Intradural Extramedullary Nerve Sheath Myxoma of the Cervical Spine: A Case Report and Review of Literature

Background: Nerve sheath myxoma is a rare benign soft tissue tumor. Intraspinal nerve sheath myxomas are rare. Only 8 cases of intraspinal nerve sheath myxoma have been reported to date, and no case of nerve sheath myxoma has been reported in the cervical spinal canal. Herein, we reported the first case of intradural extramedullary nerve sheath myxoma in the cervical spinal canal of a 57-year-old man, including its complete clinical course and radiological findings.Case Presentation: A 57-year-old male patient presented with numbness in his left finger without any obvious inducement for 3 years. CT and contrast-enhanced magnetic resonance imaging (MRI) of the spine were performed. Based on the radiological examinations, a diagnosis of schwannoma was initially made. However, nerve sheath myxoma was finally confirmed by histopathological and immunohistochemical examinations. Complete tumor excision at the C1-2 level was performed. Then, the patient recovered well, and the numbness of his left finger disappeared during the later follow-up after the surgery.Conclusion: Nerve sheath myxoma should receive diagnostic consideration for an extramedullary subdural lesion that is a clear boundary mass characterized by isointensity on T1-weighted images, heterogeneous intensity on T2-weighted images, obvious peripheral enhancement, and a growing tendency toward the intervertebral foramen.

THE UNDERLYING PATHOPHYSIOLOGY AND CLINICAL APPEARANCE OF LSS, AND THE AVAILABLE DIAGNOSTIC AND THERAPEUTIC OPTIONS

The term lumbar spinal stenosis (LSS) refers to the narrowing of the spinal canal due to anatomical reasons, and it is linked to a variety of clinical symptoms.The onset of stenosis LSS can be unilateral or bilateral, monosegmental or multisegmental. The stenosis can be characterized as central, lateral, or foraminal anatomically.Neurogenic claudication is the most prevalent symptom of LSS, which is defined as limping or cramping lumbar pain that spreads into the legs primarily during walking.Typical patient symptoms include unilateral or bilateral (exertional) back and leg discomfort that develops over months, if not years.As people live longer and seek a better quality of life, as well as increased knowledge of the condition and the availability of improved imaging techniques, the number of people diagnosed with degenerative LSS has increased.

Effect of Discectomy on Dynesys Dynamic Fixation in the Treatment of Lumbar Degenerative Diseases

Objective. To compare the effect of decompression of the spinal canal with or without discectomy on the clinical efficacy of Dynesys dynamic fixation treatment in lumbar degenerative diseases. Methods. A total of 62 patients treated for single-segment lumbar degenerative disease from October 2010 to November 2017 were retrospectively analyzed. All patients underwent decompression of the spinal canal with Dynesys dynamic fixation and were divided into two groups. Twenty-seven patients in group A did not undergo discectomy, and 35 patients in group B underwent discectomy. The intervertebral height, range of motion, Pfirrmann grade of the surgical segment and the upper adjacent segment, function scores, and operation information were compared. Results. All patients were followed up for an average of 30.7 ± 11.5 months. At the final follow-up, the intervertebral height and range of motion of the surgical segment decreased significantly in both group A and B ( p < 0.05 ), the range of motion of the upper adjacent segment increased significantly ( p < 0.05 ), and the intervertebral height did not change significantly ( p < 0.05 ). The retained percentages of surgical segment intervertebral height and ROM in group A were significantly better than those in group B ( p < 0.05 ). The intervertebral height ( p > 0.05 ) and range of motion ( p < 0.05 ) of the surgical segment in group A were higher than those in group B. The surgical segment Pfirrmann grading of group A was better than that of group B ( p < 0.05 ). Conclusion. Dynesys in the treatment of lumbar degenerative diseases may lead to a good clinical effect. In selected cases without discectomy, the range of motion and intervertebral height may be better preserved, and disc degeneration may be reduced.

Pneumorrhachis: A Rare Prognostic Lesson

Objective: We present a case of poly-traumatic epidural pneumorrhachis of an 87-year-old gentleman who had unremarkable neurology on presentation. We give an overview of aetiology and indications for intervention in pneumorrhachis. Background: Pneumorrhachis is the presence of air within the spinal canal, aetiologically it is widely variable though its observation in practice is rare. Methods: Descriptive. Results: We show figures illustrating CT images of pneumorrhachis at C3/4 level. The patient underwent progressive neurological deterioration over the course of four days on intensive care, and subsequently passed away. Conclusion: The presence of pneumorrhachis is well known to be associated with poor prognosis, and in our case predicted his subsequent neurological decline despite initial presentation. The presence of pneumorrhachis also serves as an important clue for hidden injuries.

