dural sac
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2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Hasan Banitalebi ◽  
Ansgar Espeland ◽  
Masoud Anvar ◽  
Erland Hermansen ◽  
Christian Hellum ◽  
...  

Abstract Background Magnetic Resonance Imaging (MRI) is an important tool in preoperative evaluation of patients with lumbar spinal stenosis (LSS). Reported reliability of various MRI findings in LSS varies from fair to excellent. There are inconsistencies in the evaluated parameters and the methodology of the studies. The purpose of this study was to evaluate the reliability of the preoperative MRI findings in patients with LSS between musculoskeletal radiologists and orthopaedic spine surgeons, using established evaluation methods and imaging data from a prospective trial. Methods Consecutive lumbar MRI examinations of candidates for surgical treatment of LSS from the Norwegian Spinal Stenosis and Degenerative Spondylolisthesis (NORDSTEN) study were independently evaluated by two musculoskeletal radiologists and two orthopaedic spine surgeons. The observers had a range of experience between six and 13 years and rated five categorical parameters (foraminal and central canal stenosis, facet joint osteoarthritis, redundant nerve roots and intraspinal synovial cysts) and one continuous parameter (dural sac cross-sectional area). All parameters were re-rated after 6 weeks by all the observers. Inter- and intraobserver agreement was assessed by Gwet’s agreement coefficient (AC1) for categorical parameters and Intraclass Correlation Coefficient (ICC) for the dural sac cross-sectional area. Results MRI examinations of 102 patients (mean age 66 ± 8 years, 53 men) were evaluated. The overall interobserver agreement was substantial or almost perfect for all categorical parameters (AC1 range 0.67 to 0.98), except for facet joint osteoarthritis, where the agreement was moderate (AC1 0.39). For the dural sac cross-sectional area, the overall interobserver agreement was good or excellent (ICC range 0.86 to 0.96). The intraobserver agreement was substantial or almost perfect/ excellent for all parameters (AC1 range 0.63 to 1.0 and ICC range 0.93 to 1.0). Conclusions There is high inter- and intraobserver agreement between radiologists and spine surgeons for preoperative MRI findings of LSS. However, the interobserver agreement is not optimal for evaluation of facet joint osteoarthritis. Trial registration www.ClinicalTrials.gov identifier: NCT02007083, registered December 2013.


2021 ◽  
Vol 12 ◽  
pp. 628
Author(s):  
Nobuya Murakami ◽  
Ai Kurogi ◽  
Yoshihisa Kawakami ◽  
Yushi Noguchi ◽  
Makoto Hayashida ◽  
...  

Background: Terminal myelocystocele (TMC) is an occult spinal dysraphism characterized by cystic dilatation of the terminal spinal cord in the shape of a trumpet (myelocystocele) filled with cerebrospinal fluid (CSF), which herniates into the extraspinal subcutaneous region. The extraspinal CSF-filled portion of the TMC, consisting of the myelocystocele and the surrounding subarachnoid space, may progressively enlarge, leading to neurological deterioration, and early untethering surgery is recommended. Case Description: We report a case of a patient with TMC associated with OEIS complex consisting of omphalocele (O), exstrophy of the cloaca (E), imperforate anus (I), and spinal deformity (S). The untethering surgery for TMC had to be deferred until 10 months after birth because of the delayed healing of the giant omphalocele and the respiration instability due to hypoplastic thorax and increased intra-abdominal pressure. The TMC, predominantly the surrounding subarachnoid space, enlarged during the waiting period, resulting in the expansion of the caudal part of the dural sac. Although untethering surgery for the TMC was uneventfully performed with conventional duraplasty, postoperative CSF leakage occurred, and it took three surgical interventions to repair it. External CSF drainage, reduction of the size of the caudal part of the dural sac and use of gluteus muscle flaps and collagen matrix worked together for the CSF leakage. Conclusion: Preoperative enlargement of the TMC, together with the surrounding subarachnoid space, can cause the refractory CSF leakage after untethering surgery because the expanded dural sac possibly increases its own tensile strength and impedes healing of the duraplasty. Early untethering surgery is recommended after recovery from the life-threatening conditions associated with OEIS complex.


