• Neurospine
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• 제15권4호
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• pp.388-393
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• 2018

Objective: Computed tomography following myelography (CTM) revealed an unusual flow of contrast dye into the anterior median fissure (AMF) in a patient with cervical spondylotic myelopathy. Since then, several AMF configurations have been observed on CTM. Therefore, we evaluated morphological patterns of the AMF on CTM and investigated the significance and mechanisms of contrast dye flow into the AMF. Methods: Morphological patterns of the AMF on CTM were examined in 79 patients. Group A (24 patients) underwent surgery because of symptomatic cervical myelopathy. Group B (43 patients) had no clinical symptoms but showed spinal cord compression on CTM. Group C (12 patients), who showed neither clinical symptoms nor cord changes, underwent CTM for lumbar lesion evaluation. AMF patterns were classified into 4 types according to their configurations on CTM (reversed T, Y, V, and O types). Results: In group B, the reversed T type and Y type appeared significantly more often near the compressed portion (p<0.001). A similar tendency was seen in group A. The V and O types were most frequently observed in group C (p<0.001). Conclusion: On CTM, contrast dye tends to flow into the AMF of the cervical cord when the spinal cord is compressed. We speculate that there may be 3 possible mechanisms for this phenomenon: deformation of the epipial layer of the AMF due to cervical cord compression, AMF dilatation due to atrophy of the anterior funiculus or anterior horn, and temporary AMF dilatation when it becomes an alternative route for cerebrospinal fluid circulation.

• Journal of Korean Neurosurgical Society
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• 제65권1호
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• pp.13-21
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• 2022

Objective : Nontraumatic subdural hematoma (SDH) is a common disease, and spinal cerebrospinal fluid (CSF) leakage is a possible etiology of unknown significance, which is commonly investigated by several invasive studies. This study demonstrates that heavily T2-weighted magnetic resonance myelography (HT2W-MRM) is a safe and clinically effective imaging modality for detecting CSF leakage in patients with nontraumatic SDH. Methods : All patients who underwent HT2W-MRM for nontraumatic SDH workup at our institution were searched and enrolled in this study. Several parameters were measured and analyzed, including patient demographic data, initial modified Rankin Scale (mRS) score upon presentation, SDH bilaterality, hematoma thickness upon presentation, CSF leakage sites, treatment modalities, follow-up hematoma thickness, and follow-up mRS score. Results : Forty patients were identified, of which 22 (55.0%) had CSF leakage at various spinal locations. Five patients (12.5%) showed no change in mRS score, whereas the remaining (87.5%) showed decreases in follow-up mRS scores. In terms of the overall hematoma thickness, four patients (10.0%) showed increased thickness, two (5.0%) showed no change, 32 (80.0%) showed decreased thickness, and two (5.0%) did not undergo follow-up imaging for hematoma thickness measurement. Conclusion : HT2W-MRM is not only safe but also clinically effective as a primary diagnostic imaging modality to investigate CSF leakage in patients with nontraumatic SDH. Moreover, this study suggests that CSF leakage is a common etiology for nontraumatic SDH, which warrants changes in the diagnosis and treatment strategies.

• Journal of Veterinary Science
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• 제21권6호
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• pp.84.1-84.11
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• 2020

Background: Gastroesophageal reflux (GER) has been reported to be a common finding in dogs under general anesthesia. Objectives: The aim of this retrospective study was to assess the esophageal and gastric contents in a population of dogs undergoing computed tomographic myelography (myeloCT) examination and to evaluate the factors influencing the presence of esophageal fluid (gastric content, duration of anesthesia, body position, and intrinsic factors). Methods: Esophageal and gastric contents of 83 non-brachycephalic dogs were retrospectively assessed based on plain and myelo-CT scans. Age, weight, breed, sex, and the time between the 2 computed tomography [CT] scans were included. Results: Esophageal fluid was present in 19% (16/83) of the animals, and 14% (12/83) and 46% (37/83), respectively, had fluid or food material in their stomachs. The frequency of observing esophageal fluid on myelo-CT scans was significantly increased compared with plain CT scans (p = 0.006). The presence of gastric fluid was significantly associated with an increased frequency of observing esophageal fluid compared to other gastric contents (p = 0.049; odds ratio, 3.1). The presence of esophageal fluid was not correlated with alimentary gastric contents (p = 0.17). Increased body weight and duration of anesthesia were significantly associated with an increased frequency of observing esophageal fluid (p = 0.022, p = 0.021). Conclusions: Unlike alimentary gastric contents, fluid gastric contents were correlated with the presence of esophageal fluid upon myelo-CT. The observation of fluid in the esophagus may be consistent with GER. This study provides data additional to pH monitoring studies of GER and may support previous studies recommending shorter pre-anesthetic fasting periods in dogs.

