Vertebral Involvement Research Articles

Functional and Pain Score Improvement with Vertebroplasty in De Novo Multiple Myeloma in a Public Institution in Mexico

Multiple myeloma a plasmatic cell disorder, characterized by bone marrow infiltration of clonal plasmatic cells, monoclonal immunoglobulin production and end stage organ damage. This disease has a wide range of clinical manifestations, including solitary disease or plasmacytoma. It´s the second most common hematologic disease just behind Non Hodgkin Lymphoma. More than 60% of de novo MM patients present vertebral involvement.80% of MM patients refer pain as the first symptom of the disease, and this often leads to opioid abuse and adverse effects related to pain medication. Plasmocytoma is one of the three neoplastic lesions of the vertebra that can be susceptible of percutaneous vertebroplasty.The preferred method of treatment is a percutaneous vertebroplasty (PV), a radiologic invasive treatment that can treat multiple pathologies, and is now widely used for treatment of osteoporosis vertebral fractures.For the purpose of the study we aimed to assess functional status and reincorporation to daily living, we used the Karnofsky Performance Status; and the Barthel index. For pain improvement we used the Visual Analog Scale. The Likert satisfaction scale (introduced in 1932) measures patient satisfaction in an analog scale.The main objective of the study was to assess the repercussion of the PV in pain score modification and improvement of functional scores in patients with MM at the Pain Clinic of the Instituto Nacional de Cancerología (INCan) in Mexico City.We carried out the study between January 2004 and October 2015. We compared VP treatment to bisphosphonate (BP) and radiotherapy (RT) according to the visual analog scale; and according to Karnofsky and Barthel scales, we determined the reincorporation to daily activities.We included 119 new cases con MM, of this only 64 were included in the study. Of this 54 were female, and 65 were male with a mean age of 59 years (28-87). 88% of patients referred pain as their main symptom, and 70% presented with a vertebral fracture. 26.9% had an ECOG of 3 or more. 96% (114) received RT and 99% (118) BP.64 (54%) of patients were treated with VP. Of this, 67% referred a VAS of 4 or more (moderate to severe pain). And 92% of the patients achieved a VAS of 4 or less. As for the Karnofsky we assessed an improvement of 50/80 points pre VP to 80/90 post VP. The same result was assessed in the Barthel scale, with an improvement of 50/80 points pre VP to 80/100 post VP.This data provides solid evidence of the importance of multidisciplinary approach, and that VP is a safe and effective treatment, coupled of course with BP and RT. DisclosuresNo relevant conflicts of interest to declare.

Tubercular spondylitis: A review of MRI findings in 80 cases

BackgroundTuberculosis of spine is known as tubercular spondylitis or Pott's spine. The vertebral involvement leads to various pathological processes such as abscess formation, cord compression, and gibbus deformity. Magnetic Resonance Imaging (MRI) is the imaging modality of choice which not only helps in diagnosing a case of Pott's spine but also gives valuable information about its impending complications, thereby, aiding in management of these cases. MethodsIn this study, MRI scans of 80 proven cases of tubercular spondylitis were studied retrospectively for the various pathological processes affecting the spine. ResultsOf the 80 cases included in this study, 68.8% of cases were male and 31.2% of cases were females. Majority of cases were seen in 21–40 yrs age group. Lumbar vertebrae were more commonly affected than the dorsal vertebrae. Contiguous two vertebral involvement was the most common pattern, and skip lesions were seen in 5% of cases. Pre-, paravertebral and epidural soft tissue component was seen in 96.25% and 62.5% of cases, respectively. Intervertebral disc Involvement was noted in 95% of cases, and cord edema was seen in 15% of cases. ConclusionTubercular spondylitis or Pott's spine is an extrapulmonary form of tuberculosis which affects the spine. MRI is the imaging modality of choice not only in diagnosing the condition but also in guiding the surgical management. The cases of spinal tuberculosis were systematically analyzed for various pathological lesions which are produced in the spine as the disease progresses.

