Cervicodorsal Junction Research Articles

Multiple sporadic spinal hemangioblastoma at the filum terminale and cervicodorsal junction: A case report and review of literature

Abstract Hemangioblastomas are low-grade tumors that frequently occur in the posterior fossa. Only 1%–5% of these tumors occur in the spinal cord and there are a handful of cases of filum terminale hemangioblastomas described in the literature. Here, we present a case with two spinal hemangioblastomas at filum terminale and cervicodorsal junction of sporadic origin. A 28-year-old woman presented with low back pain radiating to right lower limb with weakness of both lower limbs and urinary incontinence. The findings of the examination revealed asymmetric quadriparesis with more weakness on the left side of the body. Magnetic resonance imaging revealed a cervicodorsal and lumbar T2 hyperintense lesion with flow voids. Imaging findings were suggestive of hemangioblastoma. En bloc excision of both the tumors was performed and the diagnosis was confirmed on histopathology. She had an uneventful postoperative course and complete neurological recovery at the final follow-up. Multiple sporadic spinal hemangioblastomas involving the filum terminale are a very rare entity. Complete surgical excision provides good relief of symptoms.

Intraoperative Computed Tomography Scanner-Guided Junctional Zone Spinal Surgery in Fluoroscopic Limitation Zone-An Early Experience

Objective: Confirmation of the level for surgery at the junctional zones of the spine is associated with unique difficulties. C-Arm has its limitations in these areas. The use of intraoperative CT scan with navigation greatly helps in the surgery at junctional zones. These junctional zones include the craniocervical junction, cervico-dorsal junction, and sacroiliac junction. In 2019, we installed an Airo Brain Lab 32-slice MDCT in our facility and researched to evaluate its advantages in junctional zone fluoroscopy-restricted spine operations. Material and Methods: We performed 20 complex surgeries in all these 3 junctional zones with the use of an intraoperative computed tomography scanner. 3 patients had craniovertebral junction fixation under intra-op CT while 6 had lateral mass fixation. 3 patients had cervicodorsal junction fixation and 4 patients had lumbosacral fixation. Results: 2 out of 3patients with cervicodorsal fixation had correction of screws trajectory after usage of intra-op CT and 1 patient with lumbosacral fixation. All patients were discharged home with neurology better or the same as compared to pre-op. status while 13 patients had a favorable outcome. Conclusion: Intraoperative computed tomography scanner is opening new horizons for complex spinal surgeries. Keywords: , ,, .

360-degree Cervico-Dorsal Fixation througha Single Posterior Approach in a 19 years Old Male with Expansile Bone Mass: A Case Report

Cervico-Dorsal junction is a transitional zone of spinal column. 360-degree fixation of cervico-dorsal region in a single posterior approach is a difficult and challenging procedure accounting the spinal cord decompression, posterior vertebral body replacement and then posterior instrumentation. Here we have described a patient who presented with features of spastic paraparesis and lower motor palsy of right upper limb due to anexpansile bone mass on Rt side of cervico-dorsal region. He underwent neuronal decompression and 360-stabilisation in a single posterior approach. We review clinical and radiographic features of the patient; the procedureunderwent as well as current other treatment options with reference to the relevant literatures. Bang. J Neurosurgery 2022; 11(2): 122-127

Giant cell tumor of the cervico-dorsal junction with compressive myelopathy: A rare presentation with review of literature

Giant cell tumor (GCT) of bone, although benign in its nature, is aggressive in its course. It has a predilection for the epiphysis of long bones. Although it can affect any vertebra in the body, it has propensity to affect the fixed spine more than the mobile segments. It occurs infrequently above the sacrum, and involvement of the cervical spine is still rarer. However, sparse case reports of upper cervical spine GCT have been reported in literature. We report a case of GCT involving the C7 and D1 vertebrae in a 50-year-old woman who presented with the features of compressive myelopathy. She underwent corpectomy of C7–D1 with cage fixation and cervical plating via an anterior approach. The patient showed significant neurological improvement postoperatively.

