Location In Spine Research Articles

Sagittal Alignment in the Degenerative Lumbar Spine: Surgical Planning.

➤ Sagittal alignment of the spine has gained attention in the field of spinal deformity surgery for decades. However, emerging data support the importance of restoring segmental lumbar lordosis and lumbar spinal shape according to the pelvic morphology when surgically addressing degenerative lumbar pathologies such as degenerative disc disease and spondylolisthesis.➤ The distribution of caudal lordosis (L4-S1) and cranial lordosis (L1-L4) as a percentage of global lordosis varies by pelvic incidence (PI), with cephalad lordosis increasing its contribution to total lordosis as PI increases.➤ Spinal fusion may lead to iatrogenic deformity if performed without attention to lordosis magnitude and location in the lumbar spine.➤ A solid foundation of knowledge with regard to optimal spinal sagittal alignment is beneficial when performing lumbar spinal surgery, and thoughtful planning and execution of lumbar fusions with a focus on alignment may improve patient outcomes.

Clinical findings of Tarlov cyst according to its location and level in lumbosacral spine on magnetic resonance imaging

Background: Tarlov cysts are fluid filled cysts that are most found in the lumbosacral spine. Patients often present with a series of distinguished neurological deficits that correlate with the mass effects of cyst provided on the level and location of the lumbosacral spine. Objective: To determine the clinical findings of Tarlov Cyst associated with its level and location magnetic resonance imaging Methods: A total of 60 patients with different sets of neurological deficits were included in this descriptive cross-sectional study conducted in Ghurki Trust and Teaching hospital. Data was collected by using Questionnaire/Performa. An MRI procedure was used to assess the Tarlov cysts. A Convenient sampling technique was used in this study. Data was evaluated and analysed with SPSS v-25 and Microsoft excel. Results: Out of 60 patients, there were 40 females (66.67 %) and around 20 males (33.3%). The most common neurological deficits that was found in patients were numbness seen in 50 patients, loss of reflexes seen in 40 patients, mass effects in the affected region were seen in 20 patients and changes in the bowel function was seen in 10 patients. The most common location of Tarlov cysts found in patients was sacral region 28(46.7%), lumbosacral region 24(40%) and lumbar region 8(13.3%). Conclusion: The study concluded that the frequency of female was more than male. And the most common site of Tarlov cyst was found to be at LV4-LV5 and LV5-level S1 exhibiting different clinical manifestation.

Effect of Chemotherapy and Hormonal Therapy on Bone Mineral Density in Patients with Breast Cancer in Saiful Anwar Hospital Malang

Osteoporosis is an important health problem, and the number of patients who suffered from it is increasing. Breast cancer is a condition that has a high risk of osteoporosis. Cancer induced bone disease results from the primary disease, metastatic process, or from therapies against the prime condition, causing bone fragility. Therefore, there are still different opinions regarding the therapeutic effect of breast cancer on bone mineral density. Aim: to determine the effect of chemotherapy and hormonal therapy on bone mineral density in patients with breast cancer in Saiful Anwar Hospital Malang. Method: this is a case-control study conducted in 30 patients with breast cancer who had undergone chemotherapy and hormonal therapy are compared to 30 patients without breast cancer as controls. Bone Mineral Density (BMD) was measured by DEXA. Result: there are 53% of breast carcinoma patients having osteopenia and 13% having osteoporosis, with one patient has osteoporosis located in the femoral neck and three patients in lumbar (L1-L4). We obtain a significant T-score (p=0.02) in the great trochanter. Odds Ratio (OR) 0.233 with p = 0.008 showed a protective effect of chemotherapy and hormonal therapy for breast cancer to the bone density. Conclusion: the incidence of osteoporosis in the study was 13%, with the most location in the lumbar spine. Chemotherapy and hormonal therapy had a protective effect on BMD in patients with breast cancer in Saiful Anwar Hospital Malang.

QOLP-08. UNDERSTANDING THE EXPERIENCE OF YOUNG ADULTS (YAS) DIAGNOSED WITH AN EPENDYMOMA FROM THE ADULT EPENDYMOMA OUTCOMES PROJECT AND RARE CNS OUTCOMES AND RISK STUDY

