Intervertebral Foramen Research Articles

Magnetic Resonance Imaging Features and Misdiagnosis of Spinal Epidural Cavernous Hemangioma.

Spinal epidural cavernous hemangiomas (SECHs) are rare, and merely a few have previously been described in case reports. The present study aims to explore the magnetic resonance imaging (MRI) features of SECHs and analyze the causes of their preoperative misdiagnosis. The present retrospective study included 11 patients (three male and eight female patients, mean age ± standard deviation: 47.55±17.39 years old) with histopathologically confirmed SECH between January 2015 and April 2021. The MRI features of SECH were analyzed by two radiologists. The cervical, thoracic and thoracolumbar segments were involved in 2, 7 and 2 patients, respectively. All lesions grew along the long axis of the spine. The tumors were shuttle-shaped in six patients, oval in two patients, pseudopodia-shaped in one patient, clamp-shaped in one patient, and growing outward along the intervertebral foramen in one patient. Nine SECHs had relatively uniform isointense or hypointense T1-weighted imaging (T1WI) and hyperintense T2-weighted imaging (T2WI) signals. On the T2WI, filamentary low-signal shadows (i.e., the hairline or grid sign) with significant contrast enhancement and asymptotic strengthening were observed. Two SECHs had mixed high and low signals on T1WI and T2WI, with significant heterogeneous enhancement, hemorrhage, and hemosiderin deposition. The SECH was misdiagnosed as meningioma, neurofibromatosis and schwannoma in 1, 1 and 4 patients, respectively, while this was not diagnosed in one patient. The preoperative diagnosis was correct in merely approximately 36% of patients. Among the four patients with a correct preoperative diagnosis, hemosiderin deposition was found in three patients and small tortuous vascular shadows were found in one patient. SECH presents as a long spindle-shaped mass, and the "'pen cap sign" is common at the lesion edges. SECH also exhibits a hairline or grid sign on T2WI. Furthermore, some lesions present with hemorrhage and hemosiderin deposition. Therefore, the hairline, grid sign and hemosiderin deposition are valuable diagnostic features of SECH.

Deep Learning Algorithm Trained on Cervical Magnetic Resonance Imaging to Predict Outcomes of Transforaminal Epidural Steroid Injection for Radicular Pain from Cervical Foraminal Stenosis.

A convolutional neural network (CNN) is one of the representative deep learning (DL) model that is especially useful for image recognition and classification. In the current study, using cervical axial magnetic resonance imaging (MRI) data obtained prior to transforaminal epidural steroid injection (TFESI), we developed a CNN model to predict the therapeutic outcome of cervical TFESI in patients with cervical foraminal stenosis. We retrospectively recruited 288 patients with cervical foraminal stenosis who received cervical TFESI due to cervical radicular pain. We collected single T2-axial spine MR image obtained from each patient. The image showing narrowest width of the neural foramen in the level at which TFESI was performed was used for input data. A "favor outcome" was defined as a ≥ 50% reduction in the NRS score at 2 months post-TFESI vs the pretreatment NRS score. A "poor outcome" was defined as a < 50% reduction in the NRS score at 2 months post-TFESI vs the pretreatment score. The area under the curve of our developed model for predicting therapeutic outcome of cervical TFESI in patients with cervical spinal stenosis was 0.801. We showed that a CNN model trained using cervical axial MRI could be helpful for predicting therapeutic outcome after cervical TFESI in patients with cervical foraminal stenosis.

A Case Report of Acupotomy Treatment at Internal Intervertebral Foramen on the Chronic HIVD Patient

A Case Report of Acupotomy Treatment at Internal Intervertebral Foramen on the Chronic HIVD Patient

Ultrasound-guided transforaminal epidural injection with fluoroscopy confirmation for the treatment of unilateral lumbar radiculopathy: A randomized controlled non-inferiority study