Surgical treatment of vertebral fractures in patients with ankylosing spondylitis: a retrospective study

Background: The diagnosis of vertebral fractures in patients with ankylosing spondylitis is sometimes difficult and management should respect the nature of the disease and patient’s deformity. We aim to clarify some technical steps during diagnosis and management and analyze the possible complications. Methods: Twenty-two patients were enrolled in this study between January 2004 and December 2014. All patients were already diagnosed with ankylosing spondylitis (AS) and presented with vertebral column fractures. All patients were men with an average age of 55.9 yr. Six patients had a fractured cervical spine, one patient had a cervicodorsal junction fracture, seven had a fractured dorsal spine, and eight had dorsolumbar junction fractures. The patients were evaluated neurologically according to Frankel grading system. All patients had radiographic survey of the entire spine. CT was obtained in every patient. MRI was obtained to evaluate the neural tissues and presence of epidural hematoma. All patients required surgery to stabilize the vertebral column. Long fixation with adequate bone graft is the rule for dorsal and dorsolumbar fractures with respect to the preoperative deformity. Anterior fixation and posterior fixation were done for cervical fractures extending to more than one level. Results: All patients with cervical fractures had anterior fixation followed by posterior laminectomy and lateral mass fixation. No anterior approach or fixation was done for dorsal or dorsolumbar fractures. Five patients were admitted to the intensive care unit postoperatively. The mean follow-up period was 24.5 mo. The patients who were Frankel E postoperatively regained their preoperative level of activity. At the end of follow-up, there were no metal failures or pseudoarthrosis. Conclusions: The surgical treatment is a cornerstone with attention to the nature of the disease and the preexisting deformity of the patient.

Posterior Cervicothoracic Stabilization Using Tapered Rods

Background Data: The cervicothoracic spine is a junction area with complex biomechanics. A variety of disorders affect this region, rendering it unstable. Numerous posterior constructs have been evaluated. The clinical efficacy of a screwrodsystem utilizing tapered (dual-diameter) rods in cervicodorsal stabilization is still not evident. Purpose: Our aim is to evaluate the clinical efficacy of dual diameter rods (5.5– 3.5mm taper), connecting 3.5-mm cervical lateral mass screws/pedicle screws and 5.5-mm thoracic pedicle screws used to instrument across the cervicothoracic junction for a variety of pathologies. Study Design: A retrospective descriptive clinical case study. Patients and Methods: The authors retrospectively reviewed their archive between February 2011 and February 2015, and ten patients who were operated upon due to cervicothoracic junction pathologies were included. All patients underwent surgical treatment by posterior instrumentation utilizing tapered rods. The cases were periodically followed up. Results: There were six men and four women included in the study, with a mean age of 40 years (range 21–62 years). There were five cases of trauma, two cases of tuberculosis and three cases of spine metastasis. Seven patients experienced marked improvement of their preoperative weakness according to Frankel grades of paraplegia. All patients showed stable cervicodorsal junction with fusion after one year. Three patients suffered postoperative wound infection. Conclusion: Tapered rods are an excellent and a viable option to connect screws to stabilize cervicothoracic junction. (2015ESJ089)

Intradural Extramedullary Spinal Cord Tumors: A Series of 72 Cases

Introduction To analyze and present intradural extramedullary spinal cord tumors and the prognostic factors affecting their neurological outcome. Materials and Methods From June 2002 to June 2014, we had 72 cases of such tumors. Among them, 14 at cervical, 6 at cervicodorsal junction, and 52 at dorsal and dorsolumbar region. All of them presented with neurological symptoms and deficits. Microsurgical excision of the tumor was done in all cases. Histopathology showed schwannoma in 42 cases, meningioma in 28 cases, malignant schwannoma in 1 case, and dermoid cyst in 1 case. Results Except for the malignant schwannoma case, all patients had improvement in the neurological deficits. Follow-up period ranged from 2 months to 12 years. Postoperative CSF leak occurred in three patients, one at cervical region and two at dorsal region. CSF leak stopped with duraplasty and revision of the wound. Conclusion Size and location of the tumor, severity of neurological deficit at the time of presentation, degree of cord retraction and vascular insult during excision of tumor, and completeness of the removal are the prognostic factors in the postoperative neurological outcome of the patients with these tumors.

