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Korean Journal of Anesthesiology Aug 2022If the proportion of the spinal cord in the epidural space can be determined under C-arm fluoroscopy during cervical epidural block, a safe entry point for the epidural...
Comparison between the coronal diameters of the cervical spinal canal and spinal cord measured using computed tomography and magnetic resonance imaging in Korean patients.
BACKGROUND
If the proportion of the spinal cord in the epidural space can be determined under C-arm fluoroscopy during cervical epidural block, a safe entry point for the epidural needle can be established. The aim of this study was the measurement of the cord to canal transverse diameter ratio of each cervical spines.
METHODS
We retrospectively evaluated the imaging data of 100 patients who underwent both cervical computed tomography (CT) and cervical magnetic resonance imaging (MRI) at our hospital. We measured the diameters of the spinal canal and spinal cord from the 3rd cervical vertebra to the 1st thoracic vertebra (T1) at each level by using the patients' cervical CT and MRI images. The spinal cord and spinal canal diameters were measured in the transverse plane of the cervical MRI and CT images, respectively.
RESULTS
The spinal cord to spinal canal diameter ratio was the highest at the 4th and 5th cervical vertebrae (0.64 ± 0.07) and the lowest at T1 (0.55 ± 0.06, 99% CI [0.535, 0.565].
CONCLUSIONS
Our findings suggest that the cord to canal transverse diameter ratio could be used as a reference to reduce direct spinal cord injuries during cervical epidural block under C-arm fluoroscopy. In the C-arm fluoroscopic image, if an imaginary line connecting the left and right innermost lines of the pedicles of T1 is drawn and if the needle is inserted into the outer one-fifth of the left and right sides, the risk of puncturing the spinal cord would be relatively reduced.
Topics: Humans; Magnetic Resonance Imaging; Republic of Korea; Retrospective Studies; Spinal Canal; Spinal Cord; Spinal Puncture; Tomography, X-Ray Computed
PubMed: 35272447
DOI: 10.4097/kja.22006 -
Child's Nervous System : ChNS :... Dec 2021Synovial sarcoma (SS) is a rare mesenchymal malignant tumor. SS of the spine or retroperitoneum is an extremely rare site. Approximately 30% cases show focal...
INTRODUCTION
Synovial sarcoma (SS) is a rare mesenchymal malignant tumor. SS of the spine or retroperitoneum is an extremely rare site. Approximately 30% cases show focal calcifications on radiographs and computed tomography (CT) images, while extensive calcification rarely occurs. We presented a case of SS involving the spinal canal and paraspinal muscle and retroperitoneum, which showed extensive calcification on CT.
CLINICAL PRESENTATION
The present report describes the case of a 13-year-old girl suffering from a tumor in the spinal canal and paraspinal muscle and retroperitoneum with extensive calcification on CT. The patient underwent lumbar and retroperitoneal giant tumor resection, lumbar decompression, and spinal tumor resection with a small tumor remnant remaining in the paravertebral region. Histological examination and genetic testing after surgery confirmed synovial sarcoma. After surgery, the patient refused local radiotherapy but agreed to receive chemotherapy. After 4 months of follow-up, her condition was basically stable, and the pain in her left lower limb disappeared. The residual tumor was not increased.
CONCLUSION
Extensive calcification of SS is rare. The possibility of synovial sarcoma should be considered in those who show extensive calcification in the spinal canal and paraspinal muscle and retroperitoneum on CT. For cases that cannot be completely resected, adjuvant chemotherapy can control the residual tumor in the short term. In addition, the long-term effects need to be observed.
Topics: Adolescent; Female; Humans; Paraspinal Muscles; Sarcoma, Synovial; Spinal Canal; Spinal Neoplasms; Tomography, X-Ray Computed
PubMed: 33895870
DOI: 10.1007/s00381-021-05145-4 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Jun 2022The aim of the study was to investigate the relationship between the interpedicular distance increase ratio and the ratio of canal compromise in thoracolumbar burst...
BACKGROUND
The aim of the study was to investigate the relationship between the interpedicular distance increase ratio and the ratio of canal compromise in thoracolumbar burst fractures.
METHODS
Thirty-one patients (18 male and 13 female) with an average age of 30.8 (14-57) who had been treated for thoraco-lumbar burst fractures in the Department of Orthopaedics and Traumatology were included in the study. The initial anteroposterior radiographs of the patients were used to calculate the increase ratio of interpedicular distance (both from medial-to-medial and from center-to-center). The area measurements from the computerized tomography or magnetic resonans images were used to calculate the canal compromise. The relationship between the increase ratio of interpedicular distance and the ratio of canal compromise was investigated by correlation and linear regression analysis.
