Spinal Compression Research Articles

Spinal laser interstitial thermal therapy and radiotherapy for thoracic metastatic epidural spinal cord compression.

Spinal laser interstitial thermal therapy (sLITT) is a less invasive alternative to surgery for metastatic epidural spinal cord compression. Here, we analyze outcomes of patients treated with sLITT either in conjunction with radiotherapy or as a standalone salvage therapy. We included patients with thoracic vertebral metastatic cord compression treated with sLITT. Outcomes included freedom from local failure (FFLF) and overall survival (OS). Factors associated with FFLF were identified with univariable and multivariable analyses via a Cox proportional hazards model. Between 2013-2022, 129 patients received sLITT to 144 vertebral segments; 69% were radiotherapy naïve, 81% were radioresistant histologies, and 74% were centered in the vertebral body. Median age was 61 years. Pre-sLITT Bilsky score was 3 in 28%, 2 in 33%, and 1c in 37%. Radiotherapy was delivered in conjunction with sLITT for 80% of cases, including 68% that received stereotactic radiotherapy, at a median of 5 days after sLITT. Median follow-up was 9.1 months. One-year FFLF and OS was 80% and 78%, respectively. On multivariable analysis, variables independently associated with adverse FFLF included paraspinal/foraminal disease location (p = 0.001), and post-sLITT imaging Bilsky score of 2 (p = 0.073) or 3 (p = 0.011). Prior radiotherapy, technique of radiotherapy, and time between radiotherapy and sLITT were not associated with FFLF. sLITT with radiotherapy is an effective minimally invasive treatment approach for thoracic metastatic epidural spinal cord compression. Early treatment response may serve as a prognostic imaging biomarker.

Advances in Imaging for Metastatic Epidural Spinal Cord Compression: A Comprehensive Review of Detection, Diagnosis, and Treatment Planning.

Metastatic epidural spinal cord compression (MESCC) is a critical oncologic emergency caused by the invasion of metastatic tumors into the spinal epidural space, leading to compression of the spinal cord. If not promptly diagnosed and treated, MESCC can result in irreversible neurological deficits, including paralysis, significantly impacting the patient's quality of life. Early detection and timely intervention are crucial to prevent permanent damage. Imaging modalities play a pivotal role in the diagnosis, assessment of disease extent, and treatment planning for MESCC. Magnetic resonance imaging (MRI) is the current gold standard due to its superior ability to visualize the spinal cord, epidural space, and metastatic lesions. However, recent advances in imaging technologies have enhanced the detection and management of MESCC. Innovations such as functional MRI, diffusion-weighted imaging (DWI), and hybrid techniques like positron emission tomography-computed tomography (PET-CT) and PET-MRI have improved the accuracy of diagnosis, particularly in detecting early metastatic changes and guiding therapeutic interventions. This review provides a comprehensive analysis of the evolution of imaging techniques for MESCC, focusing on their roles in detection, diagnosis, and treatment planning. It also discusses the impact of these advances on clinical outcomes and future research directions in imaging modalities for MESCC. Understanding these advancements is critical for optimizing the management of MESCC and improving patient prognosis.

Surgical Treatment of Craniocervical Junction Tumors: Neurosurgery Department Experience of “Hôpital Principal De Dakar”

