Lower Thoracic Vertebrae Research Articles

Oblique Loading in Post Mortem Human Surrogates from Vehicle Lateral Impact Tests using Chestbands.

While numerous studies have been conducted to determine side impact responses of Post Mortem Human Surrogates (PMHS) using sled and other equipment, experiments using the biological surrogate in modern full-scale vehicles are not available. The present study investigated the presence of oblique loading in moving deformable barrier and pole tests. Threepoint belt restrained PMHS were positioned in the left front and left rear seats in the former and left front seat in the latter condition and tested according to consumer testing protocols. Three chestbands were used in each specimen (upper, middle and lower thorax). Accelerometers were secured to the skull, shoulder, upper, middle and lower thoracic vertebrae, sternum, and sacrum. Chestband signals were processed to determine magnitudes and angulations of peak deflections. The magnitude and timing of various signal peaks are given. Vehicle accelerations, door velocities, and seat belt loads are also given. Analysis of deformation contours, peak deflections, and angulations indicated that the left rear seated specimen were exposed to anterior oblique loading while left front specimens in both tests sustained essentially pure lateral loading to the torso. These data can be used to validate human body computational models. The occurrence of oblique loading in full-scale testing, hitherto unrecognized, may serve to stimulate the exploration of its role in injuries to the thorax and lower extremities in modern vehicles. It may be important to continue research in this area because injury metrics have a lower threshold for angled loading.

Discrete decreased activity in the lower thoracic spine on FDG PET/CT: another respiration-related artifact.

We observed that the diaphragmatic motion causing the well-known, so-called banana artifact on PET/CT images may additionally cause decreased FDG activity involving 1 or 2 lower thoracic vertebrae. The aim of this study was (1) to formally evaluate if this observation is indeed true and, if so, (2) to assess its frequency. One hundred fifty-four PET/CT scans (81 males and 73 females, age 61 ± 13 years) were analyzed. On the coronal CT images, the vertebra above where the hemi-diaphragmatic surfaces abut the vertebral column was defined as the target vertebra (TV). On sagittal PET images, FDG activity in TV was visually and quantitatively assessed. Then, the severity of banana artifact on coronal PET images was graded from 0 to 2: 0 if there was no artifact, 1 if a thin photopenic stripe, and 2 if a thick banana-shaped photopenic artifact in the vicinity of diaphragm. Visually decreased activity in TV was present in 0% (0/93), 3% (1/34), and 59% (16/27) of scans graded as 0, 1, and 2, respectively (grade 0 and/or 1 vs. grade 2, P < 0.001). The SUV ratio of TV to reference vertebrae were 0.99 ± 0.14, 0.99 ± 0.15, and 0.84 ± 0.19 in grade 0, 1, and 2 scans, respectively (P < 0.001). Error of attenuation correction from respiratory motion can lead to underestimation of FDG activity in the lower thoracic spine, and this should not be interpreted as possible marrow replacement process requiring further imaging if there is coexisting banana artifact.

Are there gender differences in sagittal spinal pelvic inclination before and after the adolescent pubertal growth spurt?

Significant progression of spinal deformity could occur during the peak of pubertal growth in adolescent idiopathic scoliosis (AIS). Gender differences in spinal and vertebral inclination have been reported in asymptomatic young adults and are thought to affect the risk of curve progression in male and female AIS. The present study aimed to investigate whether there were gender differences in the sagittal spinal-pelvic profile and whether any differences occurred before or developed during the normal pubertal growth spurt. The sagittal up-right standing spine X-ray films from 71 male and 82 female asymptomatic adolescents were collected. The inclination of the global spine was analyzed by measuring the spino-sacral angle (SSA) and the spinal tilt (ST). Additionally, the inclination of the vertebrae (T1-L5), thoracic kyphosis (T4-T12) and lumbar lordosis were measured. These subjects were divided into the ascending phase (non-fused triradiate cartilage) G1 subgroup, the peak (fused triradiate cartilage and Risser grade 0-1) G2 subgroup and the late phase (Risser grade 2-5) of pubertal growth G3 subgroup. The comparisons between the males and females were carried out within the subgroups. In the subgroups G1 and G2, the females showed a trend of less ventral inclination in the upper thoracic vertebrae (T1-T5) and greater dorsal inclination in the lower thoracic vertebrae (T7-T12), although the differences were not statistically significant. In the G3 subgroup, the females showed significantly larger SSA (133.7° ± 4.5° vs. 128.4° ± 4.0°), ST (96.3° ± 2.6° vs. 94.8° ± 3.4°) and dorsal inclination of T1 and T12-L2 than did the males (p < 0.05). Although a trend toward a more backward inclination of the spine and individual vertebrae might pre-exist during the ascending phase or peak of pubertal growth, the differences become more significant during the late stage of puberty. The observation could be related to relatively active anterior vertebral overgrowth that occurs in females during pubertal growth.

