Lower Spinal Canal Research Articles

Magnetic resonance morphometry of the lumbar spinal canal in Zenica - Doboj Canton in Bosnia and Herzegovina.

Aim To investigate morphometric determinants of lumbar canal in patients treated in Cantonal Hospital Zenica, and their variation according to gender. Methods Morphometry of lumbar spinal canal was assessed in 52 patients treated at the Department of Neurosurgery of Cantonal Hospital Zenica in the period between September 2022 and November 2022. Data were collected retrospectively: anteroposterior and transverse diameter of lumbar vertebrae and intervertebral discs, as well as anteroposterior diameter of the spinal canal. Results Gender appeared to be an important morphometric determinant, since it significantly differed when it comes to lumbar vertebral anteroposterior and transverse diameter, being mostly larger in males. Conclusion This study increases anatomical knowledge of the vertebras and spinal canal of the lumbar region. Therefore, the measured dimensions of the lumbar vertebrae and spinal canal could be used as a baseline point for evaluation of patients presenting with low back pain and potential spinal canal stenosis.

T1 Mapping Quantifies Spinal Cord Compression in Patients With Various Degrees of Cervical Spinal Canal Stenosis.

Age-related degeneration of the cervical spinal column is the most common cause of spinal cord lesions. T1 mapping has been shown to indicate the grade and site of spinal cord compression in low grade spinal canal stenosis (SCS). Aim of our study was to further investigate the diagnostic potential of a novel T1 mapping method at 0.75 mm resolution and 4 s acquisition time in 31 patients with various grades of degenerative cervical SCS. T1 mapping was performed in axial sections of the stenosis as well as above and below. Included subjects received standard T2-weighted MRI of the cervical spine (including SCS-grading 0-III), electrophysiological, and clinical examination. We found that patients with cervical SCS showed a significant difference in T1 relaxation times within the stenosis (727 ± 66 ms, mean ± standard deviation) in comparison to non-stenotic segments above (854 ± 104 ms, p < 0.001) and below (893 ± 137 ms, p < 0.001). There was no difference in mean T1 in non-stenotic segments in patients (p = 0.232) or between segments in controls (p = 0.272). Mean difference of the T1 relaxation times was significantly higher in grade III stenosis (234 ± 45) vs. in grade II stenosis (176 ± 45, p = 0.037) vs. in grade I stenosis (90 ± 87 ms, p = 0.010). A higher difference in T1 relaxation time was associated with a central efferent conduction deficit. In conclusion, T1 mapping may be useful as a tool for SCS quantification in all grades of SCS, including high-grade stenosis with myelopathy signal in conventional T2-weighted imaging.

Respiration and the watershed of spinal CSF flow in humans

The dynamics of human CSF in brain and upper spinal canal are regulated by inspiration and connected to the venous system through associated pressure changes. Upward CSF flow into the head during inspiration counterbalances venous flow out of the brain. Here, we investigated CSF motion along the spinal canal by real-time phase-contrast flow MRI at high spatial and temporal resolution. Results reveal a watershed of spinal CSF dynamics which divides flow behavior at about the level of the heart. While forced inspiration prompts upward surge of CSF flow volumes in the entire spinal canal, ensuing expiration leads to pronounced downward CSF flow, but only in the lower canal. The resulting pattern of net flow volumes during forced respiration yields upward CSF motion in the upper and downward flow in the lower spinal canal. These observations most likely reflect closely coupled CSF and venous systems as both large caval veins and their anastomosing vertebral plexus react to respiration-induced pressure changes.

The value of intraoperative neurophysiological monitoring for microsurgical removal of conus medullaris lipomas: a 12-year retrospective cohort study.

BackgroundLipomas in the lower spinal canal can lead to progressive neurological deficits, so they may have to be surgically removed. Intraoperative neurophysiological monitoring serves to minimize the morbidity of the surgical procedure. However, so far there are no evidence-based recommendations which type of monitoring procedure or combination of procedures to choose.MethodsThe aim of this study was to evaluate the feasibility and value of various intraoperative monitoring techniques: motor and sensory evoked potentials (MEP, SEP), free-running and triggered electromyography (EMG). Thirty cases of spinal lipomas of the Conus medullaris (dorsal Type A: 20.0%; caudal Type B: 33.3%; transitional Type C: 46.7%) were retrospectively evaluated over a 12-year period.ResultsThe patients were mostly pediatric and suffered from persistent pain (73.3%), pareses (56.7%), sensory deficits (43.4%), and/or urogenital dysfunctions (60.0%). SEPs were successfully evoked in 66.7% of cases, MEPs in 86.7% of cases, and EMGs in 100%. MEP alterations correlated with direct mechanical maneuvers in the operating site. SEP changes correlated mostly with physiological events, such as rinsing/cooling of the operating site. Spike-, burst- or tonic train-activity was found in the free-running EMG that occurred only with certain manipulation patterns. Irreversible MEP changes and signal loss in the triggered EMG correlated with post-operative deficits.ConclusionsThe results of this study showed, that intraoperative monitoring could be considered a helpful tool during lipoma tumor surgery near the Conus medullaris. Most reliable results were obtained from transcranial MEPs, free-running EMGs, and triggered EMGs. That’s why the authors favor a routine set-up consisting of at least these three techniques, as this enables mapping at the beginning of the operation, continuous functional testing during surgery, and prognosis of the post-operative symptomology.