Introduction: Craniocervical tumors are uncommon but represent a medical emergency for diagnosis and treatment. Their approaches require of course surgical expertise in addition to adapted technical platform. In light of the limited resources available in our practice, we consequently made the decision to share our experience with the surgical treatment of this pathology. Patients and method: We performed a retrospective analysis on eight observations of patients treated in the neurosurgery department of “Hôpital Principal de Dakar” between July 2015 and December 2022 for progressive tumor spinal cord compression at the craniocervical junction. Results: We observed a 10% frequency, a mean age of 39.25 years, and extremes between 8 and 62 years. There was a 0.6 sex ratio. The most common risk factor was type I neurofibromatosis, and one case of Von Hippel-Lindau disease. All of our patients had pyramidal syndrome. Overall, there were 2 tumors with posterolateral extradural site and 4 tumors with extramedullary intradural location, including 2 posterolateral and 2 anterolateral. The location was intramedullary and cerebella-medullary in one case each. The posteromedial occipitocervical approach, which was employed on six patients, was the most utilized method. Five patients had total tumor resection, whereas three had partial resection. Two of our patients had postoperative complications: a worsening of motor deficit and a death following dependence on mechanical ventilation. We only received four histological confirmations for the anatomopathological samples. Our patients' evolution was positive over an average follow-up of 21 months, with neurological improvement and walking autonomy. Conclusion: Tumors affecting the craniocervical junction are still treated surgically. Despite the need for improvement in our working conditions, our results appear to be satisfactory.

Pediatric peri-medullary arteriovenous fistula: Pearls for diagnosis and treatment

Pediatric type IVc perimedullary arteriovenous fistulae (PAVF) comprise a rare subcategory of spinal vascular malformations in which multiple spinal arteries directly connect with draining veins resulting in high-flow arteriovenous shunting and large intradural venous varicosities. Complete disconnection of the fistula is necessary to prevent hemorrhage or spinal compression. A surgical, rather than endovascular, approach proves favorable under specific circumstances. Due to the rarity of these pediatric fistulae, no large studies exist to enumerate these circumstances. This case report fills this void by detailing several considerations which favored surgery for a type IVc PAVF in a 17-year-old female patient.

Clinical Characteristics and Diagnostic Imaging of Low Back Pain: A Systematic Review

Low back pain (LBP) is a prevalent and debilitating condition with diverse clinical presentations and etiologies. This systematic review aimed to synthesize the current literature on the clinical characteristics and diagnostic imaging findings associated with LBP, providing a comprehensive overview of this multifaceted condition. A systematic search of electronic databases was conducted, encompassing studies published between 2018 and 2023. Studies reporting on clinical characteristics (pain location, duration, severity, radiation, associated symptoms) and diagnostic imaging findings (X-ray, CT, MRI) in LBP patients were included. Data extraction and quality assessment were performed independently by two reviewers. Twenty studies, with a total of 9,232 patients, were included. The most common clinical presentation was localized LBP (85%), followed by pain duration of less than 3 months (60%) and moderate pain severity (55%). Radicular pain and neurological deficits were reported in a significant minority of patients (20% and 15%, respectively). The most frequent imaging finding was degenerative changes (40-70%), followed by disc herniation (20-35%) and spondylolisthesis (5-12%). Other less frequent findings included spinal stenosis, compression fractures, and tumors. This review highlights the heterogeneity of clinical presentations and imaging findings in LBP. While localized LBP is predominant, a substantial proportion of patients experience radicular pain and neurological deficits. Degenerative changes are the most frequent imaging finding, followed by disc herniation. The choice of imaging modality should be guided by clinical presentation and suspected etiology.

Excellent RAI therapeutic response on a patient presenting skull metastasis of follicular thyroid cancer after 15 years.

Bone is the second most common site of metastasis for differentiated thyroid carcinoma (DTC). Bone metastasis (BMs) occur in about 10% of patients with DTC and is observed more often in follicular thyroid carcinoma (FTC) (7-28%) than papillary thyroid carcinoma (PTC) (1-7%). Bone metastasis is associated with unfavorable clinical outcomes mainly including skeletal-related events (SREs), such as pathologic fractures, bone pain, spinal cord compressions, and hypercalcemia, which negatively impact the quality of life of patients and reduce their life expectancy. Patients with BMs from DTC require comprehensive and multimodal treatment approaches, including radioiodine (RAI) therapy, palliative care, surgery, external beam radiotherapy, and targeted drug therapy. RAI therapy is the first-line treatment, despite being rather ineffective, especially in large BMs. The response to RAI therapy, either alone or in combination with BM focal treatment depends on iodine avidity. This study reports a rare case of metachronous skull bone metastasis from FTC in a 72-year-old female patient 15 years after initial treatment. The patient had an excellent response to RAI therapy, which resulted in the abnormal uptake disappearing. Following treatment, the patient has been disease-free for six years. This case confirms that a complete response to RAI treatment for BM depends on the degree of dedifferentiation of cancer cells, which highlights the need for long-term follow-up, especially for FTC patients.