BackgroundUltrasound (US)-guided injections for chronic pain has multiple advantages over traditional radiologic method. The study was performed to exam the clinical outcomes of lumbar transforaminal epidural injection (LTFEI) between US and fluoroscopy (FL) guidance for lumbar radiculopathy (LRP). MethodsA total of 164 patients with LRP were randomly assigned into US and FL group to receive LTFEI in a 1:1 ratio. Pain relief and functional disability were assessed by numeric rating scale (NRS) and Modified Oswestry Disability Questionnaire (MODQ) scores before treatment, 1 month and 3 months post-intervention. Contrast spread pattern, fluoroscopic image number and complications were also recorded. The primary outcome was accurate rate of contrast dispersing into lumbar epidural space, and non-inferiority margin was predefined at −15 %. ResultsThe accuracy of LTFEI was 90.2 % and 91.5 % in US and FL group, and the lower limit of the 95 %CI of mean difference between two modalities (−4.9 % (95 %CI: −12.8 %, 3.1 %)) was above the non-inferiority margin. Procedure time in US group (531.90 ± 67.12 s) was shorter than FL group (904.20 ± 120.20 s) (p < 0.05), while radiation dosage in the US group was lower than in the FL group (3047.20 ± 569.53 vs. 8807.50 ± 1039.10 μGy m2, p < 0.001). Both groups didn’t differ in pain reduction (F = 1.050, p = 0.306) and functional improvement (F = 0.103, p = 0.749) during follow-up period. No severe complications occurred in both groups. ConclusionsUS-guided LTFEI confirmed by FL was not inferior to conventional FL method in terms of accurate rate of lumbar epidural contrast dispersion. Effective pain relief and functional ability improvement were comparable between two modalities, and US technique had advantages of less radiation exposure and possible facilitation of avoiding critical vessels around intervertebral foramen.

Lumbar intradural space reduction during the Valsalva maneuver observed using cine MRI and MR myelography: a single-case experimental study.

Previous studies have shown that the Valsalva maneuver (VM) causes spinal canal object movements. We hypothesized that this occurs because of cerebrospinal fluid (CSF) flow generated from intradural space reduction. Previous studies using myelograms reported lumbar CSF space changes during inspiration. However, no similar studies have been conducted using modern MRI. Therefore, this study analyzed intradural space reduction during the VM using cine magnetic resonance imaging (MRI). The participant was a 39-year-old, healthy, male volunteer. Cine MRI involved fast imaging employing steady-state acquisition cine sequence during three resting and VM sets for 60s each. The axial plane was at the intervertebral disc and vertebral body levels between Th12 and S1 during cine MRI. This examination was performed on 3 separate days; hence, data from nine resting and VM sets were available. Additionally, two-dimensional myelography was performed during rest and the VM. Intradural space reduction was observed during the VM using cine MRI and myelography. The intradural space cross-sectional area during the VM (mean: 129.3 mm2; standard deviation [SD]: 27.4 mm2) was significantly lower than that during the resting period (mean: 169.8; SD: 24.8; Wilcoxon signed-rank test, P < 0.001). The reduction rate of the vertebral body level (mean: 26.7%; SD: 9.4%) was larger than that of the disc level (mean: 21.4%; SD: 9.5%; Wilcoxon rank sum test, P = 0.0014). Furthermore, the reduction was mainly observed on the ventral and bilateral intervertebral foramina sides at the vertebral body and intervertebral disc levels, respectively. The intradural space was reduced during the VM, possibly because of venous dilatation. This phenomenon may be associated with CSF flow, intradural object movement, and nerve compression, potentially leading to back pain.

A novel technology named as selective fenestration and axial decompression for the surgical management of lumbar degenerative diseases

