Intraspinal Pathologies Research Articles

Study of monomelic amyotrophy of the lower limbs in the territory of the Western Balkans: Case series.

Monomelic amyotrophy is a rare form of motor neuron disease in which the neurogenic atrophy is restricted to 1 limb, mostly the distal part of the arm. The disease most often occurs in Asia, especially in Japan and India, while in European countries, this disease is rarely recognized. Registration and publication of new cases of this disease aims to increase the awareness of clinicians about the existence of this disease in European countries, and with the aim of easier recognition and faster diagnosis of this essentially benign disorder. Five patients with signs of atrophy of the muscles of 1 leg were examined at our Institution. The criteria for selecting patients were as follows: clinical evidence of wasting and weakness confined to the 1 lower limb; progressive course, or initial progression followed by stationary course; absence of any definite sensory loss or central nervous system involved; no evidence of compression lesion of the spinal cord. The clinical characteristics of our patients were similar to those previously described in the literature. The characteristic clinical features were sporadic occurrence, predominance in males with an initially progressive course for 2 to 5 years followed by a stationary state. There was no family history of neuromuscular disease. The electromyographic finding was consistent with a chronic neuropathic disorder. Magnetic resonance imaging of the lumbosacral spine excluded intraspinal pathologies and root compression in all cases. Monomelic amyotrophy of the lower limb is a rare disease that should be considered in cases of slow progressive unilateral amyotrophy of a single leg, especially in younger and middle-aged men, not only in Asia but also in the Western Balkans and Europe.

Correction of Congenital Kyphoscoliosis on the Background of Failure of Vertebral Segmentation in the Thoracic Spine Associated with Diastematomyelia at the Level of the Thoracolumbar Spine

Congenital scoliosis is one of the most common deformities of the spine in children. Intraspinal anomalies are always accompanied with congenital scoliosis. Diastematomyelia is one of the most common intraspinal pathologies in congenital scoliosis. To date, there is no standard method for correcting congenital spinal deformity associated with diastematomyelia.We present a clinical case of simultaneous correction of congenital scoliosis by an endocorrector with excision of diastematomyelia.Simultaneous tactics of surgical treatment in this clinical case was the method of choice for congenital scoliosis associated with diastematomyelia, since the total lenght of the operation and the total volume of blood loss is significantly lower, and exeresis of the bone septum reduces the risk of neurological complications.Keywords: congenital scoliosis, failure of vertebral segmentation, diastematomyelia, correction.Corresponding author: Makhmetova Meruyert, doctor-resident of the National scientific center of traumatology and orthopedics named after Academician N.D. Batpenov, Astana, Kazakhstan.Postal code: Z00P5Y5Address: Abylai khan avenue 15A, Astana, Kazakhstan.Phone: +77011675975E-mail: meruert1995@mail.ruTrauma Ortho Kaz 2023; 3 (68): 38-43Recieved: 28-07-2023Accepted: 03-09-2023 This work is licensed under a Creative Commons Attribution 4.0 International License

Long-term Follow-up Results of Reconstructive Laminoplasty With L-shaped Leibinger Mini-plate for Posterior Approach in the Treatment of Intraspinal Tumor Surgery

Laminoplasty using mini-plates is one of the most common surgical techniques in surgery for intraspinal pathologies. However, limited are present in the literature. The aim of this study was to determine its long-term clinical and radiologic outcome, specifically using an L-shaped mini-plate. Patients who underwent surgery for spinal intradural pathology from January 2008 to December 2019 were retrospectively reviewed. Those who received laminoplasty using the Leibinger mini-plate and were followed for more than 2 years were included. Patient demographics and clinical and radiographic data were reviewed and analyzed. A total of 117 patients (male:female= 47:70; mean age 50.9 years, range 16-92 years) were included, and mean follow-up period was 50.3 months (range 24-151 months). The most common pathology was schwannoma (n= 66, 56.4%) followed by meningioma (n= 30, 25.6%). Gross total resection was achieved in 82.9% (n= 97). Clinical outcomes at last follow-up were mostly good and excellent (n= 95, 81.2%). Computed tomography at the postoperative 1-year follow-up were available in 32 patients (27.4%) and the overall fusion rate was 89.3% (50 of 56 laminae). The fusion rate was significantly lower in the cervical spine compared to other locations (50% vs. thoracic [100%], lumbar [85.7%], P < 0.002). No displacement of laminae or postoperative spinal deformity were observed throughout the follow-up. Laminoplasty using L-shape Leibinger mini-plates had an 89.3% fusion rate, and no displacement of the re-attached laminae was observed. We think it is a safe and feasible option in surgeries for intraspinal pathologies.