Author(s):  
Svitlana Shkrobot ◽  
Maryna Salii ◽  
Zoia Salii ◽  
Yuriy Heryak

Hirayama disease, or monomelic amyotrophy, is a rare neurological pathology manifested by unilateral or bilateral asymmetric paresis with atrophy of the distal upper extremities. The development of this disease is associated with the forward displacement of the posterior dural sac during neck flexion, which leads to compression of the spinal cord and venous stasis. The diagnosis of monomelic amyotrophy is based on the clinical picture and the results of magnetic resonance imaging of the cervical spine with flexion, showing segmental atrophy of the anterior horns of the spinal cord at C7 — Th1, detachment of the posterior dura mater and venous stasis. Most of the cases described in the literature are from India and Japan, with isolated cases diagnosed in North America and Europe. This article presents two clinical cases of progressive hand weakness in young men. The clinical picture of the disease and the results of additional examination methods are presented, which is necessary to establish a diagnosis of Hirayama’s disease.


2021 ◽  
Vol 6 (6-2) ◽  
pp. 58-72
Author(s):  
L. V. Rodionova ◽  
L. G. Samoilova ◽  
V. A. Sorokovikov

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.


2021 ◽  
pp. 028418512110681
Author(s):  
Jarruwat Charoensuk ◽  
Jiraporn Laothamatas ◽  
Witaya Sungkarat ◽  
Ladawan Worapruekjaru ◽  
Boonthida Hooncharoen ◽  
...  

Background There are no studies comparing the morphologic changes of lumbar spines between supine axial-loaded and 90° standing magnetic resonance imaging (MRI) examinations of patients with spinal stenosis. Purpose To determine whether axial-loaded MRI using a compression device demonstrated similar morphology of intervertebral disc, dural sac, and spinal curvature as those detected by 90° standing MRI in individuals with suspected spinal stenosis. Material and Methods A total of 54 individuals suspected of having spinal stenosis underwent both axial-loaded and standing MRI studies. The outcome measures included seven radiologic parameters of the lumbar spine: measures of the intervertebral disc (i.e. cross-sectional area [DA], disc height [DH], and anteroposterior distance [DAP]), dural sac (cross-sectional area [DCSA]), spinal curvature (i.e. lumbar lordosis [LL] and L1-L3-L5 angle [LA]), and total lumbar spine height (LH). Results For agreement between the two methods, intraclass correlation coefficient (ICC) ≥ 0.8 was found for all seven radiologic parameters. Supine axial-loaded MRI underestimated LL but remained correlated (ICC = 0.83) with standing MRI. Minor differences between the two methods (≤5.0%) were observed in DA, DCSA, DAP, LA, and LH, while a major difference was observed in LL (8.1%). Conclusion Using a compression device with the conventional supine MRI to simulate weight-bearing on the lumbar spine generated MRI morphology, which was strongly correlated with those from a standing MRI.


Author(s):  
Hoon Seok ◽  
Seung Yeol Lee ◽  
Dong Seong Shin ◽  
Jung Hoon Kang ◽  
Soo Bin Im ◽  
...  

BACKGROUND: Due to the anatomical characteristics of the anterior epidural space, dorsal migration of material from herniated lumbar disc is quite rare. Also, bilateral foot drop due to unilateral dorsal migration of disc herniation is extremely rare. This report presents a case of sudden bilateral foot drop caused by the unilateral dorsal migration of material from a herniated lumbar disc. CASE DESCRIPTION: A 51-year-old male presented with sudden onset severe leg pain with bilateral foot drop. The patient was referred to our emergency department by a local clinic. Neurological examination showed bilateral ankle and big toe dorsiflexion weakness grade 1. There was no perianal anesthesia, anal sphincter weaknesses, or voiding difficulty. Apart from essential hypertension, this patient’s medical history was unremarkable. Magnetic resonance imaging showed that intervertebral disc material in the dorsal extradural space at the L3-4 level had compressed the dural sac from the left side to the center. We performed an emergency operation. The pathologic result revealed fibrous cartilaginous materials. After the operation, the leg pain was markedly resolved. At postoperative three months, the patient showed improvement of foot drop. CONCLUSION: We recommended emergent mass removal, which produced a favorable outcome.


Author(s):  
Deniz Bulja ◽  
Jasna Strika ◽  
Merim Jusufbegović ◽  
Muris Bečirčić ◽  
Adnan Šehić ◽  
...  

