4d CT to assess spinal instability in developmental anomaly of posterior arch of atlas

Four-dimensional (4D) CT uniquely allows cinematic visualization of the entirety of joint motion throughout dynamic movement, which can reveal subtle or transient internal joint derangements not evident on static images. As developmental anomalies of the posterior arch can predispose to cervical spinal instability and neurological morbidity, precise assessment of spinal movement during motion is of clinical relevance. We describe the use of 4D-CT in a subject with partial absence of posterior C1 arch. This, to our knowledge, is the first such report. In at-risk individuals, 4D-CT has the potential to enable an assessment of spinal instability with a higher level of clarity and, in this sense, its more routine implementation may be a future direction.

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Critical Analysis of Extensive Cervical Laminectomy

Neurosurgery ◽

10.1227/00006123-198902000-00010 ◽

1989 ◽

Vol 24 (2) ◽

pp. 215-222 ◽

Cited By ~ 66

Author(s):

Yoshihiro Ishida ◽

Kazuhiro Suzuki ◽

Kazuo Ohmori ◽

Yoji Kikata ◽

Yoshiaki Hattori

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Surgical Technique ◽

Spinal Deformity ◽

Critical Analysis ◽

Cord Compression ◽

Spinal Instability ◽

Paraspinal Muscles ◽

Computed Tomographic ◽

Spinal Movement

Abstract Conventional extensive laminectomy has been widely performed to reduce spinal cord compression, and is greatly facilitated by the use of an air drill. Laminectomy is recognized, however, as the occasional cause of problems after surgery, such as spinal instability or deformity, acceleration of spondylotic change, constriction of the dura mater caused by extradural scar formation, and lack of posterior bony protection for the spinal cord. In an effort to eliminate these negative aspects of conventional laminectomy, a surgical technique called suspension laminotomy has been used. Fiftyfive patients treated with conventional extensive laminectomy and 55 others treated with suspension laminotomy were followed up clinically and compared. Flexibility and alignment of the cervical spine were assessed by plane radiographs, and dural configuration by computed tomographic scans. Neurologic improvement was also evaluated. Decrease of spinal movement after laminectomy was observed, notably during extension, probably as a result of functional insufficiency of paraspinal muscles. The incidence of postoperative spinal deformity was lower and the relief of dural constriction better in the patients treated with suspension laminotomy than in those treated with conventional laminectomy. Neurological recovery was significantly better in fully decompressed cases than in insufficiently decompressed cases.

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4D-CT of the Lung: Comparison of Retrospectively Gated CT, Prospectively Gated High-Pitch CT and Static Images in an Ex Vivo System

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2010.07.1558 ◽

2010 ◽

Vol 78 (3) ◽

pp. S670

Author(s):

J. Dinkel ◽

C. Hintze ◽

C. Thieke ◽

A. Sulzmann ◽

T. Allmendinger ◽

...

Keyword(s):

Ex Vivo ◽

High Pitch ◽

4D Ct ◽

Static Images

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Transpedicular approach for thoracic disc herniations

Neurosurgical FOCUS ◽

10.3171/foc.2000.9.4.4 ◽

2000 ◽

Vol 9 (4) ◽

pp. 1-4 ◽

Cited By ~ 37

Author(s):

Mark H. Bilsky

Keyword(s):

High Rate ◽

Bladder Function ◽

Spinal Instability ◽

The Past ◽

Transpedicular Approach ◽

Normal Bladder ◽

Neurological Morbidity ◽

Disc Herniations ◽

Thoracic Disc

Object Patients with symptomatic herniated thoracic discs may require operation for intractable radiculopathy or functionally disabling myelopathy. In the past, laminectomy was the procedure of choice for the treatment of thoracic herniations, but it was found that the approach was associated with an unacceptably high rate of neurological morbidity. Several strategies have been developed to excise the disc without manipulating the spinal cord. The focus of this paper is the transpedicular approach. Methods The author retrospectively reviewed the cases of 20 consecutive patients presenting with herniated thoracic discs in whom surgery was performed via a transpedicular approach. Fourteen patients presented with acute myelopathy and six with radiculopathy. Of those with myelopathy six of six regained ambulation and six of seven regained normal bladder function. No patient with myelopathy experienced neurological worsening. In four patients presenting with radiculopathy postoperative pain resolved, and in two it remained unchanged. Three minor complications (15%) occurred. No patient suffered postoperative spinal instability–related pain or delayed kyphosis. Conclusions As experience accumulates in the use of multiple approaches for the treatment of thoracic disc herniations, the role of each is becoming more clearly defined. The transpedicular approach is most applicable to lateral or centrolateral calcified or soft discs. The more anterior (transthoracic or thoracoscopic) and lateral (costotransversectomy or lateral extracavitary) approaches may be more useful for excision of central calcified discs.

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Removal of Intradural Extramedullary Schwannoma at Lumbar Level by Doing Laminoplasty in Paediatric Patient- A Case Report and Review of Literature

10.13107/bbj.2021.v02i01.020 ◽

2021 ◽

Vol 2 (1) ◽

Keyword(s):

Thoracolumbar Spine ◽

Spinal Instability ◽

Posterior Arch ◽

Case Presentation ◽

Lumbar Level ◽

Primary Surgery ◽

Intradural Extramedullary ◽

Intradural Extramedullary Tumour ◽

Prolonged Hospital

Intradural Extramedullary tumour of thoracolumbar spine has been mainly treated with laminectomy till date. Other approach has been of treating this pathology by doing laminoplasty. Objective of this case presentation is that laminoplasty is better option for IDEM in selected cases. Laminectomy has been associated with many complications which can be avoided by doing laminoplasty such as postoperative spinal instability, epidural fibro¬sis, kyphotic deformity, excessive blood loss, hematoma invasion, progressive myelopathy, persistent back pain and prolonged hospital stay. So laminoplasty has clearly advantage compared to laminectomy in preserving posterior arch of the spine. Revision surgery is also easier when primary surgery has been done by laminoplasty. In our case of 13-year-old boy having Intradural Extramedullary Schwannoma at L3 level, he was treated with flipping laminoplasty and tumour excision. At final follow up he was having complete clinical recovery and fully healed laminoplasty assessed with CT scan without any recurrence of tumour or any spinal deformity. It proves our purpose of doing laminoplasty with better outcome compared to laminectomy. Keywords: Laminoplasty; Laminectomy; Intradural Extramedullary; Spinal Cord Tumour.

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