Preoperative MRI and Intraoperative Monitoring Differentially Prevent Neurological Sequelae in Idiopathic Scoliosis Surgical Correction, While Curves >70 Degrees Increase the Risk of Neurophysiological Incidences

The aim was to investigate the role of preoperative magnetic resonance imaging (MRI) and intraoperative monitoring (IOM) in the prevention of correction-related complications in idiopathic scoliosis (IS). We conducted a retrospective case study of 129 patients with juvenile and adolescent IS. The operations took place between 2005 and 2018 in Uppsala University Hospital. Data from MRI scans and IOM were collected. The patients were divided into groups depending on Lenke’s classification, sex, major curve (MC) size, and onset age. Neurophysiological incidences were reported in ten patients (7.8%), while nine of them had no signs of intraspinal pathology. Six patients (4.7%) had transient incidences; however, in four patients (3.1%), an intervention was required for the normalization of action potentials. Three of them had an MC >70 degrees, which was significantly higher than the expected value. Eight patients (6.1%) had intraspinal pathologies, and two of them (1.5%) underwent decompression. We suggest the continuation of MRI screening preoperatively and, most importantly, the use of IOM. In three cases with no signs of pathology in the MRI, IOM prevented possible neurological injuries. MCs >70 degrees should be considered a risk factor for the occurrence of neurophysiological deficiencies that require action to be normalized.

Successful Congenital Kyphoscoliosis (with Severe Truncal Shift) Correction Associated with Syrinx and Diastematomylia without Prior Neurosurgical Intervention: A Case Report and Brief Review of Literature

Introduction and Importance: The use of halo-femoral traction to ease correction in patients with scoliosis with multiple intraspinal pathologies is an evolving technique that is not yet fully understood. This report aimed to demonstrate the efficiency of using this technique to achieve maximum deformity correction along with decreasing complication rates. Case Presentation: Congenital scoliosis with two intraspinal pathologies was corrected in a 17-year-old male with severe truncal shift, who was easily fatigued due to respiratory symptoms, utilizing the traction method with no neurosurgical intervention. The patient had consulted many hospitals locally and internationally, and was told that surgery poses a great risk of neurological deficit. He needed neurosurgical release of the cord prior to any deformity correction. Management and Outcome: The patient did not undergo any neurosurgical intervention, but rather posterior spinal correction and instrumented fusion preceded by halo-femoral traction. He was followed up for 5 years and showed complete recovery without any short-term or long-term complications. The patient was able to return to full activity and resolution of respiratory symptoms, and a good alignment on follow-up radiography was observed. Discussion: Not all patients with scoliosis associated with intraspinal pathology need treatment before spinal correction. Perioperative halo-femoral traction seems to be safe and effective in maximizing deformity correction and decreasing the risk of complications.

Is it safe and effective to correct congenital scoliosis associated with multiple intraspinal anomalies without preliminary neurosurgical intervention?

The aim of the study was to determine if multiple intraspinal anomalies increase the risk of scoliosis correction compared to the normal intraspinal condition or 1 or 2 intraspinal anomalies in congenital scoliosis (CS) and whether correction for multiple intraspinal anomalies need to be performed with preliminary neurosurgical intervention before scoliosis correction.A total of 318 consecutive CS patients who underwent corrective surgery without preliminary neurosurgical intervention at a single institution from 2008 to 2016 were retrospectively reviewed, with a minimum of 2 years of follow-up. The patients were divided into 3 groups according to different intraspinal conditions. In the normal group (N group; n = 196), patients did not have intraspinal anomalies. In the abnormal group (A group; n = 93), patients had 1 or 2 intraspinal anomalies. In the multiple anomaly group (M group; n = 29), patients had 3 or more intraspinal anomalies including syringomyelia, split cord malformation [SCM], tethered cord, low conus, intraspinal mass, Chiari malformation or/and arachnoid cyst. The occurrence of complications as well as perioperative and radiographic data were analyzed.The incidence rate of multiple intraspinal anomalies in CS patients was 9.1% (29/318). No significant difference was observed in the perioperative outcomes or radiographic parameters at the final follow-up. There were no significant differences among the 3 groups in the total, major or neurological complication rates (all P > .05). Two patients (1 in the N group and 1 in the A group) experienced transient neurological complications, whereas no patient experienced permanent neurological deficits during surgery or follow-up.To our knowledge, the current study reported the largest cohort of intraspinal anomalies in patients with CS that has been reported in the literature. The results of our study demonstrated that patients with congenital scoliosis associated with intraspinal anomalies, even multiple intraspinal anomalies that coexist with more complex intraspinal pathologies, may safely and effectively achieve scoliosis correction without preliminary neurological intervention. More complex intraspinal pathologies do not seem to increase the risk of neurosurgical complications during corrective surgery.