Study of pedicles and spinal canal diameters at the level of lumbar vertebral in normal adult Saudi population using computed tomography

The values of normal transverse (interpedicular) and sagittal (midsagittal) diameters are different at various levels of lumbar spinal canal in individuals of the same race and differ at identical levels in individuals of various races. The aim of the study was to determine normal reference range of the lumbar spinal canal dimensions and to evaluate lumbar pedicle dimensions with respect to spinal level, age, gender in Saudi population by using Computed Tomography. This study was conducted in Najran province (K.S.A), archival abdominal CT scan images from PACS in hospitals were used. The data of this study was collected from 210 (102 male and 108 female) normal Saudi adults individuals with different ages, gender over a period of 20 months (2019 - 2021). The mean spinal canal transverse distance (SCTR) showed steady decrease from L1 to L4, as there was an increasing in (SCTR) at L5 relative to L4, The mean spinal canal anteroposterior diameter (SCAP) showed a decrease from L1 to L3, and then a gradual increase from L4 to L5 (Fig.4-10). This pattern was observed in males only as there was an increase of female (SCAP) at L2 and L5, and no significant gender difference was noted at any lumbar level for (SCAP) The mean pedicle width (PW) showed steady increase from L1 to L5. While the mean pedicle height (PH) showed a gradual decrease from L1 to L5. The study conclude that Computed tomography is a reliable method for determining the morphological measurements of the spinal canal and pedicles diameter.

Activity of genes of matrix metalloproteinases and their inhibitors in the Ligamentum flavum of patients with stenosing processes in spinal canal and dural sac

New data have been obtained for assessing the expression of genes of metalloproteinases and their tissue inhibitors (MMP-1, MMP-2, MMP-3, MMP-8, MMP-9, TIMP-1 and TIMP-2) in the Ligamentum flavum in patients with lumbar stenosis of spinal canal and dural sac. The features of the metabolism of the extracellular matrix (ECM) were revealed, the data obtained were compared with those for previously studied candidate genes. The search for relationships with the features of the ECM metabolic characteristics was carried out.The aim. To study the expression of genes of metalloproteinases and their tissue inhibitors in intraoperative biopsies of the Ligamentum flavum of patients with lumbar stenosis of the spinal canal and dural sac.Materials and methods. A group of 33 people (17 women, 16 men) with lumbar stenosis of the spinal canal and dural sac was studied; the average age is 45.73 ± 1.95 years. RNA was isolated from intraoperative biopsies of the Ligamentum flavum, reverse transcription was performed, and PCR using specific primers was performed.Results. In Ligamentum flavum of patients with stenosing processes of the spinal canal and dural sac, an increased activity of MMP-1 and insufficient response of TIMP-1 and TIMP-2 were found; the expression of MMP-1 increased synchronously with Dio2, and both genes decreased their activity with increasing age of the patient. In patients with Ligamentum flavum ossification, the MMR-8 gene was more actively expressed, and the synthesis of the mRNA of the MMR-9 gene decreased compared to the subgroup without ossification.

Two Cases of Iatrogenic Lumbar Foraminal Disc Herniations

Study Design. A case report. Objective. We report two cases of iatrogenic deterioration of lumbar foraminal disc herniations following lumbar disc injections. Summary of Background Data. Complications associated with discography were reported. However, only a few reports have thus far referred to the iatrogenic deterioration of lumbar foraminal disc herniations. Cases. 60-year-old and 74-year-old men were treated with MR images of L4-5 foraminal disc herniations without fragment in the spinal canal. The patients underwent discography and disc block for its diagnosis and treatment. After disc injections, both patients complained of deterioration of L4 radiculopathy. Results. On disco-CT or reexamined MR images after disc injections, herniated fragment was migrated from neural foramen to cranial central spinal canal with was not shown in previous MR images. The herniated fragments were extirpated by means of osteoplastic laminoplasty or transforaminal lumbar interbody fusion with facetectomy. The herniated fragments were migrated from neural foramen to cranial central spinal canal. Conclusions. The injection of liquid medicine into the nucleus led the intradiscal pressure increased, and the disc fragment might prolapsed through the raptured region of annulus fibrosus and migrated to cranial central spinal canal by anatomical reason. The disc injection may have a risk for deterioration of foraminal disc herniation. Our report is instructive for the management of discography for the diagnosis of foraminal disc herniations.