Dysfunctional segmental motion treated with dynamic stabilization in the lumbar spine

OBJECTIVE

To determine the suitability of the application of dynamic stabilization (DS) as a nonfusion technique to address dysfunctional segmental motion (DSM) in the lumbar spine.

METHODS

Over a 1-year period, 25 patients were treated with the same assessment and surgical protocol. Inclusion criteria were clinical presentation of DSM with or without stenosis. On preoperative and postoperative plain anteroposterior, lateral, and lateral flexion-extension radiographs, anterior and posterior disc height (DH); anteroposterior diameter of the disc; and global, segmental, apical segment, and below level lordotic angles (LAs) were measured.

RESULTS

The study included 9 women and 16 men with a mean age of 43.48 years ± 7.6. On average, patients had symptoms for 38.04 months ± 29.6, and mean follow-up was 12.36 months ± 3.46. The average height of anterior, posterior, and mean intervertebral discs increased significantly (P = 0.002, P = 0.003, and P < 0.0001). There were no significant differences between the preoperative and postoperative global, segmental, apical segment, and below segment LAs in flexion, extension, and neutral positions. At mid-term follow-up, no patients showed new signs of degeneration at the adjacent motion segment.

CONCLUSIONS

Overall, the limited radiologic data advocate DS as a nonfusion technique in the treatment of DSM in the lumbar spine. Long-term follow-up is essential, however, to investigate the long-term efficacy of DS in the surgical treatment of DSM.

Lumbar myxopapillary ependymoma mimicking neurofibroma

OBJECTIVE

To report a case of lumbar myxopapillary ependymoma in whom neuroradiological and surgical findings strongly suggested neurofibroma.

CLINICAL PRESENTATION

The patient presented with a 2 year history of progressive monoparesthesia and monoparesia of his right leg. He reported having minimal fecal and urinary incontinence.

INTERVENTION

Total resection of the tumor was achieved by total L1-L2 laminectomies. There was no attachment to the spinal cord and dura.

CONCLUSION

In spite of contemporary sophisticated neuroradiological facilities, we may still have diagnostic difficulties in some spinal tumors.

Anterior pontine hydatid cyst: case report

We report a rare case of anterior pontine hydatid cyst. Diagnosis was established on magnetic resonance imaging (MRI) findings preoperatively and was confirmed during surgery and by laboratory findings of cyst fluid, and section of cyst wall. A classical suboccipital craniectomy was performed, followed by an approach through the floor of the fourth ventricle. After a failed attempt at the Dowling technique, we punctured the cyst, aspirated the contents, then extirpated the cyst membrane. The patient survived suffering only minor morbidity. The surgical technique and pontine myelotomy are discussed.