Acute Lumbar Paraspinal Compartment Syndrome after a Tug of War: A Case Report and Review of the Literature

Compartment syndrome of the upper and the lower extremities is a well-known entity in emergency medicine and traumatology. However, compartment syndrome of the paraspinal musculature is a very rare cause of acute back pain and may be missed at presentation despite its clinical importance. Therefore, we present a case of paraspinal compartment syndrome embedded in an overview of the actual literature. A 21- year-old woman presented with acute back pain refractory to analgesia with opiates after a tug of war match. A CT-scan of the abdomen demonstrated paraspinal swelling and an MRI ruled out intra-spinal pathologies. A compartment measurement yielded a pressure of 135mmHg. Even though conservative treatment attempts are often described, an emergency fasciotomy was carried out. Further rehabilitation was uneventful. Nevertheless, the timing of fasciotomy in the paraspinal region is under discussion, especially due to very rare experiences. Even if surgery is delayed by more than 24 hours following symptom onset, favourable postoperative outcomes have been observed.

Effect of simultaneous surgical treatment in scoliosis associated with intraspinal abnormalities: A retrospective study.

To evaluate the outcomes of single-stage surgical treatment for spinal deformity and coexisting intraspinal pathologies, 12 patients who underwent single-stage surgical treatment for spinal deformity and co-existing intraspinal abnormalities between October 2016 and January 2017 were enrolled in the present study. Treatment for intraspinal abnormalities, posterior correction, osteotomy and internal fixation were performed simultaneously. The clinical and radiological outcomes, surgical details, complications and postoperative outcomes were evaluated. The mean fusion length was 11.0±2.8. Both scoliosis Cobb angle (pre-surgery 65.9±13.4 vs. post-surgery 21.7±9.4) and kyphosis (pre-surgery 71.1±19.5 vs. post-surgery 31.4±10.4) were significantly improved post-surgery. Tethered cords were released and epidermoid cysts, gangliogliomas, meningiomas and lipomas were resected. Muscle strength in all patients was improved. The muscular tone of 8 patients was improved. No severe complications occurred postoperatively. None of the patients experienced deterioration in their neurological status nor loss of correction during the 12-24 months' follow-up. The simultaneous surgical treatment for spinal deformity and intraspinal pathology seems to be a safe and effective approach. Neurological deficits were improved postoperatively. Osteotomy produces satisfactory correction results.

Intraspinal Anomalies in Individuals with Scheuermann's Kyphosis: Is the Routine Use of Magnetic Resonance Imaging Necessary for Preoperative Evaluation?

Study DesignRetrospective study.PurposeThis study aimed to determine the incidence of intraspinal pathologies (ISPs) in individuals with Scheuermann’s kyphosis (SK) and to validate whether the routine use of magnetic resonance imaging (MRI) is necessary for preoperative evaluation.Overview of LiteratureThere are several studies on the necessity of routine MRI screening and prevalence of ISPs related to different types of scoliosis have been conducted. However, despite the well-established association between ISPs and a higher risk for neurological complications there is no any study on the scientific literature concerning the prevalence of ISPs in patients with SK has been conducted.MethodsThe database of the institution was retrospectively reviewed to identify all patients diagnosed with SK who underwent surgery between 2012 and 2015. Patients were excluded from the study if their hospital database records did not include spinal images, which are routinely collected before surgery. The presence or absence of ISPs, as indicated on magnetic resonance images, was evaluated by a radiologist.ResultsOf the 138 potential participants, 120 were included in the study. Of these, seven patients (5.8%) had ISPs, and all the cases involved syringomyelia. None of the seven patients with ISPs required additional neurosurgical procedures before corrective surgery. No complications were reported during the perioperative period, and none of the patients developed postoperative neurological deficits. ConclusionsAccording to this study, the incidence rate of ISPs in patients with SK was 5.8%, and we recommend that all patients with SK should be evaluated using MRI of the spine before corrective surgery.