• 한국임상수의학회지
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• 제21권2호
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• pp.177-180
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• 2004

Lower motor neuron signs of hind limbs, anus and bladder were identified by history taking and physical examination in the 6.8 year-old mongrel dog and 2.6 year-old Cocker spaniel. The Cocker spaniel, also showed gradual cranial migration of neurologic deficit including respiratory paralysis. On plain radiography and myelography, intervertebral disc extrusion between L2 and L3, the infiltration of contrast medium into the spinal cord and cord swelling were found in the mongrel dog, and infiltration of contrast medium like hollowness of cord parenchyma was observed in the Cocker spaniel. On the basis of clinical signs and radiographic findings, they were diagnosed tentatively as acute myelomalacia. The Cocker spaniel died of respiratory paralysis on the following day. Decompressive surgery was performed on the mongrel dog and the extensive necrosis and hemorrhage were found at surgery. It was euthanized with the owner's consent because of the perceived poor prognosis. Histopathologic examination after autopsy confirmed acute diffuse hemorrhagic myelomalacia with the swelling and the inflammation of axon, showing hemorrhagic changes in the white matter and the grey matter.

• Journal of Korean Neurosurgical Society
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• 제30권8호
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• pp.1042-1046
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• 2001

경추간판탈출증 환자에서 척수조술을 위해 요추천자를 시행한 후에 갑자기 양하지마비가 발생한 1례를 보고 한다. 척추종괴환자에서 요추천자후 합병증으로 나타나는 운동마비는 요추천자후 1~4일째에 서서히 오는 경우가 일반적이며, 수시간내에 급성으로 하지마비를 나타내는 경우는 매우 드물어 현재까지 6례 정도만 보고되고 있을뿐이며 그 원인질환은 대부분 척수종양이다. 경추간판탈출증 환자에서 척수조술을 위해 요추천자를 시행한 후에 갑자기 양하지마비가 발생한 임상보고례는 현재까지 없다. 이러한 합병증을 막기위해서는 척수장애증상을 보이는 경추간판탈출증 환자에게 척수조술대신에 자기공명촬을 시행함이 현명하리라 본다. 이러한 합병증이 올 수 있는 기전과 예방방법에 대해 고찰하다.

• 한국임상수의학회지
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• 제14권1호
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• pp.126-130
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• 1997

10개월경의 그리폰 벤딘 수컷 강아지가 8개월경부터 점점 운동 실조 및 마비증상을 나타내어 머독대학 동물병원에 내원 하였다. 내원 했을 때 주변에 매우 민감한 반응과 경계를 늦추지 않았지만 호흡과 심박수 및 체온은 정상이었다. 일반 방사선 사진 및 척수조영사진(myelography)을 촬영하여 확인한 결과 환축추의 불안정에 따른 척수의 복측 압박을 확인할 수 있었다. 외과적 고정은 복측 접근을 통하여 2개의 키르크너 강선(Kirschner wire)과 자가골이식을 실시하였으며 8주동안 외부 고정을 하였다. 수술 후 5개월 동안 지켜본 결과 증상은 꾸준히 좋아졌으며 환축추 관절으 관절고정술(arthrodesis)은 완벽한 고정을 유지하고 있었다.