Study DesignA retrospective study. PurposeTo firstly introduce a new surgical techniquenamed asselectivefenestrationand axial decompression (SFAD) to improvethe surgical treatment effectsof lumbar degenerative diseases. Overview of literaturePosterior lumbar laminectomy and interbody fusion (LIF)is a standard surgical method for the treatment of lumbar degenerative diseases. However, its application has some limitations, and the incidence of spinal cord nerve injury is relatively high. MethodsThisretrospectiveclinicalstudy was conducted fromJanuary 2018 to February2020. A total of 101 eligible patients including 62 men and 39 women withlumbar disc herniation (LDH) or lumbar spinal stenosis (LSS)underwentLIF or SFADwere enrolled in this study.The average postoperative follow-up periodof the LIF and SFAD groups were 20.1 ± 3.7 months and 19.7 ± 4.1 months, respectively.The clinical effects,imaging manifestation,and postoperative complicationsin LIF and SFAD groups were analyzed. ResultsThe operative time, blood loss and hospital stay in SFAD group were significantly lower than those in LIF group (P < 0.05). Significant clinical improvements in VAS and ODIwere achieved in bothLIF and SFAD groupsafter surgery, respectively (P < 0.05).There was no statistical difference in improvements of VAS and ODI betweentheLIFandSFADgroups (P > 0.05).Similarly, improvementsofcobb angle ofoperated segment, intervertebral space height (ISH), intervertebral space foramen (IFH)andlumbar lordosis (LL)showed no statistical differencebetween thetwogroups (P > 0.05).Finally, theprevalence of complicationratesinLIF group were significantlyhigher than theSFADgroup during the follow-up period(P < 0.05) ConclusionsThe application ofSFADto the surgical treatment of lumbar degenerative diseases can realize the three-dimensional and precise decompression of spinal cord nerve, whichis one of the ideal alternatives to traditional LIF.

ID: 217156 Lumbar-Sacral Transforaminal Nerve Root Stimulation: Applying Peripheral Nerve Stimulation Technology to Spinal Neurostimulation

The rationale and efficacy of spinal neurostimulation for treatment of neuropathic pain pathologies in lower extremities is well established. However, the presence of treatment failures, especially evident in long term follow up, justifies continued search for other ways of applying neuromodulation in spinal neurostimulation. Peripheral neurostimulation presents the advantages of increased specificity of stimulation targets and decreased risks of hardware implantation as it is performed outside the spinal axis. Lumbar-sacral transforaminal nerve root stimulation utilizes familiar transforaminal approach for placement of stimulation hardware directly inside the neural foramen, minimizing operative risks and allowing for immediate use and ease of programming of the implanted system. This approach is technically easier than the DRG stimulation placement technique previously described, as it utilizes the familiar transforaminal approach used in routine interventional pain treatment practice.

Dorsal Column Spinal Cord Stimulation for Sacral Radiculopathy Due to Sacroiliac Joint Fusion to Hardware: A Case Report

BACKGROUND: A complication of sacroiliac joint (SIJ) fusion is neuropathic pain due to intruding hardware. CASE REPORT: We present the novel management of a 57-year-old man who presented with S1 radiculopathy that began immediately after SIJ fusion, which had been performed 2 years prior. Physical exam and electromyography confirmed right S1 radiculopathy. Imaging confirmed hardware protrusion into the S1 neural foramen. The patient failed conservative management, and an outside tonic spinal cord stimulator trial (SCS) trial, but experienced 100% relief during the anesthetic phase of S1 transforaminal epidural steroid injections. A neurosurgical consult deemed the patient to be an inappropriate candidate for surgical revision due to the complete fusion of the hardware to bone. The patient successfully underwent a burst SCS trial with 100% relief as measured by the Numeric Rating Scale and increased his quality of sleep and activity with subsequent permanent implantation. CONCLUSION: SCS utilizing burst stimulation can offer a unique treatment option for resultant neuropathic pain from SIJ fusion to hardware in the event that surgical revision is not recommended. KEY WORDS: Spinal cord stimulator, scral radiculopathy, sacroiliac joint, failed back surgery syndrome, case report