Sarcoidosis: It's in the Bones

SESSION TITLE: Fellow Case Report Poster - Diffuse Lung Disease II SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: Sarcoidosis, a multisystem disease characterized by non-caseating granulomas, typically affects the lungs. Osseous sarcoidosis should be considered when bone lesions are detected. CASE PRESENTATION: A 57 year old man who presented as a trauma was found to have diffuse FDG avid lytic bone lesions throughout his spine, ribs and pelvis. There was no primary malignancy on imaging and bone biopsy showed only histiocytes. Urine free light chains were detected and although all multiple myeloma criteria were not met by bone marrow biopsy, chemotherapy was initiated. Two months later, the lytic bone lesions were unchanged but there were new FDG avid pulmonary infiltrates, mediastinal and abdominal lymphadenopathy. Chemotherapy stopped. The patient had back pain but denied respiratory symptoms. Prior imaging showed bilateral hilar adenopathy. Transbronchial biopsy of the pulmonary density showed non-caseating granulomas. AFB and fungal stains were negative. Repeat iliac bone biopsy showed giant multinucleated cells consistent with granulomatous process. Pulmonary and osseous sarcoidosis was diagnosed and treated with prednisone which transitioned to methotrexate. At 3 months the back pain resolved as had the FDG avidity of the bone lesions, lymphadenopathy and pulmonary infiltrates. DISCUSSION: Sarcoidosis involves bones in up to 10% of cases. Hands and feet are most commonly involved, however long bones and axial skeleton can be affected. Osseous involvement is a late finding often seen with pulmonary sarcoidosis. Half of patients are asymptomatic. Vertebral body involvement is more likely to cause radicular back pain. As osseous sarcoidosis can appear radiographically as lytic, sclerotic or punched out lesions and is FDG avid, it can can mimic malignancy. Bone biopsy is required to exclude malignancy or fungal / mycobacterial infections. Pathology will show non-caseating granulomas, macrophages, epitheliod and giant multinucleated cells. Immunosupression with prednisone, methotrexate or biologics have all been successful. Duration of treatment remains unclear. CONCLUSIONS: We highlight a case of osseous sarcoidosis with concurrent pulmonary sarcoidosis. Once a diagnosis of pulmonary sarcoidosis was established, bone biopsies were consistent with osseous sarcoidosis. Sarcoidosis is often managed by pulmonologists so familiarity with extrapulmonary manifestations is important. Reference #1: Sparks et al. Osseous Sarcoidosis-Clinical characteristics, Treatment and Outcome Seminars in Arthritis and Rheumatism 44 (2014) 371-379 DISCLOSURE: The following authors have nothing to disclose: Ewa Rakowski, Angeliki Kazeros No Product/Research Disclosure Information

Computed tomography-guided percutaneous biopsy for vertebral neoplasms: a department's experience and hybrid biopsy technique to improve yield.

OBJECTIVE Recent articles have identified the poor diagnostic yield of percutaneous needle biopsy for vertebral osteomyelitis. The current study aimed to confirm the higher accuracy of CT-guided spinal biopsy for vertebral neoplasms and to identify which biopsy technique provides the highest yield. METHODS Over a 9-year period, the radiology department at University Hospitals Case Medical Center performed 222 CT-guided biopsies of vertebral lesions, of which clinicians indicated a concern for vertebral neoplasms in 122 patients. A retrospective chart review was performed to confirm the higher sensitivity of the percutaneous intervention for vertebral neoplasms. RESULTS A core sample was obtained for all 122 biopsies of concern (100.0%). Only 6 cases (4.9%) were reported as nondiagnostic per histological sampling, and 12 cases (9.8%) were negative for disease. The question of vertebral neoplastic involvement warrants follow-up, and the current study was able to determine the subsequent diagnosis of each lesion. Of the 122 total, 94 (77.0%) core samples provided true-positive results, and the sensitivity of core biopsy measured 87.9%. The technical approach did not demonstrate any significant difference in diagnostic yield. However, when the vertebral cortex was initially pierced with a coaxial bone biopsy system and subsequently a 14-gauge spring-loaded cutting biopsy needle was coaxially advanced into lytic lesions, 14 true positives were obtained with a corresponding sensitivity of 100.0%. CONCLUSIONS This study confirms the higher sensitivity of image-guided percutaneous needle biopsy for vertebral neoplasms. In addition, it demonstrates how the use of a novel cutting needle biopsy approach, performed coaxially through a core biopsy track, provides the highest yield.

