Intervertebral Foramen Research Articles

Two simultaneous anatomical variations of the cervical spine - a case report discussing the concept of tandem anomalies.

forming a bony opening through which the vertebral artery (VA) enters the vertebral canal. Block vertebra is a synostosis of at least two vertebral bodies that did not separate during the embryological development. It is worth distinguishing it from the Klippel-Feil syndrome, as the latter oftentimes involves other abnormalities (namely skeletal) and is typically diagnosed in childhood. Both variants could potentially lead to an impairment of the blood flow through the VA. Case report: The following case report presents a finding of two anomalies of the cervical spine, found in a 38 y.o. female patient suffering from dizziness. A synostosis of the C4 and C5 vertebral bodies, arches and zygapophysial (facet) joint, was noted by the examining radiologist, with marked narrowing of the intervertebral foramen. Furthermore, second anatomical variation in the form of the complete bilateral arcuate foramen was identified superior to the groove for the VA on the upper surface of the posterior arch of the atlas. Conclusions: To the best knowledge of the authors, this case report is the first to present a co-existing block vertebra and bilateral complete arcuate foramen. Common presence of at least two anatomical variations that could have a synergistic clinical effect could possibly be termed 'tandem anomaly.' Notwithstanding, identification of a single anomaly explaining a patient's symptoms does not absolve the medical professionals from searching for any other potential variations that could also be present and could further influence the clinical picture.

Percutaneous Endoscopic Unilateral-Approach Bilateral Decompression for Lumbar Spinal Stenosis.

Lumbar spinal stenosis (LSS) involves the narrowing of the spinal canal due to degenerative changes in the vertebral joints, intervertebral discs, and ligaments. LSS encompasses central canal stenosis (CCS), lateral recess stenosis (LRS), and intervertebral foramen stenosis (IFS). The utilization of lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) has gained popularity in the treatment of CCS and LRS. This popularity is attributed to the rapid development of endoscopic instruments and the progress of endoscopic philosophy. In this technical report, a detailed introduction to the steps and key points of LE-ULBD is provided. Simultaneously, a retrospective review of 132 consecutive patients who underwent LE-ULBD for central canal and/or lateral recess stenosis was conducted. The outcomes after more than two years of follow-up were assessed using the visual analogue score (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores, and the modified MacNab criteria to evaluate surgical efficacy. All 132 patients underwent LE-ULBD successfully. Among them, 119 patients were rated as "excellent," while 13 patients were rated as "good" based on the modified MacNab criteria during the last follow-up. Incidental dural tears occurred in four cases, but there were no post-operative epidural hematomas or infections. The experience demonstrates that LE-ULBD is a less invasive, effective, and safe approach. It can be considered as an alternative option for treating patients with lumbar central canal stenosis and/or lateral recess stenosis.

Comparison of safety and efficacy of posterior lumbar interbody fusion (PLIF) and modified transforaminal lumbar interbody fusion (M-TLIF) in the treatment of single-segment lumbar degenerative diseases

ObjectiveTo compare modified transforaminal lumbar interbody fusion (M-TLIF) with posterior lumbar interbody fusion (PLIF) in the treatment of single-segment lumbar degenerative disorders in order to assess its safety and effectiveness.MethodsFrom January 2016 to January 2021, 74 patients who received single-segment M-TLIF were examined. A total of 74 patients having single-segment PLIF during the same time period were included in a retrospective controlled study using the same inclusion and exclusion criteria. The two groups were compared in terms of the fusion rate, the Oswestry disability index (ODI), the visual analogue scale of low back pain (VAS), the perioperative condition, the postoperative complications, and the postoperative neighbouring segment degeneration.ResultsAll patients had surgery satisfactorily and were monitored for at least a year afterwards. The baseline values for the two groups did not significantly differ. The interbody fusion rate between PLIF (98.65%) and M-TLIF (97.30%) was not significantly different. In the follow-up, the M-TLIF group's VAS score for low back and leg pain was lower than that of the PLIF group. The ODI score of the M-TLIF group was lower than that of the PLIF group at 7 days and 3 months following surgery. Both groups' post-op VAS and ODI scores for low back and leg pain were much lower than those from before the procedure. In M-TLIF group, the operation time, drainage tube extraction time, postoperative bed rest time and hospital stay time were shorter, and the amount of intraoperative blood loss was less. Compared with those before operation, the height of intervertebral space and intervertebral foramen were significantly increased in both groups during postoperative follow-up (P < 0.05). The postoperative complications and adjacent segment degeneration of M-TLIF were significantly lower than those of PLIF.ConclusionsM-TLIF is a safe and effective treatment for lumbar degenerative disorders, with a high fusion rate and no significant difference between M-TLIF and PLIF. M-TLIF's efficacy and safety are comparable to that of PLIF, particularly in terms of early relief of low back pain and improvement in quality of life following surgery. Therefore, M-TLIF technology can be popularized and applied in clinic.