Surgical Treatment Approaches in Severe Spinal Deformities Associated with Intraspinal Pathologies

Objective: Scoliosis with associated intraspinal anomalies may be treated either before the correction of spinal deformities or during the same session. Our study elucidates the impact of the timing of single- or two-stage neurosurgical and deformity treatment of intraspinal pathologies with the outcomes of serious spinal deformities and discusses the preferable method.Methods: Patients who were operated either concurrently or in two stages, due to intraspinal anomalies associated with rigid spinal deformities, were radiologically and clinically examined. Patients’ ages during the neurosurgical treatment and at the time of deformity treatment, period between two surgeries, follow-up period, clinical and radiological results and encountered complications were recorded.Results: Nineteen patients (13 females, 6 males) underwent surgery for spinal deformities associated with intraspinal pathologies between 2007 and 2014. Fifteen (78.9%) patients underwent a two-stage surgery and four (21.1%) patients’ concurrent surgeries. Mean age of the patients at the time of intraspinal pathology surgery was 8.6 ± 6.9 years and at posterior spinal fusion (PSF) 13.4 ± 3.9 years. The period between the two surgeries was 54.2 ± 67.5 months on average and the mean follow-up period was 39.8 ± 22.2 months. The anteroposterior Cobb’s angle was measured as 68.2° ± 27.1° preoperatively and 29.1° ± 18.7° at final examination (p=0.00). Visual analog scale score was 8.1 ± 1 preoperatively and 1.1 ± 0.2 at the final follow-up (p=0.00).Conclusion: The etiology, extent of deformity, curve progression and patient’s age were indicative in the surgical treatment of intraspinal pathologies and spinal curves. Concurrent surgical interventions may be recommended to avoid additional complications and for quicker recovery.

The Incidence and Interrelationship of Concomitant Anomalies in Congenital Scoliosis.

To report the incidence and interrelationship of concomitant anomalies in congenital scoliosis (CS) patients. Whole-spine computed tomography and magnetic resonance imaging (MRI) examination, echocardiography, and renal ultrasonography (USG) evaluations of 231 patients with CS were reviewed. Additionally, intraspinal pathologies and structural cardiac and renal anomalies were recorded. The incidence of intraspinal pathology was 53.7%. Echocardiography was performed in 140 of 231 patients, and congenital heart disease was detected in 38 patients. Renal USG was performed in 133 of 231 patients, and a renal disease was detected in 37 patients. In 133 patients, spinal MRI, echocardiography, and renal USG were performed. In 22 of 67 (32.8%) patients with an intraspinal anomaly, an additional cardiac anomaly was detected. In 27 of 67 (40.3%) patients with an intraspinal anomaly, an additional renal anomaly was detected. In 47.3% of patients with a cardiac anomaly, an additional renal anomaly was detected. In 15 of 133 patients (11.2%) intraspinal, cardiac, and renal anomalies were identified. Surgeons should evaluate additional anomalies in CS if patients report having a congenital anomaly. Because cardiac and renal anomalies increase intra- and postoperative complication risks, a careful and comprehensive preoperative evaluation is needed.

Two-staged Correction of Severe Congenital Scoliosis Associated With Intraspinal Abnormalities.

A retrospective study. To analyze the efficacy and safety of perioperative halo-gravity traction as an adjunct to posterior vertebral column resection (PVCR) in the treatment of patients with severe congenital scoliosis and coexisting asymptomatic intraspinal pathologies (diastematomyelia and/or tethered cord). Few reports to our knowledge review the use of perioperative halo-gravity traction and PVCR in this patient population. A total of 17 patients with a minimum 2-year follow-up who underwent PVCR using perioperative halo-gravity traction were analyzed. Patients were analyzed by age at date of examination (range, 11-23 y; mean, 14.4 y), sex (7 male, 10 female), major coronal curve magnitude (range, 108-149 degrees; average, 125 degrees), major sagittal curve magnitude (range, 72-118 degrees; average, 91 degrees). Complications related to halo traction and PVCR were reviewed. Radiographic outcomes demonstrated Cobb angle of major curve had an average correction of 28% after halo traction and it measured 53 degrees (range, 42-84 degrees) at the last follow-up, for a 58% correction. Maximal kyphosis improved to 58 degrees (range, 43-76 degrees) at ultimate follow-up. There were no permanent neurological deficits in this series. The study results suggested that surgical treatment for intraspinal abnormality may be unnecessary in asymptomatic patients with severe congenital scoliosis who are undergoing scoliosis corrective surgery. PVCR combined with perioperative traction is a safe and effective alternative for such patients.

