✓ The authors describe the case of a gas-filled intradural cyst of the lumbar spine that caused radicular pain. The cyst was similar to an intervertebral vacuum disc phenomenon and the cystic gas collection resembled the features of gas-containing pseudocyst, herniated intradiscal gas, or free gas, all of which have been found in the epidural space.
Satoshi Kawaguchi, Toshihiko Yamashita, Kazunori Ida, Tatsuru Ikeda and Osamu Ohwada
Satoshi Kawaguchi, Keiko Horigome, Hideki Yajima, Takashi Oda, Yuichiro Kii, Kazunori Ida, Mitsunori Yoshimoto, Kousuke Iba, Tsuneo Takebayashi and Toshihiko Yamashita
The present study was designed to determine clinical and radiographic characteristics of unhealed osteoporotic vertebral fractures (OVFs) and the role of fracture mobility and an intravertebral cleft in the regulation of pain symptoms in patients with an OVF.
Patients who had persistent low-back pain for 3 months or longer and a collapsed thoracic or lumbar vertebra that had an intervertebral cleft and abnormal mobility were referred to as having unhealed OVFs. Twenty-four patients with an unhealed OVF and 30 patients with an acute OVF were compared with regard to several clinical and radiographic features including the presence of an intravertebral fluid sign. Subsequently, the extent of dynamic mobility of the fractured vertebra was analyzed for correlation with the patients' age, duration of symptoms, back pain visual analog scale (VAS) score, and performance status. Finally, in cases of unhealed OVFs, the subgroup of patients with positive fluid signs was compared with the subgroup of patients with negative fluid signs.
Patients with an unhealed OVF were more likely to have a crush-type fracture, shorter vertebral height of the fractured vertebra, and a fracture with a positive fluid sign than those with an acute OVF. The extent of dynamic mobility of the vertebra correlated significantly with the VAS score in patients with an unhealed OVF. In addition, a significant correlation with the extent of dynamic vertebral mobility with performance status was seen in patients with an unhealed OVF and those with an acute OVF. Of the 24 patients with an unhealed OVF, 14 had a positive fluid sign in the affected vertebra. Patients with a positive fluid sign exhibited a statistically significantly greater extent of dynamic vertebral mobility, a higher VAS score, a higher performance status grade, and a greater likelihood of having a crush-type fracture than those with a negative fluid sign. All but 1 patient with an unhealed OVF and a positive fluid sign had an Eastern Cooperative Oncology Group Performance Status Grade 3 or 4 (bedridden most or all of the time). In sharp contrast, all 10 patients with an unhealed OVF and a negative fluid sign were Grade 1 or 2.
Unhealed OVFs form a group of fractures that are distinct from acute OVFs regarding radiographic morphometry and contents of the intravertebral cleft. Dynamic vertebral mobility serves as a primal pain determinant in patients with an unhealed OVF and potentially in those with an acute OVF. Fluid accumulation in the intravertebral cleft of unhealed OVFs likely reflects long-term bedridden positioning of the patients in daily activity.
Tomonori Morita, Tsuneo Takebayashi, Hiroyuki Takashima, Mitsunori Yoshimoto, Kazunori Ida, Katsumasa Tanimoto, Hirofumi Ohnishi, Hiroyoshi Fujiwara, Masateru Nagae and Toshihiko Yamashita
Safe and effective insertion of occipital bone screws requires morphological analysis of the occipital bone, which is poorly documented in the literature. The authors of this study present morphological data for determining the area of screw placement for optimal internal fixation.
The subjects of this institutional review board-approved retrospective study were 105 individuals without head and neck disease who underwent CT imaging at the authors’ hospital. There were 55 males and 50 females, with a mean age of 57.1 years (range 20–91 years). Measurements using CT were taken according to a matrix of 55 points following a grid with 1-cm spacing based on the external occipital protuberance (EOP).
The maximum thickness of the occipital bone was at the level of the EOP at 16.4 mm. Areas with thicknesses > 8 mm were more frequent at the EOP and up to 2 cm in all directions, as well as up to 1 cm in all directions at a height of 1 cm inferiorly, and up to 3 cm from the EOP inferiorly. The male group tended to have a thicker occipital bone than the female group, and the differences were significant around the EOP. The ratio of the trabecular bone to the occipital bone thickness was > 30% in the central region. At positions more than 2 cm laterally, the ratio was < 15%, and the ratio gradually decreased further laterally.
Screws that are 8 mm long can be placed in the area extending 2 cm laterally from the EOP at the level of the superior nuchal line and approximately 3 cm inferior to the center. These results suggest that it may be possible to effectively insert a screw over a wider area than the conventional reference range.