Use of prone position magnetic resonance imaging for detecting the terminal filum in patients with occult tethered cord syndrome

Object The pathophysiology of occult tethered cord syndrome (OTCS) with no anatomical evidence of a caudally shifted conus and a normal terminal filum is hard to understand. Therefore, the diagnosis of OTCS is often difficult. The authors hypothesized that the posterior displacement of the terminal filum may become prominent in patients with OCTS who are in a prone position if filum inelasticity exists, and they investigated prone-position MRI findings. Methods Fourteen patients with OTCS and 12 control individuals were examined using T2-weighted axial MRI with the patients in a prone position on a flat table. On each axial view, the distance between the posterior and anterior ends of the subarachnoid space (A), the distance between the posterior end of the subarachnoid space and the terminal filum (B), the distance between the posterior end of the subarachnoid space and the dorsal-most nerve among the cauda equina (C), and the distance between the posterior end of the subarachnoid space and the ventral-most nerve (D) were measured. The location ratios of the terminal filum, the dorsal-most nerve, and the ventral-most nerve were calculated by the ratio of A to B (defined as TF = B/A), A to C (defined as DN = C/A), and A to D (defined as VN = D/A), respectively. Patients underwent sectioning of the terminal filum with the aid of a surgical microscope. The low-back pain Japanese Orthopaedic Association score was obtained before surgery and at the final follow-up visit. Results On prone-position axial MRI, the terminal filum was separated from the cauda equina and was shifted caudally to posterior in the subarachnoid space in all patients with OTCS. The locations of the caudal cauda equina shifted to ventral in the subarachnoid space. The TF values in the OTCS group were significantly lower than those in the control group at the L3–4 (p = 0.023), L-4 (p = 0.030), L4–5 (p = 0.002), and L-5 (p < 0.001) levels. In contrast, the DN values in the OTCS group were significantly higher than those of the control group at the L-2 (p = 0.003), L2–3 (p = 0.002), L-3 (p < 0.001), L3–4 (p < 0.001), L-4 (p = 0.007), L4–5 (p = 0.003), and S-1 (p = 0.014) levels, and the VN values in the OTCS group were also significantly higher than those of the control group at the L2–3 (p = 0.022), L-3 (p = 0.027), L3–4 (p = 0.002), L-4 (p = 0.011), L4–5 (p = 0.019), and L5–S1 (p = 0.040) levels. Sections were collected during surgery for histological evaluation, and a decreased elasticity within the terminal filum was suggested. Improvements in the Japanese Orthopaedic Association score were observed at the final follow-up in all patients. Conclusions The authors' new method of using the prone position for MRI shows that the terminal filum is located significantly posterior and the cauda equina is located anterior in patients with OTCS, suggesting a difference in elasticity between the terminal filum and cauda equina.

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Conservative management of ossification of the posterior longitudinal ligament

Neurosurgical FOCUS ◽

10.3171/2011.1.focus10273 ◽

2011 ◽

Vol 30 (3) ◽

pp. E2 ◽

Cited By ~ 25

Author(s):

Martin H. Pham ◽

Frank J. Attenello ◽

Joshua Lucas ◽

Shuhan He ◽

Christopher J. Stapleton ◽

...

Keyword(s):

