Huge multiple spinal extradural meningeal cysts in infancy

BACKGROUND

Multiple spinal extradural meningeal cysts (SEMCs) are rare lesions. SEMCs communicate with the subarachnoid space through multiple dural defects and expand into the extradural space with progressive spinal cord compression.

CASE PRESENTATION

We report a 5-month-old boy with hydronephrosis involving nine huge SEMCs that were distributed from the T1-L5 levels. Eight SEMCs, except for one small noncommunicating cyst, were exposed through laminoplastic laminotomy at the T10-L5 and T3-5 levels. Five transdural communications with dural defects were packed with a piece of autologous muscle and fibrin glue. Tenting sutures to lift up the dura to the vertebral arch were added to minimize the extradural dead space. Postoperatively, cord compression was relieved and hydronephrosis improved.

CONCLUSION

In conclusion, packing of all dural defects and dural tenting sutures at a one-staged operation is useful in the surgical management of huge and multiple SEMCs in infancy.

The Managment of cervical spine abnormalities in children with spondyloepiphyseal dysplasia congenita: Observational study

Spondyloepiphyseal dysplasia congenita (SEDC) is an autosomal dominant disorder, characterized by disproportionate dwarfism with short spine, short neck associated with variable degrees of coxa vara. Cervical cord compression is the most hazardous skeletal deformity in patients with SEDC which requires special attention and management.Ten patients with the clinical and the radiographic phenotypes of spondyloepiphyseal dysplasia congenita have been recognized and the genotype was compatible with single base substitutions, deletions or duplication of part of the COL2A1 gene (6 patients out of ten have been sequenced). Cervical spine radiographs showed apparent atlantoaxial instability in correlation with odontoid hypoplasia or os-odontoideum.Instability of 8 mm or more and or the presence of symptoms of myelopathy were the main indications for surgery. Posterior cervical fusion from the occiput or C1-3, decompression of C1-2 and application of autorib transfer followed by halo vest immobilization have been applied accordingly.Orthopedic management of children with spondyloepiphyseal dysplasia congenita (SEDC) should begin with the cervical spine to avoid serious neurological deficits and or mortality.

Cervicothoracic spine duplication: a 10-year follow up of a neurological intact boy

PURPOSE

Spine duplication is a very rare condition with the literature being composed of only case reports. All previously reported cases were thoracolumbar spine duplications. Here, we report cervicothoracic spine duplication in a neurological intact male. According to our knowledge, it is the first case in the literature of cervicothoracic spine duplication.

CLINICAL PRESENTATION

A 3-year-old patient presented to a primary physician with a complaint of short stature. He was referred to our department with suspected spinal deformity. Computerized tomography imaging revealed anterior bony structure duplication and posterior dysmorphic elements at the C5-T9 levels. Magnetic resonance imaging revealed a syrinx cavity which splits cord at the duplication level and the relation of the syrinx with posterior mediastinum through anterior bone defect. He was followed up for 10 years.

CONCLUSION

In the literature, spine duplication has been classified as a severe form of split cord malformation because of the concurrence of bone duplication with split spinal cord malformation (SCM). This case presents a distinct form of SCM which shows non-duplicated dural tube as unclassified and cervicothoracic duplication level without neurological deficitis. Treatment of SCM was based on removal of splitting fibrous/osseous process. Neurologic intact spine duplication could be followed up without surgical intervention.

Cystic Abnormalities of the Spinal Cord and Vertebral Column

Cystic lesions of the vertebral column and spinal cord are important differential diagnoses in dogs with signs of spinal cord disease. Synovial cysts are commonly associated with degenerative joint disease and usually affect the cervical and lumbosacral regions. Arachnoid diverticulum (previously known as cyst) is seen in the cervical region of large breed dogs and thoracolumbar region of small breed dogs. This article reviews the causes, diagnosis, and treatment of these and other, less common, cystic lesions.

