T he upper and middle regions of the thoracic spine are well stabilized by the rib cage and facet joints, especially in the anteroposterior direction. Although in cases of trauma the thoracolumbar junction is particularly vulnerable because this is the transitional region where the stable thoracic spine becomes the mobile lumbar region, there have been only a few reported cases of myelopathy due to thoracic spondylosis. 8 , 9 Thoracic spondylolisthesis is considered to be a cause of thoracic myelopathy; 7 however, there have been very few reports of
Yoichi Shimada, Yuji Kasukawa, Naohisa Miyakoshi, Michio Hongo, Shigeru Ando, and Eiji Itoi
Case report and review of the literature
Sarin Kuruvath, Dominic G. O’Donovan, A. Robert Aspoas, and Karoly M. David
later after intensive physiotherapy. On follow-up examination, the patient indicated he was able to walk 3 miles every day and had resumed playing golf. The only neurological sequelae were bilateral hypesthesia of the T-3 dermatome and a left-sided present Babinski sign. The decreased sensation on the right side was probably due to injury during manipulation of the right T-3 nerve root. Repeated MR imaging 1 and 2 years after surgery demonstrated no recurrence of the tumor ( Fig. 4 ). F ig . 3. Postoperative lateral plain radiograph of the thoracic spine
Report of three cases
Luis Renato Mello, Celso Itiberê Bernardes, Yanara Feltrin, and Marco Antonio Rodacki
. Most cases are asymptomatic. 3, 9, 14, 29 When clinical symptoms are present, arachnoid calcification formation is related to previous intraspinal anesthesia; intrathecal injection of antibiotic or radiological contrasts for myelography; infections such as meningitis or tuberculosis; subarachnoid hemorrhage, spine surgery; and spinal cord trauma. 1, 4, 7, 9, 11, 12, 15, 17, 24–26, 32 In rare cases, there is no apparent cause of the calcification. 11, 28, 34 When the lesion is located in the thoracic spine, the disease affects mainly women, showing slow
Ho Jun Seol, Chun Kee Chung, and Hyun Jib Kim
D ecompression of anterior lesions in the upper thoracic spine (T1–3) is difficult, because the sternum, thoracic kyphosis, narrowness of the spinal canal, and presence of major vessels act as physical constraints, and because the anatomy is unfamiliar to most neurosurgeons. Approaches to anterior upper thoracic lesions may be classified as follows: 1) anterior routes, which include the ventral cervicothoracic approach, with or without excision of the sternum, and the transthoracic (transpleural) approach with mobilization of the scapula; and 2) posterior
Ryan M. Kretzer, Daniel M. Sciubba, Carlos A. Bagley, Jean-Paul Wolinsky, Ziya L. Gokaslan, and Ira M. Garonzik
PSs has been reported to be as high as 38.9%, 23 and the authors of cadaveric studies have reported thoracic pedicle violation of 15.9 to 54.6%, depending on the technique and insertion site used for transpedicular screw placement. 4 , 9 , 23 , 26 Recently, bilateral, crossing translaminar screws have been used as a potentially safer alternative to traditional fusion constructs involving fixation of C-2. 24 , 25 To our knowledge, however, there are no reports of translaminar screw fixation in the thoracic spine. 24 The use of translaminar screws in the upper
Krista Keachie, Kiarash Shahlaie, and J. Paul Muizelaar
and current FDA approval exclude patients with disc disease in the cervicothoracic and thoracic regions. The upper thoracic spine rarely develops disc herniation, 4 can be difficult to approach anteriorly in some patients, and does not normally have significant mobility that would justify a motion-preserving treatment strategy. In cases in which nearby cervical arthrodesis to C-7 disrupts normal biomechanics at the cervicothoracic and upper thoracic spine, 1 , 33 , 53 , 56 however, there may be increased mobility of the upper thoracic spine that predisposes to
Michael J. Strong, Julianne Santarosa, Timothy P. Sullivan, Noojan Kazemi, Jacob R. Joseph, Osama N. Kashlan, Mark E. Oppenlander, Nicholas J. Szerlip, Paul Park, and Clay M. Elswick
A ccurate localization in the thoracic spine remains a significant challenge in surgery. Sixty-eight percent of spine surgeons surveyed have admitted to wrong-level localization, although some of the wrong-level exposures were rectified intraoperatively. 1 Furthermore, approximately 1 of every 2 spine surgeons has performed a wrong-level surgery. 2 Wrong-level surgery falls under the broader term “wrong-site surgery” and is considered a sentinel event that exposes the patient to additional risks and unnecessary procedures, harms the doctor
Mehmet Arazi, Onder Guney, Mustafa Ozdemir, Omer Uluoglu, and Nuket Uzum
endocrine signs is termed the McCune—Albright syndrome. 1, 2, 5 The origin of the disease is not known, it affects males and females equally, and malignant transformation is very rare. 2–4, 11 Although any bone may be involved, the proximal femur followed by the tibia, axial skeleton, and rib are the most common sites. Involvement of the spinal column is very rare. We report a case of monostotic fibrous dysplasia involving the thoracic spine. Case Report Presentation This 53-year-old woman had suffered thoracic spinal region pain for 1 month. There was no
Vaishali S. Suri, Medha Tatke, Sushil Kumar, and Vikas Gupta
✓ The authors report the case of a patient with amyloidoma of the thoracic spine. A 34-year-old man presented with a 2-month history of upper-back pain, bilateral lower-extremity weakness, and numbness below the nipple.
A computerized tomography study revealed an extradural mass with destruction of the T-2 lamina and pedicle. Intraoperatively, there was a pinkish, partially suctionable mass infiltrating the muscle plane and causing destruction of the T-2 lamina. Histological examination showed typical amyloid masses that demonstrated apple-green double refraction on examination of the Congo red—stained section under polarized light.
Amyloidomas are rare benign lesions that, unlike other forms of amyloidosis, have an excellent prognosis. A cure is possible with complete resection of the mass.
Cheerag D. Upadhyaya, Jau-Ching Wu, Cynthia T. Chin, Gopalakrishnan Balamurali, and Praveen V. Mummaneni
T he intraoperative localization of thoracic vertebral levels remains a challenging problem. A recent questionnaire study by Mody et al. 12 found a high prevalence of wrong-level surgeries among spine surgeons with nearly 50% of surgeons performing a wrong-level surgery during their career. Correct-level spine surgery is an important patient safety and quality-of-care issue. 5 Several factors make the thoracic spine especially difficult for proper target level localization including osteoporosis, obesity, scapular/humoral shadow, anatomical variations in