Abstract Research in young adult (YA) patients is novel, particularly in central nervous system tumors like ependymomas. Stagnant survival outcomes in YAs are concerning compared to improvements within pediatric and older adults. Additionally, uncertainty of the impact of treatment on psychosocial and behavioral outcomes during an essential developmental stage warrants attention. The purpose of this report is to explore ependymoma YA outcomes data to inform care. Adult ependymoma (n=191) patients participating in a web-based outcomes study completed clinical data and validated questionnaires (EQ-5D, MDASI-BT). YAs 18–39 (n= 58) were compared to older adults (OAs) >40 (n=133). Participants were predominantly female (68%), with tumor location in brain (29%) or spine (71%). The majority of YAs (67%) reported seeing a physician within 6 months from symptom onset, whereas OAs were more likely to delay for 7 months or longer. Headaches (brain tumor 70%) and numbness (spine tumor73%) were common presenting symptoms for both age groups. 76% of YAs were working before diagnosis, however 27% stopped work, 18% reduced hours, 7% switched jobs and 2% lost their job after diagnosis. At time of participation, most participants were not on active treatment (61%), but both YA and OA frequently endorsed use of pain medication (37%). Tumor recurrence was more common in YAs (30%) compared to OAs (19%). Common moderate to severe symptoms in YAs included distress (27%) and fatigue/sadness (18%) with brain tumors compared to fatigue (56%) and distress/disturbed sleep/drowsiness (36%) with spine tumors. Over a third of YAs reported some impact on general health (usual activities, pain/discomfort, and anxiety/depression). Despite stable disease, YAs with ependymoma experienced mood and lifestyle challenges and reported significant symptoms and use of pain medication. Further exploration is needed on the impact of cancer-related effects on YAs to gain insight on appropriate management and care.

Prognostic Factors in Patients With Spinal Chordoma: An Integrative Analysis of 682 Patients.

The low incidence of spinal chordoma precludes a prospective study of prognostic factors with a large patient cohort. To perform a comprehensive integrative analysis on the prognostic factors, treatment, and outcomes of patients with spinal chordoma using data from 2 institutions and the literature. Appropriate studies were identified per search criteria. The local database was retrospectively searched to include a similar patient cohort. Overall, 108 studies from the literature and 30 patients from our local institution were identified, resulting in a total of 682 patients. The median age was 57 years old and 35.2% were female. The median follow-up was 46 months (range: 1-408). The median progression-free survival (PFS) and overall survival (OS) were 72 months and 115 months, respectively. Significant prognostic factors for PFS on multivariate analysis included age (pediatric vs adult, hazard ratio [HR]: 2.00-14.36), tumor location (mobile spine vs sacral spine, HR: 0.31-0.87), pathology (differentiated vs classic, HR: 2.48-10.90),and chemotherapy (HR:1.11-3.85). Significant prognostic factors for OS on multivariate analysis included age (geriatric vs adult, HR: 1.52-3.45 and pediatric vs adult, HR: 1.73-9.36), bladder or bowel dysfunction (HR: 1.27-5.43), pathology (dedifferentiated vs classic, HR: 2.38-11.09), recurrence or progression (HR: 1.72-4.48), and metastases (HR: 1.11-2.47). In patients with spinal chordoma, young age, location in sacral spine, dedifferentiated pathology, and chemotherapy were negative predictors of PFS, while young and old age, bladder or bowel dysfunction at presentation, dedifferentiated pathology, recurrence or progression, and metastases portended a worse OS.

Lesión medular traumática en mayores de 65 años en la provincia de Asturias

Aimsto assess incidence, causes and socio-demographicaspects of traumatic spinal cord injury among patients over 65 in Asturias (Spain). Patients and methodsA census was performed between 1951 and 2013 of patients in Asturias, over 65 years-old coded as «traumatic spinal cord injury with or without vertebral fracture». Socio-demographic, hospital and clinical variables were recorded. ResultsIn total 180 patients were registered, most of them males (60%), with a mean age of 73 years (maximum 91). The estimated incidence in 2010 was found to be 24.9, in 2011, 28.9 and in 2012, 32.9 cases/million/year. The distribution in the type of injury was homogeneous and location in the cervical spine (40%) was found to be more common. There was bone injury in 71.4%, with multilevel injury in more than half of the cases. The main cause was accidental fall (52.1%), mainly at own height (68.6%), and most of them located in the cervical spine (38.5%), followed by traffic accidents with 57.6% located in the cervical spine. ConclusionsA change was observed in the epidemiological profile of the patients over 65 years old with spinal cord injury. There were more cases associated with accidental fall. It is necessary to create specific preventive and therapeutic strategies for this group.