Neonatal and infantile spinal sonography: A useful investigation often underutilized.

Sonography is an ideal, effective, noninvasive tool for evaluation of the spinal cord in neonatal and early infantile age groups owing to lack of ossification of the posterior elements of spine. Understanding normal anatomical appearances is a prerequisite for the interpretation of various pathologies of the spinal canal and its contents. This review elucidates normal appearances of the spinal cord in this age group, in both axial and sagittal planes. Usefulness of Doppler sonography is briefly discussed, and special emphasis is placed on normal anatomical variants that may mimic spinal abnormalities. Sonographic appearances of common intraspinal pathologies, both congenital and acquired, are exhaustively described. Key points regarding sonographic diagnosis of important spinal anomalies are emphasized and explained in detail. To conclude, spinal ultrasound is a reliable and widely available screening tool, albeit the usefulness of which is often underestimated.

Unusual Sciatic Pain due to Wallet Compression A Clinical Case Series and Literature Review

Objective: To present a case series of sciatic pain in young doctors, produced by external compression of the sciatic nerve by a wallet. Summary of background data: Sciatic pain is a common problem in adults and it may be caused by various intraspinal or extraspinal pathologies. Disc rupture and degenerative spine disease are the most common intraspinal causes, while extraspinal etiology remains very rare. Methods: Description of two cases with sciatic pain produced by external compression of the sciatic nerve at the gluteal region is presented, with review of the relevant literature. Results: Complete resolution of the sciatic symptoms was achieved at 3 months following removal of the wallet from the back pocket. Conclusions: When sciatica is the only clinical finding, especially in the young patient, extraspinal causes should be suspected, as early diagnosis could reduce suffering and discomfort of the patient and prevent unnecessary procedures and investigations.

Long-segment posterior instrumentation and fusion with freeze-dried allograft in congenital scoliosis

The aim of this study was to evaluate the effectiveness of long-segment posterior instrumentation and allograft application in obtaining fusion in congenital scoliosis. Twenty-one patients with congenital scoliosis who were treated with long-segment posterior instrumentation (>6 levels) and freeze-dried allograft and followed up for more than 24 months were reviewed. Six patients were excluded from the study due to anterior procedures. Fifteen patients with congenital scoliosis (13 females, 2 males; mean age: 12.2 ± 3 years, range: 7-17 years) were retrospectively reviewed. Mean follow-up time was 30.9 ± 9.4 (range: 24 to 48) months. Six patients had laminectomy either due to previous posterior surgeries or to address intraspinal pathologies during the posterior fusion procedure. Preoperative, postoperative and final follow-up anteroposterior and lateral spine X-rays were reviewed. Fusion was graded according to the classification reported by Bridwell et al. Two patients were graded as 'no fusion' (pseudarthrosis), four patients as 'probably fused', and nine patients as 'definitely fused'. The major curve was corrected from an average of 68 ± 18.6 to 39.3 ± 12.2 degrees (p<0.001). Mean correction lost in the major curve was an average of 4.5 ± 5.2 degrees in the latest follow-up. There was significant correction in the compensatory curve (preoperative 37.9 ± 13.2 degrees, postoperative 20.2 ± 6.6 degrees; p=0.001). Preoperative and postoperative global thoracic kyphosis were 39.5 ± 13.3 and 32.3 ± 7.9 degrees, respectively (p=0.018). Preoperative and postoperative global lumbar lordosis was 36.3 ± 7.4 and 36.1 ± 8.9 degrees, respectively (p=0.883). Successful fusion was detected in %86.7 of patients in the final follow-up. The usage of allograft alone to achieve fusion increases the rates of pseudarthrosis while additional anterior procedure decreases the pseudarthrosis rate in patients with congenital scoliosis that require long-segment posterior instrumentation. Further studies should be performed to assess the efficacy of the usage of polysegment pedicle screw instrumentation.