Early predictive factors for lower-extremity motor or sensory deficits and surgical results of patients with spinal tuberculosis: A retrospective study of 329 patients.

Many studies about the characteristics of spinal tuberculosis (STB) have been published, but none has investigated the predictive factors for lower-extremity motor or sensory deficits (LMSD) in patients with STB.The objective of this study was to find early predictive factors for LMSD and evaluate surgical results of patients with STB.From 2001 through 2010, 329 patients with STB were treated in our department and surgical treatment was performed in 274 patients. The factors assessed included age, sex, duration of symptoms, worsening of illness, clinical symptoms, clinical signs, imaging characteristics, kyphotic angle, Oswestry disability index (ODI), and visual analogue scale (VAS) scores.Of the 329 patients studied, 164 presented with LMSD (the LMSD group), of which 93 patients (28.3%) had motor deficits and 177 patients (53.8%) had sensory disturbance. The other 165 patients were included in the control group (the No LMSD group). Using univariate logistic regression analysis, we found that the sex (P = 0.042), age (P = 0.001), worsening of sickness (P = 0.013), location (P = 0.009), and spinal compression (P = 0.035) were the risk factors of LMSD. Furthermore, the multivariate logistic regression analysis indicated that age (OR = 1.761, 95% CI: 1.227–2.526, P = 0.002), worsening of sickness (yes vs no: OR = 1.910, 95% CI: 1.161–3.141, P = 0.011), location (T vs C: OR = 0.204, 95% CI: 0.063–0.662, P = 0.008), and spinal compression (yes vs no: OR = 1.672, 95% CI: 1.020–2.741, P = 0.042) were independent risk factors of LMSD. Surgical treatment was performed in 274 patients. The kyphotic angle improved from 25.8 ± 9.1° preoperatively to 14.0 ± 7.6°, with a mean correction of 11.8 ± 4.0°, and a mean correction loss of 1.5 ± 1.8° at final visit. There were significant differences between the preoperative and the final ODI and VAS scores in both groups (P < 0.001 and P < 0.001, respectively).Spinal tuberculosis with cervical or lumbar vertebra involvement among the elder patients with a history of worsening of illness and spinal compression tended to cause LMSD, such as motor deficits or sensory disturbance. We should implement an appropriate treatment regimen to prevent exacerbation of STB such as operation, which can achieve thoroughness of debridement, adequate spinal stabilization, and better functional recovery.

Association of Quality and Quantity of Bone Metastases and Computed Tomography Volumetric Bone Mineral Density With Prevalence of Vertebral Fractures in Breast Cancer Patients

IntroductionIn the present study, we investigated the potential for routine staging computed tomography (CT) to assess fracture risk in breast cancer patients. Patients and MethodsA total of 184 randomized CT data sets of women with breast cancer were studied. Intellispace Density software (Philips, Amsterdam, Netherlands) was used to determine the mean volumetric bone mineral density (vBMD) of 3 nonfractured vertebral bodies (T12-L4) and predictors according to the quantitative and qualitative tumor morphology. Two radiologists detected prevalent vertebral fractures and classified them (osteoporotic vs. metastatic). For the determination of an association between bone mineral density, metastatic vertebral bone involvement, and the prevalence of vertebral fractures, a statistical analysis was conducted using multivariable logistic regression and receiver operating characteristic analyses. ResultsOf 184 women, 50 (27%) were diagnosed with prevalent vertebral metastases, of whom, 42 had vertebral fractures (23%). Of these fractures, 20 were found to be osteoporotic (11%), and 22 were associated with metastatic bone disease (12%). The vBMD T score showed the strongest association with osteoporotic fractures (odds ratio, 2.9; 95% confidence interval, 1.4-6.0; area under the curve [AUC], 0.89; P < .01). Metastatic vertebral fractures showed a strong association with the simple prevalence of metastases, regardless of tumor size (odds ratio, 9.8; 95% confidence interval, 4.3-22.3; AUC, 0.90; P < .01). Compared with the prevalence of metastases in the multivariate receiver operating characteristic statistic, the further detection of tumor size T0 and cortical bone infiltration showed a nonsignificant greater association with prevalent vertebral fractures (AUC, 0.92, P = .3; and AUC, 0.93, P = .07). ConclusionvBMD measurements and the detection of metastases and their morphology from routine staging CT allow the discrimination of breast cancer with and without vertebral fractures. The simple prevalence of vertebral metastases is strongly associated with prevalent metastatic fractures.