Conservative Management ◽

Japanese Orthopaedic Association ◽

Posterior Longitudinal Ligament ◽

Japanese Orthopaedic Association Score ◽

Clinical Progression ◽

Association Score ◽

Rate Of Progression ◽

The Mean ◽

High Chance

Object Ossification of the posterior longitudinal ligament (OPLL) can result in significant myelopathy. Surgical treatment for OPLL has been extensively documented in the literature, but less data exist on conservative management of this condition. Methods The authors conducted a systematic review to identify all reported cases of OPLL that were conservatively managed without surgery. Results The review yielded 11 published studies reporting on a total of 480 patients (range per study 1–359 patients) over a mean follow-up period of 14.6 years (range 0.4–26 years). Of these 480 patients, 348 (72.5%) were without myelopathy on initial presentation, whereas 76 patients (15.8%) had signs of myelopathy; in 56 cases (15.8%), the presence of myelopathy was not specified. The mean aggregate Japanese Orthopaedic Association score on presentation for 111 patients was 15.3. Data available for 330 patients who initially presented without myelopathy showed progression to myelopathy in 55 (16.7%), whereas the other 275 (83.3%) remained progression free. In the 76 patients presenting with myelopathy, 37 (48.7%) showed clinical progression, whereas 39 (51.5%) remained clinically unchanged or improved. Conclusions Patients who present without myelopathy have a high chance of remaining progression free. Those who already have signs of myelopathy at presentation may benefit from surgery due to a higher rate of progression over continued follow-up.

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Feasibility and Efficacy of Percutaneous Lateral Lumbar Discectomy in the Treatment of Patients with Lumbar Disc Herniation: A Preliminary Experience

BioMed Research International ◽

10.1155/2015/378612 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6

Author(s):

Wenjin Jiang ◽

Bolin Sun ◽

Qirui Sheng ◽

Xuepeng Song ◽

Yanbo Zheng ◽

...

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Japanese Orthopaedic Association ◽

Japanese Orthopaedic Association Score ◽

Lumbar Discectomy ◽

Analog Scale ◽

Association Score ◽

Lumber Disc Herniation

Objective. This study was aimed at evaluating the effectiveness and safety of percutaneous lateral lumbar discectomy (PLLD) in treating patients with lumber disc herniation.Methods. A total of 183 patients with lumbar disc herniation were recruited to receive PLLD surgery from April 2006 to October 2011. All the adverse effects were recorded during the follow-up at 1, 3, 6, and 12 months after PLLD. The clinical outcomes were determined by visual analog scale and Japanese Orthopaedic Association score.Results. The surgery was performed successfully in all patients (102 males and 81 females aged from 21 to 66 years) with a mean 16.6-month follow-up (range from 26 to 65 months). No postoperative complications, including intestinal and vascular complications, nerve injuries, and postoperative infections, were associated with PLLD. At one month after surgery, visual analog scale (3.12±1.44versus6.76±2.31,P<0.05) was significantly lower than the baseline and was sustained until 24 months after surgery (3.25±1.78versus6.76±2.31,P<0.05). Besides that, Japanese Orthopaedic Association score (25.25±3.21versus11.78±2.38,P<0.05) was increased when compared to the baseline.Conclusions. PLLD was a promising, mini-invasive, and effective treatment for lumber disc herniation.

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Repair of Pars Interarticularis Defect by Segmental Wire Fixation in Young Athletes with Spondylolysis

The American Journal of Sports Medicine ◽

10.1177/03635465030310030601 ◽

2003 ◽

Vol 31 (3) ◽

pp. 359-364 ◽

Cited By ~ 42

Author(s):

Satoshi Nozawa ◽

Katsuji Shimizu ◽

Kei Miyamoto ◽

Mizuo Tanaka

Keyword(s):

