Journal of Spinal Studies and Surgery

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Solitary plasmacytoma arising as a primary bone tumor at the craniovertebral junction is very rare, with only a few cases reported in the literature. Here, we present a 62-year-old female who presented with complaints of neck pain and restricted neck movements of short duration. She had features of upper motor neuron involvement in all the limbs, but the motor power was preserved with no bladder symptoms. The magnetic resonance imaging of the cervical spine revealed an expansile lytic lesion at the craniovertebral junction, involving the C2 vertebral body and posterior elements of C1 and C2. The bulk of the mass was extending posteriorly and compressing the cord. Since there was a chance of neurological deterioration due to the extensive anterior and posterior column involvement, we went ahead with surgical decompression of the lesion posteriorly. The posterior component was near totally decompressed, and the spine was stabilized with occiput-C3 fixation and fusion using rib grafts and steel wires due to financial constraints. The postoperative period was uneventful, and she was followed up for 2 months during which there was no neurological deterioration. Subsequently, she was lost to follow-up. She did not undergo radiation therapy or myeloma workup due to financial limitation. The histopathological examination of the lesion revealed plasmacytoma.

Context: The Diffusion Tensor Imaging (DTI) is a modality of the MRI describing the integrity white matter tracts of the neural tissue by mean of fractional anisotropy (FA) and apparent diffusion coefficient (ADC). Aims: The aim of the study is to assess the usefulness of DTI in the acute assessment of patients after cervical tSCI. Settings and Design: Pilot prospective control-matched non-randomised experimental study. Materials and Methods: Five cervical tSCI patients were prospectively enrolled into the study. Neurological examination was followed by the MRI scan with DTI FA and ADC of the injured segments of the cervical spine. Obtained values were compared to the reference (healthy volunteers) by mean of statistical analysis. Statistical Analysis Used: SPSS 21.0 and MedCalc 12 software; non-parametric Spearman's rank correlation was used. The significance level was established as P < .05. Results: The FA correlated negatively with the ASIA motor score (-0.90, P = 0.037) and severity of neurological deficits (ASIA type A-E) (-0.95, P = 0.014). The ADC was positively correlated with ASIA motor score for upper limbs (0.86, P = 0.046). Two patients found with ADC higher than the reference presented early neurological recovery. Conclusions: DTI appears to be useful in the early assessment of tSCI. The FA reflects functional status of the spinal cord whilst ADC may serve a potential prognosticator.

Purpose: The purpose of the study was to determine the influence of the loading history on changes in the recorded pressure in the intervertebral disc (IVD) and the influence of changes in the support conditions as a result of the removal of facet joints on changes in pressure. Materials and Methods: The tests were carried out on motion segments of the thoracic spine for the physiological system (with articular processes preserved) and the pathological system (with articular processes removed). Our analysis assessed changes in intradiscal pressure for three consecutive loadings, i.e., cyclic compression loading, compression loading constant in time, and unloading. The tests were conducted while maintaining full hydration of the IVD. Results: During cyclic loading, we observed a progressive decrease in intradiscal pressure. Suppression of the pressure decrease is clearly visible in the system with the preserved complete articular triad, which should be regarded as characteristic of a properly functioning system. Constant compression loading caused a progressive decrease of intradiscal pressure in all tested systems. In general, greater decreases were recorded in the systems with articular processes removed. A decrease in intradiscal pressure leads to a simultaneous change in the stiffness of the analyzed systems. The process of relaxation was unstable and showed an upward trend throughout the unloading period. Conclusion: The obtained results clearly indicate that facet joints play an important role in the transmission of loads by the spinal column and that those structures play a protective role in the overload conditions of the IVD.

Background: Os odontoideum is a congenital anomaly or a posttraumatic event of the C2 vertebra (dens), in which the odontoid process is separated from the body of the axis by a transverse gap. Trivial trauma aggravates the condition resulting in atlantoaxial dislocation (AAD) which needs stabilization. Materials and Methods: In our study, we have five patients with os odontoideum, who had developed quadriparesis after minor cervical trauma. All of them underwent C1–C2 posterior stabilization by Harms technique (C1 lateral mass screw and C2 pedicle screw with rod reconstruction), and postoperatively, all the five patients showed a significant improvement from the quadriparesis. Results: All the patients in this case series showed significant improvement in motor power following posterior C1 C2 stabilization. Conclusion: AAD following a trivial trauma in cases of os odontoideum needs to be stabilized to form solid fusion. To achieve that, the Harms technique of C1–C2 fusion is a very effective method.

Online since 27^th January, 2017