NAVIGATION ASSISTED CERVICAL SPINE OSTEOID OSTEOMA EXCISION: A CASE REPORT

Abstract: Introduction: Osteoid osteoma is a rare benign bone-forming tumor which is typically found in a patient less than 30 years of age. Males are more commonly affected than females with a ratio of 2:1. [1] . Spinal involvement accounts for about 10% of all osteoid osteomas, with the lumbar spine being the most affected area, followed by cervical spine. Case Presentation: A 16 years old male presented to our hospital with 18 months history of neck pain with occasional left upper limb numbness. There was no history of trauma or injury to the neck. Neck pain is worsened at night and improves with NSAIDs. Physical examination revealed decreased sensation over left C5 dermatome distribution and positive spurling test, and the rest of the physical examination was unremarkable. There were no signs of myelopathy. MRI was done for the patient in another hospital, which showed a C4 vertebral body lesion in the left neural foramen and paraspinal soft tissue measuring 2.7 x 1.8cm. Upon these findings, we admitted the patient to evaluate possible neoplastic or infectious causes. Laboratory tests, TB-PCR, acid-fast bacillus, inflammatory markers were all within the normal range. CT cervical, chest, abdomen and pelvis was done for the patient, and it was unremarkable except for what was found in MRI. As a result, further investigation such as a bone scan was done and it showed Osteoid osteomas. As conservative treatment was ineffective in relieving the patient\'s symptoms, we planned surgical excision. Due to the tumor\'s location, we preferred to do a posterior approach with a navigation-assisted excision system. The patient received general anaesthesia and was placed on a prone position. The posterior neck was prepped and draped in the usual manner. Under fluoroscopic guidance, entry point was located. After exposure of the posterior cervical spine from C3 proximally to C5 distally, a navigation marker with navigation was inserted, and then we excised osteoid osteoma in one piece . The resected tissue was sent for histopathologic examination and confirmation of osteoid osteoma. Postoperatively, the patient tolerated surgery well and mobilized the following day. A cervical x-ray was done before discharge on day three post-operation. Conclusion: Osteoid osteoma is a rare benign bone-forming tumor which is typically found in a patient less than 30 years of age. Spinal involvement accounts for about 10% of all osteoid osteomas, The difficulty of cervical osteoid osteomas is that it lies near adjacent vital structures such as vertebral artery, spinal cord, and nerve roots. The navigation served us several advantages in resecting the osteoid osteoma, we were able to utilize a less invasive approach with a smaller incision, we are able to visualize and remove the thick sclerotic cortex to gain access to the tumor, without violating the facet joint and cause an iatrogenic instability. Keywords: osteoid osteoma, cervical spine, navigation system.

Monoradiculopathy-induced abdominal pseudohernia caused by T11-12 soft disc herniation: a case report and literature review

BackgroundAn abdominal pseudohernia is a rare clinical entity that consists of an abnormal bulging of the abdominal wall that can resemble a true hernia but does not have an associated underlying fascial or muscle defect. Abdominal pseudohernia is believed to result from denervation of the abdominal muscles in cases of herpes zoster infection, diabetes mellitus, lower thoracic or upper lumbar disc herniation, surgical injuries, and rib fracture. To date, nine cases of abdominal pseudohernia caused by disc herniation at the lower thoracic or upper lumbar levels have been reported.Case presentationA 35-year-old man with no underlying disease or traumatic event presented with chief complaints of left flank pain and a protruding left lower abdominal mass that had formed one day earlier. There was no true abdominal hernia on abdominal computed tomography (CT), although CT and magnetic resonance imaging (MRI) showed a herniated soft (non-calcified) disc into the left neural foramen at the T11-12 level. A nonsteroidal anti-inflammatory drug was prescribed for the flank pain, and the patient was followed on a regular basis for six months. Follow-up MRI taken at the last visit showed complete resorption of the herniated disc. Abdominal pseudohernia and flank pain were also completely resolved.ConclusionWe report a rare case of monoradiculopathy-induced abdominal pseudohernia caused by foraminal soft disc herniation at the T11-12 level. In patients who have an abdominal pseudohernia without herpes zoster infection, diabetes mellitus, or traumatic events, lower thoracic disc herniations should be included in differential diagnosis.

