Posterior Elements Research Articles

Periosteal Variety of Sacral Osteoid Osteoma Encroaching into the Spinal Canal – Treatment with a Tubular Retractor System: Case Report

Background: Osteoid osteomas are benign primary bone tumors with a predilection for posterior elements of the spinal column. Complete surgical excision through a traditional open approach is the treatment of choice for patients not responding to non-steroidal anti-inflammatory medications and patients with contraindications for nidus ablation. The study aims to highlight an alternative minimally invasive technique for complete surgical excision of osteoid osteoma encroaching into the spinal canal. Methods: We report a case of 22 years-old obese male suffering from left S1 radiculopathy and night pain. Magnetic resonance imaging and computed tomography (CT)-scan of the lumbosacral region revealed a benign bony lesion of size 13 mm × 11 mm × 8 mm encroaching from S1 lamina into the spinal canal and compressing left S1 root. Peri-lesional bony sclerosis and soft tissue edema were absent. In view of obesity and a small size of the lesion, it was decided to remove the lesion with a tubular retractor system under general anesthesia. Complete resection of the lesion was carried out sparing the L5-S1 facet, with a minimally invasive approach. Results: Patient had complete symptomatic improvement after the surgery. Histopathology showed interconnected trabeculae of woven bone matrix rimmed by osteoclasts consistent with the diagnosis of osteoid osteoma. Post-operative CT scan showed that the nidus was removed completely and important structures such as facet, pedicle, and midline posterior ligament complex were preserved. The patient resumed his daily activities and remained symptoms-free at the end of 6 months of follow-up. Conclusion: Minimally invasive surgery using a tubular retractor system can be safe and effective alternative to traditional open surgery for excision of osteoid osteoma from the posterior elements. Faster recovery, minimal tissue damage, and early return to work are added advantages for an obese patient undergoing minimally invasive total surgical excision. Keywords: Benign bone tumors, Sacral spine, Osteoid osteoma, Periosteal osteoid osteoma, Minimally invasive spine surgery, Tubular retractor system

Intraoperative image guidance for lateral position surgery.

Recent advances in minimally invasive spine surgery techniques have precipitated the popularity of lateral position spine surgery, such as lateral lumbar interbody fusion (LLIF) and oblique lumbar interbody fusion (OLIF). Lateral position surgery offers a unique, minimally invasive approach to the lumbar spine that allows for preservation of anterior and posterior spinal elements. Traditionally, surgeons have relied upon fluoroscopy for triangulation and implant placement. Over the last decade, intraoperative 3-dimensional navigation (ION) has risen to the forefront of innovation in LLIF and OLIF. This technology utilizes intra-operative advanced imaging, such as comminuted tomography (CT), to map the patient’s 3D anatomy and allows the surgeon to accurately visualize instruments and implants in spatial relationship to the patient’s anatomy in real time. ION has the potential to improve accuracy during instrumentation, decrease operating room times, lower radiation exposure to the surgeon and staff, and increase feasibility of single-position surgery during which the spine is instrumented both laterally and posteriorly while the patient remains in the lateral decubitus position. Despite the advantages of ION, the intra-operative radiation exposure risk to patients is controversial. Future directions include continued innovation in ultra low radiation imaging (ULRI) techniques and image enhancement technology and in uses of robot-assisted navigation in single-position spine surgery.

Extraosseous Aneurysmal Bone Cyst at Hypothenar Area in an Adult Male- A Case Report

Aneurysmal Bone Cyst (ABC) is a benign tumour of bone which develops most frequently in the metaphysis of long bones and the posterior elements of vertebral bodies. The ABC generally occurs during the first two decades of life and has a slight predilection for the female sex. Radiographically, ABC is usually eccentric, lytic and expansile with well defined margins. Soft tissue or extra osseous ABC is extremely rare in occurrence, with only few case reports found in literature. Extraosseous ABC is usually found in soft tissues of lower limb and arm. Its occurrence in soft tissue of hands is extremely rare. Hereby, authors reported a case of a 30-year-old male patient who had swelling of approximately 9×6 cm in hypothenar area of left hand starting proximally from the wrist crease and extending distally till distal palmar crease and from the ulnar border of the palm till the mid palmer area. Authors described this case to highlight this entity, at an uncommon location (hypothenar area of palm) and importance of excisional biopsy in such cases.