• 한국임상수의학회지
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• 제27권2호
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• pp.179-182
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• 2010

경추 척추척수증(CSM)은 소형 품종 견에서 드물게 발병하는 질병이다. 두 마리의 중성화 하지 않은 페키니즈(체중 5 kg 이하)가 경부 통증과 마비성 보행을 주증으로 내원하였다. 영상 진단을 통해 척추 불안정성에 의한 CSM으로 진단하고, 배쪽 창냄술과 해면질골 이식, 외고정을 조합한 방법을 적용하였다. 수술 후 임상 증상이 현저하게 개선되었고 합병증이나 재발은 없었다. 경추의 척추척수증이 있는 소형 품종 견에서 배쪽 창냄술을 통한 감압과 골 유합을 통한 안정화를 조합한 방법은 효과적인 치료법임을 확인하였다.

• Journal of Chest Surgery
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• 제43권3호
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• pp.332-335
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• 2010

악성 고립성 섬유종은 비교적 드문 종양으로 흉막, 횡격막, 후복막 및 심낭 등에서 발생할 수 있으며, 남녀 발생 빈도는 비슷하고 60~70세 사이에 호발하나 10대의 어린 나이에도 발생하는 경우가 있다. 17세 남자에서 악성 고립성 섬유종에 의해 인접한 좌측 9번째 늑골의 형태학적 변화가 있어 섬유종의 제거 및 늑골 근위부의 부분적 절제술을 시행하였다. 술 후 뇌척수액의 흉강 내로의 누출을 CT myelography로 확인 후 뇌척수액의 배액 및 부분적 반측 추궁 절제술 및 경질막 복원술을 통한 교정을 치험하여 발표하고자 한다.

• Journal of Korean Neurosurgical Society
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• 제46권4호
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• pp.317-321
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• 2009

Objective : In the thoracic spine, insertion of a pedicle screw is annoying due to small pedicle size and wide morphological variation between different levels of the spine and between individuals. The aim of our study was to analyze radiologic parameters of the pedicle morphometry from T1 to T8 using computed tomographic myelography (CTM) in Korean population. Methods : For evaluation of the thoracic pedicle morphometry, the authors prospectively analyzed a consecutive series of 26 patients with stable thoracic spines. With the consent of patients, thoracic CTM were performed, from T1 to T8. We calculated the transverse outer diameters and the transverse angles of the pedicle, distance from the cord to the inner cortical wall of the pedicle, and distance from the cord to the dura. Results : Transverse outer pedicle diameter was widest at T1 ($7.66{\pm}2.14\;mm$) and narrowest at T4 ($4.38{\pm}1.55\;mm$). Transverse pedicle angle was widest at T1 ($30.2{\pm}12.0^{\circ}$ and it became less than $9.0^{\circ}$ below T6 level. Theoretical safety zone of the medial perforation of the pedicle screw, namely, distance from the cord to inner cortical wall of the pedicle was more than 4.5 mm. Conclusion : Based on this study, we suggest that the current pedicle screw system is not always suitable for Korean patients. Computed tomography is required before performing a transpedicular screw fixation at the thoracic levels.

• Journal of Korean Neurosurgical Society
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• 제60권5호
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• pp.540-549
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• 2017

Objective : To evaluate the diagnostic value of computed tomography-myelography (CTM) compared to that of magnetic resonance imaging (MRI) in patients with lumbar radiculopathy. Methods : The study included 91 patients presenting with radicular leg pain caused by herniated nucleus pulposus or lateral recess stenosis in the lumbar spine. The degree of nerve root compression on MRI and CTM was classified into four grades. The results of each imaging modality as assessed by two different observers were compared. Visual analog scale score for pain and electromyography result were the clinical parameters used to evaluate the relationships between clinical features and nerve root compression grades on both MRI and CTM. These relationships were quantified by calculating the receiver-operating characteristic curves, and the degree of relationship was compared between MRI and CTM. Results : McNemar's test revealed that the two diagnostic modalities did not show diagnostic concurrence (p<0.0001). Electromyography results did not correlate with grades on either MRI or CTM. The visual analog pain scale score results were correlated better with changes of the grades on CTM than those on MRI (p=0.0007). Conclusion : The present study demonstrates that CTM could better define the pathology of degenerative lumbar spine diseases with radiculopathy than MRI. CTM can be considered as a useful confirmative diagnostic tool when the exact cause of radicular pain in a patient with lumbar radiculopathy cannot be identified by using MRI. However, the invasiveness and potential complications of CTM are still considered to be pending questions to settle.