Ossification of the vertebral column in human foetuses: histological and computed tomography studies

There is no agreement in the literature as to the time of the onset and progress of the vertebral column ossification. The aim of the present study was to determine the precise sequence of ossification of the neural arches and vertebral centra.Histological and radiographic studies were performed on 27 human foetuses aged from 9 to 21 weeks. It was found that the ossification of vertebrae commences in foetuses aged 10 and 11 weeks. Ossification centres appear first for neuralarches in the cervical and upper thoracic vertebrae and by the end of 11th week they are present in all thoracic and lumbar neural arches. In the vertebral centrain foetus of 10 weeks ossification was found in the lower 7 thoracic and first lumbar vertebrae. By the end of 11th week ossification is present in the lower 4 cervical, all thoracic, all lumbar and 4 sacral vertebral centra. The study indicates that ossification of the neural arches proceeds in the craniocaudal direction,whereas in the vertebral centra it progresses from the lower thoracic vertebrae into both directions. Different shapes of ossification centres were also described.

Upper Thoracic Versus Lower Thoracic Upper Instrumented Vertebrae Endpoints Have Similar Outcomes and Complications in Adult Scoliosis at Two-Year Follow-Up

Upper Thoracic Versus Lower Thoracic Upper Instrumented Vertebrae Endpoints Have Similar Outcomes and Complications in Adult Scoliosis at Two-Year Follow-Up

Vertebral morphology influences the development of Schmorl's nodes in the lower thoracic vertebrae

Schmorl's nodes are the result of herniations of the nucleus pulposus into the adjacent vertebral body and are commonly identified in both clinical and archaeological contexts. The current study aims to identify aspects of vertebral shape that correlate with Schmorl's nodes. Two-dimensional statistical shape analysis was performed on digital images of the lower thoracic spine (T10-T12) of adult skeletons from the late medieval skeletal assemblages from Fishergate House, York, St. Mary Graces and East Smithfield Black Death cemeteries, London, and postmedieval Chelsea Old Church, London. Schmorl's nodes were scored on the basis of their location, depth, and size. Results indicate that there is a correlation between the shape of the posterior margin of the vertebral body and pedicles and the presence of Schmorl's nodes in the lower thoracic spine. The size of the vertebral body in males was also found to correlate with the lesions. Vertebral shape differences associated with the macroscopic characteristics of Schmorl's nodes, indicating severity of the lesion, were also analyzed. The shape of the pedicles and the posterior margin of the vertebral body, along with a larger vertebral body size in males, have a strong association with both the presence and severity of Schmorl's nodes. This suggests that shape and/or size of these vertebral components are predisposing to, or resulting in, vertically directed disc herniation.

Degenerative changes of the spine in people from prehistoric Okhotsk culture and two ancient human groups from Kanto and Okinawa, Japan

Degenerative changes of the spine in people of the Okhotsk culture were investigated in adult human skeletal remains from 38 males and 34 females. These findings were then compared with those in materials obtained from the medieval Kamakura period and early-modern peasants on Kumejima, Ryukyu Islands. The three samples clearly showed different patterns. In the Okhotsk series, the cervical spine of each sex had most osteophytes on the vertebral body, while the Kumejima samples had the highest frequency on the lumbar vertebrae. In the Kamakura series, males were most affected on the lower thoracic vertebrae. Moreover, severe osteophytes on the body of the lumbar vertebrae were more frequently seen in the Okhotsk males. Degenerative changes of the articular process of the Okhotsk series were most frequently seen in the lumbar vertebrae and least frequently seen in the cervical vertebrae. This is well contrasted with a high frequency of degenerative changes of cervical apophyseal joint in early-modern Kumejima peasants. The Kamakura series of each sex had generally low frequencies. Severe degenerative changes of apophyseal joint dominantly affected the Okhotsk series. It is inferred that different dynamic loads caused a high frequency of degenerative changes in the corresponding articular parts. For example, because the Okhotsk culture developed a considerable maritime infrastructure, the lifestyle required for sea-mammal hunting and fishing seems to have particularly affected the incidence of severe degenerative changes of the lumbar vertebrae.