Effectiveness of percutaneous vertebroplasty in patients with multiple myeloma having vertebral pain.

We aimed to assess the effectiveness, benefits, and reliability of percutaneous vertebroplasty (PV) in patients with vertebral involvement of multiple myeloma. PV procedures performed on 166 vertebrae of 41 patients with multiple myeloma were retrospectively evaluated. Most of our patients were using level 3 (moderate to severe pain) analgesics. Magnetic resonance imaging was performed before the procedure to assess vertebral involvement of multiple myeloma. The following variables were evaluated: affected vertebral levels, loss of vertebral body height, polymethylmethacrylate (PMMA) cement amount applied to the vertebral body during PV, PMMA cement leakages, and pain before and after PV as assessed by a visual analogue scale (VAS). Median VAS scores of patients decreased from 9 one day before PV, to 6 one day after the procedure, to 3 one week after the procedure, and eventually to 1 three months after the procedure (P < 0.001). During the PV procedure, cement leakage was observed at 68 vertebral levels (41%). The median value of PMMA applied to the vertebral body was 6 mL. Being a minimally invasive and easily performed procedure with low complication rates, PV should be preferred for serious back pain of multiple myeloma patients.

18F-FDG PET/CT features of spinal tuberculosis

Objective To investigate the diagnostic value of 18F-FDG PET/CT features of spinal tuberculosis. Methods 18F-FDG PET/CT imaging manifestation of 125 cases(70 males, 55 females, average age 44.3 years) with osseous or mixed vertebra bone destruction from January 2006 to June 2014 were analyzed retrospectively. The patients included 32 cases with spinal tuberculosis (50 lesions, study group) and 93 cases with other diseases (150 lesions, control group). The corresponding FDG PET/CT features were analyzed by two classification logistic regression (Forward: LR), then FDG PET/CT features with statistical significance in diagnosis of spinal tuberculosis were obtained. The sensitivity and specificity of those FDG PET/CT features were calculated. Results Odds ratio (OR) of FDG PET/CT features with statistical significance in diagnosis of spinal tuberculosis from high to low were paraspinalcold abscess(20.790),cold zone(10.528), intervertebral disc involvement(5.394), continuous vertebral involvement(3.493). The diagnostic sensitivity and specificity were 22.0%(11/50), 99.3%(149/150) forcold abscess, 70.0%(35/50), 90.0%(135/150) forcold zone, 82.0%(41/50), 83.0%(125/150) for intervertebral disc involvement, 82.0%(41/50), 78.0%(117/150) for continuous vertebral involvement, respectively. Spinal tuberculosis often had two or more signs. Thecontinuous vertebral involvement + intervertebral disc involvementwas most common, with the diagnostic sensitivity and specificity of 78.0%(39/50) and 88.7%(133/150). The diagnostic sensitivity and specificity ofcontinuous vertebral involvement+ intervertebral disc involvement+ cold zonewere 58.0%(29/50), 96.0%(144/150), and those of four features concurrence were 14.0%(7/50), 100%(150/150), respectively. Conclusion Regression analysis shows that FDG PET/CT features with statistical significance in diagnosis of spinal tuberculosis are paraspinalcold abscess,cold zone, intervertebral disc involvement, continuous vertebral involvement, which have high diagnostic sensitivity and specificity. Key words: Spinal tuberculosis; Tomography, emission-computed; Tomography, X-ray computed; Deoxyglucose

