Prospective, randomized, controlled human study.We checked the proportion of missed syrinx diagnoses among the examinees of the Korean military conscription.A syrinx is a fluid-filled cavity within the spinal cord or brain stem and causes various neurological symptoms. A syrinx could easily be diagnosed by magnetic resonance image (MRI), but missed diagnoses seldom occur.In this study, we reviewed 103 cases using cervical images, cervical MRI, or whole spine sagittal MRI, and syrinxes was observed in 18 of these cases. A review of medical certificates or interviews was conducted, and the proportion of syrinx diagnoses was calculated.The proportion of syrinx diagnoses was about 66.7% (12 cases among 18). Missed diagnoses were not the result of the length of the syrinx, but due to the type of image used for the initial diagnosis.The missed diagnosis proportion of the syrinx is relatively high, therefore, a more careful imaging review is recommended.
IntroductionIntracranial pressure (ICP) control is the main goal in managing traumatic brain injury (TBI).In addition to the direct injury, secondary insult due to post-traumatic in-crease in ICP or decrease in cerebral perfusion pressure is well recognized as a cause of increased mortality and morbidity. 4,15,18,22,23,27)Although debates concerning its effectiveness in improving patient outcomes are ongoing, decompressive craniectomy (DC) is widely performed throughout the world to manage TBI. 38)Although DC has been shown to decrease ICP, 36) there is no clear evidence of an association between DC and better outcomes. 32)Therefore, DC is regarded as only an "option" among guidelines for head injury management. 24)eportedly, acute subdural hematoma (ASDH) is found in up to one third of patients with severe TBI. 5,40)ASDH may be treated conservatively or surgically, and surgery is often undertaken to prevent secondary brain injury upon
Superficial siderosis (SS) in central nervous system is a rare, slowly progressive disease and usually misdiagnosed or diag- nosed too late when the patient is chronically devastated. A 55-year-old man with deafness and gait disturbance for ten years was referred from otorhinologist for evaluation of brain. Magnetic resonance image (MRI) showed symmetric hypointense rim partially delineated the bilateral hemisphere on gradient-recalled-echo T2-weighted image, and it was diagnosed as he- mosiderin deposition in subarachnoid and subpial meningeal layer. The correct diagnosis of cerebral superficial siderosis can be achieved by careful neurological examination and MRI because computed tomography findings and symptoms are am - biguous. Serial follow-up of imaging study and education for patient are necessary to prevent progression of SS. (Korean J Neurotrauma 2013;9:139-141)
Objective The purpose of this study is to determine whether the changes of contralateral sensorimotor cortical activation on functional magnetic resonance imaging (fMRI) can predict the neurological outcome among spinal cord injury (SCI) patients when the great toes are stimulated without notice. Methods This study enrolled a total of 49 patients with SCI and investigated each patient's preoperative fMRI, postoperative fMRI, American Spinal Injury Association (ASIA) score, and neuropathic pain occurrence. Patients were classified into 3 groups according to the change of blood oxygenation level dependent (BOLD) response on perioperative fMRI during proprioceptive stimulation with repetitive passive toe movements : 1) patients with a response of contralateral sensorimotor cortical activation in fMRI were categorized; 2) patients with a response in other regions; and 3) patients with no response. Correlation between the result of fMRI and each parameter was analyzed. Results In fMRI data, ASIA score was likely to show greater improvement in patients in group A compared to those belonging to group B or C (p<0.001). No statistical significance was observed between the result of fMRI and neuropathic pain (p=0.709). However, increase in neuropathic pain in response to the signal change of the ipsilateral frontal lobe on fMRI was statistically significant (p=0.030). Conclusion When there was change of BOLD response at the contralateral sensorimotor cortex on perioperative fMRI after surgery, relief of neurological symptoms was highly likely for traumatic SCI patients. In addition, development of neuropathic pain was likely to occur when there was change of BOLD response at ipsilateral frontal lobe. Key Words: Functional MRI · Spinal cord injury · Proprioceptive · Neuropathic pain.