Expert’s comment concerning Grand Rounds case entitled “Congenital kypho-scoliosis: a case of Thoracic Insufficiency Syndrome and the limitations of treatment” (by A.D. Chatterjee, K. Hassan and M.P. Grevitt)

The authors describe a case of a 7-year-old girl with a severe spine deformity and repeated chest infections from birth [1]. On clinical exam, she presented a severe right-sided kypho-scoliosis and a stiff chest unable to expand. Oxygen saturation dropped to 85% when walking short distances. X-rays showed on the coronal plane a right long curve including the thoracic and lumbar spine with the apex localized at the lower thoracic vertebra. The authors did not provide any information about the angular value of the deformity but it probably reached 80o Cobb angle. The sagittal plane presented an angular kyphosis, over 90o Cobb angle. The apex seemed to be localized also at the lower thoracic vertebra, probably T10–T11. 3D CT reconstruction imaging showed multiple congenital anomalies affecting the spine and the rib cage, with defects of formation and segmentation localized at the thoracic spine. The rib cage presented multiple bilateral fused ribs. No anomalies were found in the MRI. Flexibility of this deformity was only assessed clinically under suspension that confirmed the rigidity of the kyphosis. The deformity was defined as Thoracic Insufficiency Syndrome because of the congenital multiple fused ribs and the patient’s inability to maintain adequate levels of oxygen saturation while walking. This patient was surgically treated with an anterior in situ fusion using two strut grafts from the mid thoracic spine to L2. The main aim was to prevent further progression of the deformity. The patient experienced an uneventful recovery retaking normal physical activity 1 year after surgery although the PFT did not improve.

Anterior decompression and autograft fusion under video-assisted thoraco-scopic to treat lower thoracic vertebrae bursting fracture complicated with intervertebral disc injury

Objective To study the effect of anterior decompression and autograft fusion under video-assisted thoracoscopic to treat lower thoracic vertebrae bursting fracture complicated with intervertebral disc injury.Methods Eleven patients who suffered from lower thoracic vertebrae bursting fracture complicated with intervertebral disc injury were treated with anterior decompression and autograft fusion under video-assisted thoracoscopic from December 2005 to May 2008.The involved vertebrae included T12 in 5cases,T11 in 4 cases,T10 in 1 case and Ts in 1 case.According to the AO classification,4 patients were A2.2and 7 were A3.According to the Frankel classification,5 patients were rated as grade A,2 as grade C,2 as grade D and 2 as grade E.Results Every patient underwent successful operation.The operation time was 3.5-8 h(average,5.2±1.6).The blood loss was 600-3800 ml(average,1195±576).One patient got intercostal neuralgia after operation,which disappeared after treating with analgesic drugs for 7 days.All patients were followed up for 36-65 months (average,49.5±5.9).All patients got bony fusion according to the CT scans 24month after operation.There were no neurological function deterioration and other instrument complications happened.At the last follow-up,5 patients were rated as grade A,2 as grade D and 4 as grade E,according to the Frankel classification.Conclusion Anterior decompression and autograft fusion under video-assisted thoracoscopic is an effective method to treat lower thoracic vertebrae bursting fracture complicated with intervertebral disc injury.However,this method needs higher technology and has a long study-curve. Key words: Thoracoscopes; Thoracic vertebrae; Fractures, bone

Use of Imaging Agent to Determine Postoperative Indwelling Epidural Catheter Position

BackgroundEpidural anesthesia is widely used to provide pain relief, whether for surgical anesthesia, postoperative analgesia, treatment of chronic pain, or to facilitate painless childbirth. In many cases, however, the epidural catheter is inserted blindly and the indwelling catheter position is almost always uncertain.MethodsIn this study, the loss-of-resistance technique was used and an imaging agent was injected through the indwelling epidural anesthesia catheter to confirm the position of its tip and examine the migration rate. Study subjects were patients scheduled to undergo surgery using general anesthesia combined with epidural anesthesia. Placement of the epidural catheter was confirmed postoperatively by injection of an imaging agent and X-ray imaging.ResultsThe indwelling epidural catheter was placed between upper thoracic vertebrae (n = 83; incorrect placement, n = 5), lower thoracic vertebrae (n = 123; incorrect placement, n = 5), and lower thoracic vertebra-lumbar vertebra (n = 46; incorrect placement, n = 7). In this study, a relatively high frequency of incorrectly placed epidural catheters using the loss-of-resistance technique was observed, and it was found that incorrect catheter placement resulted in inadequate analgesia during surgery.ConclusionsAlthough the loss-of-resistance technique is easy and convenient as a method for epidural catheter placement, it frequently results in inadequate placement of epidural catheters. Care should be taken when performing this procedure.