Demographics of Tuberculosis of Spine and Factors Affecting Neurological Improvement in Patients Suffering from Tuberculosis of Spine - A Retrospective Analysis of 312 Cases

Objective The purpose of the study was to study demographics of tuberculosis of Spine and analyze factors that might affect neurological improvement in patients suffering from tuberculosis of spine. Materials: Of the 638 suspected cases of spinal tuberculosis, 312 cases with confirmed diagnosis with at least one year follow up were selected for retrospective analysis. 200 cases that presented with neurological deficit were further divided into three groups- completely improved, partially improved, and no improvement according to AIS (American Spinal Injury Association impairment scale) grading. All continuous variables and categorical variables were compared across groups. Results 66.99% patients had typical clinical presentation. 84.62% had typical MRI presentation. Thoracic levels (T1–10) were most commonly affected in 45.78% followed by thoracolumbar levels 27.52%(T11-L2). In 80.32% disease was restricted to one or two adjoining vertebrae. At presentation 35.89% patients were neurologically intact whereas 31% were AIS-D, 20.83% were AIS-C, 2.5% were AIS-B and 9.61% were AIS-A. The three groups of patients with complete improvement, partial improvement, and no improvement were significantly different in their levels of vertebral involvement, AIS grade at presentation, bladder and bowel involvement and its duration on statistical analysis. Conclusion Age, sex, radiological presentation, co–morbidities and presence of pulmonary tuberculosis has no significant effect on neurological improvement. Levels of vertebral involvement, AIS grade at presentation, bladder and bowel involvement and its duration significantly effects the final neurological improvement in cases of tuberculosis of spine.

SAPHO Syndrome: Imaging Findings of Vertebral Involvement.

Imaging findings in patients with a combination of synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) are often misinterpreted as discitis/osteomyelitis or metastases, resulting in multiple biopsies and delayed diagnosis. We have incidentally noted a semicircular morphology in vertebral body imaging in several cases of SAPHO syndrome with vertebral involvement. Our goal was to evaluate the prevalence of this distinctive morphology in these patients. A retrospective review of patients with SAPHO syndrome diagnosed between July 1998 and August 2013 was conducted. A descriptive analysis of MR imaging, CT, radiography, bone scanning, and PET imaging was performed for the presence and distribution of vertebral body signal intensity or attenuation changes and/or enhancement; contiguous vertebral body involvement; vertebral body collapse; endplate irregularity; disc space, facet, and spinous process involvement; subligamentous thickening; and paraspinal soft-tissue involvement. Eighteen patients (16 women [89%]; mean age, 52.9 years) with SAPHO and spine involvement were included. Contiguous involvement of ≥2 vertebral bodies was found in 16 patients (89%), with a curvilinear or "semicircular" pattern involving portions of adjacent vertebral bodies in 10 (63%, P = .14). Most intervertebral discs demonstrated absence of abnormal T2 hyperintensity (73%) and enhancement (89%). Subligamentous thickening was present in 12 (67%). Paraspinal soft-tissue involvement was present in 6 (33%). SAPHO syndrome should be included in the differential diagnosis in a patient with a curvilinear or semicircular pattern of vertebral involvement, contiguous vertebral body involvement, and absence of intervertebral disc edema and enhancement.

Dysplasie fibromusculaire des artères rénales

Fibromuscular dysplasia is non-atherosclerotic, non-inflammatory disease of the medium caliber arteries causing segmental stenosis, and sometimes aneurysm and/or dissection. Renal involvement is either asymptomatic or revealed by hypertension, rarely acute complications (renal infarction/hemorrhage). Cross-sectional imaging or angiography differentiates multifocal fibromuscular dysplasia (pearl necklace appearance) and focal fibromuscular dysplasia (tubular stenosis). Several differential diagnoses are to be mentioned. Carotid and vertebral involvement are possible. Smoking cessation must be encouraged. Selected patients benefit from renal revascularization. The best indications are recent or resistant hypertension, and progressive renal atrophy. Angioplasty without stent revascularization is the technique of choice in purely stenotic forms.