Malunion and nonunion of spinous process of the cervicodorsal junction: a case report

Malunion and nonunion of spinous process of the cervicodorsal junction: a case report

Permanent cardiac pacemaker for cardiac arrest following cervico-dorsal spinal injury

Bradycardia and rarely cardiac arrest as a complication of cervical spine injury due to reduced sympathetic activity is well known, which usually settles down in 4-6 weeks of injury. There are few case reports in literature of high cervical spinal cord injury requiring permanent cardiac pacemaker due to this complication, but an injury as low as cervico-dorsal junction requiring permanent cardiac pacemaker has never been reported. A 47-year-old male suffered traumatic C7-D1 dislocation and continued to have severe bradycardia with multiple episodes of cardiac arrest till 2 months after injury, which finally warranted permanent cardiac pacemaker as a life saving measure. Following permanent cardiac pacemaker no cardiac arrest occurred and the patient was successfully rehabilitated. The case directs our attention to a rare complication of cardiac arrest occurring in an injury as low as cervico-dorsal junction when all other causes are ruled out and shows importance of using permanent cardiac pacemaker to ensure patient safety in community.

Cervical Spine Tuberculosis in Children

The presentation and outcome of pediatric cervical spine tuberculosis are different from those of adult cervical spine tuberculosis. We retrospectively reviewed the clinical and radiographic outcome of 58 children with cervical spine tuberculosis treated nonoperatively and operatively between 1996 and 2004. The mean age was 3.7 years (range, 1.9-14 years). The cervicodorsal junction was affected in 27 children, the atlantoaxial complex in 19 children, and the mid-cervical spine in 12 children. Multifocal noncontiguous spinal lesions were observed in 21 patients. Surgery was performed in 25 children for: neurologic deficit (14); drainage of retropharyngeal abscesses (four); atlantoaxial fusion for late C1-C2 instability (three); and progressive deformity and pain (four). Neurologic recovery occurred in all patients. Seven patients were lost to followup within 2 years. The minimum followup was 2.4 years (mean, 3.5 years; range, 2.4-10 years). We attributed the improved functional outcome after anti-TB chemotherapy alone to the remodeling potential of the pediatric cervical spine. Surgery was performed only for neurologic deficit, an atlantodental interval greater than 5 mm on flexion/extension view, and progressive deformity. Four patients developed superficial wound infection, two patients had graft repositioning for a slipped graft, and seven children developed a grade 1 pressure sore over the scalp while on traction.

Cervical cord tethering due to split cord malformation at the cervico‐dorsal junction presenting with self‐mutilation of the fingers

An unusual case of cervical spinal cord tethering with diplomyelia is described. A 12‐month old female presented with self‐mutilation of the fingers due to sensory loss in the hands, absent reflexes, poor muscle tone, and reduced distal upper‐limb movements. There was a deep skin dimple overlying the T1 spinous process. Imaging showed angulation of the lower cervical cord and an operation revealed a low cervical meningocele and a split cord malformation with tethering of one half of the cord; the cord was untethered. In this report the literature is reviewed.

Tuberculosis of the cervicodorsal junction.

Sixteen patients had paraplegia due to tuberculosis of the cervicodorsal junction. Spinal decompression was performed through an extended lower cervical approach, and a humeral allograft was used to reconstruct the anterior column. All patients improved neurologically with satisfactory correction of the deformity and successful incorporation of the allograft.

Tuberculosis of the Cervicodorsal Junction

Sixteen patients had paraplegia due to tuberculosis of the cervicodorsal junction. Spinal decompression was performed through an extended lower cervical approach, and a humeral allograft was used to reconstruct the anterior column. All patients improved neurologically with satisfactory correction of the deformity and successful incorporation of the allograft.

An approach to the radiological examination of the cervicodorsal junction following injury

In 257 cases of cervical spinal cord injury the orthopaedic level of injury was found to be between C6 and T1 in 34%, emphasising the frequency of injury in the cervico-dorsal region. This is a difficult region of the spine to X-ray and different techniques to demonstrate this region have been assessed. An additional technique which has proved useful is described and a scheme is suggested for the adequate visualisation of the cervico-dorsal region.