Masaya Mizutamari

L5 radiculopathy caused by a ganglion cyst of the posterior longitudinal ligament in a teenager

BACKGROUND CONTEXT There is no previous report on the intraspinal ganglion cyst of the posterior longitudinal ligament in a teenager. PURPOSE To report a case of radiculopathy caused by a ganglion cyst of the posterior longitudinal ligament in a teenager. STUDY DESIGN Case report. METHODS A 17-year-old male with a 4-month history of left L5 radicular pain was found to have an intraspinal cystic lesion causing radicular compression. Magnetic resonance imaging showed a cystic lesion located in the ventral side of the dura. The patient suffered from severe leg pain. As a result, a surgical operation was therefore performed. RESULTS The cyst containing jelly-like components and a hemorrhage was punctured and then extirpated. It originated from the posterior longitudinal ligament. A histological study revealed the cyst to be without any synovial layers. CONCLUSIONS This is the first report to describe a ganglion cyst originating from the posterior longitudinal ligament in a teenager. This possible etiology should be kept in mind for any other individuals displaying symptoms of spinal nerve root compression as well as disc herniation.

Corresponding scapular pain with the nerve root involved in cervical radiculopathy.

Purpose. To correspond scapular pain with the nerve root involved in cervical radiculopathy. Methods. In the anatomic study, 11 Japanese adult cadavers were dissected to examine the numbers and courses of the cutaneous nerves from C3 to C8 dorsal rami. In the clinical study, 14 men and 11 women aged 34 to 77 years who presented with scapular pain as well as pain, numbness or motor weakness in the upper limbs secondary to cervical radiculopathy were assessed. The involved nerve roots were identified based on the symptoms and signs in the arm and/or fingers, the radiological diagnosis, and the pain response to cervical nerve root blocks. The sites and characteristics of radicular pain were assessed. Results. In the anatomic study of 22 cutaneous nerves from medial branches of dorsal rami, 18 involved the C5 nerve root, 0 the C6 root, one the C7 root, and 8 the C8 root. In the clinical study, the radicular pain often occurred in the suprascapular region involving the C5 root, in the suprascapular to posterior deltoid region involving the C6 root, in the interscapular region involving the C7 root, and in the interscapular and scapular regions involving the C8 root. All patients with C5 or C8 radiculopathy had both superficial and deep pain, whereas almost all patients with C6 or C7 radiculopathy had deep pain only. No patient had superficial pain only. Conclusion. Cervical radiculopathy can cause scapular pain. Pain sites and characteristics are related to the affected nerve root.

Gas-filled intradural cysts of the lumbar spine and the possible pathogenesis

BACKGROUND CONTEXT There have only been four reports of gas-filled intradural cysts, and the pathogenesis is unknown. PURPOSE To document the radiologic and histopathologic features of gas-filled intradural cysts and to discuss the pathogenesis with a review of the literature. STUDY DESIGN Case report. METHODS A 67-year-old woman, admitted to our institute, presented with severe right thigh pain. On admission to the institute, enhanced magnetic resonance imaging, showed a cystic lesion in the spinal canal at the L2-L3 level, with an intensity suggesting the presence of gas. An enhanced region around the cyst was noted. Computed tomography after discography also revealed a water-soluble contrast filled the subarachnoid space and area around the cyst, but not inside. RESULTS The cyst was surgically resected. One of the nerve roots was firmly adherent to the gas-filled cyst. The cyst wall comprised fibrous tissue, including small granulations and herniated disc material. CONCLUSION Gas-filled intradural cysts are rare. The pathogenesis appears to involve gas in a degenerated intervertebral disc, and spontaneous absorption of herniated disc material.

Unilateral atlantoaxial transpedicular screw and rod/plate fixation with sublaminar polyethylene cable fixation

This report presents 2 of the cases of primary posterior unilateral atlantoaxial transpedicular screw and rod/plate fixation supplemented by a polyethylene cable as sublaminar wiring for the treatment of a patient with atlantoaxial subluxation. The patients had a unilateral high-riding vertebral artery at the axis, and a unilateral screw and rod/plate fixation with sublaminar fixation was performed to provide more rigid stabilization at the atlantoaxial junction. One patient with a delayed nonreducible odontoid fracture had a good outcome with a complete reduction and posterior fusion. The other elderly patient achieved a sufficient union at the fracture site of the odontoid process; however, resorption of the interlaminar grafting bone was observed. The stability of the unilateral transpedicular screw and rod/plate fixation with sublaminar polyethylene cable fixation might therefore be insufficient to obtain the fusion of the grafted bone in an osteoporotic elderly patient. Another procedure such as a laminar screw procedure should thus be considered for such a patient.