RESULTS
There was a 'very good' correlation between the from medial-to-medial and from center-to-center measurements of interpedicular distance (Pearson correlation coefficient: 0.89, p<0.001). The correlation between the ratio of canal compromise and from medial-to-medial and from center-to-center measurements of interpedicular distance was 'good' with Pearson correlation coef-ficients of 0.60 and 0.63, respectively (p<0.001). No statistically significant relationships were found between the fracture levels, types, neurologic status of the patients, and the increase ratio of interpedicular distance or the ratio of canal compromise.
CONCLUSION
Depending on the correlation coefficients which were obtained in this study: To predict the canal compromise from the ratio of interpedicular distance increase is not a reliable method for all of the patients.
Topics: Adult; Female; Fractures, Comminuted; Humans; Lumbar Vertebrae; Male; Spinal Canal; Spinal Fractures; Thoracic Vertebrae
PubMed: 35652885
DOI: 10.14744/tjtes.2021.99560 -
Clinical Imaging Mar 2020Diagnosis of extramedullary spinal diseases is often complex, firstly requiring a good anatomic knowledge for a precise localization of pathologies. The spinal canal, a... (Review)
Review
Diagnosis of extramedullary spinal diseases is often complex, firstly requiring a good anatomic knowledge for a precise localization of pathologies. The spinal canal, a tubular space delimited by vertebral bodies and neural arches, contains the spinal cord, nerve roots and cauda equina. Neural structures are surrounded and supported, from outer to inner, by meninges: dura, arachnoid and pia mater; meningeal layers divide extramedullary spaces in epidural, subdural and subarachnoid. Extramedullary diseases may be broadly classified in degenerative, neoplastic, traumatic, infective or miscellaneous. Imaging (MRI, CT) plays a fundamental role in the identification of pathologies, providing elements of differential diagnosis and accurate informations (location, extension, tissue characteristics) to guide further management. MRI is the best imaging modality technique to investigate extramedullary spaces and their diseases; however, CT may be useful in cases of bone involvement. The purposes of this article are to depict extramedullary anatomy, describe the most important extramedullary diseases following physiopathological and space-to-space criteria, illustrate imaging features of extramedullary pathologies, and underline imaging clues for differential diagnosis.
Topics: Arachnoid; Dura Mater; Humans; Magnetic Resonance Imaging; Meninges; Spinal Canal; Spinal Cord; Spinal Diseases; Spine; Subdural Space
PubMed: 31865214
DOI: 10.1016/j.clinimag.2019.12.004 -
Neurology India 2023There have been reports on the significant canal cross-sectional area (CSA) expansion difference between pre- and post-operation, but no comparison of CSA expansion...
BACKGROUND
There have been reports on the significant canal cross-sectional area (CSA) expansion difference between pre- and post-operation, but no comparison of CSA expansion between the hinge-side area (Area H) and the open-side area (Area O) has been reported. This study aimed to measure the spinal CSA expansion between Area H and Area O retrospectively after open-door laminoplasty using new titanium spacers and evaluated this common decompression procedure's effectiveness.
MATERIALS AND METHODS
This study included 27 patients diagnosed with cervical spondylotic radiculopathy or myelopathy, ossification of the posterior longitudinal ligament, and developmental canal stenosis from February 2021 to October 2022. The CSA difference between pre- and post-cervical laminoplasty (C4-C6 levels) was measured with cervical transverse computed tomography scan images. The CSA difference in Area H and Area O between pre- and post-laminoplasty was similarly calculated.
RESULTS
The spinal canal areas of each segment after open-door laminoplasty were significantly enlarged (P < 0.05). Area O was also significantly enlarged compared to that of Area H (P < 0.05).
CONCLUSION
Area O was more enlarged than Area H, and both sides were statistically enlarged after open-door laminoplasty.
Topics: Humans; Laminoplasty; Retrospective Studies; Spinal Cord Compression; Cervical Vertebrae; Spinal Canal; Laminectomy; Spondylosis; Treatment Outcome
PubMed: 37635499
DOI: 10.4103/0028-3886.383874 -
The Journal of Orthopaedic and Sports... Jun 2020A 33-year-old man was referred to physical therapy by his primary care physician for low back pain that had been present for 7 months. The neurologic screen with mixed...