Evaluation of cervical spine injury and predicting neurological deficit by magnetic resonance imaging

Background: The consequences of cervical spine injuries range from simple neck pain, to quadriplegia, or even death. MR imaging has become part of the diagnostic and prognostic tools for spinal cord injury. Aim: To prospectively evaluate cervical spine injuries by MR imaging and to find out association of MR imaging findings with degree of neurological deficit. Material and Methods: Descriptive longitudinal hospital based study was conducted on 30 patients with known or suspected cervical spine trauma who presented to the emergency department. Results: Mean age of the cases was about 42 years, with female to male ratio of 1:6.5. C6-C7 spinal level was most commonly involved. Proportions complete spinal cord injury (CSCI), incomplete spinal cord injury (ISCI) and neurologically normal (NN) were 23.33%, 60% and 16.67% respectively. Out of 12 MRI findings, cord haemorrhage, contusion, posterior element fracture, disc injury, prevertebral hematoma, subluxation and soft tissue injury was statistically associated with degree of neurological deficit. Cord contusion, cord haemorrhage and posterior element fracture were potential predictors of neurological status at admission. Cord contusion, cord haemorrhage and subluxation were potential predictors at 3 months. Conclusion: MRI proved a pivotal role in the diagnosis of SCIs, deciding prompt management and predicting neurological deficit and prognosis of neurological recovery. So, MRI is an excellent diagnostic modality for the evaluation of spinal trauma and predicting the degree of neurological deficit and recovery.

Atypical Fracture of Axis With False Localising Sign

Introduction: Injuries of upper cervical spine many times associated with false localizing signs as a neurological deficit means there is a no clinic-radiological correlation. Purpose of this case report is to diagnose rare clinical presentation due to injury of pyramidal tract decussating at lower medulla. Method and Materials: A 21 years old male patient presented with traumatic quadriplegia (Frankel-A). Primary treatment was given along with immobilization of neck with collar. Routine X-ray of cervical spine was taken. X-ray was showing shear fracture of C 2 vertebra with intact dens. Crucified tong was inserted. Methyl Prednisolon injection in proper dose within 8 hours was given. (NASCIS II) CT SCAN was done to know exact fracture geometry. It was showing a fracture of C2 body in an oblique plane shearing off in one piece with the dens tilted towards right side and with subluxation of C1-C2 articular process on left side. Clinically patient improved in 24 hours in form of 4/5 power grade in all limbs except left upper limb. Left upper limb shoulder and elbow muscle power was grade 2/5 and o/5 in hand. Bladder/bowel was improved. Even though there was a weakness of left upper limb, but reflexes were preserved remarkably (Cruciate paralysis as a false localizing sign). Considering atypical unstable fracture, open indirect reduction of C-1-2 done from posteriorly and stabilization done with apofix clamps after fusion between C1-C2 posterior arches. Result: Patient had Frankel grade-A on admission. At three months follow up patient had almost full neurological recovery except finger grip power grade was 4/5. On final follow up at 12 months, neurology improved to Frankel grade-E. He had no neck pain with mild restriction of rotation. X-ray of cervical spine in flexion-extension shows stability and fusion of C1-C2 posterior elements. Conclusion: Atypical clinical presentation like cruciate paralysis as a false localizing sign should be kept in mind while dealing with fracture of upper cervical spine. As this fracture has good prognosis, proper treatment is needed. If close reduction is not achieved then open reduction and stabilization with fusion will provide early mobilization and faster neurological recovery. Keywords: Fracture; Axis; Cruciate; Paralysis.

Gorham-Stout disease of the spine presenting with intracranial hypotension and cerebrospinal fluid leak: A case report and review of the literature

Background: Gorham-Stout (GS) disease or “vanishing bone disease” is rare and characterized by progressive, spontaneous osteolysis resulting in loss of bone on imaging studies. Treatment modalities include combinations of medical and/or surgical treatment and radiation therapy.Case Description: A 14-year-old female with GS disease presented with a 1-year history of thoracic back pain and atypical headaches consistent with intracranial hypotension. Magnetic resonance imaging and operative findings demonstrated a spontaneous thoracic cerebrospinal fluid leak (CSF) (e.g., that extended into the pleural cavity) and complete osteolysis of the T9-10 posterior bony elements (e.g., including the rib head, lamina, and transverse processes). The patient underwent repair of CSF fistula followed by a T6-11 instrumented fusion.Conclusion: This case of GS disease, involving a thoracic CSF fistula and absence/osteolysis of the T9-T10 bony elements, could be successfully managed with direct dural repair and an instrumented T6-T11 fusion.