Wirbelsäulenerkrankungen und assoziierte ZNS-Fehlbildungen – Tethered-Cord und Arnold-Chiari-Fehlbildung

Tethered cord syndrome (TCS) and the Chiari malformation (CM) are generally related to congenital malformations, but both entities can be acquired.TCS often presents with progressing sensory and motor symptoms that can be attributed to increased tension of the spinal cord. Fixation of the spinal cord can occur congenitally (primary TCS) or in association with other intraspinal pathologies or postoperative scarring (secondary TCS). Exact diagnosis in the adult can be difficult if symptoms are interpreted as being related to degenerative disorders of the spine. In the presence of neurological symptoms, surgery is indicated. A preventive surgical procedure in asymptomatic patients is discussed controversially in the literature and is established in TCS patients only with correction of a scoliosis. However, most patients suffering from TCS benefit from surgical treatment.CM can be divided into four abnormal alterations of the posterior fossa, with most cases being of types I and II. In adults, Chiari type I is most common. Chiari I may present congenitally; however, it is also secondarily observed following lumboperitoneal shunting or in association with hydrocephalus. Surgical intervention is recommended depending on the extent of herniated tissue and the neurological symptoms. The optimal surgical procedure is still controversial. Most centers recommend bony decompression with dural graft extension for Chiari I.The appropriate treatment of both complex disorders requires a close and critical interdisciplinary approach in order to offer patients an individually adapted therapy.

Simultaneous Surgical Treatment in Congenital Scoliosis and/or Kyphosis Associated With Intraspinal Abnormalities

Retrospective clinical study. To show retrospective analysis of 21 consecutive patients who underwent simultaneous surgical treatment for progressive spinal deformity and coexisting intraspinal pathologies (tethered cord and/or diastematomyelia). The classic advocated approach in patients with congenital spine deformity associated with intraspinal anomalies is first to perform surgery for the intraspinal pathologies and then surgery for correction and stabilization of the deformity 3 to 6 months later. To our knowledge, there is no study on simultaneous surgical treatment for these 2 associated conditions. In the surgery; after the exposure of the determined levels, placement of all pedicle screws was performed as the initial part of surgical procedure. Then surgical treatment for intraspinal pathology was performed by the neurosurgical team and then followed by completion of instrumentation and correction of the deformity. Additional anterior surgery was done later to prevent pseudarthrosis and crankshaft phenomenon. The mean age of the patients at presentation ranged from 3 to 19 years (mean, 13 years). There were 17 female patients and 4 male patients. Four patients had neurologic deficits at the time of presentation, and all 4 had associated kyphosis. The mean operation time was 9.3 hours (range, 7-12 hours) and the mean blood loss was 1980 mL (range, 1500-3000 mL). The average follow-up was 6.8 years (2-12 years). None of the patients experienced deterioration in their neurologic status after surgery. None of the patients had infection, pseudarthrosis, or loss of correction during the follow-up visits. The simultaneous surgical treatment for congenital deformity and intraspinal abnormality does not involve significant complications and seems to be an alternative and safe treatment option.

Are there magnetic resonance imaging‐detectable pathologies in idiopathic scoliosis patients?

AbstractScoliosis may be a spinal manifestation of underlying disease, therefore, imaging plays a very important role in determining the underlying aetiology of so‐called ‘idiopathic’ scoliosis. If underlying intraspinal defects go unrecognised and untreated, irreversible neurological deficit can develop.Magnetic resonance imaging (MRI) is the modality of choice for imaging the spinal canal, albeit controversially. This literature review has been designed to find out whether there are associated MRI‐detectable pathologies in idiopathic scoliosis patients. If so, what is the incidence of such abnormalities? And when would MRI evaluations be warranted for idiopathic scoliosis patients?Twenty studies relating to MRI and scoliosis met the criteria and were used to perform a meta‐analysis. The majority of the articles took the view that a non‐invasive investigation which does not use ionising radiation and which can reliably exclude such intraspinal occult disease should not be withheld.Results showed that, in a population of 1398 idiopathic scoliosis patients, MRI detected 226 (16%) related intraspinal pathologies. The most common pathologies were 73 syringomyelias (32%) and 44 Chiari malformations (19%). In conclusion, until further investigation is conducted into the clinical significance of the intraspinal diseases with idiopathic scoliosis, whole spine MRI evaluations with a variety of imaging planes and pulse sequences are warranted in all idiopathic scoliosis patients, even if it is from a defensive risk management viewpoint.

