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Der Orthopade Oct 2019Lumbar spinal stenosis is caused by various pathological conditions. With the diagnostic tools available, a precise classification of the condition should be made,... (Review)
Review
BACKGROUND
Lumbar spinal stenosis is caused by various pathological conditions. With the diagnostic tools available, a precise classification of the condition should be made, which enables a consistent and appropriate therapeutic approach.
OBJECTIVES
In the present article, the currently used classifications of lumbar spinal stenosis are discussed and the diagnostic tools are presented, focussing on the imaging descriptions of morphological changes.
MATERIALS AND METHODS
This article is based on a PubMed literature search of the past 60 years and our own experiences.
RESULTS
Lumbar spinal stenosis is caused mainly by degenerative changes to the spine. MR tomographic imaging can result in precise anatomical illustration and classification of the stenosis.
CONCLUSIONS
Although modern imaging procedures deliver a very precise illustration of lumbar spinal stenosis, clinical symptoms make a considerable contribution to therapeutic decision-making. With the anatomical classification, differentiated surgical decompression of the spinal canal can be planned.
Topics: Decompression, Surgical; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Spinal Canal; Spinal Stenosis
PubMed: 31101963
DOI: 10.1007/s00132-019-03746-1 -
Der Orthopade Oct 2019
Topics: Constriction, Pathologic; Humans; Lumbar Vertebrae; Spinal Canal; Spinal Stenosis
PubMed: 31559468
DOI: 10.1007/s00132-019-03771-0 -
Radiologic Clinics of North America Mar 2019Cross-sectional spinal imaging is common, and extraspinal findings are often incidentally identified during interpretation. Although some of these findings may cause... (Review)
Review
Cross-sectional spinal imaging is common, and extraspinal findings are often incidentally identified during interpretation. Although some of these findings may cause symptoms that mimic a spinal disorder, the majority are entirely asymptomatic and incidental. It is essential that the radiologist not only identify those abnormalities that may have clinical significance but also recognize those that are clinically irrelevant and thereby prevent patients from being subjected to further unnecessary, expensive and potentially harmful interventions. This article focuses on those abnormalities that are commonly encountered and provides practical guidance for follow-up and management based on current recommendations.
Topics: Digestive System Diseases; Endocrine System Diseases; Female; Humans; Incidental Findings; Lymphadenopathy; Magnetic Resonance Imaging; Spinal Canal; Tomography, X-Ray Computed; Urologic Diseases; Vascular Diseases
PubMed: 30709480
DOI: 10.1016/j.rcl.2018.09.009 -
Injury Feb 2020Traumatic pneumorrhachis (PR) is a rare entity. There are only a few single cases published in English literature. In most of these cases PR was accidentally found...
INTRODUCTION
Traumatic pneumorrhachis (PR) is a rare entity. There are only a few single cases published in English literature. In most of these cases PR was accidentally found during CT-diagnostics and remained asymptomatic. The exact pathogenesis of traumatic PR has not been conclusively clarified. It is assumed, that a sudden increase in thoracic pressure causes air to escape the alveoli and migrates along the fasciae towards the spinal canal. In this study we reviewed the patients of our clinic for 13 years. Eight Patients with traumatic PR could be detected. This study represents the biggest account of traumatic PR in literature and gives a hint for the diagnostic and therapeutical regimen.
METHODS
We reviewed the radiological findings of our patients with thoracic trauma in the period from 2004 to 2016. We could detect eight patients with traumatic epidural PR and recorded any further injuries, therapies and outcome. Furthermore, a systematic literature review was carried out.
RESULTS
We found a total of eight patients suffering from traumatic PR. One of them hat a combination of epidural and subarachnoidal PR due to an open skull injury. Another of these patients got spondylodiscites nine months later at the level of the PR. In one Patient we could show the spontaneous reabsorption of the air in a CT-scan 4 days after trauma.
DISCUSSION
Traumatic PR remains a rare entity. It can be diagnosed with CT an MRT-scans. It needs no specific initial therapy besides the therapy of the underlying injuries. The prognosis of traumatic epidural PR is good and determined by the accompanying injuries. In cases of elevated paraclinical infection parameters one has to consider the development of spondylodiscitis in areas of PR.