Development of a chronic compression spinal cord injury model in neonatal and adult rats.

Spinal cord injury presents a significant burden globally, with traumatic spinal cord injury being the predominant cause historically. However, nontraumatic spinal cord injury (NTSCI) is emerging as a significant contributor, particularly in developed nations, yet it remains poorly understood due to underreporting and misclassification. NTSCI, spanning various etiologies such as bony growths, vascular conditions, infections, neoplastic conditions, and immune disorders, poses unique challenges in diagnosis and treatment, often resulting in lifelong morbidity. This study addresses the lack of suitable animal models for NTSCI research, especially in neonatal animals. Utilizing a solid spacer approach, we developed a compression NTSCI model applicable to both neonatal and adult Sprague-Dawley rats. Through anatomical measurements and invivo experiments, we confirmed the feasibility and safety of the spacer insertion procedure and observed no acute off-target effects. The versatility of this model lies in its adaptability to different ages of rats, offering a cost-effective and reproducible means to induce graded injuries. Moreover, behavioral assessments demonstrated observable hindlimb function, validating the model's utility for studying functional outcomes. Although challenges persist, particularly in accounting for spinal column growth in neonatal animals, this model fills a crucial gap in pediatric NTSCI research. By providing a platform to investigate pathophysiological mechanisms and test potential treatments, it offers promising avenues for advancing our understanding and management of pediatric NTSCI.

Case report: a rare case of intradural and pleural wall cystic echinococcosis

BackgroundCystic echinococcosis (CE) is prevalent in livestock farming regions around the world. However, it remains relatively rare compared to other infectious diseases. CE typically affects the liver, lungs, brain, and kidneys. Spinal and pleural wall involvement is exceedingly rare. We report a unique case of intradural and pleural wall CE in a young male, successfully treated with surgery and postoperative medication.Case presentationA 19-year-old Tibetan male from the Qinghai-Tibet Plateau was diagnosed with intradural and pleural wall CE through imaging, serology, and surgical pathology. According to the Dew/Braithwaite & Lees (BL) classification, his condition was an exceptionally rare form of spinal echinococcosis, compounded by an even rarer pleural wall involvement. Prompt surgical intervention and postoperative medication resulted in significant improvement in spinal cord compression symptoms.ConclusionsThis case highlights the diagnostic and therapeutic challenges of rare CE locations. MRI proved superior to CT in diagnosing bony cystic echinococcosis. Early surgical intervention combined with medication facilitates spinal cord function recovery, providing valuable insights for managing similar cases.

Non-traumatic spinal cord injury - etiological profile and associated factors: single rheumatological center experience.