A 33-year-old man was referred to physical therapy by his primary care physician for low back pain that had been present for 7 months. The neurologic screen with mixed upper and lower motor neuron signs was of concern for spinal cord involvement. The primary care physician was contacted and magnetic resonance imaging ordered. Facet arthrosis and epidural lipomatosis were present, resulting in thoracic and lumbar spinal stenosis. .
Topics: Adult; Decompression, Surgical; Humans; Laminectomy; Lipomatosis; Low Back Pain; Magnetic Resonance Imaging; Male; Osteoarthritis, Spine; Physical Therapy Modalities; Spinal Canal; Spinal Stenosis
PubMed: 32476581
DOI: 10.2519/jospt.2020.9059 -
Journal of Orthopaedic Surgery and... Sep 2023The purpose of the study was to evaluate the efficacy of OLIF combined with pedicle screw internal fixation in the treatment of lumbar spinal stenosis by assessing the...
PURPOSE
The purpose of the study was to evaluate the efficacy of OLIF combined with pedicle screw internal fixation in the treatment of lumbar spinal stenosis by assessing the changes in spinal canal before and after surgery.
METHODS
In this retrospective study, we included sixteen patients who underwent a combination of single-segment OLIF and pedicle screw internal fixation for the treatment of lumbar spinal stenosis at the Affiliated Hospital of Jiangxi University of Chinese Medicine between February 2018 and August 2022. The patients' pre- and post-operative data were compared. Intraoperative bleeding, duration of surgery, visual analogue score (VAS), Oswestry Disability Index (ODI), disc height (DH), cross-sectional area of vertebral canal (CSAVC), cross-sectional area of dural sac (CSADS), cross-sectional area of intervertebral foramen (CSAIF), spinal canal volume (SCV), spinal canal volume expansion rate, lumbar lordosis, and sagittal vertical axis were observed and recorded. The efficacy of OLIF combined with pedicle screw internal fixation for lumbar spinal stenosis on spinal canal changes before and after surgery was summarized.
RESULTS
The results showed that OLIF combined with pedicle screw internal fixation effectively restored disc height and increased the cross-sectional area of the spinal canal. It also had an indirect decompression effect. The intraoperative bleeding and duration of surgery were within acceptable ranges. The VAS and ODI scores significantly improved after surgery, indicating a reduction in pain and improvement in functional disability. The CSAVC, CSADS, CSAIF, SCV, and spinal canal volume expansion rate were all increased postoperatively. Additionally, there was improvement in lumbar lordosis and sagittal vertical axis. We conducted a follow-up of all patients at 1 year after the surgery. The results revealed that the parameter values at 1 year post-surgery showed varying degrees of decrease or increase compared to the immediate postoperative values. However, these values remained statistically significant when compared to the preoperative parameter values (P < 0.05).
CONCLUSIONS
OLIF combined with pedicle screw internal fixation effectively restores disc height and increases the cross-sectional area of the vertebral canal in patients with LSS, reflecting the indirect decompression effect. Measuring parameters such as DH, CSAVC, CSADS, CSAIF, SCV, and SCV expansion rate before and after surgery provides valuable information for evaluating the efficacy and functional recovery of the lumbar spine in LSS patients treated with OLIF surgery.
Topics: Animals; Humans; Spinal Stenosis; Lordosis; Pedicle Screws; Retrospective Studies; Spinal Canal
PubMed: 37749636
DOI: 10.1186/s13018-023-04209-2 -
Scientific Reports Sep 2021A known prevalence of concurrent cervical and lumbar spinal stenosis was shown to be 5-25%, but there is a lack of evidence regarding direct relationships in canal...
