Intradural Extramedullary Capillary Hemangioma In the Upper Thoracic Spine with Simultaneous Extensive Arachnoiditis

Capillary hemangiomas are benign tumors found in the skin and soft tissues in younger people. They occur in the central nervous system only rarely, and intradural occurrence is extremely rare. We report here a 60-year-old man presenting with thoracic girdle pain and progressive gait disturbance. Magnetic resonance images of the thoracic spine showed a12×8×20 mm, well-defined intradural mass at the T2 level, compressing the spinal cord laterally. Relative to the spinal cord, the mass was hypo- to isointense on T1-weighted images and relatively hyperintense on T2-weighted images, with strong enhancement on contrast-enhanced T1-weighted images. The patient underwent T1-2 hemilaminectomy with resection of the intradural extramedullary tumor, which showed characteristics of a capillary hemangioma on histologic examination. The patient’s symptoms improved following the surgery and no clinical or radiological evidence of recurrence was noted at the 2-year follow-up. We present this case with a review of the literature, highlighting features for differential diagnosis.

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Anatomical location dictating major surgical complications for intradural extramedullary spinal tumors: a 10-year single-institutional experience

Journal of Neurosurgery Spine ◽

10.3171/2013.9.spine12913 ◽

2013 ◽

Vol 19 (6) ◽

pp. 701-707 ◽

Cited By ~ 19

Author(s):

Ankit I. Mehta ◽

Owoicho Adogwa ◽

Isaac O. Karikari ◽

Paul Thompson ◽

Terence Verla ◽

...

Keyword(s):

Thoracic Spine ◽

Surgical Complications ◽

Neurological Deficits ◽

Spinal Tumors ◽

Anatomical Location ◽

Upper Thoracic Spine ◽

Csf Leakage ◽

Institutional Experience ◽

Intradural Extramedullary ◽

Upper Thoracic

Object Intradural extramedullary (IDEM) neoplasms are uncommon lesions that can pose a challenge for resection. Numerous factors affect the resectability and ultimately the outcome of these lesions. The authors report their 10-year institutional experience with the resection of IDEM neoplasms, focusing on the effect of location on surgical outcomes. Methods The authors performed a retrospective review of 96 consecutive patients who presented with a cervical and/or thoracic IDEM tumor that was resected between February 2000 and July 2009. All patients underwent MRI, and the axial location of the tumor was categorized as anterior, posterior, or lateral. Postoperative complications were assessed, as was neurological status at the patient's last follow-up clinic visit. Major complications assessed included CSF leakage requiring lumbar drainage, reexploration for epidural hematoma, and major postoperative neurological deficits. Results The mean ± SD age at presentation was 51.16 ± 17.87 years. Major surgical approach–related complications occurred in 15% of patients. Major non–approach related surgical complications occurred in 7.1% of patients, while minor complications occurred in 14.2% of patients. Postoperative neurological deficits occurred most commonly in the thoracic spine between T-1 and T-8. Based on axial spinal cord location, the surgery-related complications rates for all anterior tumors (n = 12) was 41.6%, whereas that for all lateral tumors (n = 69) was 4.4% and that for all posteriorly located tumors (n = 17) was 0%. Conclusions Spinal IDEM tumors that are anteriorly located in the upper thoracic spine were found to have the highest rate of surgery-related complications and postoperative neurological deficits. This finding may be associated with the unforgiving anatomy of the upper thoracic spine in which there is a higher cord-to-canal ratio and a tenuous vascular supply.

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Chance Fracture of the Upper Thoracic Spine

American Journal of Roentgenology ◽

10.2214/ajr.185.2.01850555 ◽

2005 ◽

Vol 185 (2) ◽

pp. 555-555 ◽

Cited By ~ 1

Author(s):

Richard H. Daffner

Keyword(s):

Thoracic Spine ◽

Upper Thoracic Spine ◽

Chance Fracture ◽

Upper Thoracic

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Novel free-hand T1 pedicle screw method: Review of 44 consecutive cases

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.139974 ◽

2014 ◽

Vol 05 (04) ◽

pp. 349-354 ◽

Cited By ~ 2

Author(s):

Mark A. Rivkin ◽

Jessica F. Okun ◽

Steven S. Yocom

Keyword(s):