Non-traumatic spinal cord injury (NTSCI) represents a medical-surgical emergency. In Burkina Faso, limited data exist on the etiological profiles of this syndrome in rheumatology. This study aimed to describe the etiological profile of NTSCI in the Rheumatology Department of the University Hospital Center of Bogodogo (CHU-B). This was a cross-sectional, retrospective study with descriptive and analytical aims, conducted from March 1, 2017, to December 31, 2023, in the Rheumatology Department of CHU-B. Patients diagnosed with non-traumatic spinal cord compression syndrome during hospitalization were included. The frequency in the Rheumatology Department of NTSCI was 2.94%, accounting for 104 patients. There were 68 men (65.38%), with a sex ratio of 1.88. The average age of the population was 57.91 years. All patients experienced back pain, with a lumbar location in 77 patients (74.04%). The average duration of the motor deficit was 2.97 months. A total of 3,532 patients were admitted to the conventional hospitalization unit of the Rheumatology Department at the CHU-B from March 1, 2017, to December 31, 2023. Among these, 104 patients had NTSCI, yielding a frequency of 2.94%. Spinal MRI was performed in 58 patients (55.77%), and the compression was extradural in 76.92% of cases (n = 80). The etiologies identified were Pott's disease in 32 patients (30.77%), followed by spinal metastases in 22 patients (21.15%). Twenty-nine patients (27.89%) experienced complications related to prolonged bed rest. No factor was significantly associated with the recovery of the motor deficit. Non-traumatic spinal cord injury is relatively rare in rheumatological practice in Ouagadougou. The etiology is predominantly Pott's disease, which confirms the geographical distribution of NTSCI causes.

Spinal metastases and metastatic spinal cord compression: interpretation for National Institute for Health and Care Excellence (NICE) 2023 guideline

Spine is a common site of metastasis in patients with malignant tumors, and tumor metastasis to the spine can lead to pain, pathological fractures, and nerve compression. In order to optimize the diagnosis and management of patients with spinal metastases and metastatic spinal cord compression (MSCC), the National Institute for Health and Care Excellence (NICE) in the UK proposed the first diagnostic and treatment guidelines for patients with MSCC (or at risk of MSCC) in 2008. In recent years, with the rapid advancement of spinal surgery and radiotherapy technology, the standardized process of MSCC diagnosis and treatment urgently needs to be updated. In 2023, NICE launched new guidelines for spinal metastases and MSCC. Based on a thorough study of the guidelines, this article discusses and interprets pain management, corticosteroid treatment, application of bisphosphonates and denosumab, tools for assessing spinal stability and prognosis, radiation therapy, surgical timing and approach, etc., providing reference for clinical diagnosis and treatment in China.

Accurate Preoperative Localization of Thoracolumbar Disc Extrusion in Dogs: A Prospective Controlled Study.

Intervertebral disc disease (IVDD) is a very common cause of spinal cord compression in dogs. The errors of human surgeons operating on the wrong level or wrong side is a recognized problem and has been largely analyzed. To date, little information is available regarding these errors in dogs. The objective of this study was to assess the accuracy of disc localization prior to possible surgery for IVDD to ensure the surgeon begins their incision directly over the extruded disc. Eighty-five chondrodystrophic or brachycephalic dogs that presented with IVDD confirmed by CT or MRI scan were included in the study. Two small Backhaus clamps were placed cranial and caudal to the lesion site and a control clamp placed at the wing of the ilium. The main interest was whether the surgeon was able to preoperatively pinpoint the correct site for the surgery. Dorsoventral radiographs were taken to verify by another person if the clamps had been placed in the correct position. If the result was incorrect, the surgeon was asked to try again without knowing that the clamps were incorrect, and another radiograph was taken. This was repeated until the position was correct. The results were recorded as correct or incorrect and the number of attempts were registered. The results suggested no significant trend over time for any of the outcomes examined. There were some slight improvements over time, but none of the results was close to statistical significance. The findings of the study showed that in the thoracolumbar region the surgeon has a higher chance of incorrectly marking the exact site for surgery.

Impact of congenital spinal stenosis on the outcome of three-level anterior cervical discectomy and fusion in patients with cervical spondylotic myelopathy: a retrospective study.