Effect of bone cement-reinforced pedicle screws combined with fusion repositioning therapy on lumbar spine function and postoperative complications in patients with severe lumbar spondylolisthesis

ObjectiveTo retrospectively study the efficacy of bone cement-enhanced pedicle screws combined with interbody fusion reduction in the treatment of severe lumbar spondylolisthesis, its effect on lumbar function and complications. MethodsFrom January 2019 to June 2021, 82 cases of severe lumbar spondylolisthesis in our hospital were analyzed. According to the different treatment plans, the patients were divided into two groups: A and B, in which group A patients were treated with pedicle screws combined with fusion and reduction, and group B patients were treated with bone cement reinforced pedicle screws combined with fusion and reduction. Perioperative indexes, pain severity (VAS), Oswestry dysfunction index (ODI), and low back and leg pain score of Japan Orthopedic Association (JOA), spondylolisthesis reduction, intervertebral space height, intervertebral foramen height, complications, and screw loosening were compared between the two groups. ResultsThere was no significant difference in the amount of intraoperative bleeding between group A and group B (P > 0.05). The operation time of group B was longer than that of group A, and the hospitalization time was shorter than that of group A. The vertebral fusion rate of group B was higher than that of group A (P < 0.05). The VAS, ODI and JOA scores at the last follow-up in both groups were lower than those before surgery, and group B was lower than group A (P < 0.05). Compared with the preoperative period, the postoperative slippage degree grading improved in both groups, while the improvement rate in group B was higher than that in group A (P < 0.05). At the last follow-up, the scores of intervertebral foramen height and intervertebral space height in both groups were higher than those before operation, and those in group B were higher than those in group A (P < 0.05). There was no difference in the incidence of complications and screw loosening between the two groups (P > 0.05). ConclusionCompared with conventional screw treatment, bone cement-reinforced pedicle screws combined with fusion repositioning can further improve the repositioning rate of slipped vertebrae in the treatment of severe LSL, while achieving a better intervertebral fusion rate. Therefore, the treatment of severe LSL with bone cement reinforced pedicle fusion and reduction is a safe and effective method.

Comparison of Short-Tau Inversion Recovery With Short-Tau Inversion Recovery-Slice Encoding for Metal Artifact Correction for Spine Imaging at 1.5 T in the Setting of Metallic Implants.

To compare the image quality of short-tau inversion recovery (STIR) and the STIR-slice encoding for metal artifact correction (SEMAC) sequence for postsurgery spine magnetic resonance imaging (MRI). Twenty-nine patients with metallic spinal implants who underwent spinal 1.5 T MRI with STIR and STIR-SEMAC sequences between July 2016 and November 2020 were retrospectively enrolled. Qualitative assessments were performed using 5-point scales; higher scores indicated better image quality. For screw metal artifact analysis, scores were obtained for artifacts on vertebral bodies and neural foramina, screw artifact widths, and bone marrow signal intensities. For patient-based analysis, scores were obtained for imaging quality and fat suppression quality, signal intensity, and cerebrospinal fluid noise. A paired t test was performed for statistical analyses. We analyzed 163 screws in 29 patients. In the screw metal artifact analysis, the vertebral body and neural foramen scores were significantly higher for the STIR-SEMAC images than for the STIR (all P < 0.001). The artifact width in the STIR-SEMAC images (9.8 ± 3.4 mm) was significantly smaller than that in the STIR images (16.0 ± 4.7 mm, P < 0.001). In patient-based analysis, the fat suppression and imaging quality scores were significantly higher for the STIR-SEMAC images than for the STIR images (all P < 0.001). The cerebrospinal fluid signal intensity, noise, and signal-to-noise ratios were significantly higher for the STIR images (all P < 0.005). Short-tau inversion recovery-SEMAC sequences provide good metallic artifact reduction and fat suppression for postsurgery spine 1.5 T MRI.