Role of MRI in detection of lumber spine pathologies using 1.5 tesla (MRI)

Background: This study investigates the diagnostic accuracy of MRI in detecting various lumbar spine pathologies in patients with lower back pain. Lower back pain (LBP) is a prevalent issue affecting 80%–85% of the population during their lifetime, contributing significantly to global disability. LBP is nonspecific in 95% of cases but can stem from underlying pathologies such as disc herniation, spinal stenosis, infection, inflammation, tumours, or fractures. Objective: To emphasize the importance of magnetic resonance imaging (MRI) in patients suspected of lumbar spinal examinations. Methods and material: The research focused on adult patients with radicular syndrome, spinal stenosis, spinal tumours, spinal fractures, spinal infection/inflammation, disc herniation, spondylolisthesis, spondylolysis, ankylosing spondylitis, disc displacement, osteoporotic fractures, and other degenerative disc diseases. Utilizing a 1.5 Tesla MRI machine, the descriptive, cross-sectional observational study spanned one year and included 150 patients. Results: revealed that diffuse disc bulge (87.33%) and disc protrusion (87.33%) were the most common pathologies, followed by partial desiccation (34.67%), neural foramina stenosis (16.00%), spondylosis (1.33%), osteoporosis (12.00%), spinal haemorrhage (2.00%), osteophyte spurs (29.33%), and sclerotic changes (3.33%). Discussion and Conclusion: The study's discussion highlighted notable findings, including a higher prevalence of lumbar spine abnormalities in females (51.33%) and a substantial association with a history of lower back pain (40.00%). The conclusion underscores the significance of MRI in diagnosing lumbar spine pathologies, with specific attention to the prevalence of disc bulge and protrusion in the studied population.

Effectiveness of Physical Activity Combined with Medical Rehabilitation in Cervical HNP Patient Post Radiofrequency Ablation (RFA) Procedure: A Case Report

Introduction : Cervical disc herniation most likely happens in people over 30-years-old-age with a job that need holding a posture that can make body alignment easily diverge. Case presentation : A 48-year-old male presented with radiate pain from the wrist going upward to the neck. He also felt numbness or tingling sensation on the right side of the arm. MRI showed protrusion of intervertebral disc C5-6 and C6-7 with narrowing of right and left neural foramen. The patient was diagnosed with C5-C6 cervical disc herniation, Radiofrequency Ablation (RFA) was performed twice. An Anterior Cervical Discectomy and Fusion (ACDF) procedure was suggested but the patient declined it and then he received 3 months of physical therapy, and he performed physical activity regularly. Eventually the patient reported resolution of all the symptoms after. Conclusions : This case report emphasizes the effectiveness of combining physical activity with medical rehabilitation in a patient with cervical herniated nucleus pulposus after RFA procedure. The combination of these approaches yielded positive results measured by NPRS and ROM examination, with the patient experiencing reduced pain, improved daily function, and return to their daily activities.

Study of Morphometric Analysis of Foramen Transversarium and Uncinate Process and Clinical Relevance in Typical Cervical Vertebrae

The foramen transversarium differentiates the cervical vertebrae from the other vertebrae of the spinal column. From the first part of the subclavian artery, the vertebral artery arises and passes through the foramen transversarium. FT protects the vertebral artery. The medial boundary of the luschka joint is a safe sight to protect the vertebral artery. The Uncovertebral Joint, also known as the Luschka Joint, is a joint that was formed by the Uncinate Process between the cervical vertebra bodies. These joints form the medial border of an intervertebral foramen in the cervical area below C-2 and are rarely found on the first thoracic vertebra. The present study was carried out on 100 dry human typical cervical vertebrae of unknown age and sex to determine the morphometric dimensions of FT and Uncinate Process in typical cervical vertebrae. The dimensions were taken by the digital vernier caliper on the superior aspect of the FT and Uncinate Process. The length and width of the FT were more on the left side than on the right side which was statistically insignificant (p-value &gt;0.05). The narrow FTs were also observed in the present study. The mean difference between the Right and Left sides of the Uncinate Process was statistically not significant (p-value&gt;0.05).