Conus Medullaris Syndrome due to Ligamentum Flavum Thickening and Intervertebral Disc Bulging

Abstract A 72-year-old male with past medical history of common chronic illness presented to a rehabilitation clinic with a chief complaint of trouble walking and falls over 6 months. On detailed questioning, he has developed progressive bladder incontinence and unable to achieve erection. Physical exam revealed normal rectal tone and minimal bladder retention. Lumbar spine MRI shows severe spinal canal stenosis, with posterior elements impinging on the Conus Medullaris. He underwent T9-11 laminectomy. Upon follow up nearly 2-years post-operation, he is continent of bladder and able to walk with a rolling walker. The main differential diagnosis was Cauda Equina syndrome. Although both syndromes are surgical emergencies, accurate diagnosis would affect the surgical approach and outcome.

In Vivo Ultrasound Imaging of the Spinal Cord and Subarachnoid Space at the C1-C2 Level in Healthy Adult Subjects.

Ultrasound (US) imaging of the spinal canal is applied in early infants before formation of posterior spine bony elements. Here, we demonstrate for the first time in adult healthy subjects that excellent visualization of intrathecal structures at the level of C1-C2 is possible by transcutaneous US in flexion, extension, and neutral head positions through the soft tissue US window between C1-C2. We show with US that the posterior subarachnoid space increases significantly in head extension. Accordingly, C1-C2 US guidance can facilitate cervical myelography. In addition, we suggest that US of the C1-C2 spine level may offer an adjunct tool to diagnosing structural abnormalities in the setting of traumatic, congenital, or degenerative pathologies of the craniocervical junction.

SURG-22. CERVICAL SPINE ANEURYSMAL BONE CYST OF A PEDIATRIC PATIENT

BACKGROUNDAneurysmal bone cysts (ABCs) are benign, expanding lesions that represent 15% of all primary spine tumors, and only 2% have been found at the cervical level. There are different therapeutic options; the most successful is complete surgical resection. Although not always possible, due to high blood loss that occurs during the procedure, a combination of surgery with other treatment modalities was used in 40% of the cases reported so far. We describe a pediatric patient that we managed with embolization plus surgery. CASE REPORT: A 5-year-old girl presented with painful torticollis associated with a left posterior cervical mass, without neurological impairment. Magnetic resonance imaging of the cervical spine showed a multiseptated bony lesion with multiple fluid levels, involving the posterior elements of C2, associated with diffuse soft tissue enhancement of the left paravertebral muscles. We proposed a multi-staged treatment with pre-operative arterial embolization followed by the posterior surgical approach. Super selective embolization of the left ascending cervical artery was performed. The right ascending cervical artery also contributed to the tumor blush, but due to its connection to the right vertebral artery and, therefore, associated with a high risk of neurological injury, we prefer not to embolize it. Two days later, we performed a posterior surgical approach, with a gross total resection of the tumor. Histological examination revealed an ABC.CONCLUSIONAn aneurysmal bone cyst is a rare cervical spine lesion that demands a multidisciplinary approach due to its locally aggressive behavior and the excessive blood loss related to surgery.

Short-term comparison of preoperative and postoperative pain after indirect decompression surgery and direct decompression surgery in patients with degenerative spondylolisthesis