Pre-existent vertebral rotation in the human spine is influenced by body position

Both the humans as well as the quadrupedal spine have been shown to exhibit a pattern of pre-existent rotation that is similar in direction to what is found in the most common types of idiopathic scoliosis. It has been postulated that human bipedalism introduces forces to the spine that increase a tendency of the vertebrae to rotate. The objective of this study was to examine the effect of body position on vertebral rotation in vivo. Thirty asymptomatic volunteers underwent magnetic resonance imaging scanning of the spine (T2-L5) in three different body positions; upright, quadrupedal-like (on hands-and-knees) and supine. Vertebral rotation in the local transverse plane was measured according to a pre-established method and compared at different spinal levels between the three body positions. It was shown that in all three positions the mid- and lower thoracic vertebrae were predominantly rotated to the right. However, vertebral rotation was significantly less in the quadrupedal position than in both the standing upright and supine positions.

Accuracy of Thoracic Vertebral Screw Insertion in Adolescent Idiopathic Scoliosis

A cross-sectional study with axial computed tomography (CT) to compare the accuracy of vertebral screw insertion in the thoracic spine for adolescent idiopathic scoliosis (AIS) between the thoracoscopic and the mini-open thoracotomy approach. To evaluate the safety of vertebral screw placement in anterior instrumentation for thoracic AIS. Thoracoscopic anterior instrumentation has been used with good results for AIS. It is technically demanding especially for the insertion of vertebral screws. The important issue of whether the screws inserted thoracoscopically is as accurate and safe as those inserted through thoracotomy approach has not been well studied. Thirty-one patients with thoracic AIS receiving thoracoscopic or mini-open thoracotomy anterior instrumentation were included in this study. They were divided into Group A and B, respectively. Postoperative sequential CT scanning on the thoracic vertebral screws was carried out. The relative position between screws and the spinal canal, the aorta, and the bicortical purchase were analyzed with CT images. The percentage of screws in good position was defined and further analyzed. Seventy-three and 162 thoracic vertebral screws were inserted in 10 patients in Group A and 21 patients in Group B, respectively. Eighty-nine percent of screw tips in Group A and 80.2% in Group B were distant from the aorta, 89.0% and 87.0% of screws achieved bicortical purchase in Group A and B, respectively. No significant difference was found in all thoracic levels including the upper thoracic, periapical, or lower thoracic vertebrae. Seventy-four percent and 66.7% of screws were in good positions in Group A and B, respectively and there was no statistically significant difference between the 2 groups. The vertebral screws inserted through thoracoscopic approach were as accurate as those inserted through a mini-open thoracotomy approach. The accuracy could be enhanced by using screws with smaller increments, with special attention to the possible migration of aorta with anterior spinal instrumentation.

Pneumopericardium and esophagopericardial fistula presenting as pericarditis in a 1-year-old boy

Esophagopericardial fistula (EPF) is an uncommon complication of esophageal disease. Although, the esophagus is in direct contact with the pericardium in the lower thoracic vertebrae level, EPF is still rare. Recorded causes of EPF include ingested foreign bodies such as fish bone, benign ulceration in association with hiatus hernia, esophageal carcinoma, and achalasia. Congenital EPF occurs even less but with a high ratio of mortality and misdiagnosis. We present a case of PEF in a 1-year-old boy. It is unique in that the patient was a very young child which is rarely reported in literature and the main cause factor seemed to be repeated vomiting since birth. However, he had a good outcome with surgical treatment.

Analysis of Preexistent Vertebral Rotation in the Normal Spine

A newly developed CT measurement method was used to investigate axial rotation from T2 to L5 in the normal, nonscoliotic spine. To identify a preexistent rotational pattern in the normal, nonscoliotic spine. The data available on axial rotation measurements in the normal spine are scant and limited to only a few vertebrae. Systematic analysis of the thoracic and lumbar vertebrae of the normal spine, based on computed tomography has, to our knowledge, not been performed. CT scans of the thorax and abdomen of 50 persons without clinical or radiologic evidence of scoliosis were used to measure vertebral axial rotation from T2 to L5 with a newly developed semiautomatic computerized method. The results of the present study showed a predominant rotation to the left of the high thoracic vertebrae, and to the right of the mid and lower thoracic vertebrae in the normal, nonscoliotic spine, which differed significantly from an equal right-left distribution. This rotational pattern is present in both males and females. The normal, nonscoliotic spine demonstrates a preexistent pattern of vertebral rotation that corresponds to what is seen in the most prevalent types of thoracic idiopathic scoliosis.