Quality of life after en bloc resection of tumors in the mobile spine

Background contextLittle has been reported regarding the patient-centered quality-of-life (QOL) outcomes after en bloc spondylectomy (ES). Despite lower local recurrence rates, it is unknown whether outcomes justify the surgical morbidity. PurposeThe purpose of this study was to report on patient QOL after ES as measured by validated instruments and to identify factors that may predict better postoperative QOL. Study designThis is a retrospective case-control study (Level III). Patient sampleThirty-five consecutive patients with mobile spine tumors were included. Twenty-seven patients underwent en bloc resection, whereas 8 patients received definitive radiation and no surgery. Minimum follow-up was 6 months (median, 32 months). Outcome measuresThe outcome measures were European Quality Group 5-Dimensional Questionnaire (EQ5D), four Patient-Reported Outcome Measurement Information System (PROMIS) short-form metrics, Neck Disability Index, and Oswestry Disability Index (ODI). MethodsWe performed statistical comparisons between the surgery and radiation groups, of the general US population, and within the study group itself to identify predictors of higher QOL scores. ResultsWe identified a significant difference in QOL between the surgery and radiation groups in only one instrument, PROMIS pain interference, with surgery having more pain interference (15.7 vs. 10.1, p=.04). For most metrics, including EQ5D, pain interference, pain behavior, and ODI, scores were around one standard deviation worse than the US population mean. Multivariable linear regression for each instrument demonstrated that preoperative factors such as better performance status, tumor location in the cervical spine, lack of mechanical back or neck pain, and shorter fusion span were independently predictive of better QOL scores. Postoperative factors such as poor performance status, chronic narcotic use, and local recurrence were more dominant than preoperative factors in predicting worse QOL. ConclusionsPatients may experience more pain interference after surgery as opposed to definitive radiotherapy, but we did not identify a difference for most metrics. Quality of life in our study group was significantly worse than the general population for most metrics. Cervical tumors, lack of mechanical pain, better baseline performance status, and less extensive surgery predict better QOL after surgery.

Primary Spinal Marginal Zone Lymphoma Relapse at a Different Spinal Level after Remission of the Primary Lesion

Study Design Case report. Objective Most spinal lymphomas occur in the context of systematic lymphomas. Marginal zone lymphoma (MZL) is a type of B-cell lymphoma originating from the marginal zone of B-cell follicles. Mucosa-associated lymphoid tissue (MALT) lymphoma is a type of extranodal MZL and rarely occurs in the central nervous system. To date, there has been only one case report of primary spinal MALT lymphoma and there are no case reports of relapsed MALT lymphoma at a different location of the spine. Results A 58-year-old man complained of gait disturbance and urinary dysfunction. Magnetic resonance images showed an abnormal lesion in the epidural space at T11–L1 compressing the conus medullaris. The patient underwent laminectomy and partial resection of the tumor. Histopathologic and immunohistochemical findings were consistent with MALT lymphoma. Following postoperative radiotherapy, the epidural mass disappeared completely. Three years later, epidural MALT lymphoma at a different location in the thoracic spine (T8–T10) occurred and caused myelopathy again. Histologic diagnosis of the relapsed tumor was the same as had been seen 3 years previously. Conclusions This is the first case report of relapsed spinal MALT lymphoma at a different location of the thoracic spine. Though the prognosis of MALT lymphoma is fairly good, careful follow-up is needed to screen any relapse or transformation to a high-grade lymphoma.

E-051 Upper cervical spinal dural arteriovenous fistulae: an under recognized entity?

IntroductionSpinal dural arteriovenous fistulae (dAVFs) are uncommon lesions that often present with slowly progressive myelopathy. These shunts are located most commonly in the thoracolumbar region. A location in the cervical...

Osteochondromas of the cervical spine in atypical location

In the current article we review the available English literature by pubmed search engine on the topic of osteochondromas and their location in the cervical spine. The focus is to investigate the location of the lesions in cervical spine and to analyze clinical presentations and symptoms of patients, the aetiology and histopathology examination of the masses. In addition we report a rare illustrative case of a 62 year-old man with an osteochondroma of the cervical spine. The mass developed at a very slow rate for many years and produced no clinical symptoms. The location of the extradural mass in the right atlanto-axial joint of C1 and C2 is extremely rare and was not been reported so far. After preoperative CT- and MRI-imaging the entire mass could be removed.

Chromosomal imbalances and NF2 mutational analysis in a series of 10 spinal nerve sheath myxomas

To report the demographic, clinical and molecular profile of a series of intraspinal nerve sheath myxomas. Nerve sheath myxomas are diagnostically challenging, mainly cutaneous spindle cell neoplasms exhibiting Schwann cell differentiation. They are frequently mistaken for neurothekeomas and their genetic features are essentially unknown. Ten spinal nerve sheath myxomas with a preferential location in the lumbar spine (70%) were investigated. Presenting symptoms consisted of sciatic pain (100%), muscle weakness and paraesthesia (60% each). Intraoperatively, all tumours were attached to a spinal nerve. Chromosomal imbalances by comparative genomic hybridization were found in 8/10 cases, consisting of -22q (80%) and -19 (30%). Polymerase chain reaction analysis of the NF2 gene (exons 1-16) revealed two tumours with mutations in exon 8 and 14, respectively. Although these 10 nerve sheath myxomas exhibited Schwann cell differentiation and frequently showed loss of chromosome 22q typically encountered in peripheral nerve tumours, only two cases demonstrated mutations of the NF2 gene. This may indicate involvement of other tumour suppressor genes on 22q in nerve sheath myxomas and shows that they are more closely related at the molecular level to sporadic schwannomas, underscoring the presumption that they are true nerve sheath tumours.