Introduction: Axial-loaded magnetic resonance imaging (MRI), which can simulate an upright position of the patient may cause a significant reduction of the dural sac cross-sectional area (DCSA) compared with standard MRI, thus providing valuable information in the assessment of the lumbar spinal canal. The purpose of this study was to investigate excessiveness of the change in DCSA and depth of lateral recesses (DLRs) before and after axial-loaded imaging in relation to body mass index (BMI) of the subjects.Methods: Twenty patients were scanned to evaluate DCSA and DLR at three consecutive lumbar spine intervertebral disc levels (L3/4, L4/5, and L5/S1) on conventional-recumbent MRI, and after axial loading were applied.Results: Axial-loaded MRI demonstrates a significant difference of DSCA in comparison to conventional MRI. Furthermore, results show a significant correlation between the DCSA and BMI on level L3/L4, both before and after axial loading MRI. With axial loading, there is a reduction of DSCA of 12.2%, 12.1%, and 2.1% at the levels L3/L4, L4/L5, and L5/S1, respectively. After axial loading has been applied, the depth of the neural foramen has been reduced by an average of 10.1%.Conclusion: Axial-loaded MRI reduces DCSA and DLRs in comparison to standard MRI. Information obtained in this way may be useful to explain the patient’s symptomatology and may provide an additional insight that can influence the treatment decision plan accordingly.


2021 ◽  
Vol 6 (4) ◽  
pp. 311-315
Author(s):  
Rakhi V Jagdale ◽  
Mamta V Kripalani ◽  
Jaydeep N Pol ◽  
Sachin J Patil ◽  
Santosh S Kullolli

Cutaneous meningiomas (CM) are rare variants of meningiomas which are further classified into three subtypes. Type I CM (TICM) or Rudimentary meningocele (RM) is an uncommon developmental anomaly in which meningothelial elements are displaced into the skin and soft tissue. We present a case of 11 year boy with an upper back swelling since early childhood. His MRI spine showed a lesion at T4-T7 level with a fistulous tract connecting it to dural sac. Histopathology revealed clusters of oval to spindle cells arranged in whorls amidst collagen bundles and psammoma bodies. On immunohistochemistry these cells expressed EMA and Vimentin. A diagnosis of TICM was rendered based on these characteristic clinico-radiological & histopathological features. TICM pose a diagnostic challenge clinically and histopathologically and have an excellent prognosis. This is the 4 Indian case of RM and the 1 case of RM to be located in the spine in the Indian literature.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chen-yang Xu ◽  
Can Liu ◽  
Xiao-ju Jin ◽  
Fan Yang ◽  
Fang Xu ◽  
...  

Abstract Background The anatomical dimensions of the lumbar dural sac determine the sensory block level of spinal anesthesia; however, whether they show the same predictive value during continuous epidural anesthesia (CEA) remains undetermined. We designed the present study to verify the efficacy of the anatomical dimensions of the lumbar dural sac in predicting the sensory block level during labor analgesia. Methods A total of 122 parturients with singleton pregnancies requesting labor analgesia were included in this study. The lumbar dural sac diameter (DSD), lumbar dural sac length (DSL), lumbar dural sac surface area (DSA), and lumbar dural sac volume (DSV) were measured with an ultrasound color Doppler diagnostic apparatus. CEA was performed at the L2-L3 interspace. After epidural cannulation, an electronic infusion pump containing 0.08% ropivacaine and sufentanil 0.4 μg/ml was connected. The sensory block level was determined with alcohol-soaked cotton, a cotton swab, and a pinprick. The analgesic efficacy of CEA was determined with a visual analog scale (VAS). The parturients were divided into two groups, “ideal analgesia” and “nonideal analgesia,” and the groups were compared by t test. Pearson’s correlation was performed to evaluate the association between the anatomical dimensions of the lumbar dural sac and sensory block level. Multiple linear regression analysis was used to create a model for predicting the sensory block level. Results In the ideal analgesia group, the height, DSL, DSA, DSV and DSD were significantly smaller, and the body mass index (BMI) was significantly larger (P < 0.05). In addition, the DSL demonstrated the strongest correlation with the peak level of pain block (r = − 0.816, P < 0.0001; Fig. 2A), temperature block (r = − 0.874, P < 0.0001; Fig. 3A) and tactile block (r = − 0.727, P < 0.0001; Fig. 4A). Finally, the multiple linear regression analysis revealed that DSL and BMI contributed to predicting the peak sensory block level. Conclusion In conclusion, our study shows that the sensory block level of CEA is higher when the DSL, DSA, DSV and DSD of puerperae are lower. DSL and BMI can be treated as predictors of the peak sensory block level in CEA during labor analgesia.


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