Clinical and imaging findings in dogs with nerve root signature associated with cervical intervertebral disc herniation.

Intervertebral disc herniation (IVDH) is the most common spinal cord disease in dogs. Little information is available regarding the clinical presentation of nerve root signature (NRS) associated with cervical IVDH. To detail the clinical and magnetic resonance imaging (MRI) findings in dogs with NRS associated with cervical IVDH. Forty-seven client-owned dogs presenting with thoracic limb NRS and MRI confirmed IVDH. Medical records from 2010 to 2020 were retrospectively reviewed for dogs that met inclusion criteria. Imaging studies were evaluated by 2 individuals to characterize location and severity of neural tissue compression. Chondrodystrophoid dogs comprised the majority of the study cohort, with dachshund the most common breed (n = 10). Three-quarters of dogs were ≥7 years of age. Interobserver agreement was moderate or good for all of the imaging variables evaluated. The C6-C7 intervertebral disc space was significantly overrepresented (P = .01), comprising 32% (15/47) of the affected discs. However, 42% (20/47) of cases involved C2-C3 though C4-C5 disc sites. Disc material was more frequently located laterally compared to medially within the vertebral canal (P = .0005), and to be associated with compression of the nerve root at the level of the intervertebral foramen (P = .012). NRS is most commonly associated with lateralized or foraminal cervical disc herniations. It is most prevalent with C6-C7 intervertebral disc involvement, suggesting that there might be unique anatomic factors that contribute to development of NRS at this site, but can be a clinical manifestation of IVDH occurring anywhere along the cervical spine.

The Impact of Posterior Intervertebral Osteophytes on Patient-Reported Outcome Measures After L5-S1 Anterior Lumbar Interbody Fusion and Transforaminal Lumbar Interbody Fusion.

Retrospective cohort study. (1) To develop a reliable grading system to assess the severity of posterior intervertebral osteophytes and (2) to investigate the impact of posterior intervertebral osteophytes on clinical outcomes after L5-S1 decompression and fusion through anterior lumbar interbody fusion (ALIF) and minimally-invasive transforaminal lumbar interbody fusion (MIS-TLIF). There is limited evidence regarding the clinical implications of posterior lumbar vertebral body osteophytes for ALIF and MIS-TLIF surgeries and there are no established grading systems that define the severity of these posterior lumbar intervertebral osteophytes. A retrospective analysis of patients undergoing L5-S1 ALIF or MIS-TLIF was performed. Preoperative and postoperative patient-reported outcome measures of the Oswestry Disability Index (ODI) and leg Visual Analog Scale (VAS) at 2-week, 6-week, 12-week, and 6-month follow-up time points were assessed. Minimal clinically important difference (MCID) for ODI of 14.9 and VAS leg of 2.8 were utilized. Osteophyte grade was based on the ratio of osteophyte length to foraminal width. "High-grade" osteophytes were defined as a maximal osteophyte length >50% of the total foraminal width. A total of 70 consecutive patients (32 ALIF and 38 MIS-TLIF) were included in the study. There were no significant differences between the two cohorts in patient-reported outcome measures or achievement of MCID for Leg VAS or ODI preoperatively or at any follow-ups. On multivariate analysis, neither the surgical approach nor the presence of high-grade foraminal osteophytes was associated with leg VAS or ODI scores at any follow-up time point. In addition, neither the surgical approach nor the presence of high-grade foraminal osteophytes was associated with the achievement of MCID for leg VAS or ODI at 6 months. ALIF and MIS-TLIF are both valid options for treating degenerative spine conditions and lumbar radiculopathy, even in the presence of high-grade osteophytes that significantly occupy the intervertebral foramen. 3.