The value of intraoperative neurophysiological monitoring for microsurgical removal of conus medullaris lipomas: a 12-year retrospective cohort study

BackgroundLipomas in the lower spinal canal can lead to progressive neurological deficits, so they may have to be surgically removed. Intraoperative neurophysiological monitoring serves to minimize the morbidity of the surgical procedure. However, so far there are no evidence-based recommendations which type of monitoring procedure or combination of procedures to choose.MethodsThe aim of this study was to evaluate the feasibility and value of various intraoperative monitoring techniques: motor and sensory evoked potentials (MEP, SEP), free-running and triggered electromyography (EMG). Thirty cases of spinal lipomas of the Conus medullaris (dorsal Type A: 20.0%; caudal Type B: 33.3%; transitional Type C: 46.7%) were retrospectively evaluated over a 12-year period.ResultsThe patients were mostly pediatric and suffered from persistent pain (73.3%), pareses (56.7%), sensory deficits (43.4%), and/or urogenital dysfunctions (60.0%). SEPs were successfully evoked in 66.7% of cases, MEPs in 86.7% of cases, and EMGs in 100%. MEP alterations correlated with direct mechanical maneuvers in the operating site. SEP changes correlated mostly with physiological events, such as rinsing/cooling of the operating site. Spike-, burst- or tonic train-activity was found in the free-running EMG that occurred only with certain manipulation patterns. Irreversible MEP changes and signal loss in the triggered EMG correlated with post-operative deficits.ConclusionsThe results of this study showed, that intraoperative monitoring could be considered a helpful tool during lipoma tumor surgery near the Conus medullaris. Most reliable results were obtained from transcranial MEPs, free-running EMGs, and triggered EMGs. That's why the authors favor a routine set-up consisting of at least these three techniques, as this enables mapping at the beginning of the operation, continuous functional testing during surgery, and prognosis of the post-operative symptomology.

Postoperative Systemic Dissemination of Injected Elemental Mercury

There were only a few reports of mercury on pulmonary artery. However, there is no data on surgery related mercury dissemination. The objective of the present article is to describe one case of postoperative injected mercury dissemination. A 19-year-old man presented severe neck pain including meningeal irritation sign and abdominal pain after injection of mercury for the purpose of suicide. Radiologic study showed injected mercury in the neck involving high cervical epidural space and subcutaneous layer of abdomen. Partial hemilaminectomy and open mercury evacuation of spinal canal was performed. For the removal of abdominal subcutaneous mercury, C-arm guided needle aspiration was done. After surgery, radiologic study showed disseminated mercury in the lung, heart, skull base and low spinal canal. Neck pain and abdominal pain were improved after surgery. During 1 month after surgery, there was no symptom of mercury intoxication except increased mercury concentration of urine, blood and hair. We assumed the bone work during surgery might have caused mercury dissemination. Therefore, we recommend minimal invasive surgical technique for removal of injected mercury. If open exposures are needed, cautious surgical technique to prohibit mercury dissemination is necessary and normal barrier should be protected to prevent the migration of mercury.

Sacral Mass in a Fetus

A female neonate who had an antenatally diagnosed sacralmass is admitted to the neonatal intensive care unit immediately after birth. ### Prenatal History The 26-year-old mother had two previous normal pregnancies. In the current pregnancy, a mass was discovered at 20 weeks’ gestation. The woman underwent serial ultrasonographic imaging to monitor the mass. Fetal magnetic resonance imaging obtained at 24 weeks’ gestation revealed a mixed solid-cystic mass in the sacrococcygeal region, extending inferiorly (Figure 2). Elective cesarean section is performed at 37 weeks’ gestation Figure 1. Figure 2. ### Birth History and Presentation Abdominal radiographs reveal a 13×15-cm broad-based pedunculated soft-tissue mass projecting from the lower sacrococcygeal area (Figure 3). Figure 3. Postnatal ultrasonography demonstrates a large mass posterior to the coccyx. The mass has a heterogeneous echotexture with solid, cystic, and vascular components. The lower spinal canal appears normal. Serum α-fetoprotein (AFP) concentration is 335,700 ng/mL (35,700 μg/L). The infant undergoes surgery on the third day after birth. Histopathologic examination of the surgical specimen reveals the presence of mature neuroglial tissue, choroid plexus, adipose tissue, smooth muscle cells, squamous epithelium, cartilage, and bone (Figures 4 and 5). Figure 4. Figure 5. Newborn who has a sacral mass Sacrococcygeal teratoma (SCT) SCTs are the most common tumors in newborns, occurring in 1 per 20,000 to 40,000 births. Females are four times more likely to be affected than males, but malignant change is seen more frequently in males. Sizes range from 1 to 30 cm, …