To investigate whether congenital cervical spinal stenosis (CCSS) affects the outcome of three-level anterior cervical discectomy and fusion (ACDF) in patients with cervical spondylotic myelopathy (CSM). One hundred seventeen patients with CSM who underwent three-level ACDF between January 2019 and January 2023 were retrospectively examined. Patients were grouped according to presence of CCSS, which was defined as Pavlov ratio ≤ 0.75. The CCSS and no CCSS groups comprised 68 (58.1%) and 49 (41.9%) patients, respectively. The Japanese Orthopaedic Association (JOA) score did not significantly differ between the two groups at any postoperative time point (p > 0.05). The JOA improvement rate was lower in the CCSS group 1 month after surgery (41.7% vs. 45.5%, p < 0.05), but showed no difference at any follow-up time point after one month. Multivariate logistic regression identified preoperative age (OR = 10.639), JOA score (OR = 0.370), increased signal intensity (ISI) in the spinal cord on T2-weighted MRI (T2-WI) (Grade 1: OR = 6.135; Grade 2: OR = 29.892), and degree of spinal cord compression (30-60%: OR = 17.919; ≥60%: OR = 46.624) as independent predictors of a poor oneyear outcome (JOA recovery rate < 50%). Although early JOA improvement is slower in the CCSS group, it does not affect the final neurological improvement at 1 year. Therefore, CCSS should not be considered a contraindication for three-level ACDF in patients with CSM. The main factors influencing oneyear outcome were preoperative age, JOA score, ISI grade, and degree of spinal cord compression.

Surgical treatment of spinal neurenteric cysts

Background. Spinal neurenteric cysts are very rare benign space-occupying lesions in the vertebral canal emerging due to anomalies of neural tube development during prenatal development of the fetus. Clinically, neurenteric cysts can manifest both in childhood and adulthood.Aim. To evaluate the results of surgical treatment of adult patients with spinal neurenteric cysts who were operated on at the Neurosurgery Division of the Clinic of Nervous System Diseases of the I.M. Sechenov First Moscow State Medical University.Materials and methods. The study group included 3 patients (2 women and 1 man) with mean age of 33 years. The main diagnosis method was magnetic resonance imaging. In all cases, radical cyst resection was performed with subsequent histological examination of cyst walls.Results. In all observations, cyst walls had local areas of increased density and thickness: a distinctive solid component accumulating the contrast agent in magnetic resonance images. This type of structure is considered extremely rare per descriptions presented in literature, but in our case series it was detected in all patients. Cyst resection led to pain syndrome regression and almost full regression of clinical manifestations of spinal cord compression which justifies active surgical tactics in this pathology.Conclusion. Neurenteric cyst of the vertebral canal can cause spinal cord compression. The main diagnostic method of this pathology is magnetic resonance imaging, however magnetic resonance semiotics of these cyst has not been standardized. The presence of constant pain syndrome without marked clinical signs of compression myelopathy is sufficient reason for cyst resection surgery. Cyst resection allowsto achieve regression of pain syndrome and neurological abnormalities caused by spinal cord compression.

Cervical epidural hematoma: a case series highlighting uncommon causes

BackgroundCervical epidural hematoma (CEH) is a rare but potentially devastating condition, characterized by the accumulation of blood within the epidural space of the cervical spine, leading to spinal cord compression (Perron AD, Huff JS. Spinal cord disorders. In: Marx JA, et al. editors. Rosen’s emergency medicine: concepts and clinical practice. 8th ed. Philadelphia: Saunders; 2013. pp. 1419–27.); (Raasck K, Habis AA, Aoude A, Simoes L, Barros F, Reindl R. Spontaneous spinal epidural hematoma management: a case series and literature review. Spinal Cord Ser Cases. 2017;3:16043. https://doi.org/10.1038/scsandc.2016.43.); (Ryo Yamamoto M, Ito H, Shimuzu K, Wakabayashi H, Oyama. Two cases of cervical epidural hematoma presenting with left-sided hemiplegia and requiring surgical drainage. Cureus. 2022;14(4):e23915. https://doi.org/10.7759/cureus.23915.). While trauma and iatrogenic causes are well-documented, cases attributed to neck strain and acupuncture are uncommon. (Raasck K, Habis AA, Aoude A, Simoes L, Barros F, Reindl R. Spontaneous spinal epidural hematoma management: a case series and literature review. Spinal Cord Ser Cases. 2017;3:16043. https://doi.org/10.1038/scsandc.2016.43.); (Shiraishi S, Goto I, Kuroiwa Y, Nishio S, Kinoshita K. Spinal cord injury as a complication of an acupuncture. Neurology. 1979;29(8):1188–90. https://doi.org/10.1212/wnl.29.8.1188.) Here, we present two cases of CEH secondary to these unusual aetiologies. Both cases highlight the importance of considering uncommon causes of CEH to ensure early recognition and prompt treatment.Case presentationsCase 1 is an 81-year-old lady who presented with left hemiparesis and paraesthesia following a fall with neck strain. Magnetic resonance imaging (MRI) of cervical spine revealed left C3-C7 epidural haematoma with severe cord compression. In Case 2, a 35-year-old gentleman experienced sudden onset numbness and weakness in all limbs just 10 minutes after receiving acupuncture. MRI showed an epidural hematoma at the C2-C4 levels. Both patients underwent immediate surgical decompression and had significant recovery.ConclusionAlthough CEH is a rare occurrence, it can potentially be a neurosurgical emergency. Physicians must remain cognizant of the diverse aetiologies associated with CEH and the necessity for early recognition and immediate treatment.