Topics: Adult; Aged; Craniocerebral Trauma; Databases, Factual; Epidural Space; Female; Germany; Humans; Male; Middle Aged; Pneumorrhachis; Retrospective Studies; Spinal Canal; Spinal Diseases; Subarachnoid Space; Thoracic Injuries; Tomography, X-Ray Computed; Young Adult
PubMed: 31711655
DOI: 10.1016/j.injury.2019.10.075 -
Journal of Pediatric Orthopedics Mar 2018Congenital scoliosis is a failure of vertebral formation, segmentation, or a combination of the 2 arising from abnormal vertebral development during weeks 4 to 6 of... (Review)
Review
BACKGROUND
Congenital scoliosis is a failure of vertebral formation, segmentation, or a combination of the 2 arising from abnormal vertebral development during weeks 4 to 6 of gestation. The associated spinal deformity can be of varying severity and result in a stable or progressive deformity based on the type and location of the anomalous vertebra(e). Bracing for congenital scoliosis is rarely indicated, while recent reports have demonstrated the utility of serial derotational casting for longer curves with multiple anomalous vertebrae as an effective "time buying strategy" to delay the need for surgery. Earlier hemivertebra excision and short-segment posterior spinal fusion have been advocated to prevent future curve progression of the deformity and/or the development of large compensatory curves. It has been shown in recent long-term follow-up studies that growth rates of the vertebral body and spinal canal are not as dramatically affected by pedicle screw instrumentation at a young age as once thought. Growth friendly surgery with either spine-based or rib-based anchors has demonstrated good results with curve correction while maintaining spinal growth. Rib-based anchors are typically more commonly indicated in the setting of chest wall abnormalities and/or when spinal anatomy precludes placement of spinal instrumentation. Recently, magnetically controlled growing rods have shown promising results in several studies that include a small subset of congenital scoliosis cases.
METHODS
A literature search was performed to identify existing studies related to the treatment of congenital scoliosis published from January 1, 2005 to June 1, 2016. Databases included PubMed, Medline, and the Cochrane Library. The search was limited to English articles and yielded 36 papers. This project was initiated by the Pediatric Orthopaedic Society of North America Publications Committee and was reviewed and approved by the Pediatric Orthopaedic Society of North America Presidential Line.
RESULTS
A total of 36 papers were selected for review based upon new findings. Classic manuscripts on congenital scoliosis are also included to provide sufficient background information.
CONCLUSIONS
Congenital scoliosis represents a wide range of pathology from the simple, stable hemivertebra to the complex, progressive spinal deformity with chest wall abnormalities and associated cardiac, renal, and neural axis anomalies. This paper reviews the natural history and associated anomalies with congenital scoliosis as well as the most up-to-date classification schemes and various treatment options for the care of this challenging patient population.
LEVEL OF EVIDENCE
Level 5.
Topics: Braces; Disease Progression; Humans; Pedicle Screws; Postoperative Complications; Scoliosis; Spinal Canal; Spinal Fusion; Spine; Treatment Outcome
PubMed: 28009797
DOI: 10.1097/BPO.0000000000000922 -
World Neurosurgery Aug 2022Benign tumors that grow in the spinal canal are heterogeneous neoplasms with low incidence; from these, meningiomas and nerve sheath tumors (neurofibromas and... (Review)
Review
Benign tumors that grow in the spinal canal are heterogeneous neoplasms with low incidence; from these, meningiomas and nerve sheath tumors (neurofibromas and schwannomas) account for 60%-70% of all primary spinal tumors. Benign spinal canal tumors provoke nonspecific clinical manifestations, mostly related to the affected level of the spinal cord. These tumors present a challenge for the patient and healthcare professionals, for they are often difficult to diagnose and the high frequency of posttreatment complications. In this review, we describe the epidemiology, risk factors, clinical features, diagnosis, histopathology, molecular biology, and treatment of extramedullary benign meningiomas, osteoid osteomas, osteoblastomas, aneurysmal bone cysts, osteochondromas, neurofibromas, giant cell tumors of the bone, eosinophilic granulomas, hemangiomas, lipomas, and schwannomas located in the spine, as well as possible future targets that could lead to an improvement in their management.
Topics: Humans; Meningeal Neoplasms; Meningioma; Neurilemmoma; Neurofibroma; Neurofibromatoses; Spinal Canal; Spinal Cord Neoplasms; Spinal Neoplasms
PubMed: 35552036
DOI: 10.1016/j.wneu.2022.04.135 -
Magnetic Resonance Imaging Clinics of... Aug 2016Spinal stenosis is common and presents in a variety of forms. Symptomatic lumbar stenosis occurs in approximately 10% of the population and cervical stenosis in 9% over... (Review)
Review
Spinal stenosis is common and presents in a variety of forms. Symptomatic lumbar stenosis occurs in approximately 10% of the population and cervical stenosis in 9% over age 70. Imaging is central to the management decision process and first-choice MR imaging may be substituted with CT and CT myelography. A review of the literature is presented with particular emphasis on the clinical-radiologic correlation in both neurogenic intermittent claudication and cervical spondylotic myelopathy. Advanced techniques promise improvements, particularly with radicular compressive lesions, but remain underutilized in routine clinical practice.
Topics: Humans; Magnetic Resonance Imaging; Neuroimaging; Spinal Canal; Spinal Stenosis; Tomography, X-Ray Computed
PubMed: 27417399
DOI: 10.1016/j.mric.2016.04.009 -
International Journal of Developmental... May 2018Spinal ultrasonography is a safe, rapid, and non-invasive diagnostic tool that allows visualization of the spinal cord and its surrounding meninges. The non-ossified...