Symptomatic Intraosseous Synovial Cyst in the Cervical Spine: A Case Report

A case report and review of the literature are presented. To describe an unusual location for a cervical synovial cyst and to review characteristic presentations and findings of synovial cysts in the cervical spine. Synovial cysts in the cervical spine are rare. To date, only 27 have been reported in the literature. None, however, has been reported as cysts involving or eroding into the vertebral body. A single case of an intraosseous synovial cyst in the cervical spine is presented with a review of the literature. History, examination, and radiographic evaluation suggested an intraosseous cystic lesion, which pathologically was determined to be synovial in origin. We present a case of a cervical synovial cyst in a previously undescribed intraosseous location in the cervical spine, treated successfully with surgical excision.

An effective extraction technique for the treatment of closed macrocomedones.

Closed macrocomedones are unsightly lesions that may be resistant to medical treatments and comedone extractors. Light cautery has been used to treat macrocomedones, which are 1 to 3 mm in size; however, its success in larger and chronic lesions is limited. To introduce an alternative treatment technique for this neglected problem. We treated these lesions by using cautery and standard dissecting forceps. After puncturing the macrocomedones in the center using the sharp-tipped cautery point, we grasped the base of the comedone using standard dissecting forceps and squeezed and pulled out the contents. Twelve patients were treated with this technique, all of whom tolerated the procedure well and judged the cosmetics results as very good. We recommend this procedure for patients who have closed macrocomedones larger than 3 mm in size, although it is an effective treatment for macrocomedones of any size.

Determination of inter-spinous process distance in the lumbar spine. Evaluation of reference population to facilitate detection of severe trauma.

Fracture of a spinal segment with minimal or no compression of the vertebral body can be highly unstable. Screening for such an injury in the lumbar spine is often obstructed in a multi-injured patient, because of difficulty in obtaining adequate sagittal radiographs. The position of the spinous processes in relation to each other is the key for proper evaluation of the status of the posterior stabilising structures. The amount of separation or axial rotation of the posterior part of the vertebra that can occur before failure of the posterior structures has not been unambiguously defined. Despite this, it can be assumed that severe separation of the spinous processes indicates a more or less pronounced loss of mechanical support. An analysis of how the posterior spinous processes relate to each other on an anteroposterior (AP) radiograph could obviate this problem. A new, simple and reproducible radiographic tool is presented for screening of an eventual rupture of posterior structures of the lumbar spine. This method is based on measurements of the variation in interspinal process distance between adjacent levels in lumbar spine in a normal population. Two hundred normal AP radiographs of non-injured thoracolumbar spine were studied. The interspinal process distance was measured as the distance between the cranial ends of the adjacent projections of spinous processes on AP radiographs. The mean values and 99% confidence limits for changes in the interspinal process distances between adjacent spinal levels were determined and analysed in relation to age, gender and spinal segment level. An upper limit of a normal difference in distance between the spinous processes at two adjacent levels was determined to be 7-10 mm, depending on age and location in the lumbar spine. A difference in interspinal process distance exceeding 7 mm between two adjacent lumbar levels should alert a surgeon to severe and unstable injury.

Chondrosarcoma of the cervical spine: A case report

Among spinal bone tumors, chondrosarcoma occupies the third rank after myeloma and chordoma. Its location in the cervical spine is exceptional. The authors report a case of this lesion involving C7. This new case illustrates well the therapeutic and diagnostic difficulties of this tumor site at the cervico-thoracic level. The radiologic and histologic aspects do not differ from these of the other locations of this tumor. This insidious lesion is often voluminous at the time of discovery. This is why diagnostic delay does not always allow a wide carcinologically satisfactory excision. Despite the development of radiotherapy protocols, the only efficient treatment consists of total vertebrectomy. Surgical procedures are often carcinologically insufficient at the cervical level, which explains the poor prognosis of this tumor. However, results should improve with earlier diagnosis thanks to new radiologic imaging, especially with MRI. This will be then allow better surgical treatment.