Spinal cord compression by cystic IgG4-related spinal pachymeningitis mimicking neurocysticercosis: a case report

BackgroundTo report a case of IgG4-related pachymeningitis presenting with cystic lesions mimicking neurocysticercosis.Case presentationA 40-year-old female patient with tetraparesis, dysphagia and dysphonia was evaluated with clinical examination, magnetic resonance imaging, and meningeal biopsy. Magnetic resonance imaging (MRI) revealed diffuse pachymeningeal enhancement involving the cranial, cervical, thoracic, and lumbar segments with spinal cord compression and cystic lesions. CSF immunology was initially positive for cysticercus cellulosae. After disease progression a meningeal biopsy was compatible with IgG4 related disease. The patient had partial response to rituximab and needed multiple surgical procedures for spinal cord decompression and CSF shunting.ConclusionsThis case highlights the possibility of IgG4-related disease in patients with diffuse pachymeningitis causing spinal cord compression, even with cystic lesions on MRI. Diagnosis of IgG4-related pachymeningitis is paramount due to the possibility of treatment response to immunotherapy, particularly to anti-CD20 agents.

Ischemia-reperfusion injury after spinal cord decompressive surgery-An invivo rat model.

Although decompression surgery is the optimal treatment for patients with severe degenerative cervical myelopathy (DCM), some individuals experience no improvement or even a decline in neurological function after surgery, with spinal cord ischemia-reperfusion injury (SCII) identified as the primary cause. Spinal cord compression results in local ischemia and blood perfusion following decompression is fundamental to SCII. However, owing to inadequate perioperative blood flow monitoring, direct evidence regarding the occurrence of SCII after decompression is lacking. The objective of this study was to establish a suitable animal model for investigating the underlying mechanism of spinal cord ischemia-reperfusion injury following decompression surgery for degenerative cervical myelopathy (DCM) and to elucidate alterations in neurological function and local blood flow within the spinal cord before and after decompression. Twenty-four Sprague-Dawley rats were allocated to three groups: the DCM group (cervical compression group, with implanted compression material in the spinal canal, n = 8), the DCM-D group (cervical decompression group, with removal of compression material from the spinal canal 4 weeks after implantation, n = 8), and the SHAM group (sham operation, n = 8). Von Frey test, forepaw grip strength, and gait were assessed within 4 weeks post-implantation. Spinal cord compression was evaluated using magnetic resonance imaging. Local blood flow in the spinal cord was monitored during the perioperative decompression. The rats were sacrificed 1 week after decompression to observe morphological changes in the compressed or decompressed segments of the spinal cord. Additionally, NeuN expression and the oxidative damage marker 8-oxoG DNA were analyzed. Following spinal cord compression, abnormal mechanical pain worsened, and a decrease in forepaw grip strength was observed within 1-4 weeks. Upon decompression, the abnormal mechanical pain subsided, and forepaw grip strength was restored; however, neither reached the level of the sham operation group. Decompression leads to an increase in the local blood flow, indicating improved perfusion of the spinal cord. The number of NeuN-positive cells in the spinal cord of rats in the DCM-D group exceeded that in the DCM group but remained lower than that in the SHAM group. Notably, a higher level of 8-oxoG DNA expression was observed, suggesting oxidative stress following spinal cord decompression. This model is deemed suitable for analyzing the underlying mechanism of SCII following decompressive cervical laminectomy, as we posit that the obtained results are comparable to the clinical progression of degenerative cervical myelopathy (DCM) post-decompression and exhibit analogous neurological alterations. Notably, this model revealed ischemic reperfusion in the spinal cord after decompression, concomitant with oxidative damage, which plausibly underlies the neurological deterioration observed after decompression.

