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Corduroy Cloth Vertebra
Published in Michael E. Mulligan, Classic Radiologic Signs, 2020
Vertebral body hemangiomas have been described as striated or reticulated from the time of the earliest radiographic reports concerning these lesions. Rudolf Virchow (1821–1902) is credited with the first report (in 1862) of a vertebral hemangioma. ‘The first publication in the English literature mentioning … hemangioma goes back to the mid-nineteenth century [1845] when Toynbee1 reported a single case involving the parietal bone’2. William Anspach3 (Children’s Memorial Hospital, Chicago) seems to have been the first to use the term corduroy cloth to describe the radiographic appearance. He wrote in 1937, ‘An almost constant X-ray appearance has been produced, according to numerous recent reports, when hemangiomas involve vertebral bodies. Vertical streaks of parallel densities are seen on the roentgenograms somewhat resembling corduroy cloth. Older persons are especially prone to have this type of tumor. No other benign tumor has so uniformly produced these parallel densities.’3 This sign is still considered characteristic (Figure 1). The parallel line appearance is due to reinforcement of the remaining vertical trabeculae within the vertebral body to make up for those lost because of the hemangioma. Occasionally, one may have difficulty distinguishing a Pagetoid vertebra from a vertebral hemangioma. Enlargement of the vertebral body associated with increased density is a clue that the changes are due to Paget’s disease.
Reduction and Fixation of Sacroiliac joint Dislocation by the Combined Use of S1 Pedicle Screws and an Iliac Rod
Published in Kai-Uwe Lewandrowski, Donald L. Wise, Debra J. Trantolo, Michael J. Yaszemski, Augustus A. White, Advances in Spinal Fusion, 2003
Kai-Uwe Lewandrowski, Donald L. Wise, Debra J. Trantolo, Michael J. Yaszemski, Augustus A. White
Percutaneous application of an acrylic bone cement, polymethylmethacrylate (PMMA), to vertebral defects was pioneered in France in 1984 by Galibert et al. [1]. This procedure, called vertebroplasty, was first used to treat aggressive vertebral hemangioma and resulted in good pain relief. In 1991, Debussche-Depriester et al.[2] focused the treatment on osteoporotic compression fractures and also experienced success in pain control. Indications were subsequently extended to other weakening lesions, such as vertebral myeloma or metastatic vertebral lesions. In 1993, vertebroplasty was introduced to North America, but unlike in Europe, where vertebroplasty is mainly performed to manage pain due to tumor-related bone diseases [3-8], the focus in North America has been on the relief of pain associated with osteoporotic vertebral fractures that has failed to respond to conservative therapy [9,10].
Radiofrequency ablation may improve the beneficial results of vertebroplasty for vertebral hemangiomas: analysis of 46 patients
Published in Neurological Research, 2022
Ali Serdar Oguzoglu, Nilgun Senol, Hakan Murat Göksel
In this study, we compared the effect of VP alone and RFA+VP on pain in vertebral hemangioma cases. Significant pain reduction and life quality improvement could be achieved in both study groups without any complication. Although both modalities are effective on pain reduction, both the numerical values and graph depiction of assesment results at 6th month showed a tendency of better VAS and ODI scores in RFA+VP group. This difference may depend on the significant heating effect of RFA as the only variation between study groups. The bone cement (PMMA) produce heat almost always under 50°C, at the core of the cement mass, while RFA electrode causes temperatures as high as 60–90°C around the electrode tip [33,34]. These levels of tissue temperature is enough for local sensorial nerve fiber destruction, while vertebroplasty cannot create this effect [35].
Combined surgical and endovascular approach for treatment of aggressive vertebral haemangiomas
Published in British Journal of Neurosurgery, 2018
Daniel G. Eichberg, Robert M. Starke, Allan D. Levi
Ten patients had thirteen surgical decompression and tumour resection procedures for aggressive vertebral hemangioma. One patient experienced tumour recurrence at 1 year, requiring a second staged surgery. A second patient required a staged surgery for resection of multiple VHs. Seven patients had subtotal resections, two patients had gross total resections, and one patient had an en bloc resection of tumour. Data regarding intraoperative blood loss is detailed in Table 1. Recorded estimated blood loss ranged from 700 mL to 2600 mL, one patient was transfused with eight units of pRBCs intraoperatively, one patient was transfused with five units of pRBCs postoperatively, and nine cases had unspecified intraoperative blood loss. No patients had postoperative epidural hematoma.
Anterior cervical approach for the treatment of axial or high thoracic levels
Published in British Journal of Neurosurgery, 2018
Ran Harel, Maya Nulman, Zvi R. Cohen, Nachshon Knoller
During the study period, 13 patients had undergone anterior cervical approach surgery extending to the axial spine (3 patients) or to the thoracic spine (10 patients). All patients were operated by a single surgeon (RH). All of the patients that were planned for surgery with standard cervical approach were operated in that fashion (none of the cases needed extension by manubriectomy or trans-oral/transnasal approach). Mean follow-up period was 9.4 months (range 2–24 months). Table 1 summarizes the demographic data, the pathologic process and surgical indications, the surgical details, outcomes and complications. Average patients’ age was 53 years old and ranged 11 to 77 years old; 62% were males and 38% females. One trauma patient was scored as ASIA A, three were scored as ASIA C, two were ASIA D and the rest were ASIA E. The cohort included one smoker, three (23%) patients with diagnosis of diabetes mellitus, four (31%) patients with diagnosis of hypertension. Ten patients had tumour resection surgery and the remaining three patients had surgery to treat trauma, spondylotic myelopathy or infection. The median number of vertebral bodies involved was 1 (range: 1–3), corpectomies were performed in all cases but one; fusion was performed with cage and plate in 11 of 13 patients (rigid plate in 9 patients and dynamic plate in 2 patients). Three patients diagnosed with high thoracic tumours had previously undergone postero-lateral approaches with decompression and fusion at other hospitals. Since these patients had anterior compressing lesions, they did not improve but rather deteriorated neurologically. A patient with a circumferential D1 Vertebral hemangioma causing a pathological fracture and cord compression was initially operated via a posterior approach and D1 corpectomy was performed as a second stage. A cervico-thoracic trauma patient was initially operated by anterior only approach achieving C7–D1 corpectomies and C6–D2 fusion but during follow-up kyphosis angulation was increasing and 11 days after the initial approach, posterior instrumentation augmentation was performed. A C2 osteomyelitis causing epidural abscess and instability due to dens fracture had undergone C2 corpectomy and densectomy, epidural abscess evacuation and initial stabilization with halo traction (Figure 1). The patient was later stabilized by Halo-vest and posterior occipito-cervical instrumentation was performed 40 days after the initial surgery. Average surgical duration was 96 minutes (range: 48–181 minutes) and estimated blood loss (EBL) was 1440cc (range: minimal–7000cc); two renal cell carcinoma metastases (Figure 2) and one vertebral hemangioma patient's EBL was over 2500cc. Complications were recorded in 30% of the patients including prolonged ventilation, pneumonia, CSF leak, post-operative hand weakness and three patients suffered temporary hoarseness due to vocal cord paralysis. Table 1 lists the surgical indications, surgical approach, outcome and complications. Figure 1 and 2 are examples of axial and high thoracic cases respectively.