The purpose of this study was to compare the short-term clinical outcomes between extreme lateral interbody fusion (XLIF) and minimally invasive surgery (MIS)–transforaminal interbody fusion (TLIF) in patients with degenerative spondylolisthesis with stenosis. One hundred-six patients were enrolled; 44 were treated with MIS–TLIF (direct decompression group; DP), and 62 were treated with XLIF (indirect decompression group; IDP). Perioperative indexes included operation time and intraoperative bleeding. Perioperative indexes preoperative and postoperative numeric rating scale (NRS) scores for low back pain (NRS-BP), leg pain (NRS-LP), and leg numbness (NRS-LN), and the preoperative score on the Japanese version of the painDETECT questionnaire (PDQ-J) were also assessed. The average follow-up period for the collection of NRS scores was 12.6 months. The operation time was significantly shorter in the IDP than in the DP group (109.9 ± 35.4 vs. 153.3 ± 50.9 min; p < 0.001). Intraoperative blood loss was also significantly less in the IDP group than in the DP group (85.4 ± 125.4 vs. 258.3 ± 220.4 mL; p < 0.001). The PDQ-J score and preoperative NRS scores (NRS-BP, NRS-LP, and NRS-LN) did not differ significantly between groups. Less improvement in the NRS-BP (ΔNRS-BP) was observed in the DP group than in the IDP group (p < 0.05). Although pain improved after surgery in both groups, IDP surgery was advantageous in minimizing bleeding and preserving posterior support elements such as the facet joints, lamina, and paraspinal muscles. These findings suggest that this may have contributed to the higher rate of improvement in low back pain compared with DP surgery.

Percutaneous vertebroplasty for the treatment of symptomatic vertebral hemangioma with long-term follow-up

There is a paucity of literature on vertebroplasty in hemangioma. The effectiveness with short-term and long-term follow-up is an important insight for research. This study aims to evaluate the effectiveness and the long-term efficacy of vertebroplasty in the treatment of the patient with symptomatic vertebral hemangioma. Materials and methodsThis is a retrospective cohort study. The outcome was evaluated by immediate post-procedure and 3 months, 1 year, and 5 years of follow-up clinical status of the patients. The significance was determined by using a paired t-test between the pre-procedure and post-procedure severity of pain, activity score, and analgesic. The P-value < 0.05 indicated statistical significance. ResultsA total of 38 vertebroplasties were performed in 34 patients. Additionally, the embolization of residual soft tissue was performed in 4 patient and Percutaneous alcohol injection for posterior elements involvement was performed in 9 patients. Immediate after the procedure, 44.12% of patients became asymptomatic, 38.23% of patients showed significant improvement, 11.77% of patients remained static and 2.94% of patients deteriorated and needed laminectomy. The complication rate was 29.4%, but only 2 patients were symptomatic and needed surgical decompression. There was significant relief of pain (P < 0.05), reduced analgesic intake (P < 0.05), and increased activity (P < 0.05) immediately after the procedure, 3 months, 1 year, and 5 years follow-up. ConclusionPVP is an effective therapeutic option for the treatment of VH with fewer complications. The additional procedures like preprocedural embolization and percutaneous alcohol injection enhance the outcome and avoid complicated surgical interventions.

Automated measurement of anteroposterior diameter and foraminal widths in MRI images for lumbar spinal stenosis diagnosis.

Lumbar Spinal Stenosis causes low back pain through pressures exerted on the spinal nerves. This can be verified by measuring the anteroposterior diameter and foraminal widths of the patient's lumbar spine. Our goal is to develop a novel strategy for assessing the extent of Lumbar Spinal Stenosis by automatically calculating these distances from the patient's lumbar spine MRI. Our method starts with a semantic segmentation of T1- and T2-weighted composite axial MRI images using SegNet that partitions the image into six regions of interest. They consist of three main regions-of-interest, namely the Intervertebral Disc, Posterior Element, and Thecal Sac, and three auxiliary regions-of-interest that includes the Area between Anterior and Posterior elements. A novel contour evolution algorithm is then applied to improve the accuracy of the segmentation results along important region boundaries. Nine anatomical landmarks on the image are located by delineating the region boundaries found in the segmented image before the anteroposterior diameter and foraminal widths can be measured. The performance of the proposed algorithm was evaluated through a set of experiments on the Lumbar Spine MRI dataset containing MRI studies of 515 patients. These experiments compare the performance of our contour evolution algorithm with the Geodesic Active Contour and Chan-Vese methods over 22 different setups. We found that our method works best when our contour evolution algorithm is applied to improve the accuracy of both the label images used to train the SegNet model and the automatically segmented image. The average error of the calculated right and left foraminal distances relative to their expert-measured distances are 0.28 mm (p = 0.92) and 0.29 mm (p = 0.97), respectively. The average error of the calculated anteroposterior diameter relative to their expert-measured diameter is 0.90 mm (p = 0.92). The method also achieves 96.7% agreement with an expert opinion on determining the severity of the Intervertebral Disc herniations.