Pedicle Screw ◽

Thoracic Spine ◽

Pedicle Screws ◽

High Rate ◽

Imaging Modalities ◽

Neurological Deficits ◽

Upper Thoracic Spine ◽

Starting Point ◽

Grade 3 ◽

Upper Thoracic

ABSTRACT Summary of Background Data: Multilevel posterior cervical instrumented fusions are becoming more prevalent in current practice. Biomechanical characteristics of the cervicothoracic junction may necessitate extending the construct to upper thoracic segments. However, fixation in upper thoracic spine can be technically demanding owing to transitional anatomy while suboptimal placement facilitates vascular and neurologic complications. Thoracic instrumentation methods include free-hand, fluoroscopic guidance, and CT-based image guidance. However, fluoroscopy of upper thoracic spine is challenging secondary to vertebral geometry and patient positioning, while image-guided systems present substantial financial commitment and are not readily available at most centers. Additionally, imaging modalities increase radiation exposure to the patient and surgeon while potentially lengthening surgical time. Materials and Methods: Retrospective review of 44 consecutive patients undergoing a cervicothoracic fusion by a single surgeon using the novel free-hand T1 pedicle screw technique between June 2009 and November 2012. A starting point medial and cephalad to classic entry as well as new trajectory were utilized. No imaging modalities were employed during screw insertion. Postoperative CT scans were obtained on day 1. Screw accuracy was independently evaluated according to the Heary classification. Results: In total, 87 pedicle screws placed were at T1. Grade 1 placement occurred in 72 (82.8%) screws, Grade 2 in 4 (4.6%) screws and Grade 3 in 9 (10.3%) screws. All Grade 2 and 3 breaches were <2 mm except one Grade 3 screw breaching 2-4 mm laterally. Only two screws (2.3%) were noted to be Grade 4, both breaching medially by less than 2 mm. No new neurological deficits or returns to operating room took place postoperatively. Conclusions: This modification of the traditional starting point and trajectory at T1 is safe and effective. It attenuates additional bone removal or imaging modalities while maintaining a high rate of successful screw placement compared to historical controls.

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P39. Radiographic Outcome of Pedicle Screw Fixation for Upper Thoracic Spine (T1-T5) Fractures

The Spine Journal ◽

10.1016/j.spinee.2006.06.298 ◽

2006 ◽

Vol 6 (5) ◽

pp. 102S-103S

Author(s):

Ralph Mobbs ◽

Charles Fisher ◽

Sandeep Singh

Keyword(s):

Pedicle Screw ◽

Thoracic Spine ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Radiographic Outcome ◽

Upper Thoracic Spine ◽

Upper Thoracic

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FLEXION-DISTRACTION INJURY OF THE UPPER THORACIC SPINE ASSOCIATED WITH TRACHEOESOPHAGEAL PERFORATION

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-200206000-00021 ◽

2002 ◽

Vol 84 (6) ◽

pp. 1028-1031 ◽

Cited By ~ 6

Author(s):

SHIH-HAO CHEN ◽

TSUNG-JEN HUANG ◽

YEUNG-JEN CHEN ◽

HUI-PING LIU ◽

ROBERT WEN-WEI HSU

Keyword(s):

Thoracic Spine ◽

Upper Thoracic Spine ◽

Upper Thoracic

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Widespread Pressure Pain Sensitivity and Referred Pain from Trigger Points in Patients with Upper Thoracic Spine Pain

Pain Medicine ◽

10.1093/pm/pnz020 ◽

2019 ◽

Vol 20 (7) ◽

pp. 1379-1386 ◽

Cited By ~ 1

Author(s):

Ricardo Ortega-Santiago ◽

Maite Maestre-Lerga ◽

César Fernández-de-las-Peñas ◽

Joshua A Cleland ◽

Gustavo Plaza-Manzano

Keyword(s):

Thoracic Spine ◽

Pain Sensitivity ◽

Trigger Points ◽

Pressure Pain ◽

Upper Thoracic Spine ◽

Upper Trapezius ◽

Spine Pain ◽

Pressure Pain Thresholds ◽

Upper Thoracic ◽

Thoracic Spine Pain

Abstract Objectives The presence of trigger points (MTrPs) and pressure pain sensitivity has been well documented in subjects with neck and back pain; however, it has yet to be examined in people with upper thoracic spine pain. The purpose of this study was to investigate the presence of MTrPs and mechanical pain sensitivity in individuals with upper thoracic spine pain. Methods Seventeen subjects with upper thoracic spine pain and 17 pain-free controls without spine pain participated. MTrPs were examined bilaterally in the upper trapezius, rhomboid, iliocostalis thoracic, levator scapulae, infraspinatus, and anterior and middle scalene muscles. Pressure pain thresholds (PPTs) were assessed over T2, the C5-C6 zygapophyseal joint, the second metacarpal, and the tibialis anterior. Results The numbers of MTrPs between both groups were significantly different (P < 0.001) between patients and controls. The number of MTrPs for each patient with upper thoracic spine pain was 12.4 ± 2.8 (5.7 ± 4.0 active TrPs, 6.7 ± 3.4 latent TrPs). The distribution of MTrPs was significantly different between groups, and active MTrPs within the rhomboid (75%), anterior scalene (65%), and middle scalene (47%) were the most prevalent in patients with upper thoracic spine pain. A higher number of active MTrPs was associated with greater pain intensity and longer duration of pain history. Conclusions This study identified active MTrPs and widespread pain hypersensitivity in subjects with upper thoracic spine pain compared with asymptomatic people. Identifying proper treatment strategies might be able to reduce pain and improve function in individuals with upper thoracic spine pain. However, future studies are needed to examine this.

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