Miliary Tuberculosis With Vertebral Involvement (Pott's Disease)

Figura 1. A. Multiples nodulos milimetricos uniformes de distribucion difusa, bilateral y aleatoria con predominio en los lobulos superiores, sin distorsion del parenquima pulmonar. B. Masa de partes blandas circunferencial que presenta realce periferico con areas de liquido atrapadas en su interior. La masa tiene un importante componente prevertebral con un pequeno componente epidural anterior que comprime minimamente la medula, pero no asocia mielopatia compresiva. C. Extensa alteracion de la morfologia y senal de cuerpos vertebrales T8 y T9 con acunamiento de ambos, desestructuracion del disco y hundimiento de la plataforma superior de T9.

MAGNETIC RESONANCE IMAGING FINDINGS IN THE SPINE OF SIX DOGS DIAGNOSED WITH LYMPHOMA.

Lymphoma is one of the most common neoplasms in the dog. Despite its prevalence and the increasing use of advanced diagnostic imaging in veterinary patients only few reports of magnetic resonance imaging (MRI) findings in spinal lymphoma have been published to date. The purpose of this retrospective case series study was to describe the MRI findings in dogs with confirmed lymphoma affecting the spine and/or paraspinal soft tissues. Medical records were searched for patients that had MRI of the spine and a diagnosis of lymphoma during the period of 2005-2015. Data recorded from retrieved MRI studies were presence of focal or multifocal disease, structures involved, and signal characteristics on T2-W, short tau inversion recovery (STIR), and T1-W sequences prior to and following intravenous contrast medium administration. Six dogs met the inclusion criteria. Common findings included multifocal disease (4/6), vertebral involvement (5/6), spinal cord compression (4/6), and involvement of more than one spinal compartment (medullary cavity, vertebral canal, paraspinal soft tissues) (6/6). Vertebral changes were confined to the medullary cavity without evidence of cortical osteolysis. There was questionable involvement of the spinal cord in one case. All spinal and paraspinal lesions identified were T2-W isointense to hyperintense, STIR hyperintense, T1-W hypointense to isointense, and showed variable moderate to strong contrast enhancement. Additional lesions identified were enlarged intraabdominal lymph nodes, hepatomegaly, splenomegaly, and a splenic nodule. The STIR and T1-W postcontrast sequences were subjectively the most useful in identification of the spinal and paraspinal lesions.

Intra thoracic extra pulmonary supra apical tuberculoma in Pott's disease: A case report and review of literatures

Background: Spinal tuberculosis is one of the commonest forms of skeletal tuberculosis in India. It accounts for about 50 % of osteo-articular tuberculosis. Spinal tuberculosis causes significant morbidity in Indian Population. Often patients present with Pott’s disease related paraplegia attended by "destruction of vertebral body, lamina, pedicle and spinous process with perivertebral abscess". Huge intra-thoracic extra-pulmonary extra-plural supra- apical tuberculoma due to extension of spinal tuberculosis is not reported yet. We describe here such a case of complete paraplegia with huge chest mass and its successful management. Case Description: A 20 years young male presented with upper thoracic Pott’s paraplegia showing involvement of D1-D3 vertebra with their left pedicle , part of lamina , costo-vertebral and costo-transverse joint with a huge intra thoracic extra-pulmonary supra apical granular tuberculoma mimicking apical tumor. The patient was managed by a posterior “T” shaped vertical midline approach with debridement and decompression of spinal cord and excision of intra thoracic supra apical tuberculoma extra-pleurally. He was administered ATT perioperatively. Postoperatively he followed up for 1 year and now able to walk, run and play normally as before. Conclusion: Pott’s spine may present with intra-thoracic extra-pleural mass which can be managed by posterior costo-transversectomy and laminectomy. So proper assessment of disease and early need full surgical intervention with anti tubercular therapy can control severe morbidity and disability.

The Diagnostic Value of MRI in Brucella Spondylitis With Comparison to Clinical and Laboratory Findings.