Chronic Hyperinsulinemia Enhances Adrenergic Vasoconstriction and Decreases Calcitonin Gene-Related Peptide-Containing Nerve-Mediated Vasodilation in Pithed Rats

The present study investigated the influence of chronic hyperinsulinemia on vascular responsiveness induced by adrenergic nerves and calcitonin gene-related peptide-containing (CGRPergic) nerves in pithed rats with insulin resistance. Male Wistar rats (6 weeks old) received 15% fructose solution in drinking fluid for 10 weeks (fructose-drinking rats: FDR), which resulted in significant increases in plasma levels of insulin, total cholesterol and triglyceride, and systolic blood pressure, as compared with control rats. Pithed FDR showed greater adrenergic nerve-mediated pressor response to spinal cord stimulation (SCS) at the lower thoracic vertebra (Th 9-12) and pressor response to exogenous noradrenaline than control rats. In pithed FDR with blood pressure artificially increased by continuous infusion of methoxamine and blockade of autonomic ganglia by hexamethonium, CGRPergic nerve-mediated depressor responses to SCS were significantly smaller than those in control rats, but depressor responses to other vasodilators such as acetylcholine, CGRP and sodium nitroprusside were similar to those in control rats. These results suggest that chronic hyperinsulinemia in FDR facilitates adrenergic nerve-mediated vasoconstriction, which is associated with attenuated CGRPergic nerve-mediated vasodilation.

Spinal cord

The spinal cord and meninges lie in the vertebral canal. In the 3-month fetus, the spinal cord and vertebral canal are the same length but the vertebral canal grows more rapidly so that in the adult the cord extends from the foramen magnum to the level of the first or second lumbar vertebra. Thus, the adult spinal cord occupies only the upper two-thirds of the vertebral canal. It is roughly cylindrical in shape being slightly flattened antero-posteriorly and possesses cervical and lumbar enlargements from which originate the nerves supplying the upper limb (C4–T1) and the lower limb (L1–S3) plexuses. These enlargements lie opposite the lower cervical and lower thoracic vertebrae, respectively. 31 pairs of spinal nerves emerge from the cord and, since the adult spinal cord is shorter than the vertebral canal, these nerve roots descend in the canal, with increasing obliquity and length, to reach their appropriate intervertebral foramina, through which they exit the canal. The lumbar and coccygeal nerves are the longest and descend beyond the end of the spinal cord as the cauda equina (Figure 1). The inferior end of the spinal cord tapers (conus medullaris) and from its end a thin strand of pia mater, the filum terminale, descends through the cauda equina to be attached to the coccyx.

断層撮影におけるファントム型補償フィルタの応用

We reported a new device of phantom type compensating filters for pulmonary hilar tomography with polytome U at the 35th annual meeting of the Japanese society of radiological technology. This report is to show application of this compensated method to the head, the hip joint and the lower thoracic spine in tomography. Using the filters optimal density can be obtained in all area of aim part on a X-ray film, and thus makes to get more information. 1) In the head clear shadow of pars nasalis, sinus paranasales and sella turcica is obtained. Destruction or defect of bone contour is easily. detected. It is also useful to differentiate the disorders and to determine the expansivity of the lesion. 2) In the hip joint this method has advantages over the ordinary method. There is a few misdiagnosis in trochanteric lesions such as tuberculosis or bone tumor, because of high density at the trochanteric region in ordinary method, but in this method optimal density can be obtained, and misdiagnosis is improved. Soft tissue is sharply visualized, indication usefulness in diagnosis of existence of hematoma or abscess.3) In the lower thoracic vertebra it is useful to diagnosis of the thoracic spondylosis, tuberculous spondylitis and compression fracture of the vertebral body, since optimal density of the spine can be obtained. It is also quite useful to detect small ossifications in the vertebral foraman in ossification of the flavum ligament.

