＝0.014). The loads applied to the construct at displacements of 5mm and 7.5mm from the start of the universal testing machine loading were also significantly higher in the R group. The mean stiffness levels in the P and R groups were 88.3N/mm and 119.6N/mm, respectively (p＝0.014). Posterior fixation using spinal instrumentation is biomechanically stronger than conventional posterior plate fixation. This procedure may be the optimal method for treating unstable sacral fracture fixation