Improving the imaging performance of the 1.5 T MR-linac using a flexible, 32-channel, on-body receive array

High impedance coils (HICs) are suitable as a building block of receive arrays for MRI-guided radiotherapy (MRIgRT) as HICs do not require radiation-attenuating capacitors and dense support materials. Recently, we proved the feasibility of using HICs to create a radiation transparent (i.e. radiolucent) window. In this work, we constructed a fully functional 32-channel array based on this design. The anterior element is flexible and follows the shape of the subject, while the posterior element is rigid to support the subject. Both elements feature a 2 × 8 channel layout. Here, we discuss the construction process and characterize the array’s radiolucency and imaging performance. The dosimetric impact of the array was quantified by assessing the surface dose increase and attenuation of a single beam. The imaging performance of the prototype was compared to the clinical array in terms of visual appearance, signal-to-noise ratio (SNR), and acceleration performance, both in phantom and in-vivo measurements. Dosimetry measurements showed that on-body placement changed the anterior and posterior surface dose by +3% and −16% of the dose maximum. Attenuation under the anterior support materials and conductors was 0.3% and ≤1.5%, respectively. Phantom and in-vivo imaging with this array demonstrated an improvement of the SNR at the surface and the image quality in general. Simultaneous irradiation did not affect the SNR. G-factors were reduced considerably and clinically used sequences could be accelerated by up to 45%, which would greatly reduce pre-beam imaging times. Finally, the maximally achievable temporal resolution of abdominal 3D cine imaging was improved to 1.1 s, which was > 5 × faster than could be achieved with the clinical array. This constitutes a big step towards the ability to resolve respiratory motion in 3D. In conclusion, the proposed 32-channel array is compatible with MRIgRT and can significantly reduce scan times and/or improve the image quality of all on-line scans.

Spinal trauma in DISH and AS: is MRI essential following the detection of vertebral fractures on CT?

BACKGROUNDBoth ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) cause a rigid spine, but through different pathophysiology. Recent data has shown that characteristic fracture patterns may also differ following trauma since the posterior osseous and soft tissue elements are often spared in DISH. CT and MRI are important in diagnosing spine injury, but given the differences between AS and DISH, the utility of obtaining both studies in all patients warrants scrutiny. PURPOSETo assess the prevalence of posterior element injury on CT and MRI in DISH and AS patients with known vertebral body injury detected on CT; to determine whether MRI demonstrates additional injuries in neurologically intact patients presumed to have isolated vertebral body injuries on CT. STUDY DESIGNMulticenter, retrospective, case-control study. PATIENT SAMPLEDISH and AS patients presenting after spine trauma between 2007 and 2017. OUTCOME MEASURESReview of CT and MRI findings at the time of presentation. METHODSOne hundred sixty DISH and 85 AS patients presenting after spine trauma were identified from 2 affiliated academic hospitals serving as level 1 trauma and tertiary referral centers. A diagnosis of DISH or AS was verified by a board-certified emergency radiologist with 3 years of experience. Age, gender, mechanism of injury, fracture type, spine CT and MRI imaging findings, surgical intervention, and neurologic deficit were recorded. The CT and MRI studies were reviewed by the same radiologist for fracture location and type using the AO spine classification. No funding source or conflict of interest was present. RESULTSMedian age was 72 and 79 years old for the AS and DISH groups, respectively. Both were predominantly male (81%) and most presented after a low energy mechanism of injury (74% and 73%). Type C AO spine injuries were seen in 52% of AS patients but only 4% of DISH patients. In patients with known vertebral body injury on CT, additional injury to the posterior elements on CT or MRI in DISH patients was 51% versus 92% in AS patients. However, in patients with an isolated vertebral body fracture on CT and no neurological deficit, MRI identified posterior element injury in only 4/22 (18%) DISH patients compared to 5 of 7 (71%) AS patients. None of the MRI findings in the DISH patients were considered clinically important while all 5 AS patients eventually underwent operative treatment despite having no neurological deficit. Epidural hematoma on MRI was seen in 43% of AS patients as opposed to 5% of DISH patients. CONCLUSIONBased on our small sample size, CT alone may be adequate in DISH patients with isolated vertebral body fractures and no neurologic deficit, but an additional MRI should be considered in the presence of an unclear neurological exam or deficit. MRI should be strongly considered for any AS patient regardless of neurologic status.