Multiple ependymomas in a patient with Turcot's syndrome

A 21-year-old woman was diagnosed with Turcot's syndrome (TS) at age 16 years. She had two ependymomas, one was located in the left middle cerebellar peduncle and the other in the low sacral spinal canal. Her mother and brother both had colectomies for colonic polyposis. Her maternal uncle and grandfather also had this disease and both died from cancer of the colon in their fourth decade of life. The patient was found to have hyperpigmented spots in the retina, skull osteomas and normal neurological examinations. The bone scan and CSF were normal and she had a germline mutation in the segment 3 of the adenomatous polyposis coli (APC) gene. Following partial resection of the two ependymomas, she was treated with radiation and chemotherapy. One year after surgery, paraspinal desmoid tumors were found and removed. She is presently 42 months postsurgical resection of the neural tumors and has remained central nervous system tumor-free. The occurrence of multiple ependymoma in TS has not been reported, and the control of this patient's ependymomas is consistent with other reports of long-term survival with TS and glial tumors. © 1997 Wiley-Liss, Inc.

High frequency of hemorrhagic strokes in Jerusalem during the Persian Gulf War.

sional polyphasic units up to 5 mV in the rectus femoris, vastus medialis, and tibialis anterior, with no spontaneous activity except for some fibrillation potentials in the medial gastrocnemius. Paraspinal EMG activity was normal. There was no myokymia. Leg weakness progressed over 5 months without additional symptoms. In late August, she received 5 days of 500 mg/d of methylprednisolone, with transient subjective (but not objective) worsening of weakness. Progressive improvement commenced in October 1990 and has continued since. She is now only mildly troubled when climbing hills or stairs. These changes have been confirmed with myometry of hip flexion and abduction, knee flexion and extension, and with timed performance tests. The knee jerks have returned. Discussion. This woman developed a symmetric, lower motor syndrome that primarily, but not exclusively, affected the quadriceps. Electrophysiology confirmed extensive motor involvement and demonstrated subclinical postganglionic sensory nerve involvement. During the 5 months of progressive deterioration, tumor recurrence within the pelvis, retroperitoneal space, and spinal canal was considered, but the later resolution of the weakness argues strongly against this. Symmetry and absence of any pain or sphincter involvement suggested postirradiation damage, a diagnosis for which negative CSF examination and imaging of the pelvis, retroperitoneal space, and lower spinal canal are required.’ Since the cauda equina and the lumbosacral plexus are usually included in the radiation field for pelvic malignancy (including lymphatic drainage), most realize that postirradiation damage may occur in both sites. In our case, the upper border of the radiation field was at the lower L-5 level, and yet the main damage was to the nerves supplying the quadriceps, implying that the major clinically apparent damage was to the lumbosacral plexus. The radiation dosage was within standard limits, but calculation of “safe doses” is always The

Extraneural Metastasis in Cerebellar Medulloblastomas

This paper deals with the clinicopathological findings in two cases of cerebellar mudulloblastoma with extraneural metastasis. These two cases fulfill Weiss' minimal criteria for confirmation of extraneural metastasis of a glioma. The first case was an 18 month-old boy with a 14 month clinical history. A ventriculoperitoneal shunt was performed, followed by three series of Linac irradiations, for a total dose of 13, 750 rads. An autopsy revealed a cerebellar vermis tumor accompanied by ventricular and spinal subarachnoidal seeding. Milliary metastatic nodules were noticed macroscopically in the liver, and microscopic deposits were also recognized in the right ventricular wall of the heart, pericardium, lumbar vertebrae, capsules of the pancreas and spleen, and adipose tissue surrounding the adrenal gland. Tumor cell invasion in a small vein within the vermis tumor was thought to be a cause of blood-stream metastases. The second case was a 10 year-old boy with a clinical history of 16 months. The cerebellar vermis tumor was partially removed and a ventriculoperitoneal shunt was performed at the same time. The patient was given radiotherapy, 4, 000 rads in the whole brain, 4, 000 rads in the upper spinal canal and 3, 000 rads in the lower spinal canal. One month later he felt pain in the hip joint and lower back. Radiography showed osteolytic changes in the pelvis and femoral bone, and later in the humerus, ribs and scapulas. Local irradiation of bony metastase was effective for a while. An autopsy revealed a small tumor remnant in the cerebellar vermis accompanied by spinal subarachnoidal seeding. Systemic bony metastasis was confirmed with no metastasis to the internal organs and lymphoid tissues. The dura mater at the primary site of the tumor was invaded by tumor cells, and this seemed to be the route of blood-spread metastasis. Approximately 80 cases of cerebellar medulloblastoma with extraneural metastasis have been reported in assorted report. The mode and site of metastasis, diagnosis and treatment are critically reviewed in this paper.

EKG changes after spinal subarachnoid hemorrhage.

Marked morphological electrocardiographical changes occurred in a patient whose subarachnoid hemorrhage originated in the lower spinal canal. Thus, the electrocardiogram can show the changes well known for intracranial subarachnoid hemorrhage even when the source of bleeding is in the lower spinal canal.

NEOPLASMS OF THE LOWER SPINAL CANAL.

NEOPLASMS OF THE LOWER SPINAL CANAL.