Diagnosis and Treatment of Thoracic Spondylotic Myelopathy

A report is made in 6 cases of thoracic spondylotic myelopathy. Their age ranges from 28 years to 68 years old. Of them two cases are male and 4 are female. Generally the site of this disease is said to be most frequent at the lower thoracic vertebra, but this myelopathy can be also observed in the upper thoracic vertebra. As for the clinical symptoms sensory disturbances of the legs, disturbances of movement, and rectovesical disturbances can be pointed out, that gradually progress in some cases, while in others this myelopathy is induced by sternomutator or by fall, that aggravates by degree. X-ray picture reveal the narrowing of the inervertebral disc space, the calcification of inervetebral disc and sclerosis of the posterior margin of vertebral body in some cases, but these changes seem to be aging phenomena, that cannot at once be concsidered necessarily as the direct cause of myelopathy. There are cases where no abnomality of humoral findings, that symptoms are not always consistent. At the present stage myeography is most useful for the diagnosis. As long as the case be definititly diagnosed as myelopathy due to the disturbance of intervertebral disc, anterior decompression proves to be most rational, but there are cases difficult of diagnosis. We have performed laminectomy in five cases and obtained favorable results in all of them.

Vertebral aging in hypopituitary dwarf mice.

Changes occurring in lumbar and lower thoracic vertebrae of aging dwarf mice (dwdw) were compared with those found in non-dwarfs of the same strain (Dwdw or DwDw) and of strain C&lt;sub&gt;57&lt;/sub&gt;B1. Dwarf vertebrae, besides remaining smaller, develop less completely and more slowly than those of non-dwarfs. Retarded development is indicated by the presence of non-resorbed epiphyseal cartilage, by diminished removal of cancellous bone from the vertebral bodies and possibly also by the failure of osseous replacement of the cartilaginous end-plates. The slowing of the aging process manifests itself in decreased degeneration of the growth zones, delayed loss of mucopolysaccharide from the matrix of the articular cartilage and by an attenuated tendency to develop spondylosis.

Neurofibromatosis and Intrathoracic Meninqocele

IN 1933 POHL (1) reported the first case of intrathoracic meningocele which was associated, incidentally, with cutaneous neurofibromatosis. Since that time there have been described 19 similar cases and 10 of meningocele without neurofibromatosis. Of 3 bilateral cases, 2 were associated with neurofibromatosis. The pathologic changes which permit the formation of a meningocele have been the subject of much discussion, and several theories have been advanced. We are presenting in this article an additional case of bilateral intrathoracic meningocele associated with neurofibromatosis, with a sevenyear follow-up. We are also proposing a theory of genesis. A 36-year-old Caucasian female was admitted to the hospital in 1949 for investigation of a mass in her right chest. Recurrent episodes of low thoracic pain had occurred over the past ten years. Slight tenderness was present over the lower thoracic vertebrae but no bone abnormalities could be palpated. Numerous soft skin papules and brownish pigmentations typical of von Recklinghausen's neurofibromatosis were found. No neurologic deficit was noted. Roentgenograms (Fig. 1) revealed a rounded mass in the posterior right chest as well as scalloped defects of the posterior margins of the lower thoracic vertebrae and dislocation of the right eleventh rib (Fig. 2). A preoperative diagnosis of intrathoracic neurofibroma and cutaneous neurofibromatosis W'lS made. Thoracotomy showed the mass to be a large meningocele communicating with the spinal canal through defects in the pedicles of the tenth and eleventh thoracic vertebrae (Fig. 3). The sac was aspirated and excised, and the dura was imbricated over the defect. The postoperative course was uneventful. An overexposed chest film following operation revealed a hitherto unsuspected mass in the left retrocardiac area, but no further treatment was instituted. In the ensuing years the patient was well except for a mild backache. In 1956 this became severe enough to warrant further treatment. Spine films again showed defects in the lower thoracic vertebrae, and myelography revealed a communication between the spinal cord and the left retrocardiac mass (Fig. 4), thus establishing its identitv as a meningocele. This mass had not enlarged in the intervening years and no recurrence was noted on the right. Fusion of the involved vertebral segments was performed and the meningocele was left undisturbed. A review of the 20 published cases of intrathoracic meningocele associated with cutaneous neurofibromatosis revealed vertebral deformities but no other bone involvement. Pohl believed that the changes were caused by periosteal neurofibromas, but Gould (2), reporting on microscopic sections of vertebrae of patients with neurofibromatosis, stated that the only abnormal finding was a very marked excess of osteoid tissue, with relatively little normal bone.