A cadaveric anatomical study of the adrenals: Relationship with the posterior abdominal wall muscles revisited

The main difficulties during retroperitoneal laparoscopic adrenalectomies are due to its location. Our objective was to define the relationship of the adrenals with the diaphragm and the psoas muscle. Our work is an anatomical dissection of 80 fresh cadavers' adrenals. To study the right adrenal, we performed a right nephrectomy and adrenal remained attached to the Inferior vena cava by its main vein. On the left, the edges of the adrenal have been identified by needles and the adrenal was reclined to study its projection on the posterior muscular wall. The right adrenal is located higher, 13mm [4-20mm] above the medial arcuate ligament (MAL) in 16 cases (40%). Its lower border was at the same level as the MAL in 18 cases (45%) and 11mm [10-17mm] below the MAL in 6 cases (15%). The posterior support of the right adrenal was the right crus of the diaphragm (Right-CD) in 34 cases (85%) and straddling the Right-CD and the psoas in 6 cases (15%). The study of the relationships of the left adrenal with the MAL showed that the lower edge of the gland was at its same level in 16 cases (40%) and below in 24 cases (60%) by 14mm [8-24mm]. The posterior support of the left adrenal was the left crus of the diaphragm (Left-CD) in 16 cases (40%) and straddling the Left-CD and the psoas in 24 cases (60%). Our results showed that the right adrenal is higher. The MAL is an important posterior element to the adrenal gland that could serve as an anatomical landmark to identify the adrenal during laparoscopic adrenalectomy.

Surgery Versus Radiofrequency Ablation in the Management of Spinal Osteoid Osteomas: A Spine Oncology Referral Center Comparison Analysis of 138 Cases

Osteoid osteomas (OOs) are benign bone forming tumors that, usually, occur in the extremities, with about 10% of them arising in the spine more commonly in the posterior elements. The aim of this study is to evaluate the long-term results of patients suffering from spinal OO treated with surgery and radiofrequency ablation. This was a retrospective comparison analysis of data prospectively collected from 2 cohorts of consecutive patients diagnosed with OO of the spine treated at the same Institute from November 2002 to February 2019. The first cohort included patients submitted to an intralesional extracapsular excision of the lesion (surgery group); the second cohort included patients submitted to radiofrequency ablation (RFA group). The surgery group showed a local recurrence rate of 1.7% versus a recurrence rate of 12.5% in the RFA group with a statistically significant difference in the disease-free survival at longest follow-up (P= 0.012). No statistically significant differences were observed in local recurrence rate stratified for level and site of lesion. No complications were observed in both groups at the time of first procedure. Surgery and RFA are both safe and effective interventional procedures for the management of spinal OO, although RFA is associated with a greater recurrence rate. Treatment should be tailored according to the relationship of lesions with neural structures and to advantages and disadvantages of each technique.

Oroantral communication closure with Bichat adipose body: etiology, clinical and radiographics features

Objective: This study aims to clarify to the dentist about the possible etiological factors responsible for such complication, to identify its clinical and radiographic signs and to describe the surgical technique adopted in these cases. Case Report: For this purpose, the authors present the clinical case of a patient with post-exodontia oroantral fistula of the right permanent maxillary first molar. The proposed treatment was the closure of the fistula under local anesthesia using the Bichat adipose body, with advantages of being a simple procedure, easy to perform, that does not require specific material, minimal complications, low morbidity and can be performed in the own dental practice and with high success rates proven by several studies. Discussion: The oroantral fistula is a common pathological occurrence in the dental clinic, characterized by communication of the maxillary sinus with the oral cavity when the maxillary sinus is pneumatic or during dental extractions of upper posterior elements whose roots are closely related to the maxillary sinus. Conclusion: Communications should be treated immediately, if there are signs of inflammation it should be treated first, so that surgical correction can be performed later.