[Changes of breathing during sleep in normal condition and in neurological alterations on different levels of respiratory regulation]

Disturbances of the rhythm and depth of the respiratory movements during sleep are common phenomena among healthy individuals. These disturbances could manifest themselves as apnoea, hypopnoea or some pathological types of breathing not affecting human wellbeing and functioning. When the quantity of breathing disturbances exceeds the specified threshold the clinical syndromes of sleep disordered breathing appear, each of them having their own clinical features and ways of pathogenesis. 343 patients (162 males and 181 females) with different forms of neurological lesions which could affect respiratory regulation on cerebral, spinal, neural and muscular levels were studied. It was found that the most prominent sleep breathing disturbances develop with the damage on a central level of respiratory regulation. There was certain specificity in the occurrence of different types of disordered breathing depending on the level of impact.

Congenital cervical spinal cord lesions: pathogenesis, management, and outcome

Three patients (2 boys) presented with nontraumatic congenital lesions of the spinal cord resulting in paralysis and contractures of their upper limbs from birth. Limited improvement occurred in all. Two survived. One patient required ventilation support after birth; his upper limbs had lower motor neuron flaccid paralysis, and his lower limbs evolved to pyramidal tract impairment. He died at 9 months of age with an intercurrent chest infection. The other 2 patients had lower motor neuron pathology in their upper limbs and normal lower limb function. One of these patients attained ambulation. All 3 patients retained normal higher mental function. Neuroimaging of the spinal cord from the most affected patient demonstrated atrophy of the cervical and high thoracic regions (C4-T3). Spinal neuroimaging results from the less affected patient were normal. Multidisciplinary management assisted these children to reach their full potential in a resource-poor setting. The etiology of focal pathology to the cervical region in these infants with congenital nontraumatic insults remains undefined, similar to the few cases in the literature. The diverse pathogeneses are hypothesized and the literature reviewed.

Myelination of congenitally dysmyelinated spinal cord axons by adult neural precursor cells results in formation of nodes of Ranvier and improved axonal conduction

Emerging evidence suggests that cell-based remyelination strategies may be a feasible therapeutic approach for CNS diseases characterized by myelin deficiency as a result of trauma, congenital anomalies, or diseases. Although experimental demyelination models targeted at the transient elimination of oligodendrocytes have suggested that transplantation-based remyelination can partially restore axonal molecular structure and function, it is not clear whether such therapeutic approaches can be used to achieve functional remyelination in models associated with long-term, irreversible myelin deficiency. In this study, we transplanted adult neural precursor cells (aNPCs) from the brain of adult transgenic mice into the spinal cords of adult Shiverer (shi/shi) mice, which lack compact CNS myelin. Six weeks after transplantation, the transplanted aNPCs expressed oligodendrocyte markers, including MBP, migrated extensively along the white matter tracts of the spinal cord, and formed compact myelin. Conventional and three-dimensional confocal and electron microscopy revealed axonal ensheathment, establishment of paranodal junctional complexes leading to de novo formation of nodes of Ranvier, and partial reconstruction of the juxtaparanodal and paranodal molecular regions of axons based on Kv1.2 and Caspr (contactin-associated protein) expression by the transplanted aNPCs. Electrophysiological recordings revealed improved axonal conduction along the transplanted segments of spinal cords. We conclude that myelination of congenitally dysmyelinated adult CNS axons by grafted aNPCs results in the formation of compact myelin, reconstruction of nodes of Ranvier, and enhanced axonal conduction. These data suggest the therapeutic potential of aNPCs to promote functionally significant myelination in CNS disorders characterized by longstanding myelin deficiency.

[Congenital spinal cord malformation concurrent with ependymoma of the third brain ventricle]

This paper describes a very rare case of congenital spinal cord malformation as two tumoroid masses of spinal cord rudiments and located in the area of the cauda equina. In addition, ependymoma of the third brain ventricle was detected in a male child aged 2 years and 4 months.

An unusual type of split cord malformation

A 4-year-old girl with an unusual type of split cord malformation (SCM) is reported. She presented with a capillary hemangioma in the lumbosacral region. Computed tomography and magnetic resonance imaging studies of the whole spinal axis revealed SCM. There was a Type II SCM at the L1 level and a dorsal bony septum at the S2 level. The conus medullaris terminated at the upper end of the L2 vertebral body. There was no tethered cord syndrome. There is no reported case to date of SCM with this malformation. She did not undergo surgical treatment due to the absence of tethered cord syndrome. Her neurological examination was unremarkable and she is still being followed up without any neurological abnormalities.