Spinal ultrasonography is a safe, rapid, and non-invasive diagnostic tool that allows visualization of the spinal cord and its surrounding meninges. The non-ossified spinous processes were used as an acoustic window for imaging the spinal cord in human and canine neonates. No available literatures have been published describing the ultrasonographic appearance of caprine neonatal spinal cord. The present study was performed on 20 one day-old goat kids. Sagittal and transverse ultrasound scans were obtained using 8MHz linear transducer. The spinal cord appeared as a tubular anechoic to hypoechoic structure within the spinal canal. The cord was surrounded by hyperechoic dura and pia matter as well as the anechoic subarachnoid space in-between. The mean sagittal diameter of the cord at the cervical region was (4.6±0.3mm), the thoracic region (3.9±0.2mm), and the lumbar region (4.3±1.1mm). The sagittal diameter of the cord at the cervical and lumbar regions was significantly wider than the diameter at the thoracic region. Identification of the normal ultrasonographic appearance of caprine neonatal spinal cord may represent the basis for diagnosing congenital spinal cord lesions.
Topics: Animals; Animals, Newborn; Goats; Spinal Canal; Spinal Cord; Ultrasonography
PubMed: 29233724
DOI: 10.1016/j.ijdevneu.2017.12.001 -
The Journal of Veterinary Medical... Sep 2022Cervical vertebral stenotic myelopathy (CVSM), a common cause of cervical spinal cord compression, is a neurological disease characterized by general proprioceptive...
Cervical vertebral stenotic myelopathy (CVSM), a common cause of cervical spinal cord compression, is a neurological disease characterized by general proprioceptive ataxia and weakness of hindlimbs that tends to develop in young adult Thoroughbred horses. Although male horses seem to be at increased risk for CVSM, the mechanism for the occurrence of sex differences in the prevalence of CVSM is still poorly understood. Hence, we hypothesized that sex differences in the development of cervical spinal cord and spinal canal would affect the development of CVSM. This study aimed to evaluate sex differences in the development of cervical spinal cord and spinal canal in Thoroughbred horses. A total of 29 Thoroughbred horses underwent computed tomographic myelography. Thereafter, the volumes of cervical spinal cord and spinal canal were calculated. Accordingly, male horses had significantly lager cervical spinal cord volume and cervical spinal cord-to-spinal canal volume ratio than those of female horses (P<0.05). Sex differences in the cervical spinal cord-to-spinal canal volume ratio gradually decreased until around 1,400 days of age. Younger male horses have narrower interspace between the cervical spinal cord and spinal canal than younger female horses, suggesting that an imbalanced cervical spinal cord and spinal canal growth is one of the causes of CVSM.
Topics: Animals; Cervical Cord; Female; Horse Diseases; Horses; Male; Sex Characteristics; Spinal Canal; Spinal Cord Compression; Spinal Cord Diseases; Spinal Stenosis
PubMed: 35944983
DOI: 10.1292/jvms.22-0234 -
Journal of Neuroimaging : Official... Nov 2022Several distinct conditions present as cystic or pseudocystic lesions within the spinal canal. Some of the most common spinal cystic lesions include spinal meningeal... (Review)
Review
Several distinct conditions present as cystic or pseudocystic lesions within the spinal canal. Some of the most common spinal cystic lesions include spinal meningeal cysts, juxtafacet cysts, dermoid/epidermoid cysts, nerve sheath tumors, and syringohydromyelia. Clinical presentation is usually nonspecific and imaging characteristics are frequently overlapping, which may pose a challenging presurgical diagnosis. We provide a pictorial review of cystic intraspinal lesions and discuss the main imaging features that can aid the neuroradiologist in the differential diagnosis. First, we propose a categorization of the lesions according to their location as extradural, intradural extramedullary, and intramedullary. This is a crucial initial step in the diagnostic workup and surgical planning. Second, for each of these locations, we organize the lesions according to their etiology: congenital and developmental disorders, degenerative disorders, traumatic or postsurgical collections, infectious conditions, neoplastic lesions, and other miscellaneous disorders. Finally, we summarize the clinical highlights and MR features that provide important insights for the differential diagnosis. MR is the technique of choice in presurgical evaluation and postsurgery follow-up. It provides accurate lesion localization and characterization and, most of the times, it will allow a confident differential diagnosis. High-resolution three-dimensional T2-weighted sequences and diffusion-weighted imaging can provide important hints in specific cases. Signal correlation with T1-weighted and fat-saturated sequences allows to differentiate true cystic lesions from hemorrhage or fat tissue.
Topics: Humans; Magnetic Resonance Imaging; Spinal Cord Diseases; Spine; Spinal Canal; Diffusion Magnetic Resonance Imaging; Diagnosis, Differential
PubMed: 35942824
DOI: 10.1111/jon.13037