Reconstruction of the Laminar Roof With Miniplates for a Posterior Approach in Intraspinal Surgery: Technical Considerations and Critical Evaluation of Follow-up Results

A retrospective clinical follow-up study of patients who underwent intraspinal surgery with reconstruction of the laminar roof using titanium miniplates. To evaluate the surgical technique of laminar roof reconstruction and to analyze follow-up results with regard to bony healing of the laminae and the development of spinal deformities. The reconstruction of the laminar roof was initially proposed to overcome adverse effects associated with extensive cervical laminectomy in children. Because technical evolutions such as the use of an air drill and miniplates have facilitated the procedure, it has gained more widespread use as a posterior approach for intraspinal surgery. Thus, with a sufficient number of patients treated and a longer period of follow up, it seems reasonable to critically evaluate the technique and its suitability as a standard approach for intraspinal surgery. The surgical procedures of 79 patient who underwent intraspinal surgery with osteotomy and reconstruction of a total of 323 spinal laminae using an air drill and miniplates were analyzed. In 59 patients, data of a complete clinical and radiologic follow-up examination were evaluated. Plain radiographs and computed tomography scans were analyzed for bony healing of the laminae and spinal alignment. Minor complications such as cerebrospinal fluid collections and disturbed wound healing occurred within normal ranges. The was no case of dural, nerve root, or spinal cord injury attributable to laminotomy or laminar reconstruction. Eight (14.3%) patients complained of moderate to severe local pain at the time of follow-up examination and 8 patients stated impaired mobility of their spine at the surgical site. Bony healing was confirmed radiologically in 86.1% of the laminae. In 12 patients, a preexisting spinal deformity worsened after surgery and five patients demonstrated a new spinal malalignment. No patient required additional surgery because of progressive spinal deformity. Intramedullary location of the lesion and cervical location of surgery were significantly associated with the development of spinal malalignment, whereas incomplete bony healing of the laminae was not. The reconstruction of the laminar roof using the technique described is safe, well suitable to serve as a standard posterior approach to intraspinal pathologies, and offers distinct advantages over laminectomy. However, some patients, particularly those with intramedullary cervical lesions, could develop spinal malalignment after surgery despite reconstruction of the laminar roof and sufficient bony healing of the laminae.

The Efficacy of Convex Hemiepiphysiodesis in Patients With Iatrogenic Posterior Element Deficiency Resulting from Diastematomyelia Excision

Retrospective analysis was performed. To investigate the safety and efficacy of anterior and posterior hemiepiphysiodesis in patients with iatrogenic posterior element deficiency. Anterior and posterior convex hemiepiphysiodesis is a well-accepted treatment method for severe and progressive congenital scoliosis in young children. Many patients with congenital spinal deformities have intraspinal pathologies that require neurosurgical intervention with laminectomy. The efficacy of this method has not been studied in these patient populations. Between 1990 and 2001, among 82 patients with congenital spinal deformity, 38 were treated with convex epiphysiodesis. This study included 18 of these patients (2 males and 16 females) who underwent diastematomyelia excision and had at least 2 years of follow-up evaluation. Diastematomyelia excision was performed before the orthopedic procedure in 8 patients and at the same anesthetic setting sequentially in 10 patients. The mean age at the time of the fusion was 20 months (range, 6-60 months), and the average follow-up period was 39 months (range, 24-120 months). The mean Cobb angle was 54 degrees (range, 31-90 degrees) before surgery and 48 degrees (range, 30-84 degrees) at the final follow-up assessment. Any increase of more than 6 degrees was accepted as progression. Eight patients (44%) had a true epiphysiodesis effect: 58 degrees (range, 40-90 degrees ) before surgery and 39 degrees (range, 30-70 degrees) at follow-up evaluation. Eight patients (44%) had a fusion effect: 49 degrees (range, 31-68 degrees) before surgery and 50 degrees (range, 37-74 degrees) at follow-up assessment. Two patients (12%) had a postoperative progression of deformity: 63 degrees (range, 54-72 degrees) before surgery and 75 degrees (range, 65-84 degrees) at follow-up evaluation. Convex epiphysiodesis is an effective method for patients with midline laminectomy defect as those with intact posterior elements. Because the facet joints and transverse processes usually are unaffected, the presence of midline defect does not diminish the efficacy of the technique.