Congenital paravertebral arteriovenous fistula: a case report

Congenital paraspinal arteriovenous fistulae are rare and usually diagnosed after neurologic or cardiovascular manifestations. They may be discovered unexpectedly in children during clinical examination, which reveals the presence of a vascular murmur. The association with multicystic kidney is exceptional. We report 1 case with thoracic localization of a congenital paraspinal arteriovenous fistula associated with a multicystic kidney in a 3-year-old boy who was treated by endovascular embolization.

The relationship of the spinal cord to scoliosis

The authors present an original description of the tethered spinal cord. This submission in its day was not welcomed by the contemporaries of Dr. Robert Heimburger who theorized that there may be an association between the tethered spinal cord and scoliosis. Today we know that abnormal curvatures of the spinal cord can result from distal abnormal tensions placed on the spinal cord. This historical paper, now printed in full, may very well be one of the earliest descriptions of this association. It offers a unique window into the early cause-and-effect thinking regarding this neurosurgical lesion.

[Spinal ultrasound study in pediatrics: its role in the diagnosis of spinal cord malformations and postoperative conditions]

The advent of new technologies in neurosurgery has made it necessary to create a current algorithm of the radiation diagnosis of congenital spinal cord diseases in children in the pre- and postoperative period. Due to the efficiency and low cost of a study, ultrasound diagnosis becomes an important element of this algorithm.

[Central hemodynamic changes in children reoperated on for congenital spinal cord hernia using balanced anesthesia based on midasolam and propofol]

The central hemodynamics was studied and analyzed in 51 patients reoperated on for congenital spinal cord hernia under balanced anesthesia based on midasolam and proforol. The procedure for anesthesiological provision of replastic repair of operated spinal hernia, which is based on propofol of bolus administration of midasolam with a hypnotic appliance, was found to cause no negative hemodynamic effects. When the benzodiazepine antagonist flumazenyl is used, the interval between the end of surgery and tracheal extubation is virtually identical in the propofol and midasolam groups since the intravenous injection of flumazenyl induces a drastic awakening effect.

[The peculiarities of stability of vertical posture in patients with segmental lesions of the spinal cord]

Using computer stabilography, vertical posture has been studied in 3 groups of children and adolescences with traumatic lesion of the spinal cord after surgery of congenital myelocele (n=10) and myelodysplasia (n=10) and in 124 healthy controls. Also, an extent of segmental lesions was investigated by electroneuromyography of lower extremities muscles. Patients with pronounced segmental lesion had small-amplitude, -velocity and -frequency variations of body center of gravity (BCG) during standing with visual control. After excluding visual control of vertical posture, there was a significant decrease of vertical stability that suggests a relevant role of visual analyzer in the control of vertical posture. In patients with minor segmental lesion, BCG variations of small amplitude, velocity and frequency were observed. Exclusion of visual control did not result in significant reduction of vertical stability. It is concluded that stabilographic survey is an objective method for diagnosis of an extent of segmental lesion of the spinal cord.

Congenital defects of the ruminant nervous system

Abnormalities of the nervous system are common occurrences among congenital defects and have been reported in most ruminant species. From a clinical standpoint, the signs of such defects create difficulty in arriving at an antemortem etiology through historical and physical examination alone. By first localizing clinical signs to their point of origin in the nervous system, however, a narrower differential list can be generated so that the clinician can pursue a definitive diagnosis. This article categorizes defects of the ruminant nervous system by location of salient clinical signs into dysfunction of one of more of the following regions: cerebrum, cerebellum,and spinal cord. A brief review of some of the more recognized etiologies of these defects is also provided. It is important to make every attempt to determine the cause of nervous system defects because of the impact that an inherited condition would have on a breeding program and for prevention of defects caused by infectious or toxic teratogen exposure.

Ketamine patient-controlled analgesia for dysesthetic central pain

STUDY DESIGN

Case report.

OBJECTIVES

To describe the first use of intravenous (IV) ketamine as the sole agent in a patient-controlled analgesic delivery system (ie PCA) in a patient with cervical syringomyelia.