Endoscopic posterior cervical foraminotomy techniques and outcomes

Posterior cervical foraminotomy is a commonly performed procedure to address cervical radiculopathy through direct decompression of the neural foramen by partially resecting the dorsal aspect of the facet joint. The procedure is an alternative to anterior cervical approaches such as anterior cervical discectomy and fusion and cervical disc arthroplasty, which require complete discectomy to address foraminal stenosis that cause cervical radiculopathy. The procedure has evolved from open to minimally invasive techniques including endoscopic methods, which has recently increased in interest by spine surgeons. This review discusses the currently existing endoscopic techniques for cervical posterior foraminotomy and synthesizes the existing literature.

Comparison of the surgical outcomes of the posterior approach, video-assisted thoracic surgery, and combined approach for thoracic dumbbell tumors based on a new classification: a retrospective study

The appropriate surgical treatment strategy was based on the regions of tumor invasion. There is no classification to aid the surgeon in selection. A retrospective study of the clinical data of patients who underwent resection of thoracic dumbbell tumors at the Neurosurgery and Thoracic Surgery Department of Hospital between January 1, 2016, and December 31, 2021 was conducted. Patient data, images, and surgical outcome data were collected. The thoracic spine was divided into areas A, B, and C with respect to the line through the middle of the intervertebral foramen and the line of the costo-transverse joint lateral margin in the horizontal plane. Type I tumors were located in areas A or A and B, type II tumors were located in areas B or B and C, and type III tumors were located in areas A, B, and C. Fifty-five patients with thoracic dumbbell tumors were surgically treated (mean age, 43.1 years; 22 (40%) female). The patients with type I and III tumors underwent the posterior approach, type III tumors had more bleeding during the operation and longer operation times than type I. Among the patients with type II tumors who underwent video-assisted thoracic surgery and the posterior approach, the posterior group had more bleeding and a longer operation time than the others. The patients with type III tumors underwent the combined approach and the posterior approach; although there was no clear difference in the bleeding volume or operation time, the combined approach group had a lower incidence of complications. The new classification of different types of thoracic dumbbell tumors can simply and effectively guide the selection of surgery.

Evaluation of Three Imaging Methods to Quantify Key Events in Pelvic Bone Metastasis.

The purpose of this study is to compare turbo spin echo diffusion-weighted images in radial trajectory (BLADE DWI) with multi-shot echoplanar imaging (RESOLVE DWI) for imaging the metastatic lesion in the pelvic bone to find a correlation between ADC values and standardized uptake values (SUVs) of FDG uptake in PET/CT. The study also seeks to compare the values of metastatic lesions with those of benign bone lesions, specifically red marrow hyperplasia. The retrospective IRB-approved study included patients with bone metastasis and red marrow hyperplasia in the pelvic bone who underwent 3.0 T MRI with BLADE/RESOLVE DWI sequences and F-18 FDG PET/CT within one month. BVC (best value comparator) was used in determining the nature of bone lesions. Apparent diffusion coefficient (ADC) and standardized uptake value (SUV) were measured by a radiologist and a nuclear medicine physician. MRI image quality was graded with a Likert scale regarding the visualization of the sacroiliac joint, sacral neural foramen, hamstring tendon at ischial tuberosity, and tumor border. Signal-to-noise ratio (SNR) and imaging time were compared between the two DWIs. Mean, peak, and maximum SUVs between metastatic and benign red marrow lesions were compared. SUVs and ADC values were compared. AUROC analyses and cut-off values were obtained for each parameter. Mann-Whitney U, Spearman's rho, and Kolmogorov-Smirnov tests were applied using SPSS. The final study group included 58 bone lesions (19 patients (male: female = 6:13, age 52.5 ± 9.6, forty-four (75.9%) bone metastasis, fourteen (24.1%) benign red marrow hyperplasia). ADCs from BLADE and RESOLVE were significantly higher in bone metastasis than red marrow hyperplasia. BLADE showed higher ADC values, higher anatomical scores, and higher SNR than RESOLVE DWI (p < 0.05). Imaging times were longer for BLADE than RESOLVE (6 min 3 s vs. 3 min 47 s, p < 0.05). There was a poor correlation between ADC values and SUVs (correlation coefficient from 0.04 to 0.31). The AUROC values of BLADE and RESOLVE MRI ranged from 0.892~0.995. Those of PET ranged from 0.877~0.895. The cut-off ADC values between the bone metastasis and red marrow hyperplasia were 355.0, 686.5, 531.0 for BLADE min, max, and average, respectively, and 112.5, 737.0, 273.0 for RESOLVE min, max, and average, respectively. The cut-off SUV values were 1.84, 5.01, and 3.81 for mean, peak, and max values, respectively (p < 0.05). Compared with RESOLVE DWI, BLADE DWI showed improved image quality of pelvic bone MRI in the aspect of anatomical depiction and SNR, higher ADC values, albeit longer imaging time. BLADE and RESOLVE could differentiate bone metastasis and red marrow hyperplasia with quantifiable cut-off values. Further study is necessary to evaluate the discrepancy between the quantifiers between PET and MRI.