A known prevalence of concurrent cervical and lumbar spinal stenosis was shown to be 5-25%, but there is a lack of evidence regarding direct relationships in canal dimension and canal-body ratio between cervical and lumbar spine. Total 247 patients (mean age: 61 years, male: 135) with cervical and lumbar computed tomography scans were retrospectively reviewed. Midsagittal vertebral body and canal diameters in reconstructed images were measured at all cervical and lumbar vertebrae, and canal-body ratios were calculated. The canal diameter and ratio were also compared according to the gender and age, and correlation analysis was performed for each value. There were significant correlations between cervical (C3-C7) and lumbar (L1-L5) canal dimension (p < 0.001). C5 canal diameter was most significantly correlated with L4 canal diameter (r = 0.435, p < 0.001). Cervical canal-body ratios (C3-C7) were also correlated with those of lumbar spine (L1-L5) (p < 0.001). The canal-body ratio of C3 was most highly correlated with L3 (r = 0.477, p < 0.001). Meanwhile, mean canal-body ratios of C3 and L3 were significantly smaller in male patients than female (p = 0.038 and p < 0.001) and patient's age was inversely correlated with C5 canal diameter (r = - 0.223, p < 0.001) and C3 canal-body ratio (r = - 0.224, p < 0.001). Spinal canal dimension and canal-body ratio have moderate degrees of correlations between cervical and lumbar spine and the elderly male patients show the tendency of small canal diameter and canal-body ratio. This relationship of cervical and lumbar spine can be an important evidence to explain to the patients.
Topics: Cervical Vertebrae; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Spinal Canal; Spinal Stenosis
PubMed: 34531481
DOI: 10.1038/s41598-021-98038-0 -
Biological Reviews of the Cambridge... Jun 2020The origin and evolution of the vertebrate skull have been topics of intense study for more than two centuries. Whereas early theories of skull origin, such as the... (Review)
Review
The origin and evolution of the vertebrate skull have been topics of intense study for more than two centuries. Whereas early theories of skull origin, such as the influential vertebral theory, have been largely refuted with respect to the anterior (pre-otic) region of the skull, the posterior (post-otic) region is known to be derived from the anteriormost paraxial segments, i.e. the somites. Here we review the morphology and development of the occiput in both living and extinct tetrapods, taking into account revised knowledge of skull development by augmenting historical accounts with recent data. When occipital composition is evaluated relative to its position along the neural axis, and specifically to the hypoglossal nerve complex, much of the apparent interspecific variation in the location of the skull-neck boundary stabilizes in a phylogenetically informative way. Based on this criterion, three distinct conditions are identified in (i) frogs, (ii) salamanders and caecilians, and (iii) amniotes. The position of the posteriormost occipital segment relative to the hypoglossal nerve is key to understanding the evolution of the posterior limit of the skull. By using cranial foramina as osteological proxies of the hypoglossal nerve, a survey of fossil taxa reveals the amniote condition to be present at the base of Tetrapoda. This result challenges traditional theories of cranial evolution, which posit translocation of the occiput to a more posterior location in amniotes relative to lissamphibians (frogs, salamanders, caecilians), and instead supports the largely overlooked hypothesis that the reduced occiput in lissamphibians is secondarily derived. Recent advances in our understanding of the genetic basis of axial patterning and its regulation in amniotes support the hypothesis that the lissamphibian occipital form may have arisen as the product of a homeotic shift in segment fate from an amniote-like condition.
Topics: Animals; Anura; Biological Evolution; Birds; Cervical Vertebrae; Extinction, Biological; Fossils; Hypoglossal Nerve; Mammals; Neck; Occipital Bone; Phylogeny; Reptiles; Skull; Spinal Canal; Urodela; Vertebrates
PubMed: 31912655
DOI: 10.1111/brv.12578 -
Afadin Signaling at the Spinal Neuroepithelium Regulates Central Canal Formation and Gait Selection.Cell Reports Jun 2020Afadin, a scaffold protein controlling the activity of the nectin family of cell adhesion molecules, regulates important morphogenetic processes during development. In...
Afadin, a scaffold protein controlling the activity of the nectin family of cell adhesion molecules, regulates important morphogenetic processes during development. In the central nervous system, afadin has critical roles in neuronal migration, axonal elongation, and synapse formation. Here we examine the role of afadin in development of spinal motor circuits. Afadin elimination in motor neuron progenitors results in striking locomotor behavior: left-right limb alternation is substituted by synchronous activation, characteristic of bound gait. We find that afadin function at the neuroepithelium is required for structural organization of the spinal midline and central canal morphogenesis. Perturbation of afadin results in formation of two central canals, aberrant contralateral wiring of different classes of spinal premotor interneurons, and loss of left-right limb alternation, highlighting important developmental principles controlling the assembly of spinal motor circuits.
Topics: Animals; Female; Gait; Male; Mice; Microfilament Proteins; Motor Neurons; Mutation; Nectins; Signal Transduction; Spinal Canal; Spinal Cord
PubMed: 32521266
DOI: 10.1016/j.celrep.2020.107741