Osteophytic Iliac Venous Compression: Technical Considerations for a Bony May-Thurner Syndrome Variant

May-Thurner syndrome (MTS) results in compression of the left common iliac vein between the spine and right common iliac artery leading to symptomatic venous outflow obstruction. The authors depict a classic case of MTS followed by four variant cases in which the primary culprit lesions causing compression were degenerative vertebral osteophytes. The osteophytic variant of MTS poses distinct diagnostic and therapeutic challenges.

Review Article: Osteophytes

An osteophyte is a fibrocartilage-capped bony outgrowth that is one of the features of osteoarthritis. This study reviewed the types, risk factors, pathophysiology, clinical presentations, and medical and surgical treatment of osteophytes. Extraspinal osteophytes are classified as marginal, central, periosteal, or capsular, whereas vertebral osteophytes are classified as traction or claw. Risk factors for development of osteophytes include age, body mass index, physical activity, and other genetic and environmental factors. Transforming growth factor β plays a role in the pathophysiology of osteophyte formation. Osteophytes can cause pain, limit range of motion, affect quality of life, and cause multiple symptoms at the spine. Medical treatment involves the use of bisphosphonates and other non-steroidal anti-inflammatory agents. Surgical treatment in the form of cheilectomy for impingement syndromes during joint replacement is recommended.

Interobserver reproducibility of radiographic evaluation of lumbar spine instability

ABSTRACT Objective: To measure the interobserver reproducibility of the radiographic evaluation of lumbar spine instability. Methods: Measurements of the dynamic radiographs of the lumbar spine in lateral view were performed, evaluating the anterior translation and the angulation among the vertebral bodies. The tests were evaluated at workstations of the organization, through the Carestream Health Vue RIS (PACS), version 11.0.12.14 Inc. 2009© system. Results: Agreement in detecting cases of radiographic instability among the observers varied from 88.1 to 94.4%, and the agreement coefficients AC1 were all above 0.8, indicating excellent agreement. Conclusion: The interobserver analysis performed among orthopedic surgeons with different levels of training in dynamic radiographs of the spine obtained high reproducibility and agreement. However, some factors, such as the manual method of measurement and the presence of vertebral osteophytes, might have generated a few less accurate results in this comparative evaluation of measurements.

UTILIDAD DE LA CISTERNOGRAFÍA RADIOISOTÓPICA HÍBRIDA SPECT/CT 99MTC-O4--DTPA Y RMN EN EL DIAGNÓSTICO DE UN CASO DE HIPOTENSIÓN INTRACRANEAL ESPONTÁNEA: REVISIÓN DEL TEMA

Spontaneous intracranial hypotension (HIE) is an uncommon cause of secondary orthostatic headache, characterized by a decreased pressure and volume of cerebrospinal fluid (CSF), where dural quality and mechanical factors such as vertebral osteophytes play an important role, that after minimal trauma allow CSF leakage. We present the case of a 56-year-old male patient, who presented with severe postural headache, with a history of mild trauma at the level of the low thoracic spine with CSF pressure at the lower limit of normality, in whom radioisotopic SPECT/CT cisternography, provided the definitive diagnosis and exact anatomical location of the CSF leak, guiding treatment. A review of the pathophysiology, clinical presentation, diagnosis and treatment of HIE is carried out, emphasizing the diagnostic aid modalities, where hybrid imaging in nuclear medicine with SPECT/CT equipment allows a definitive diagnosis and management of HIE.