Tumor neuroectodérmico primitivo na coluna cervical de um cão - Relato de Caso

ABSTRACT A case of peripheral primitive neuroectodermal tumor in the cervical region of a canine is described. The patient was a canine, male, five years old, large size, with acute neurological clinical signs, severe neck pain and tetraplegia. On computed tomography, an oval-shaped mass located dorsally to cervical vertebrae C4 to C7 was observed, with infiltration over the spinal cord between vertebrae C4 and C5, discreetly widening the dorsal intervertebral foramina of the cervical vertebrae and compressing the dorsal portion of the spinal cord of this segment. Under microscopy, the neoplastic cells were small, irregular in shape and with scarce cytoplasm. Immunoreactivity for vimentin, which can only be expressed in PTNEs tumors, was decisive for diagnostic confirmation. Additionally, the positivity of the S-100 protein, which is expressed in neuroectodermal cells mainly of the neural crest cells, reinforced the classification as PTNE, and the negativity in the expression for glial fibrillary acidic protein (GFAP) ruled out the presence of small cell glioma of the central nervous system. Based on the clinical history, imaging exams, cellular morphology and mainly on immunohistochemical staining, the diagnosis of primitive neuroectodermal tumor (PTNE) with infiltration and compression of the spinal cord in the cervical region of the dog was confirmed, considered uncommon in this species.

Effect of photobiomodulation on lower urinary tract dysfunction in rat cystitis model.

Photobiomodulation selectively controls the activity of the sensory nervous system associated with A-delta and C fibers. Hypersensitivity involving the afferent A-delta and C fibers occurs in cystitis and decreases urinary function. This study aimed to investigate the effect of photobiomodulation on urinary storage dysfunction and voiding functions in cystitis model rats. We prepared the rat cystitis model. Under anesthesia, a cannula was connected to the bladder via a ventral incision. 0.3% acetic acid or saline was injected into the bladder. Continuous cystometry was performed, measuring bladder pressure and voiding urine volume with rats freely mobile. Laser irradiation was applied to the L6 lumbosacral intervertebral foramen using an 830 nm laser. Residual urine was extracted post-cystometry. In the rat cystitis model groups, there was a significant decrease in the voiding interval and volume compared to the group receiving normal saline infusion. After sham or laser irradiation, only the group with laser irradiation showed a significant increase in voiding interval (217%, p = 0.0002) and voiding volume (192%, p = 0.0012) in the parameters of storage dysfunction. The basal pressure, intravesical pressure, and residual urine volume remained unchanged in all groups before and after irradiation. This study indicates that photobiomodulation may improve urine storage dysfunction without exacerbating voiding function in a rat model of cystitis. Thus, photobiomodulation may be a new treatment option for the hypersensitivity and detrusor overactivity caused by cystitis.

Management outcomes of cervical radiculopathy with conservative treatment, anterior cervical discectomy fusion (ACDF), and anterior cervical disc replacement (ACDR)—Retrospective single center matched cohort study