SETTING

A tertiary-care university teaching hospital in New York City.

METHODS

A 41-year-old tetraplegic female on high-dose opioids suffering from intractable dysesthetic central pain received her best pain relief from a low-dose ketamine infusion after failing trials with multiple neuropathic medications. After several weeks of titrating her infusion rate up and down, she was switched to an IV ketamine PCA device.

RESULTS

The patient was maintained on an IV ketamine PCA for almost 1 year under the following settings: 2.7 mg/h basal rate; 2.7 mg/h demand dose; 15 min lockout period. Although she continues to report some pain, it has dramatically decreased since the ketamine PCA was instituted, enabling us to significantly reduce her opioid dosage.

CONCLUSIONS

Ketamine PCA may be a viable treatment option in patients suffering from intractable central pain. The rationale for this treatment, along with dosing guidelines and possible drawbacks, is discussed.

Diastematomyelia presenting as progressive weakness in an adult after spinal fusion for adolescent idiopathic scoliosis

BACKGROUND CONTEXT

Diastematomyelia is uncommon and rarely presents in adulthood. This report draws attention to the fact that patients who underwent spinal fusion for deformity before the widespread use of computed tomography (CT) and magnetic resonance imaging (MRI) may have unrecognized spinal cord abnormalities. This should be considered if revision surgery is contemplated.

PURPOSE

This case report focuses on the late presentation of lower-extremity weakness in a 44-year-old woman with a split cord malformation (diplomyelia), diastematomyelia and tethered cord syndrome.

METHODS

The patient underwent instrumented posterior spinal fusion with a Harrington rod as a child for progressive thoracolumbar scoliosis. As an adult, she developed paraparesis after a traumatic event. The patient underwent decompressive laminectomy, subtotal resection of the old fusion mass and resection of the osseous septum. Postoperatively, an anterior spinal fluid leak in the lower thoracic region required repeated fascial grafting, resection of a pseudomeningocele and reverse left latissimus dorsi flap transfer. The leak was controlled, and the patient had near complete resolution of her paraparesis 1 year after her surgery.

RESULTS

The case described herein is unusual in that patients with diplomyelia and diastematomyelia rarely are symptomatic in adulthood. However, trauma may precipitate the onset of neurologic symptoms. This patient underwent spinal surgeries to address deformity, pain and progressive lower-extremity weakness. Preoperative CT and MRI studies showed a split cord malformation and diastematomyelia at L1-L2 with spinal stenosis and tethering of both hemicords.

CONCLUSIONS

Progressive weakness without any previous neurologic deficit or neurocutaneous stigmas of an underlying spinal cord abnormality may develop in the adult with unrecognized diastemotomyelia. This case demonstrates that a thorough preoperative workup of patients with complex spinal deformities is imperative.

A split cord malformation with paresis of the unilateral lower limb: case report

BACKGROUND

We report a rare case of split cord malformation.

CASE DESCRIPTION

A female neonate presented with split cord malformation (SCM) manifesting as right lower limb paresis. Myelomeningocele and meningocele were found in the lumbosacral region at birth. Magnetic resonance imaging (MRI) demonstrated division of the spinal cord into two hemicords below the T5 level. The right hemicord formed a hemimyelomeningocele and the left hemicord terminated in the low-lying conus. Three-dimensional computed tomography (3D CT) showed extensive vertebral body abnormalities. The hemimyelomeningocele was repaired 1 day after birth, and septectomy and the repair of the meningocele were performed when the patient was 1 year old. The patient has been followed up as an outpatient, and has residual right lower limb paresis.

CONCLUSION

SCM can be associated with multiple spinal abnormalities. MRI and 3D-CT are useful for identifying such abnormalities and planning the surgical treatment.

