Journal of neurosurgery. Spine
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The aim of this study was to correlate the degree of L4-5 spondylolisthesis on plain flexion-extension radiographs with the corresponding amount of L4-5 facet fluid visible on MR images. ⋯ There is a linear correlation between the degree of segmental motion seen on flexion-extension plain radiography in patients with DS at L4-5 and the amount of L4-5 facet fluid on MR images. If L4-5 facet fluid in patients with DS is seen on MR images, a corresponding anterolisthesis on weight-bearing flexion-extension lateral radiographs should be anticipated. Obtaining plain radiographs will aid in the diagnosis of anterolisthesis caused by an L4-5 hypermobile segment, which may not always be evident on MR images obtained in supine patients.
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In this study, the authors assessed the construct validity and the reliability of the World Health Organization Quality of Life-Bref (WHOQOL-Bref) questionnaire in patients with cervical spondylotic myelopathy (CSM) and compared the performance of the WHOQOL-Bref and the 36-Item Short Form Health Survey (SF-36) in assessing quality of life (QOL) in patients with CSM. ⋯ The WHOQOL-Bref, like the SF-36, is valid and reliable in assessing outcome in patients with CSM. It measures impairment in CSM in a more uniform manner than the SF-36, but its domains are less responsive to postoperative changes. Because the WHOQOL-Bref measures different constructs and has additive value, it should be used along with the SF-36 for QOL assessment in patients with CSM.
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Case Reports
Cervical spine dural arteriovenous fistula presenting with congestive myelopathy of the conus.
Spinal dural arteriovenous fistulas (DAVFs) are the spinal vascular malformations that are encountered most often, and they are usually encountered in the lower thoracic region. Cervical spine DAVFs are exceedingly rare and may be difficult to differentiate from radicular arteriovenous malformations, epidural arteriovenous shunts, or perimedullary AVFs. Typical angiographic findings in spinal DAVFs include a slow-flow shunt with converging feeding vessels from radiculomeningeal arteries draining via a radicular vein centripetally into perimedullary veins. ⋯ The authors present the case of a 51-year-old man presenting with lower thoracic and conus medullaris congestive edema due to a cervical spine DAVF that was located at the C-5 level. Transarterial embolization with N-butyl cyanoacrylate closed the proximal vein and completely obliterated the fistula. Clinical and imaging follow-up confirmed occlusion of the fistula, with improvement in clinical symptoms.
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Spontaneous spinal epidural hematoma (SSEH) is a rare disease. The goal of this study was to clarify the treatment results and management options in SSEH. ⋯ Impaired preoperative hemostasis contributes to larger size of SSEH, high probability of postoperative recurrence of spinal epidural hematoma, and poor functional recovery following surgical evacuation. Incomplete spinal cord dysfunction before surgery predicts good outcome and warrants emergent evacuation of SSEH especially in the cervical and thoracic regions, where the clots are located in proximity to the spinal cord.