Lumbar discal cyst followed by intervertebral disc herniation: MRI findings of two cases.
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Adolescent↗
Biomedical subjects
Toshimi Aizawa
Publications and source records attributed to Toshimi Aizawa.
Thoracic myelopathy in Japan: epidemiological retrospective study in Miyagi Prefecture during 15 years.
Thoracic myelopathy is defined as spinal cord compression in the thoracic region, leading to sensory and motor dysfunctions in the trunk and lower extremities, and can be caused by various degenerative processes of the spine. Thoracic myelopathy is rare, and there are many unsolved problems including its epidemiological and clinical features. We have established a registration system of spinal surgeries, which covered almost all surgeries in Miyagi Prefecture, and enrolled the data of 265 patients with thoracic myelopathy from 1988 to 2002. The annual rate of surgery gradually increased and averaged 0.9 per 100,000 inhabitants, which was less than 1/10 of that for cervical myelopathy. About 20 patients with thoracic myelopathy are operated on in Miyagi Prefecture each year. It frequently develops in middle-aged males. About half of the cases were caused by ossification of the ligamentum flavum, followed by ossification of the posterior longitudinal ligament, intervertebral disc herniation and posterior spur. Patients usually noticed numbness or pain in the legs and the preoperative duration was long, averaging 2 years. Its symptomatic similarities to lumbar disorders might cause difficulty in making a correct diagnosis. Since thoracic myelopathy can markedly restrict the activities of daily life, even general physicians should recognize this entity.
Adult↗
Facet cyst in the lumbar spine: radiological and histopathological findings and possible pathogenesis.
OBJECT: The authors define facet cyst as a cyst located beside the facet joint and exhibiting a communication with the joint, as demonstrated on arthrography and subsequent computed tomography (CT) of the joint space. The purpose of this study was to determine the pathogenesis of facet cysts based on their radiological and histological features. METHODS: Forty-six juxtafacet cysts in 45 patients (26 men and 19 women, age range 41-82 years) were surgically treated after evaluation by arthrography and subsequent CT scanning. A communication channel between the cyst and the joint was confirmed in all cases and thus the lesions were designated facet cysts. In almost all patients the involved facet joint showed moderate to severe degeneration. After a thorough preoperative radiological evaluation, these cysts were excised en bloc by medial facetectomy with the entire ligamentum flavum. The specimens were cut axially at the maximum diameter and were histologically investigated. Morphologically, the cysts exhibited three shapes, appearing as: 1) a small protrusion, 2) a semicircular cyst, or 3) a round cyst. The cyst walls consisted of elastic and collagen fibers undergoing fibrinoid degeneration, but no synovial lining cells were detected. The cystic cavities were regularly filled with fibrinoids, and myxoid degeneration was found particularly in the larger cysts. CONCLUSIONS: Facet cysts are closely related to the degeneration of the neighboring facet joint. Analysis of the findings in this histological study suggests that there are several shapes of facet cysts. The authors propose that the shape could depend on the stage of the cyst's development.
Adolescent↗
Thoracic myelopathy caused by ossification of the ligamentum flavum: clinical features and surgical results in the Japanese population.
OBJECT: Data obtained in patients with thoracic myelopathy caused by ossification of the ligamentum flavum (OLF) were retrospectively reviewed to clarify clinical features and surgical outcomes in the Japanese population. METHODS: Seventy-two patients who underwent surgery for OLF-induced myelopathy in the Miyagi Prefecture, Japan, between 1988 and 2002 were observed for at least 2 years. Clinical data were collected from medical and operative records. The patients were evaluated pre- and postoperatively using the modified Japanese Orthopaedic Association (JOA) scale (maximum score 11). The relationships among various factors (age, sex, and preoperative duration of symptoms) affecting the preoperative severity of myelopathy and postoperative improvement were also examined. CONCLUSIONS: In this series the surgical outcome was relatively good and depended on the severity of myelopathy; thus early and correct diagnosis is required to avoid poorer results. The male/female ratio was 3:2 and the mean patient age at surgery was 61 years for men and 68 for women. The patients commonly noticed numbness or pain in their lower legs or gait disturbances. In a total of 104 decompressed intervertebral disc levels, more than 80% of the ossified ligaments were at the T9-10 level or lower. The mean preoperative JOA score of 5.1 improved to 7.9 after an average of 46 months. The postoperative results statistically depended on the preoperative severity of myelopathy. Among studies of patients with OLF-related myelopathy, the present study had the largest sample size, which should help clarify the clinical features of OLF myelopathy.
Aged↗
Signal intensity changes on MRI during the healing process of spinal Langerhans cell granulomatosis: report of two cases.