US of the spinal cord in newborns: spectrum of normal findings, variants, congenital anomalies, and acquired diseases

Ultrasonography (US) of the spinal cord is performed in newborns with signs of spinal disease (cutaneous lesions of the back, deformities of the spinal column, neurologic disturbances, suspected spinal cord injury due to traumatic birth, and syndromes with associated spinal cord compression). The examination is performed with high-frequency linear- and curved-array transducers in the sagittal and axial planes from the craniocervical junction to the sacrum. Normal variants such as transient dilatation of the central canal and ventriculus terminalis can be demonstrated with US. US allows detection of congenital malformations, such as myelocele or myelomeningocele, spinal lipoma, dorsal dermal sinus, tight filum terminale syndrome, diastematomyelia, terminal myelocystocele, lateral meningocele, caudal regression syndrome, and hydromyelia or syringomyelia. Acquired intraspinal diseases following birth trauma and transient alterations after lumbar puncture can also be detected with US. US can demonstrate the entire spectrum of intraspinal anatomy and pathologic conditions with high geometric resolution. Therefore, US should be considered the initial imaging modality of choice for investigating the spinal cord in newborns.

Congenital spinal lipomas--tumor versus hamartoma

Congenital spinal lipomas as a form of dysraphism are frequently reported in literature. A few studies have highlighted their histologic features and found them different from lipomas in other parts of the body. In a review of eight cases of spinal lipomas, we found heterotopic tissue in seven. Neural tissue, muscle, bone and cartilage were frequently encountered. The presence of meningothelial cells in one case was an unusual finding. These findings support the concept of their hamartomatous origin. Malignancy, occurring later in life in one of the heterotopic elements is known, though uncommon, and is one of the reasons, besides neurologic deficit, for long term follow-up.

The club-shaped cord terminus in siblings with caudal agenesis: MRI

We report a rare instance of caudal agenesis occurring in siblings, with MRI. Both our patients had a club-shaped spinal cord, ending at T11. Radiological and urological findings are presented.

Idiopathic localized hydromyelia: dilatation of the central canal of the spinal cord of probable congenital origin

Three adult patients are reported with asymptomatic localized widening of the central canal of the spinal cord. These patients were followed for a period of 24 years by imaging and/or clinical history and physical examination without evidence of signs or symptoms related to the spinal cord. This condition probably represents persistence into adult life of a fetal configuration of the central canal of the spinal cord. This process may be termed "idiopathic localized hydromyelia" to distinguish it from syringomyelia secondary to such causes as Chiari malformation, trauma, infection, or neoplasm.

Trends in the treatment of patients with spinal cord lesions seen within a period of 20 years in German centers

Twenty-one special centers are running treatment of spinal cord injuries in Germany. Their heads represent a study group to coordinate methods and to investigate results collecting data since 1976. So we have experiences for about 20 years. 1500 recent cases are treated per annum. Seventy-five percent got their lesion by trauma. Beside these there is only a little capacity to treat patients with non-traumatic or congenital lesions (25%). Sixty-two percent are para-, 38% are tetraplegic, 28% female, 2% are children. Within 22,212 recent cases 35% got their injury by traffic, 14% at work. Sports and diving caused 4%, suicide 5% and killing attempts 1%. Though numbers since 1976 are decreasing, traffic and work are main reasons causing spinal injuries. Readmission reasons are mainly disorders of soft tissues (23%) and the urinary tract (21%). Out-patients are checked in 67% of all cases. All investigation data represent very stable trends within the last 20 years. Altogether the special centers carried out treatment and consultation in about 22,000 recent cases, 45,000 readmissions and 80,000 out-patients.

Spinal intradural neuroepithelial cyst associated with multiple congenital anomalies in a child

A case of spinal intradural neuroepithelial cyst is presented. The patient, who had thoracolumbar hypertrichosis, underwent magnetic resonance imaging which demonstrated a cystic lesion within spinal canal. The cystic lesion was removed surgically. Histological study proved it to be a neuroepithelial cyst. Spinal intradural neuroepithelial cyst associated with other congenital malformations is a rare condition.