Kinetic MRIs of cervical spines were obtained and analyzed according to the amount of motion and the degenerative grade of the intervertebral disc.To define the relationship between the grade of disc degeneration and the motion unit of the cervical spine and elucidate changes in the role of each cervical spine unit during flexion-extension motion caused by degeneration.Degenerative changes in the cervical disc occur with age. The correlation between the degree of cervical disc degeneration and extent of cervical spine mobility has not yet been determined. The effect of degeneration on the overall motion of the functional spinal unit also remains undefined.We studied 164 patients with symptomatic neck pain. The cervical intervertebral discs were graded by spine surgeons according to the degenerative grading system (Grades I to V). All radiologic data from kinetic MRIs were recorded on a computer for subsequent measurements. All measurements and calculations for translational motion and angular variation of each segment were automatically performed by a computer analyzer.The translational motion in discs with Grade II degeneration (mild degeneration) increased to Grade III degeneration (higher degeneration). However, the translational motion and angular variation significantly decreased for the Grade V (severe degeneration). For patients with relatively low grades of degeneration, Grades I and II discs, the C4-C5 and C5-C6 segmental units contributed the majority of total angular mobility of the spine. However, for the severely degenerated segments, Grade V discs, the contributions of the C4-C5 and C5-C6 U significantly decreased.The changes that occur with disc degeneration progress from the normal state to an unstable phase with higher mobility and subsequently to an ankylosed stage. This study evaluated the contribution of different levels to the changes in overall motion that occur with degeneration.
In Brief Study Design. Retrospective review of a consecutive, single surgeon case series. Objective. To compare minimum 2-year postoperative outcomes between 4.0-mm stainless steel and 4.75-mm titanium alloy single-rod anterior thoracoscopic instrumentation for the treatment of thoracic idiopathic scoliosis. Summary of Background Data. Advances in anterior thoracoscopic spinal instrumentation for scoliosis have attempted to mitigate the postoperative complications of rod failure, pseudarthrosis, and deformity progression. Biomechanical data suggest that the 4.75-mm titanium construct has a lower risk of fatigue failure compared to the 4.0-mm stainless steel construct. Methods. Sixty-four consecutive anterior thoracoscopic spinal instrumentation cases in patients with thoracic scoliosis performed by a single surgeon and with minimum 2-year follow-up were retrospectively reviewed. The first 34 cases used a 4.0-mm stainless steel (SS) construct, whereas the subsequent 30 cases used a 4.75-mm titanium (Ti) alloy instrumentation system. The first 10 SS cases and the first 5 Ti cases were excluded from the statistical comparison to account for a potential learning curve effect. A multivariate analysis of variance (P < 0.05) was used to compare radiographic, perioperative, and postoperative complication data between patients surgically treated with the 2 different instrumentation systems. Results. Patients in the SS group (n = 24) underwent surgery from 2000 to 2001, whereas patients in the Ti group (n = 25) underwent surgery from 2002 to 2004. The mean age at surgery, gender ratio, length of hospitalization, estimated blood loss, and operative time were not statistically different between the 2 patient groups (P > 0.13). The average follow-up in the SS group was, however, significantly longer than in the Ti group (4.0 ± 1.4 years vs. 2.3 ± 1.0 years; P = 0.001). Preop main thoracic Cobb angles were similar between the 2 groups (P = 0.62); however, the 2-year main thoracic Cobb was significantly smaller (P = 0.03) and the 2-year percent correction was significantly greater in the Ti group (P = 0.03). Five patients (21%) in the SS group had a pseudarthrosis, 3 (13%) experienced rod failure, and 2 (8%) required a revision posterior spinal fusion. In the Ti group, 2 patients (8%) had a pseudarthrosis, and no patient experienced rod failure or required a revision procedure. Conclusion. Although the average follow-up in the Ti group was significantly shorter than in the SS group, the 4.75-mm titanium alloy construct resulted in improved maintenance of deformity correction at 2-years postop and a lower incidence of instrumentation-related complications (pseudarthrosis, rod breakage, and surgical revisions) compared to the 4.0-mm stainless steel construct. Improved outcomes with the titanium alloy construct are likely because of the mechanical properties of the implant, refined patient selection criteria, and greater surgical experience gained with time. A retrospective comparison of 2 anterior thoracoscopic instrumentation systems in patients with thoracic scoliosis and minimum 2-year follow-up found that the 4.75-mm titanium alloy construct resulted in improved maintenance of scoliosis correction and a lower incidence of complications compared to the 4.0-mm stainless steel construct. Improved outcomes with the titanium system are likely due to improved mechanical properties of the implant, refined patient selection criteria, and greater surgical experience with time.
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