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ABSTRACT: A schwannoma is a benign tumor arising from a schwann cell and occurs mainly in the nerve sheath in the intradural extramedullary region. Schwannomas have been well described as occurring in the lumbar spine, but total cystic degeneration of schwannomas is rarely reported. The authors describe the clinical and radiographic evaluations and treatment of a rare case of an intraextradural totally cystic schwannoma on the lumbar spine.Two patients reported a history of 6 to 12 months of pain accompanied by weakness in the lower extremities. On examination, 1 patient had bilateral lower-extremity muscle strength graded at 4/5, and magnetic resonance imaging revealed a cystic schwannoma (1.5×2.0 cm in the sagittal dimension) at L2-L3. The other patient had a right lower-extremity muscle strength graded at 3/5, and magnetic resonance imaging revealed a cystic schwannoma (2.0×3.0 cm in the sagittal dimension) at L4-L5. The patients underwent operative treatment, and the tumors were completely removed, as were the filum terminale adhered to the tumor. Pedicle screws were used to maintain stability of the lumbar spine. Gross examination of the tumors showed yellowish-white soft contents. Histologic examination confirmed that they were benign totally cystic schwannomas. Postoperatively, the patients' neurologic symptoms completely resolved.Cystic schwannomas can be diagnosed using preoperative magnetic resonance imaging. The filum terminale cut off the tumor walls did not cause the clinical symptoms in the 2 patients.
Orthopedics 05/2013; 36(5):e679-e682. · 2.66 Impact Factor
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ABSTRACT: STUDY DESIGN.: A retrospective study. OBJECTIVE.: To assess the radiographical bony union and clinical outcomes of 207 patients who underwent an anterior cervical discectomy and fusion (ACDF) with only local decompression bone for the treatment of cervical disc degeneration. SUMMARY OF BACKGROUND DATA.: Many sources of bone graft have been used for ACDF. Autologous iliac bone is most likely suitable for biologic bone fusion ability, but there may be many problems such as high donor site morbidity. Allograft and artificial bones are less effective for bone fusion. Use of local decompression bone could be a good solution. METHODS.: A total of 207 patients (range, 35-80 yr) underwent ACDF, using carbon fiber-reinforced polyetheretherketone cage lled with local decompression bone with anterior cervical plating to treat symptomatic cervical disorders. Computed tomographic scan of the cervical spine was used to assess fusion rates, and Odom's criteria were used to evaluate the clinical outcome. RESULTS.: Almost all patients had symptomatic improvement, and 97% of patients (201 of 207) exhibited excellent/good clinical outcomes. All interbody disc spacers with local decompression bone achieved successful fusion, confirmed by radiographs and computed tomographic scans, and no cage subsidence occurred at all levels. CONCLUSION.: As applied in anterior cervical fusion, the local decompression bone embedded into carbon fiber-reinforced polyetheretherketone cages is enough and can achieve successful fusion, poignant clinical outcomes while achieving no donor site morbidity.
Spine 06/2012; 37(20):E1260-3. · 2.08 Impact Factor
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ABSTRACT: Substantial data exist from cadaveric and magnetic resonance imaging studies regarding the position of the conus medullaris in normally developed adults. However, no large studies have documented the position of the conus medullaris in patients with diagnosed lumbar spinal stenosis. To goal of the current study was to determine the position of the conus medullaris within a living adult population with existing pathology of lumbar spinal stenosis. In a retrospective study, 234 patients (110 women and 124 men; mean age, 48.8 years) with diagnosed lumbar spinal stenosis had their T2-weighted, midline, sagittal, spin-echo magnetic resonance imaging studies compared to assess and confirm the position of the conus medullaris. A straight line perpendicular to the long axis of the spinal cord in the median sagittal sequence was subtended to the adjacent vertebra or disk space, and the position was defined in relation to the vertebra or disk space. The conus medullaris position was labeled in relation to the upper, middle, and lower segments of the adjacent vertebral body or the adjacent disk space and assigned numerical values from 1 to 12. The position of the conus medullaris in patients with lumbar spinal stenosis followed a normal distribution. The mean conus medullaris position was mainly within the lower third of the L1 vertebral body (ranged from the middle third of T12 to the upper third of L3). No significant differences existed between men and women with lumbar spinal stenosis. The conus medullaris position was found to be unaffected by the pathology of lumbar spinal stenosis.
Orthopedics 06/2012; 35(6):e899-902. · 2.66 Impact Factor
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ABSTRACT: Ossification of the posterior longitudinal ligament and ossification of the yellow ligament are the main causes of spinal canal stenosis. This article describes a case of ossification of the posterior longitudinal and yellow ligaments on the lumbar spine. The patient presented with gradually worsening left lower-extremity ache and pain. The deep tendon reflex was hyperreflexia in the lower extremities. Disturbances existed in the blade and bowel. The ossified lesion of ossification of the posterior longitudinal ligament was observed at L5-S1, and plain lateral radiographs and computed tomography revealed ossification of the yellow ligament on L3, which occupied a large part of the spinal canal. Because of the findings on the preoperative radiographs, we performed posterior approach decompression and bone grafting and excisied the ossified lesion. Pedicle screws were inserted from L3 to S1. The patient's symptoms disappeared postoperatively, and his Japanese Orthopaedic Association score was 25 two weeks postoperatively. No standard surgical procedure exists for the treatment of lumbar ossification of the posterior longitudinal ligament, but it is important to select a surgical procedure according to individual patient conditions. Many factors, such as local mechanic stress, tissue metabolism, high glucose, and genetics, contribute to the progression of ossification of the posterior longitudinal and yellow ligaments on the lumbar spine. However, the mechanism is unclear. Further study and long-term follow-up on lumbar ossification of the posterior longitudinal ligament is needed.
Orthopedics 01/2012; 35(2):e298-301. · 2.66 Impact Factor