Abstract Background: Degenerative cervical radiculopathy results from nerve root compression in the cervical neural foramina, often due to a herniated disc, osteophyte, or facetal/ligamentum flavum hypertrophy. Typically, 80% of patients show improvement within the initial 12 weeks through nonoperative measures, with surgical intervention considered for non-responders. This study aimed to compare clinical and radiological outcomes in cervical radiculopathy patients undergoing prolonged conservative care, anterior cervical discectomy and fusion (ACDF), or anterior cervical disc replacement (ACDR) after a 1‐year follow‐up. Materials and Methods: Our study was a retrospective single‐center study involving 780 cervical radiculopathy patients from January 2012 to December 2021. About 80.12% found relief with conservative management within 12 weeks. Remaining 155 patients were offered surgery, with 73 opting for continued conservative care, and 82 undergoing surgery (55 with ACDF and 27 with ACDR). Evaluation was done using visual analogue scale (VAS), Neck Disability Index (NDI), and radiographic parameters. Results: The mean follow‐up was 11.58 ± 6.7 months. ACDR group: Mean age 43.38 ± 8.56, VAS 7.81 ± 1.04 preoperatively, improved significantly to 2.07 ± 1.34 (P &lt; 0.05) at 1‐year follow‐up. ACDF group: Mean age 44.85 ± 10.65, VAS 8.22 ± 1.21 preoperatively, improved significantly to 2.09 ± 1.01 (P &lt; 0.05) at 1‐year follow‐up. Conservative group: Mean age 45.04 ± 11.19, VAS 7.77 ± 1.86 preoperatively, improved significantly to 2.08 ± 1.40 (P &lt; 0.05) at 1‐year follow‐up. Radiographic parameters significantly improved in all groups at 1‐year follow‐up (P &lt; 0.05). Range of motion (ROM) changes varied across groups. Miyazaki’s grading and Kim’s score showed comparable results. Conclusion: Comparable clinical and radiological outcomes were observed among conservative, ACDF, and ACDR approaches. ACDR approach demonstrated a better NDI score outcome. Neck ROM was better maintained or improved in the ACDR approach, decreased in ACDF, and remained almost similar in the conservative group.

Value of chemical shift imaging in the evaluation of neural foramen stenosis

BackgroundChemical shift Magnetic Resonance Imaging (MRI) is often routinely acquired to assess a spectrum of spinal lesions due to its ability versatility to obtain rapid sequences at the expense of spatial resolution images. It is one of the quickest sequences to acquire at the expense of spatial resolution. ObjectiveIn this study we assess the diagnostic efficacy of Chemical shift Magnetic Resonance Imaging (MRI) in the evaluation of Neural Foraminal stenosis. Materials and methodsConventional T2, T1 and STIR sagittal and axial images as well as ‘in’ and ‘out’ phase chemical shift sagittal MRI sequences of 25 consecutive patients presenting with back pain and radiculopathy were reviewed. The degree of neural stenosis in the lumbar spine foramina on both sides was graded using the Lee classification on T2 and ‘in’ and ‘out’ phase MRI sequences by two independent MSK radiologists. Statistical analysis was performed using paired T-Test and Cohen's weighted kappa test was applied as a measure of agreement between the two observed raters. ResultsA total of 250 lumbar neural foramina were assessed. There was substantial agreement (Cohen's weighted kappa) for both raters between ‘in’ and ‘out’ phase chemical shift sagittal MRI sequences (rater 1 = 0.699, rater 2 = 0.718), as well as good agreement between raters for both ‘in’ and ‘out’ phase chemical shift sagittal MRI sequences (in phase = 0.656, ‘out’ phase = 0.576). However, when compared to the gold standard rating on a T2 based sequence, ratings on in’ and ‘out’ phase MRI sequences overestimated the degree of stenosis. When comparing ‘in’ and ‘out’ ratings to the T2 ratings, agreement was poor with kappa ranging from 0.132 to 0.202. ConclusionThough both ‘in’ and ‘out’ phase chemical shift sagittal MRI sequences can be used to analyse neural foraminal stenosis, given its propensity to over-estimate the degree of stenosis in comparison to the T2 based images, assessment of the condition on these complementary limited sequences technique should be avoided/should be undertaken with caution.

Diagnostic and Surgical Challenges of a Lumbar Extradural Hydatid Cyst: A Case Report and Review of Literatures

Spinal hydatid cysts, though uncommon, are a serious condition. An 14-year-old boy experienced back pain, increasing weakness, and numbness in his legs. Lumbar region MRI revealed a cystic lesion with a regular outline in the extradural space, exhibiting T1-weighted images showed a lesion that was hypointense, while T2-weighting images displayed hyperintense. The lesion severely compressed the dural sac and caudal roots, extending into the L3 and L4 neural foramina. The condition was addressed through an L3 laminectomy and completely removing the hydatid cyst. This report discusses the clinical symptoms, diagnostic process, and surgical treatment of this rare spinal hydatid disease case, along with a review of all documented primary extradural hydatid cyst cases in the literature.

