Intraspinal Pathology Research Articles

Preoperative spinal canal investigation in adolescent idiopathic scoliosis curves > or = 70 degrees.

This is a prospective evaluation of a consecutive series of patients with adolescent idiopathic scoliosis (AIS) with curves > or = 70 degrees. The authors investigated the possibility that large curve size may constitute an atypical presentation of idiopathic scoliosis suggestive of underlying neurologic pathology, which would warrant preoperative investigation. The potential for intraspinal pathology to cause scoliosis is well accepted. The incidence of spinal canal abnormalities in congenital or atypical scoliosis may be as high as 30-60%. Identification of clinical neurologic deficits, congenital abnormalities, or atypical features of scoliosis are often helpful in identifying the subpopulation of scoliosis patients at risk for spinal canal pathology. Thirty-three consecutive patients with large (> or = 70 degrees) adolescent idiopathic scoliosis (AIS) and without evidence of neurologic or congenital abnormalities, were evaluated with either computed tomography/myelogram (n = 3) or magnetic resonance imaging (n = 30) to assess the entire spinal canal. None of the studies revealed any pathology of the neuraxis, and all 33 patients were treated with surgery without any neurologic sequelae. Preoperative investigation of the central neuraxis is not mandatory in large (> or = 70 degrees) but otherwise typical AIS curves. These large curves do not appear to suggest associated spinal canal anomalies.

Atlantoaxial Lateral Mass Osteoarthritis

Localized C1-C2 lateral mass osteoarthritis is a degenerative disorder of the upper cervical spine that has a natural history markedly different from that of degenerative afflictions of the lower cervical spine. Atlantoaxial lateral mass arthritis is a distinct cause of occasionally severe occipitocervical pain in elderly persons. In this series, the diagnosis was suggested by the medical history of nine elderly patients who presented with severe occipitocervical pain (frequently diagnosed as occipital neuralgia). Physical examination demonstrated marked restriction of rotation of the cervical spine to the affected side, and localized tenderness unilaterally at the occipitocervical junction. The diagnosis was confirmed by plain radiographs of the C1-C2 articulation (open-mouth view), demonstrating marked, usually unilateral joint-space narrowing, osteophyte formation, and subchondral sclerosis. Bone scanning demonstrated focal uptake unilaterally at the occipitocervical junction. Additional imaging studies, including computed tomography, magnetic resonance imaging, or cervical myelogram, were performed to rule out coexisting intraspinal pathology. Conservative treatment was usually successful; however, C1-C2 arthrodesis was successful for severe occipitocervical pain due to atlantoaxial lateral mass arthritis not responsive to conservative treatment.

Selective Calf Weakness Suggests Intraspinal Pathology, Not Peripheral Neuropathy

Four patients, referred as having peripheral neuropathy, were noted to be able to walk on their heels but not on their toes. In each, intraspinal disease was found: ependymoma of the filum terminale, spinal muscular atrophy, spinal stenosis, and meningeal carcinomatosis. By comparison, in 86 cases of hereditary motor and sensory neuropathy type 1, ankle plantar flexors were never weaker than ankle dorsiflexors. Patients with greater weakness in plantar flexors than in dorsiflexors should be suspected of having intraspinal disease rather than peripheral neuropathy. Physiologic and biomechanical factors may explain why muscles innervated by the peroneal nerve are weaker, or graded weaker, in peripheral neuropathy.

Short review of CT in the study of some intraspinal diseases.

We present our experience of the usefulness of high definition computed tomography (HDCT) in 30 cases of isolated intraspinal pathology (12 extramedullary and 18 intramedullary cases). The results are assessed in comparison to myelography.

Pediculate thinning: a normal variant at the thoracolumbar junction

Abstract A review of 200 rontgenograms of the thoracic and lumbar spines demonstrated an important variation in normal pediculate appearance that may mimic a spinal mass. Localized flattening of the pedicles at the thoracolumbar junction is a normal variant which may be seen in 7 per cent of patients without any intraspinal pathology.

Large-volume myelography. An aid in the evaluation of curvatures of the spine.

Abstract The authors injected 12 to 88 ml Pantopaque in the myelography of 32 patients with varying degrees of kyphoscoliosis. The amount of contrast medium must be sufficient to completely fill the subarachnoid space at the site of curvature, allowing complete evaluation of the dural sac and spinal cord at that site. Intraspinal pathology such as tumors and syringomyelia can be excluded and the degree of compression of the dural sac and spinal cord evaluated. In this series 4 unsuspected abnormalities were defined by myelography: 2 syringomyelias, 1 diastematomyelia, and 1 intraspinal lipoma.

Technetium tc 99m serum albumin. The use of high specific activity technetium tc 99m serum albumin as a tracer for subarachnoidal and ventricular scintiphotography.

OVER the past four years a steadily increasing interest has been evident in investigating the cerebrospinal fluid (CSF) cavities by means of radioisotope scanning techniques (scintiphotography). As a possible indication of this, contributions^1-7from seven different centers were presented on this subject alone at the Eighth Symposium Neuroradiologicum held in September 1967 in Paris. The reports dealt with the clinical applications of these techniques in a number of conditions including intraspinal pathology, hydrocephalus, CSF, rhinorrhea and otorrhea, subarachnoidal cysts, and porencephaly. <h3>Choice of Tracer</h3> Numerous radioactive tracers have been used for studying the spinal and endocranial cerebrospinal fluid pathways by external detection (Table). Among these agents^99mTc-pertechnetate stands out for its almost ideal physical characteristics: 6-hour half-life, lack of β-emission, and single 140 Kev γ-photon. Therefore, sodium pertechnetate (Na-^99mTcO₄) was tried as agent for isotope cisternography by one of us.^12,19It became apparent,