Lethal congenital contracture syndrome (LCCS), a fetal anterior horn cell disease, is not linked to the SMA 5q locus

The lethal congenital contracture syndrome (LCCS) is an autosomal recessive syndrome (McKusick 253310) leading to perinatal death owing to early onset degeneration of the anterior horn motor neurones of the spinal cord. The neuropathological findings in the LCCS closely resemble those of spinal muscular atrophy (SMA). Since all the three types of SMA have been localised to the same gene locus on the long arm of chromosome 5, we analysed samples from seven families with 10 LCCS fetuses with the microsatellite markers assigned to the SMA 5q region. Linkage analyses between the SMA linked DNA markers and the disease allele in the LCCS families excluded the critical chromosomal region around the SMA locus as the critical chromosomal region for the LCCS locus.

Imaging evaluation of patients with spinal deformity

CT myelography and MRI provide the best means of preoperatively assessing patients with spinal deformities. Owing to its noninvasive nature and its superior soft-tissue contrast, MRI represents the single best modality in the evaluation of a patient with any deformity. MRI allows complete preoperative surgical planning and obviates the need for any additional studies. Screening of the entire cord in a patient with a deformity is best accomplished with sagittal and coronal (as needed) T1W images. These images allow assessment of the cord for compression, tethering, syrinx, enlargement, and Arnold-Chiari malformation. Evaluation of cord compression at the apex of a curve is the single most important consideration other than the diagnosis of intrinsic cord abnormality. Subsequent sagittal or axial T2W images may be helpful if specific abnormalities are noted on T1W screening images. Coronal images are particularly helpful in patients with prominent curves or in those with vertebral anomalies. Additionally, coronal images may be useful in assessing patients with suspected diastematomyelia. Advances in hardware and software design have resulted in marked improvements in the ability to satisfactorily image all aspects of patients with spinal deformities. New phased array coils allow rapid imaging of larger portions of the spine. For instance, a complete MRI of the spine can be performed in a child in the same length of time that would have been necessary for a single lumbar examination when MRI was in it's infancy. The use of fast spin-echo imaging also permits more rapid acquisition times. CT myelography remains useful for those patients who cannot undergo MRI or for those with specific abnormalities such as multilevel central spinal stenosis when dynamic information obtained during the myelogram might be helpful. CT myelography represents the only means of assessing the central spinal canal of patients with metallic instrumentation in place. With the exception of these limited applications, MRI has replaced CT myelography as the imaging study of choice in the evaluation and examination of patients with spinal deformities.

Sacral agenesis associated with spinal cord syrinx

The antemortem diagnosis of syringomyelia in the setting of sacral agenesis has not been reported before. We describe the clinical and neuroimaging features in 3 patients. None has required surgical intervention to date.

Spinal dysmyelination in new-born brown Swiss x Braunvieh calves

In four new-born Braunvieh calves suffering from connate recumbency and body tremor, a hitherto not described myelination disorder of the spinal cord was examined. Bilateral symmetric hypo- as well as demyelination in several spinal tracts were the most conspicuous findings, affecting the ascending gracile funiculus, the ascending dorsolateral spinocerebellar tract, and the mainly descending sulcomarginal tract. Deficient myelin production, loss of myelin, consecutive axonal degenerations, and prominent astrogliosis within these tracts were the histological hallmarks of the disease. This possibly inherited primary myelination disorder of the spinal cord differs markedly from known hereditary neurological diseases in Brown Swiss and Braunvieh cattle, respectively, i.e. the weaver-syndrome and the spinal muscular atrophy.

[Reconstructive microsurgery in the combined treatment of children with spinal cord disorders]

The use of microsurgical techniques in operations for autoneuroplasty with intercostal nerves in patients with congenital abnormality of the spinal cord makes it possible to adequately approximate of the interrupted roots of the spinal cord and creates promising prerequisites for restoration of pelvic and motor functions. Observations have shown that the functions of the pelvic organs in children are gradually restored and active movements appear in the lower extremities. The use of the omentum on a nutrient pedicle made it possible to arrest hydrocephalic phenomena. Due to its obvious efficacy, the suggested method can be recommended for wider use in pediatric neurosurgery.

Imaging of common congenital anomalies of the brain and spine

The term congenital anomalies refers to those processes that are present before or at birth. In congenital brain anomalies these defects are usually manifested as structural abnormalities. The central nervous system (CNS) starts forming at approximately the 17th day of intrauterine life and myelination is almost completed at about the 18th month of life when the brain reaches adult characteristics. For the purpose of this article, the major CNS abnormalities are reviewed according to the time of insult, beginning with the earlier ones. This article does not attempt to be a complete review; the emphasis is on illustrating the most important CNS anomalies utilizing ultrasound (US), computed tomography (CT), and magnetic resonance (MR) imaging.