Angulation error assessment for the trajectory in the anteroposterior and lateral fluoroscopic views during percutaneous endoscopic transforaminal lumbar discectomy

BackgroundAnteroposterior (AP) and lateral fluoroscopies are often used to evaluate the intraoperative location and angulation of the trajectory in percutaneous endoscopic transforaminal lumbar discectomy (PETLD). Although the location of the trajectory shown in fluoroscopy is absolutely accurate, the angulation is not always reliable. This study aimed to evaluate the accuracy of the angle shown in the AP and lateral fluoroscopic views.MethodsA technical study was performed to assess the angulation errors of PETLD trajectories shown in AP and lateral fluoroscopic views. After reconstructing a lumbar CT image, a virtual trajectory was placed into the intervertebral foramen with gradient-changing coronal angulations of the cephalad angle plane (CACAP). For each angulation, virtual AP and lateral fluoroscopies were taken, and the cephalad angles (CA) of the trajectory shown in the AP and lateral fluoroscopic views, which indicated the coronal CA and the sagittal CA, respectively, were measured. The angular relationships among the real CA, CACAP, coronal CA, and sagittal CA were further demonstrated with formulae.ResultsIn PETLD, the coronal CA is approximately equal to the real CA, with a small angle difference and percentage error, whereas the sagittal CA shows a rather large angle difference and percentage error.ConclusionThe AP view is more reliable than the lateral view in determining the CA of the PETLD trajectory.

Clinical and radiologic comparison between oblique lateral interbody fusion and minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis

To compare the short-term clinical efficacy and radiologic differences between oblique lateral interbody fusion(OLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for degenerative lumbar spondylolisthesis. A retrospective analysis was performed on 58 patients with lumbar spondylolisthesis treated with OLIF or MIS-TLIF from April 2019 to October 2020. Among them, 28 patients were treated with OLIF (OLIF group), including 15 males and 13 females aged 47 to 84 years old with an average age of (63.00±9.38) years. The other 30 patients were treated with MIS-TLIF(MIS-TLIF group), including 17 males and 13 females aged 43 to 78 years old with an average age of (61.13±11.10) years. General conditions, including operation time, intraoperative blood loss, postoperative drainage, complications, lying in bed, and hospitalization time were recorded in both groups. Radiological characteristics, including intervertebral disc height (DH), intervertebral foramen height (FH), and lumbar lordosis angle (LLA), were compared between two groups. The visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the clinical effect. The operation time, intraoperative blood loss, postoperative drainage, lying in bed, and hospitalization time in OLIF group were significantly less than those in the MIS-TLIF group (P<0.05). The intervertebral disc height and intervertebral foramen height were significantly improved in both groups after the operation (P<0.05). The lumbar lordosis angle in OLIF group was significantly improved compared to before the operation(P<0.05), but there was no significant difference in the MIS-TLIF group before and after operation(P>0.05). Postoperative intervertebral disc height, intervertebral foramen height, and lumbar lordosis were better in the OLIF group than in the MIS-TLIF group (P<0.05). The VAS and ODI of the OLIF group were lower than those of the MIS-TLIF group within 1 week and 1 month after the operation (P<0.05), and there were no significant differences in VAS and ODI at 3 and 6 months after the operation between the two groups(P>0.05). In the OLIF group, 1 case had paresthesia of the left lower extremity with flexion-hip weakness and 1 case had a collapse of the endplate after the operation;in the MIS-TLIF group, 2 cases had radiation pain of lower extremities after decompression. Compared with MIS-TLIF, OLIF results in less operative trauma, faster recovery, and better imaging performance after lumbar spine surgery.

Resection of Cervical Dumbbell-Shaped Schwannoma Using Posterior Unilateral Approach: Impact on Postoperative Cervical Function and Clinical Outcomes.

A retrospective comparative study. This study aimed to evaluate the radiographical changes in cervical sagittal alignment (CSA) and clinical outcomes after tumor resection using a posterior unilateral approach without spinal fixation for patients with cervical dumbbell-shaped schwannoma (DS). Seventy-three patients with DS who were followed up for at least 2years were included. The Eden classification was used to designate the types of DS. The CSA and range of motion (ROM) were analyzed using radiographs. The clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) score and JOA cervical myelopathy questionnaire. The CSA in the neutral, flexion, and extension position and cervical ROM were not significantly reduced in the follow-up period. The JOA scores showed significant improvement after surgery. The postoperative radiographic parameters and clinical outcomes of Eden type II or III DS, which needed facetectomy for the resection, did not show any statistically significant difference compared with those of Eden type I tumor, which was resected without facetectomy. Fifty-two cases (71.2%) achieved gross total resection, whereas 21 cases (28.8%) remained in partial resection (PR). One case underwent reoperation due to the regrowth of the remnant tumor whose margin was at the entrance of the intervertebral foramen. Tumor resection using the posterior unilateral approach preserved CSA and resulted in favorable clinical outcomes in patients with DS. When the resection ends in PR, the proximal margin of the remnant tumor should be located distally away from the entrance of the foramen to prevent regrowth.