Japanese Orthopaedic Association ◽

Japanese Orthopaedic Association Score ◽

Radiographic Examination ◽

Young Athletes ◽

Sports Activity ◽

Association Score ◽

Lumbar Spondylolysis ◽

Pars Interarticularis ◽

Wire Fixation ◽

Sports Activities

Background Although segmental wire fixation has been successful in the treatment of nonathletes with spondylolysis, no information exists on the results of this type of surgery in athletes. Purpose To evaluate the outcome of surgical repair of pars interarticularis defect by segmental wire fixation in young athletes with lumbar spondylolysis. Methods Between 1993 and 2000, 20 athletes (6 women and 14 men; average age, 23.7) with lumbar spondylolysis were treated surgically with this technique. They were actively engaged in sports such as baseball, tennis, and golf. Nineteen athletes had one level of spondylolysis and one athlete had two levels. The level of spondylolysis was L4 in 2 athletes and L5 in 19. The average follow-up period was 3.5 years (range, 1.3 to 8.6). Surgical outcome was evaluated by radiographic examination, the Japanese Orthopaedic Association score, preoperative and postoperative sports activity levels and intensities, and the presence of complications. Results Bony fusion at the site of spondylolysis was obtained in all cases, and the Japanese Orthopaedic Association score was increased significantly after surgery (preoperatively, 21.2 ± 3.9; postoperatively, maximum 27.7 ± 1.0; recovery rate, 80.4%). All of the patients returned to their sports activities, although at varying degrees. No severe complications were noted. Conclusion We recommend this technique in cases of lumbar spondylolysis in athletes who hope to resume their sports activities.

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Factors Associated With Return to Work After Surgery for Degenerative Cervical Spondylotic Myelopathy: Cohort Analysis From the Canadian Spine Outcomes and Research Network

Global Spine Journal ◽

10.1177/2192568220958669 ◽

2020 ◽

pp. 219256822095866

Author(s):

Alexander Romagna ◽

Jefferson R. Wilson ◽

W. Bradley Jacobs ◽

Michael G. Johnson ◽

Christopher S. Bailey ◽

...

Keyword(s):

Confidence Interval ◽

Return To Work ◽

Odds Ratio ◽

Cohort Analysis ◽

Japanese Orthopaedic Association ◽

Japanese Orthopaedic Association Score ◽

Research Network ◽

Duration Of Symptoms ◽

Factors Associated

Study design: Retrosepctive analysis of prospectively collected data from the multicentre Canadian Surgical Spine Registry (CSORN). Objective: Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in North America. Few studies have evaluated return to work (RTW) rates after DCM surgery. Our goals were to determine rates and factors associated with postoperative RTW in surgically managed patients with DCM. Methods: Data was derived from the prospective, multicenter Canadian Spine Outcomes and Research Network (CSORN). From this cohort, we included all nonretired patients with at least 1-year follow-up. The RTW rate was defined as the proportion of patients with active employment at 1 year from the time of surgery. Unadjusted and adjusted analyses were used to identify patient characteristics, disease, and treatment variables associated with RTW. Results: Of 213 surgically treated DCM patients, 126 met eligibility, with 49% working and 51% not working in the immediate period before surgery; 102 had 12-month follow-up data. In both the unadjusted and the adjusted analyses working preoperatively and an anterior approach were associated with a higher postoperative RTW ( P < .05), there were no significant differences between the postoperative employment groups with respect to age, gender, preoperative mJOA (modified Japanese Orthopaedic Association) score, and duration of symptoms ( P > .05). Active preoperative employment (odds ratio = 15.4, 95% confidence interval = 4.5, 52.4) and anterior surgical procedures (odds ratio = 4.7, 95% confidence interval = 1.2, 19.6) were associated with greater odds of RTW at 1 year. Conclusions: The majority of nonretired patients undergoing surgery for DCM had returned to work 12 months after surgery; active preoperative employment and anterior surgical approach were associated with RTW in this analysis.

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Does Obesity Correlate With Worse Patient-Reported Outcomes Following Elective Anterior Cervical Discectomy and Fusion?

Neurosurgery ◽

10.1227/neu.0000000000001252 ◽

2016 ◽

Vol 79 (1) ◽

pp. 69-74 ◽

Cited By ~ 7

Author(s):

John A. Sielatycki ◽

Chotai Silky ◽

Kay Harrison ◽

David Stonko ◽

Matthew McGirt ◽

...