Neuropathology of the spinal cord

The neuropathology of the spinal cord is described and illustrated from the viewpoint of a neuropathologist observing at necropsy the many traumas and pathologic diseases affecting the spinal cord. The article provides the clinician with an insight into the disease processes and anatomic derangements underlying the neurologic deficits in paraplegia and quadriplegia. Today, the clinical examination of patients with spinal cord trauma or spinal cord disease is greatly assisted by many anciliary investigations, notably, radiology and the newer imaging techniques now applied to successfully to the spinal cord. Comparison of the patient's neuropathology with the classical neurophathology of the spinal cord, provided in this article, remains important for the clinician.

Bladder and sphincter behavior in patients with spinal cord lesions

To ascertain the relationship between the clinical neurological level, and bladder and sphincter behavior, the video-urodynamic studies of 489 patients with spinal cord lesions due to a variety of causes were retrospectively analyzed. Patients were classified based on the clinical neurological level, etiology of the lesion and presence or absence of signs of sacral cord involvement. Urodynamic findings were classified as either detrusor hyperreflexia, detrusor-external sphincter dyssynergia, detrusor areflexia or normal. The results indicate that although there was a general correlation between the neurological level of injury and the expected vesicourethral function, it was neither absolute nor specific. For example, 20 of 117 cervical cord lesions had detrusor areflexia, 42 of 156 lumbar cord lesions had detrusor-external sphincter dyssynergia and 26 of 84 sacral cord had either detrusor hyperreflexia or detrusor-external sphincter dyssynergia. However, if one considers the presence of neurological abnormalities, 84% of the suprasacral cord lesions with detrusor areflexia have sacral cord signs. In contrast, all suprasacral cord lesions with no evidence of sacral cord involvement have either detrusor hyperreflexia or detrusor-external sphincter dyssynergia. The positive predictive value for positive sacral cord signs and detrusor areflexia was 87%. The positive predictive value for negative sacral cord signs and detrusor hyperreflexia/detrusor-external sphincter dyssynergia was 81%. These data suggest that the clinical neurological examination alone is not an adequate barometer to predict neurourological dysfunction and that video-urodynamic evaluation provides a more precise diagnosis for each patient.

Imaging of cystic and cavitary lesions of the spinal cord and canal. The value of MR and intraoperative sonography

This article discusses the utility and technique of magnetic resonance imaging and intraoperative spinal sonography in the evaluation of cystic and cavitary lesions of the spinal cord and canal. The pathophysiology and fluid dynamics of these lesions are also discussed.

Tethered cord syndrome versus low-placed conus medullaris in an over-distended spinal cord following initial repair for myelodysplasia

We present findings obtained from a total of 100 patients who had previously undergone surgery for spina bifida and whose progress had been monitored by magnetic resonance imaging (MRI) in our meningomyelocele clinic. Fourteen of these patients (14.0%) developed delayed symptom(s) of progressive spinal neurologic dysfunction. In those with myeloschisis, increase of motor deficit was the most common clinical manifestation during infancy and early childhood (mean age: 6.8 years), whereas pain on back flexion was seen in patients who were over 15 years of age (mean age: 17.3 years). MRI carried out in myeloschisis patients invariably demonstrated that the conus medullaris was in an abnormally low position, suggesting over-distension of the spinal cord. This was irrespective of whether symptom(s) developed or not and did not correlate with the initial surgical procedure (reconstructive or otherwise) used. Patients with symptom(s) were revealed by MRI to have an extremely low conus set at the spinal level of S-1 or below; neurological examinations showed that the motor deficit occurred at high levels in the spine. Results from lipomeningocele patients were more erratic in terms of conus position and delayed development of neurological defects.(ABSTRACT TRUNCATED AT 250 WORDS)

The value of different neuro-imaging methods in the diagnosis of a congenital, spinal, epidural meningeal cyst