Analysis of risk factors for contralateral symptomatic foraminal stenosis after unilateral transforaminal lumbar interbody fusion.

To analyze the risk factors of contralateral symptomatic foraminal stenosis (FS) after unilateral transforaminal lumbar interbody fusion (TLIF) and to guide and standardize the operation process of unilateral TLIF to reduce the occurrence of contralateral symptomatic FS. A retrospective study was undertaken on 487 patients with lumbar degeneration who underwent unilateral TLIF in the Department of Spinal Surgery of Ningbo Sixth Hospital between January 2017 and January 2021, comprising 269 males and 218 females, with a mean age of 57.1years (range, 48-77years). Cases of intraoperative improper operations, such as screw deviation, postoperative hematoma, and contralateral disc herniation, were excluded, and cases of nerve root symptoms caused by contralateral FS were analyzed. Post-surgery, 23 patients with nerve root symptoms caused by contralateral FS were categorized as group A, and 60 patients without nerve root symptoms were randomly selected as group B during the same period. The general data (gender, age, body mass index (BMI), bone mineral density (BMD), and diagnosis) and imaging parameters before and after operation (including contralateral foramen area (CFA), lumbar lordosis angle (LL), segmental lordosis angle (SL), disc height (DH), foramen height (FH), foramen width (FW), fusion cage position, and the difference between postoperative and preoperative) were compared between the two groups. Univariate analysis was performed, and multivariate analysis was undertaken through logistics analysis to determine the independent risk factors. Additionally, the clinical outcomes of the two groups were compared immediately before surgery and one year after surgery, using the visual analogue scale (VAS) score and the Japanese Orthopaedic Association (JOA) score for evaluation. The patients in this study were followed up for a period of 19-25 (22.8atien months. Among them, 23 cases (4.72% incidence) were diagnosed with contralaterally symptomatic FS after the surgery. Univariate analysis indicated significant differences between the two groups in CFA, SL, FW, and cage coronal position. Logistic regression analysis identified preoperative contralateral foramen area (OR = 1.176, 95% CI (1.012, 1.367)), small segmental lordosis angle (OR = 2.225, 95% CI (1.124, 4.406)), small intervertebral foramen width (OR = 2.706, 95% CI (1.028, 7.118)), and cage coronal position not crossing the midline (OR = 1.567, 95% CI (1.142, 2.149)) as independent risk factors for contralateral symptomatic FS after unilateral TLIF. However, there was no statistically significant difference in the pain VAS score between the two groups one year after the operation. In contrast, there was a significant difference in the JOA score between the two groups. The identified risk factors for contralateral symptomatic FS after TLIF include preoperative contralateral intervertebral foramen stenosis, a small segmental lordosis angle, a small intervertebral foramen width, and the coronal position of the cage not crossing the midline. For patients with these risk factors, it is recommended to carefully lock the screw rod during the recovery of lumbar lordosis and ensure that the coronal position of the fusion cage is implanted beyond the midline. If necessary, preventive decompression should also be considered. However, this study did not quantify the imaging data for each risk factor, and further research is needed to improve our understanding of the topic.