MULTISPIRAL COMPUTED AND MAGNETIC RESONANCE IMAGING OF THORACOLUMBAR SPINE INJURY IN CHILDREN

Introduction. Spinal injury in pediatric practice is met relatively rare; spinal fractures in children do not exceed 5%, and the incidence rate does not exceed 5:100000. However, spinal injuries have a high rate of fetal outcomes (up to 5-10%), and have significant long-lasting negative effects. Therefore, to timely detect such injuries is extremely important for determining treatment tactics, preventing secondary damage to nerve structures and preventing the formation of spinal deformity. Purpose. To assess and compare CT and MRI potentials for developing a diagnostic algorithm in children with thoracolumbar spine injury. Material and methods. 4355 patients, aged 6 months - 17 years, with thoracolumbal spine injury were included into the study . All patients had radiography of the thoracic or lumbar spine and MRI of three spinal sections. Multispiral computed tomography ( MSCT) was performed with Brilliance 16 and 64 scanners. Information on the thoracolumbal spine picture obtained by scanning the chest and abdomen was assessed using findings of frontal and sagittal and 3D reformatted images. MRI was performed on Achieva 3 T scanner; multi-planar T1-, T2-weighted images of (WI) TSE and STIR images in axial, frontal and sagittal projections with a slice thickness of 2-4 mm were obtained. A special spinal 32 channel coil was used. Results. To compare the effectiveness of CT and MRI techniques in the diagnostics of thoracolumbar spinal injury, a sampling of 95 patients was selected. The number of injuries (total and their distribution by the type of injury) was defined using the sample findings. The total number of detected injuries was: only by MRI = 325; only by CT = 228; MRI + CT = 199. By the results of McNemar test, it has been found out that MRI detects statistically significantly better explosive fractures of the vertebrae, ruptures of the posterior longitudinal ligament (PLL) and yellow ligament (YL), ruptures of third column ligaments, herniated discs, epidural and sublingual hematomas, hematomyelia, complete and partial ruptures of the spinal cord and its edema; CT has superiority in detecting fractures of posterior vertebral elements. Conclusion. Currently, MSCT remains a key imaging technique in the diagnostics of acute spinal injuries in most cases in children and adults. Our findings confirm that MRI - in the absence of standard absolute contraindications - can serve as a worthy alternative for assessing damages of the vertebral bodies, ligaments, intervertebral discs, spinal cord and its roots in the acute stage of injury, yielding only in detecting injuries in vertebra posterior elements. The absence of ionizing radiation is also one of MSCT advantages which makes its use preferable for spinal injury diagnostics in children, both for primary and for control examinations.

Posterior Column Osteotomy of the Lumbar Spine: 2-Dimensional Operative Video.

The posterior column osteotomy (PCO) is a tool for correction in spinal deformity. It allows for the induction of lordosis and coronal plane correction. It can be performed at multiple levels to loosen and mobilize the spine. Although the PCO does not provide as much correction as a 3-column osteotomy, it can be done in less operative time and with less morbidity. Performing a PCO involves the resection of posterior bony elements, including entire facet complexes, the ligamentum flavum, and at least part of the lamina. The ligamentum flavum laterally is also resected, and the exiting nerve roots are skeletonized bilaterally. Compression of the osteotomy can cause foraminal stenosis, and it is important to ensure that the exiting nerve roots are adequately decompressed to avoid potential postoperative radiculopathy. The authors present an illustration of the technique with saw bones, a clinical case describing the use of PCOs, and an intraoperative video of a PCO performed at L5-S1. The patient consented to the surgical procedure and video/image recording for possible publication purposes prior to the operation being performed.

Surgical management of aneurysmal bone cyst of fibular head with en bloc excision: A case report

Aneurysmal bone cysts (ABCs) are benign but locally destructive, blood filled reactive lesions of the bone. Although a wider age group may be affected, most commonly they are seen in patients younger than 20 years of age, with a slight female preponderance. Most common sites include metaphysis of femur followed by tibia and then humerus. Vertebral lesions involving the posterior elements are common. Aneurysmal bone cyst of proximal fibula is a rare and uncommon. Here, we report a case of 32 year old male with classic histologic, clinical, and radiographic findings that was treated by en bloc resection.