Background:Brucellosis is an endemic zoonotic disease, especially in the Middle East and Mediterranean regions and can involve many organs and tissue. Osteoarticular involvement is the most common complication. Spondylitis is its most prevalent clinical form in adults, and there may be difficult in diagnosis and treatment. In present study, we aimed to assess these diagnostic value of MRI, in patients with spondylitis due to brucella, comparing with clinical and laboratory findings.Method:Patients with low back pain who were admitted to Sheikhol-raees MRI center were included in this study. None of these patients had any documented infectious disease. Diagnosis of brucellosis was made, based on MRI findings, which would be approved by serology. After confirmation with serology, the group with positive serology were compared with the negative group, in sex, age, MRI findings level of vertebral involvements, signal intensity in T1 weighted and T2 weighted.Results:Among 53 patients with diagnosis of brucella spondylitis, 33 underwent serology study, 20 were positive and 13 were negative and the others consider out of study. From these 20, 3 had tuberculosis spondylitis, whose mean age was 56 and the 67% of them were male. Mean age in the positive brucella spondylitis were 46 and 67% of them were male. In negative group mean age was 55, and of whom 57% were male. There was no statistically significant difference in MRI findings such as changes in signal intensity, disk space narrowing, Intracanalicular mass, Abscess formation. Level of invlovment in vertebrae.Conclusion:The results of this study shows that although MRI is Modality of choice in diagnosis of spondylitis, it is not enough specific to diagnosis the reasons of spondylitis.

Http://www.archivesofrheumatology.org/abstract/745

Objectives: This study aims to determine the prevalence of obstructive sleep apnea syndrome (OSAS) and assess sleep efficiency in patients with ankylosing spondylitis. Patients and methods: A total of 42 patients (36 males, 6 females; mean age 39.4±9.1 years; range 23 to 63 years) with ankylosing spondylitis were included in this study. Demographic data, spinal mobility measurements, disease activity measurements, and sleep questionnaire results were recorded for each patient. All subjects underwent an overnight polysomnography test and their sleep records were evaluated. Results: Polysomnography test revealed OSAS in 13 (30.9%) patients. Patients with OSAS had a significantly greater occiput-to-wall distance and neck circumference (p=0.025 and p=0.004, respectively). In addition, there was a positive correlation between apnea hypopnea index and occiputto-wall distance and neck circumference (r=0.355, p=0.021; r=0.413, p=0.007, respectively) whereas apnea hypopnea index and body mass index did not significantly correlate. Conclusion: Our study showed that patients with ankylosing spondylitis had higher OSAS prevalence than reported in the general population. Furthermore, OSAS prevalence accordingly increased with the severity of cervical vertebral involvement.

Detailed description of anatomy of the fracture line in hangman's injury: a retrospective observational study on motor vehicle accident victims.

To study the precise location of fracture line in hangman's fracture to determine the fracture patterns, symmetry and involvement of different vertebral elements. 32 cases of hangman's fractures were retrospectively evaluated. All patients presented with motor vehicle accidents. CT scans were studied to accurately localize the fracture lines. Symmetry of fracture lines on both sides was assessed, and involvement of the vertebral bodies, lamina, facet joints and foramen transversarium was also determined. 20 patients showed asymmetric fracture locations, 13 of them had a unilateral pedicle fracture and a contralateral pars fracture which comprised the most common injury pattern (40% of cases). Less frequent combinations for the two sides of asymmetric C2 ring disruption include pars-vertebral body (3 patients), pedicle-vertebral body (2 patients) and pedicle-lamina (2 patients). 12 patients showed symmetrical fractures (5 through the pars and 7 through the pedicles). Vertebral body and facet joint involvement were demonstrated in 15 (47%) and 16 (50%) cases, respectively. 18 cases had fractures extending into the foramen transversarium (56%). In total, 26 fracture lines primarily affected the pars (40%) and 31 affected the pedicles (49%). Asymmetric hangman's fracture is more common with the usual pattern being fracture pedicle on one side and pars on the other followed by the symmetric bilateral pedicle and bilateral pars fractures. Fracture lines running into the transverse foramen and facet joints are very frequent as well as those involving the vertebral bodies. There is controversy in literature regarding the fracture locations in hangman's injury owing to lack of studies that address this subject. This article is the first to describe precisely the anatomical locations and patterns of this injury.