Two patients with spinal Langerhans cell granulomatosis were followed by magnetic resonance imaging, and the observed signal changes were detailed. Both patients had no neurologic abnormalities but back pain. They were treated by immobilization with a brace and bed rest. Their back pain disappeared after about a month. At the first visit, the tumorous lesions involving vertebrae showed mainly low signal intensity on T1-weighted imaging (T1WI) and high intensity on T2-weighted imaging (T2WI). They were clearly enhanced by gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA). Their original intensities changed to iso-intensities on both T1WI and T2WI without enhancement by Gd-DTPA after a year. These signal changes might indicate the healing stage of the involved vertebrae and recommend the removal of the spinal brace.
Adult↗
Gorham disease of the spine: a case report and treatment strategies for this enigmatic bone disease.
Gorham disease is an extremely rare condition of unknown etiology characterized by progressive osteolysis. Only 28 cases of its spinal involvement have been reported, and some of those cases showed kyphosis, kyphoscoliosis, subluxation or dislocation. No definite regimen of treatment has been established yet. A 10-year-old boy presented with a severe and progressive kyphosis over 90 degrees caused by Gorham disease from T3 to T12. In situ posterior fusion with a hook and rod system and iliac bone grafts were performed, but after surgery, he had complete paraplegia and its cause was uncertain. Based on the unfortunate consequence of the present case and the review of the literature, we propose the treatment strategies for spinal Gorham disease.
Child↗
Myofibers express IL-6 after eccentric exercise.
BACKGROUND: Interleukin (IL)-6 is locally produced in skeletal muscles and shows a remarkable increase in plasma after eccentric exercises. OBJECTIVE: To elucidate the cell types in the muscles responsible for IL-6 production after eccentric exercises. STUDY DESIGN: Controlled laboratory study. METHODS: An eccentric contraction model was made using electrical stimulation. The authors investigated the muscle damage and regeneration processes after eccentric exercises histologically, and the cell types expressing IL-6 and its subcellular compartimentalization with time immunohistochemically after eccentric exercises. RESULTS: Swollen myofibers were detected from 8 hours to 3 days after exercises. Disrupted myofibers were detected from 24 hours to 7 days, with a peak of 3 days. IL-6 was detected only in the cytoplasm of myofibers until 12 hours; thereafter, it was found in the inflammatory cells and proliferating satellite cells as well. The swollen myofibers were negatively stained for IL-6. The positive ratios of IL-6 in myofibers immediately increased after exercises, peaked in 12 hours, and then decreased. CONCLUSIONS: After eccentric exercises, IL-6 expression increased in myofibers preceding the disruption of myofibers. IL-6 might be closely related to muscle damage caused by strenuous exercises.
Animals↗
Medial superior cluneal nerve entrapment neuropathy in teenagers: a report of two cases.
Medial superior cluneal nerve entrapment neuropathy causes pain radiating from the low back down to the posterior thigh. It tends to be misdiagnosed as a lumbar spine disorder. Patients in previous reports were in the middle or old age at the onset. Proposing simultaneous full flexion of the ipsilateral hip and knee joints as a provocation test, we present two cases of teenager females who spent long before diagnosis of their condition. Both of them had engaged in vigorous sports activities and completely recovered from the disability following local anaesthetic and corticosteroid injection at the trigger point.
Adolescent↗
Successful treatment for rhabdomyosarcoma by total spondylectomy in a child.
A 7-year-old girl with a retroperitoneal rhabdomyosarcoma having invaded the L3 vertebra was treated by combination therapy consisting of chemotherapy, surgical resection and intraoperative radiation. Surgically, total spondylectomy was performed through a combined anterior and posterior procedures, and the spine was reconstructed with fibula bone grafts using a pedicle screw system made of titanium alloy. Transverse junction plates were not used at operation because of their bulkiness for the patient. Five days postoperatively, the rods dislodged from the screws and the grafted bones leaned. A Chance fracture-like transverse fracture of the L4 vertebra occurred during the revisional operation. Transverse plates and sublaminar wires were used to reduce the fracture and achieved stability. Six years postoperatively, the spine was completely fused and no local recurrence or metastasis is detected.
Antineoplastic Combined Chemotherapy Protocols↗
Intramedullary plasma cell granuloma in the cervicothoracic spine. Case report.
Intraspinal plasma cell granuloma, which is a nonneoplastic entity, is extremely rare. To date, only four cases have been documented in the spinal meninges. The authors report the first case of a C7-T1 intramedullary plasma cell granuloma. After excision of the lesion, the patient's gait and bladder dysfunction improved. This plasma cell granuloma initially showed no delineated mass on T1-weighted magnetic resonance (MR) images, low signal intensity on T2-weighted images, and was well enhanced after administration of gadolinium diethylenetriamine pentaacetic acid. The latter MR imaging modality should help to detect this tumorous lesion. Histologically, the granuloma needs to be distinguished from lymphoplasmacyte-rich meningioma and plasmacytoma.
Cervical Vertebrae↗