Microsurgical treatment of spinal intradural capillary hemangioma: A consecutive case series of 18 patients and literature review

PurposeIntradural capillary hemangioma is a rare condition with unclear etiology. Although intradural capillary hemangiomas are benign, they exhibit significant proliferative activity, and their clinical significance should not be underestimated. MethodsWe report a series of spinal intradural capillary hemangiomas to illustrate the characteristics, surgical management, and outcomes. MethodsA total of 18 consecutive patients who underwent microsurgical treatment were retrospectively reviewed. Patient characteristics were recorded in each case, including presenting symptoms, imaging findings, neurologic status, a surgical procedure performed and follow-up. ResultsThere were 11(61.1 %) male and 7(38.9 %) female patients, with the ages ranging from 25 to 62 years. The thoracic spine was the most commonly affected site, accounting for 77.8 % (14/18) of the cases. 9 tumors were identified as intradural extramedullary, 3 tumors as intramedullary, and 2 tumors as both extramedullary and intramedullary. There were also 4 cases of tumors localized to the cauda equina. Clinical presentations included back pain, sensory deficits, weakness and gait ataxia with a duration of symptoms ranging from 1 to 12 months. The lesion was hypointense or isointense with the spinal cord on T1- weighted images and hyperintense on T2-weighted images and showed intense enhancement after contrast medium injection. All patients underwent surgical treatment, and no significant postoperative complications were observed. Postoperatively, patients were followed up for an average of 44 months. Follow-up showed that the majority of patients experienced significant improvement in neurological function, with no cases of recurrence. ConclusionSurgical resection is typically the preferred method for treating spinal intradural capillary hemangiomas. Complete resection can relieve spinal cord compression and minimize the risk of recurrence.

Development of a mouse model of chronic ventral spinal cord compression: Neurobehavioral, radiological, and pathological changes.

The main objective of this study was to establish a mouse model of spinal ligament ossification to simulate the chronic spinal cord compression observed in patients with ossification of the posterior longitudinal ligament (OPLL). The study also aimed to examine the mice's neurobiological, radiological, and pathological changes. In the previous study, a genetically modified mouse strain was created using Crispr-Cas9 technology, namely, Enpp1 flox/flox /EIIa-Cre (C57/B6 background), to establish the OPLL model. Wild-type (WT) mice without compression were used as controls. Functional deficits were evaluated through motor score assessment, inclined plate testing, and gait analysis. The extent of compression was determined using CT imaging. Hematoxylin and eosin staining, luxol fast blue staining, TUNEL assay, immunofluorescence staining, qPCR, and Western blotting were performed to evaluate levels of apoptosis, inflammation, vascularization, and demyelination in the study. The results demonstrated a gradual deterioration of compression in the Enpp1 flox/flox /EIIa-Cre mice group as they aged. The progression rate was more rapid between 12 and 20 weeks, followed by a gradual stabilization between 20 and 28 weeks. The scores for spinal cord function and strength, assessed using the Basso Mouse Scale and inclined plate test, showed a significant decline. Gait analysis revealed a noticeable reduction in fore and hind stride lengths, stride width, and toe spread. Chronic spinal cord compression resulted in neuronal damage and activated astrocytes and microglia in the gray matter and anterior horn. Progressive posterior cervical compression impeded blood supply, leading to inflammation and Fas-mediated neuronal apoptosis. The activation of Bcl2 and Caspase 3 was associated with the development of progressive neurological deficits (p < 0.05). The study presents a validated model of chronic spinal cord compression, enabling researchers to explore clinically relevant therapeutic approaches for OPLL.