Interdisciplinary Rehabilitation Program for a Young Man with Type 1 Neurofibromatosis: A Case Report

Neurofibromatosis NF is an autosomal dominant neurocutaneous condition characterized by a set of clinical symptoms that affect multiple systems in the human body. Due to its multisystem involvement an interdisciplinary plan of care is crucial for effective rehabilitation. This study highlights a 23-year-old man diagnosed with NF-1 at the cervical level of C2-C4 causing widening of the neural foramen for which he underwent laminectomy and decompression surgery from C2 to C5 levels. After the surgery he experienced limitations in his daily activities and mobility. After the evaluation on the basis of the International classification of functioning model the patient and parents were educated about the condition and progress. The interdisciplinary team set a plan of care and told the patient about the realistic goals that they could achieve. At discharge the patient had met the goals and there was a significant improvement in his daily functional activities and quality of life.

Spine Surgical Robotics: Current Status and Recent Clinical Applications.

With the development of artificial intelligence and the further deepening of medical-engineering integration, spine surgical robot-assisted (RA) technique has made significant progress and its applicability in clinical practice is constantly expanding in recent years. In this review, we have systematically summarized the majority of literature related to spine surgical robots in the past decade, and not only classified robots accordingly, but also summarized the latest research progress in RA technique for screw placement such as cervical, thoracic, and lumbar pedicle screws, cortical bone trajectory screws, cervical lateral mass screws, and S2 sacroiliac screws; guiding targeted puncture and placement of endoscope via the intervertebral foramen; complete resection of spinal tumor tissue; and decompressive laminectomy. In addition, this report also provides a detailed evaluation of RA technique's advantages and disadvantages, and clarifies the accuracy, safety, and practicality of RA technique. We consider that this review can help clinical physicians further understand and familiarize the current clinical application status of spine surgical robots, thereby promoting the continuous improvement and popularization of RA technique, and ultimately benefiting numerous patients.

Is Nothing Sacrum? Identification and Treatment of Sacral Insufficiency Fractures

Sacral insufficiency fractures are an overlooked etiology of back pain that can also be difficult to diagnose radiographically. Advanced imaging, including MR and scintigraphy, are useful modalities for diagnosis, as these fractures are frequently missed on plain films. Management is often conservative to avoid surgical fixation, a rarely performed surgery due to its high morbidity. Radiologists are also able to provide symptomatic relief via sacroplasty, a minimally invasive, percutaneous, image-guided procedure first described in 2002. The most common sites of pelvic insufficiency fractures include the sacral ala and parasymphyseal region of the os pubis. The butterfly or “H-shaped” pattern is a classic sign of this fracture on scintigraphy, best appreciated posteriorly. MR is considered the gold standard in diagnosing insufficiency fractures and is characterized by low T1 band-like signal intensity with corresponding high T2/T2 short-tau inversion recovery (STIR) signal intensity. Such fractures can be treated via sacroplasty by carefully injecting polymethylmethacrylate bone cement via one or more trocar needles. Knowledge of sacral anatomy is critical during the procedure to not violate specific sacral zones or traverse any of the neural foramina.

The Symptomatic Calcification and Ossification of the Ligamentum Flavum in the Spine: Our Experience and Review of the Literature.

We report our experience regarding the clinical features and pathological findings of the calcification of the ligamentum flavum (CLF) and ossification of the ligamentum flavum (OLF) in the spine. In addition, we reviewed the previous studies on CLF and OLF to enhance the understanding of these conditions. We compared the clinical, radiological, and histopathological features of CLF and OLF. In CLF, a computed tomography (CT) scan showed egg-shaped or speck-like calcification in the ligamentum flavum. Magnetic resonance (MR) imaging demonstrated spinal cord compression due to a thickened ligamentum flavum, which appeared as a low-intensity mass. Pathological findings demonstrated fused islands of calcification resembling sand-like calcification. In OLF, CT showed beak-like ossification extending into the intervertebral foramen. MR imaging demonstrated spinal cord compression by a low-intensity mass. Pathological findings revealed laminar ossification of LF with chondrocytes near the calcification and laminar hyaline cartilage. CLF and OLF appear to be distinct entities based on their clinical, neuroradiological, histopathological, and pathogenetic features. We suggest that the causes of CLF include both metabolic and dystrophic factors, while the pathogenesis of OLF is characterized by enchondral ossification induced by a genetic cascade triggered by shearing/tension stress.