Keyword(s):

Scale Score ◽

Patient Reported Outcomes ◽

Minimal Clinically Important Difference ◽

Japanese Orthopaedic Association ◽

Neck Disability Index ◽

Japanese Orthopaedic Association Score ◽

Association Score ◽

Clinically Important Difference ◽

Patient Reported ◽

Neck Disability

Abstract BACKGROUND Studies have investigated the impact of obesity in thoracolumbar surgery; however, the effect of obesity on patient-reported outcomes (PROs) following anterior cervical discectomy and fusion (ACDF) is unknown. OBJECTIVE To examine the relationship between obesity and PROs following elective ACDF. METHODS Consecutive patients undergoing ACDF for degenerative conditions were evaluated. Patients were divided into groups with a body mass index ≥35. The EuroQol-5D, Short-Form 12 (SF-12), modified Japanese Orthopaedic Association score, and Neck Disability Index were used. Correlations between PROs and obesity were calculated at baseline and 1 year. RESULTS A total of 299 patients were included, with 80 obese (27%) and 219 nonobese (73%). patients At baseline, obesity was associated with worse myelopathy (modified Japanese Orthopaedic Association score: 10.7 vs 12.2, P = .01), general physical health (SF-12 physical component scale score: 28.7 vs 31.8, P = .02), and general mental health (SF-12 mental component scale score: 38.9 vs 42.3, P = .04). All PROs improved significantly following surgery in both groups. There was no difference in absolute scores and change scores for any PRO at 12 months following surgery. Furthermore, there was no difference in the percentage of patients achieving a minimal clinically important difference for the Neck Disability Index (52% vs 56%, P = .51) and no difference in patient satisfaction (85% vs 85%, P = .85) between groups. CONCLUSION Obesity was not associated with less improvement in PROs following ACDF. There was no difference in the proportion of patients satisfied with surgery and those achieving a minimal clinically important difference across all PROs. Obese patients may therefore achieve meaningful improvement following elective ACDF.

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COMPARISON OF SECTION OF FILUM TERMINALE AND NON-NEUROSURGICAL MANAGEMENT FOR URINARY INCONTINENCE IN PATIENTS WITH NORMAL CONUS POSITION AND POSSIBLE OCCULT TETHERED CORD SYNDROME

Neurosurgery ◽

10.1227/01.neu.0000290902.07943.e6 ◽

2007 ◽

Vol 61 (3) ◽

pp. 550-556 ◽

Cited By ~ 17

Author(s):

Paul Steinbok ◽

Rajeev Kariyattil ◽

Andrew E. MacNeily

Keyword(s):

Urinary Incontinence ◽

Lower Limb ◽

Medical Management ◽

Controlled Trial ◽

Tethered Cord ◽

Tethered Cord Syndrome ◽

Consecutive Series ◽

Definitive Answer ◽

Occult Tethered Cord

Abstract OBJECTIVE Patients with persistent urinary incontinence and a normal location of the conus on magnetic resonance imaging scans may have occult tethered cord syndrome (OTCS). We compare outcomes in such patients after filum section versus nonoperative treatment. METHODS We performed a retrospective analysis of a consecutive series of children with refractory urinary incontinence and normal location of the conus who were offered section of the filum for treatment of possible OTCS. RESULTS Eight children, aged 4.4 to 9.8 years, underwent filum section, with one child undergoing two such operations. Clinical urological improvement occurred in seven children at a mean follow-up period of 3.1 years, with improved urodynamic findings in four of the seven children tested postoperatively. Other non-urological back or lower limb abnormalities improved in five out of six children with such findings. None of the patients underwent additional urological operations after filum section. Seven children, aged 3.1 to 13.5 years, all of whom had abnormal urodynamic findings, did not undergo filum section. At a mean follow-up period of 3.3 years, two patients had urological improvement and three patients had undergone bilateral ureteric reimplantations. Other non-urological back and/or lower limb abnormalities were present in five patients and did not improve. One patient had the filum cut after 8 years and improved thereafter. CONCLUSION Section of the filum in children with refractory urinary incontinence and OTCS may produce better urological outcomes than continued medical management. A definitive answer to the question of whether section of the filum is better than non-neurosurgical medical management for children with OTCS awaits the conclusion of a randomized controlled trial.

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