Early in vivo Radiation Damage Quantification for Pediatric Craniospinal Irradiation Using Longitudinal MRI for Intensity Modulated Proton Therapy

Proton vertebral body sparing craniospinal irradiation (CSI) treats the thecal sac while avoiding the anterior vertebral bodies in an effort to reduce myelosuppression and growth inhibition. However, robust treatment planning needs to compensate for proton range uncertainty, which contributes unwanted doses within the vertebral bodies. This work aimed to develop an early in vivo radiation damage quantification method using longitudinal magnetic resonance (MR) scans to quantify the dose effect during fractionated CSI. Ten pediatric patients were enrolled in a prospective clinical trial of proton vertebral body sparing CSI, in which they received 23.4 to 36 Gy. Monte Carlo robust planning was used, with spinal clinical target volumes defined as the thecal sac and neural foramina. T1/T2-weighted MR scans were acquired before, during, and after treatments to detect a transition from hematopoietic to less metabolically active fatty marrow. MR signal intensity histograms at each time point were analyzed and fitted by multi-Gaussian models to quantify radiation damage. Fatty marrow filtration was observed in MR images as early as the fifth fraction of treatment. Maximum radiation-induced marrow damage occurred 40 to 50 days from the treatment start, followed by marrow regeneration. The mean damage ratios were 0.23, 0.41, 0.59, and 0.54, corresponding to 10, 20, 40, and 60 days from the treatment start. We demonstrated a noninvasive method for identifying early vertebral marrow damage based on radiation-induced fatty marrow replacement. The proposed method can be potentially used to quantify the quality of CSI vertebral sparing and preserve metabolically active hematopoietic bone marrow.

Intervertebral Foramen - A Gateway to Epidural Space in Severe Lumbar Scoliosis.

We describe cases in which a preoperative computed tomography was used to guide the placement of an epidural catheter through the defect in the intervertebral foramina in patients with severe lumbar scoliosis. We demonstrate the adroitness with which epidural catheters were inserted through the intervertebral foramina. Computed tomography scan illustrates and plots the needle path creating a 3-dimensional image of the vertebral body rotation, needle trajectory, and the distance from the skin to the intervertebral foramina. Severe scoliosis is defined as a lateral curvature (Cobb's angle) of more than 50 degrees. It was proposed in severe idiopathic scoliosis that interventional pain management techniques are managed with fluoroscopic imaging or an alternative form. However, after a computed tomography evaluation of the scoliotic spine, we assumed that the intervertebral foraminal anatomy would facilitate a safe and efficient epidural needle and subsequent catheter positioning in severe scoliotic patients.

Effect and safety of C7 neurotomy at the intervertebral foramen in patients with chronic poststroke aphasia: a multicentre, randomised, controlled study protocol

IntroductionAphasia affects many stroke survivors; therefore, effective treatments are urgently needed. Preliminary clinical findings have suggested an association between contralateral C7–C7 cross nerve transfer and recovery from chronic aphasia. Randomised...

Resection of cervical extra-intraspinal neuromas through the enlarged intervertebral foramen: Results in 34 case series patients.

The purpose of this study was to analyze the techniques used to resection cervical extra-intraspinal neuromas (also known as cervical dumbbell neuromas) through the enlarged intervertebral foramen. A total of 34 consecutive patients (19 male, 15 female) with cervical dumbbell neuromas reviewed retrospectively between April 2008 and May 2020. Sixteen tumors were found in the intervertebral foramen of C1-C3, four in C3-C4, and 14 in C4-T1. The approach in all cases was to expose the tumors by intermuscular dissection and to remove them through the enlarged intervertebral foramen without excision of any bony structures. However, to expose tumors at different locations, the incisions shall be made accordingly. In this case series, the incisions were made along the posterior border of the sternocleidomastoid muscle for the C1-C3 tumors and along the anterior border of the muscle for the C3-C4 tumors. Transverse incisions were required for the C4-T1 tumors. Following the mentioned incising approach, all 34 tumors were completely exposed. 31 were completely removed in one stage, and 3 tumors underwent subtotal resection because of brachial plexus nerve adhesion. The vertebral artery and spinal cord were undamaged for all cases. The patients who had total tumor resection showed no sign of recurrence on enhanced magnetic resonance imaging during follow-ups. The status of patients who underwent subtotal resection was stable after radiation therapy. None of the patients developed spinal instability. Cervical dumbbell neuromas can be exposed and removed through the enlarged intervertebral foramen without causing spinal instability or injury to the spinal cord or vertebral artery. This operative approach can retain the integrity of the structures of spine and should be considered the ideal approach for cervical dumbbell neuromas.