Erdheim-Chester disease in thoracic spine: a rare case of compression fracture

A55-year-old man with back pain for about 2 months was admitted to an orthopedics department. A plain radiological examination of the thoracic spine revealed a collapse of the T2 vertebra. Preoperative magnetic resonance imaging and a computed tomography scan showed a collapse of the T2 vertebra body (Figs. 1 and 2). The lesion involving theT2 vertebra body showed heterogenous enhancement inT1-weightedmagnetic resonance images after administration of gadolinium (Fig. 2). An open bone biopsy of the T2 vertebra body was performed. Based on the histopathologic and radiological findings, the patient was diagnosed with Erdheim-Chester disease (ECD) with involvement of bone marrow (Fig. 3). Erdheim-Chester disease is an infrequent, non-Langerhans cell histiocytosis of unknown etiology that typically affects the lower extremity of long bones, causing osteosclerosis. Isolated axial skeleton involvement of ECD is extremely rare. Imaging features of ECD involvement of vertebra are not specific, so pathologic confirmation is needed. As in our case, the possibility of ECD in patients with compression fracture can be considered [1,2]. References

Vertebral lesion distribution in multiple myeloma--assessed by reduced-dose whole-body MDCT.

To observe the distribution and potential distribution patterns of osteolytic and sclerotic vertebral involvement in a representative collective of multiple myeloma patients. A total of 66 consecutive patients with a diagnosis of multiple myeloma at initial diagnosis or during follow-up were examined by multidetector reduced-dose computed tomography to evaluate the distribution of bone lesions along the spine with focus on size, location, and lesion character. Confirmation of diagnosis was performed by comparison to follow-up computed tomography or magnetic resonance tomography. If >50% of all detected malignant lesions occurred in one spinal segment, the distribution pattern was called cervical, thoracic, lumbar, or sacral, otherwise a "mixed" pattern was classified. Of a total number of 933 osseous spine lesions, 632 (67.7%) were classified as malignant (98.9% of them osteolytic) and 293 (31.5%) as benign. The distribution pattern analysis yielded two patients (3.8%) with a cervical, 26 (50%) with a thoracic, 4 (7.7%) with a lumbar, one (1.9%) with a sacral pattern, and 19 cases (36.6%) showed a mixed distribution pattern. Segment-wise, the mean lesion size was 6.52 ± 2.76 mm (cervical), 8.97 ± 5.43 mm (thoracic), 11.97 ± 7.11 mm (lumbar), and 17.5 ± 16.465 (sacral), whilst, related to the vertebra size, the lesion/vertebra size ratio is decreasing through the whole spine beginning from the top. Multiple myeloma bone lesions occur preferably and are larger in the thoracic and lumbar spine. Moreover, a specific distribution pattern is present in about 60%.

Surgery for vertebral involvement in multiple myeloma.

To evaluate the results of surgery for vertebral involvement in multiple myeloma (MM) following the introduction of the new chemotherapy in 2006. Retrospective cohort study evaluating the patients with MM vertebral lesions from January 2006 to January 2014. Outcomes were based upon participation in ODI and EQ-5D. Statistical interpretation of the data was performed with SPSS version 19 software (SPSS Inc, Chicago, IL, USA). One hundred twenty patients affected by MM were potentially eligible for recruitment. About 1/3 patients needed an operation for vertebral involvement. The disability was mainly related to the number of vertebrae affected by MM. No difference in disability and quality of life was observed between operated and non-operated patients, according to age, levels, and follow-up. The operated patients with a Thoracic location reported lower disability and higher quality of life than non-operated patients. Non-operated patients with one or two vertebrae affected reported lower levels of quality of life. When a spinal column involvement occurs, the probability of undergoing surgery is about 40%. Operated patients show a moderate disability and the increased tendency is related to the number of vertebrae involved. The quality of life is middle in average and middle-high in patients operated for thoracic lesions. Nowadays the spinal surgeon must have a perspective view about MM vertebral lesions, evaluating the stability of the spine, the presence of deformity, the risk of vertebral fractures and the presence of drug resistant pain, that deteriorate the disability and the quality of life related to the underlying disease.