Congenital, spinal, epidural cysts are rare causes of transverse or radicular spinal lesions. Usually these cysts are located in the thoracal region, are oblong-shaped, and extend over several segments dorsally to the cord. Frequently, they cause no symptoms for years. They are fairly accessible to diagnostics by modern neuro-imaging methods. We report on a 15 year old girl with paraparesis, which showed a slow progression over two years, short-term remissions, and finally impairment of bladder function. Myelogram, computer-assisted tomography and nuclear magnetic resonance tomography showed a large space-occupying mass from D8 to L1 epidural and dorsal of the myelon. Operation disclosed an epidural cyst from D10 to L2. Histologically, the removed material was classified as a meningeal cyst. Post-operatively the girl's condition improved under intensive physio-therapy. For the diagnosis of this spinal dysrhapic disorder CT scanning after intrathecal application of contrast medium and magnetic resonance imaging were most valuable.

Dorsal enteric cysts--a study of eight cases

Dorsal enteric cysts have been recognized in association with a wide variety of developmental anomalies of the back, the spine, the central nervous system, the mediastinum and the gut. These lesions can be lethal and they caused the deaths of three of the eight patients in this study: two from meningitis and one from erosion into the aorta. Two of these deaths might have been prevented if they had been fully investigated earlier and the life-threatening components of these complex lesions removed. In the most recent case, however, the lesion was detected antenatally, expediting postnatal investigation and surgery. Three of the five survivors have neurological sequelae attributable to their intraspinal pathology.

[Spinal sonography of a newborn infant with postpartal paraplegia]

Cranial ultrasonography is a well established diagnostic procedure. In contrast ultrasonography of the spine and the spinal cord is less frequently used. It is indicated in infants with spinal dysraphism and may help to diagnose patients with meningomyelocele, spinal lipoma or cord tethering. We present a newborn with parplectic symptoms as a result of an epidural hematoma, which could be demonstrated exclusively by ultrasonography. We want to stress that spinal ultrasonography is a method of high clinical value.

Anatomical observation of six calves affected with segmental aplasia of the spinal cord

Four male and two female Holstein-Friesian calves with segmental aplasia of the spinal cord were examined macroscopically and radiographically, and in some cases also histologically. External symptoms included inability to stand, deep depression of the body near the middle of the back but without any blemish in the skin, and slight reduction of the body length. Both hind limbs were almost normal. In every case segmental aplasia of the spinal cord was observed between the caudal thoracic and the cranial lumbar region. Owing to this defect, the vertebrae of that limited area consisted only of the body and the ribs fused on both sides. The sternum showed abnormal ossification at its caudal part. Other defects were observed such as kyphoscoliosis (six cases), polycystic kidney (one case), cryptorchidism (one case), and XX/XY chimerism (one case). From these findings it was apparent that this anomaly was uniquely different from the other two main spinal cord anomalies, spina bifida and perosomus elumbis. One conceivable pathogenesis of this rare anomaly, it was conjectured, is as follows: This anomaly results primarily from a segmental disorder of the neural tube, probably due to vascular problems, whereby a part of the spinal cord fails to develop properly from its normal genesis. Anomalous shapes of the vertebral column and ribs are perhaps secondary defects caused by aplasia of the spinal cord.

Long-term results of surgically treated congenital intradural spinal arachnoid cysts

The authors report long-term results in 17 patients with surgically treated congenital intradural spinal arachnoid cysts. Comparison between the immediate and long-term results demonstrates that surgical removal of the cyst allowed a significant neurological improvement in all cases, but clinical worsening of various degrees was observed later. The authors attempt to explain the results in terms of mechanical and vascular factors.

Congenital intramedullary spinal ependymal cyst

A rare case of congenital intramedullary ependymal cyst of the dorsal cord in a 7-year-old boy associated with kyphoscoliosis and rachidian malformations of the dorsal spine is reported. Myelography suggested an intramedullary lesion. The posterior location and presence of a clear plane of cleavage from the medullary tissue enabled total enucleation of the cyst. Histological differentiation from other similar intradural cysts is discussed and the relevant literature is reviewed. This is the fifth such case reported in the literature.