Anterior Cervical Discectomy and Fusion for the Treatment of Pincer Cervical Spondylotic Myelopathy: A Single-Center Retrospective Study

BackgroundAnterior and posterior compression of the cervical spinal cord is usually called pincer cervical spondylotic myelopathy (p-CSM), and surgery is generally recommended; however, there is some controversy about the choice of surgical approach because single anterior or posterior surgery cannot effectively relieve contralateral compression, and combined surgery may cause problems related to trauma and effects on cervical spine function. ObjectiveTo investigate the feasibility and indications of single anterior cervical discectomy and fusion (ACDF) for the treatment of p-CSM. MethodsThe data of twenty-one p-CSM patients who were treated with ACDF at a single center from 2019 to 2022 were collected. Neurological status was evaluated by the Japanese Orthopedic Association (JOA) scoring system. The radiological parameters included the percentage of space occupied by the spinal canal, the cervical sagittal Cobb angle, and the cross-sectional area of the spinal cord before and after the operation. Complications and spinal cord compression rates were also observed. Correlations between the decompressive effects and various prognostic factors were statistically analyzed. ResultsThe mean follow-up period was 24.1±3.55 months. The average JOA score significantly increased, with a mean recovery rate of 65.88±8.97%. The fusion rate was satisfactory. Correlation analysis revealed that the number of operation segments and age were important predictors of decompressive effects. There was no further deterioration of spinal cord function after the operation. ConclusionACDF is an effective method for treating pincer spinal cord compression in terms of neurological recovery, radiological parameters, fusion rates, and complications, especially for patients younger than 60 years of age with single operative segments.

Effective management of hip adductor spasticity: A case report on diagnostic obturator nerve block and botulinum toxin injection

It is important to distinguish spasticity from contracture in patients presenting with upper motor neuron (UMN) syndrome and restricted range of movement (ROM) because treatment strategies differ. We demonstrate how we perform ultrasound-guided obturator nerve (ON) block to distinguish spasticity from contracture in a patient with bilateral hip adductor spasticity secondary to a non-traumatic spinal cord injury. We report here a 26-year-old gentleman with a history of Mycobacterium tuberculosis thoracic spondylodiscitis with spinal cord compression. His neurological status was T6 ASIA impairment scale C and his impairments were spastic paraparesis, neurogenic bowel and neurogenic bladder. He had difficulty with wheelchair transfer and positioning, perineal care as well as intermittent self- catheterization due to severe spasticity of bilateral hip adductors with significantly restricted ROM. Bilateral ON block resulted in clinically significant improvement in spasticity and ROM of the right lower limb but not the left. The effects were similar following intramuscular BTX-A injection of bilateral hip adductors. Ultrasound-guided diagnostic ON block via the distal approach is inexpensive, safe and can be readily performed in clinic setting without the need for sedation or prolonged monitoring. Improvement in MAS score of at least 1 point and ROM of at least 15° following ON block should be used to distinguish hip adductor spasticity from contracture in patients with UMN syndrome and reduced ROM. Diagnostic nerve block allows for greater physician certainty when discussing various treatment options including expedited referral for surgical consult. The findings of this report offer insights into the decision-making process in managing complex presentations of UMN syndrome.