• Annals of Clinical Neurophysiology
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• 제8권1호
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• pp.29-35
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• 2006

Background: Transcranial magnetic stimulation (TMS) is a non-invasive diagnostic method particularly suited to investigation the long motor tracts. The clinical value of TMS in most spinal cord diseases has still to be made. Diagnostic value of magnetic motor evoked potential (MEP) parameters in intramedullary spinal cord lesions was investigated. Methods: MEP elicited by TMS was recorded in 57 patients with clinically and radiologically defined intramedullary myelopathy. Twenty five patients with cervical myelopathy (CM) and 32 thoracic myelopathy (TM) were included. Recordings were performed during resting and minimal voluntary contraction at both abductor pollicis brevis (APB) and tibialis anterior (TA) muscles. Stimulation threshold(ST), amplitude, and central motor conduction time (CCT) were measured at resting and facilitated conditions. CCT was calculated by two means; central motor latency (CML)-M using magnetic transcranial and root stimulation, and CML-F using electrical F-wave study. The results were compared between patient groups and 10 normal control group. Results: Facilitated mean ST recorded at TA was elevated in both CM and TM compared with control group. Resting mean CML-M at TA was significantly prolonged in both CM and TM, and CML-M was absent or delayed in 37.1% of CM and 8% of TM at APB with facilitation. Facilitated mean MEP amplitude at ABP was lower in CM than in TM, while MEP/M ratios were not different significantly between groups. Conclusions: Magnetic motor evoked potential has diagnostic value in intramedullary myelopathy and localizing value in differentiating between CM and TM by recording at APB and TA. It is a noninvasive way to investigate the functional status of motor tracts of spinal cord.

• Journal of Korean Neurosurgical Society
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• 제65권5호
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• pp.719-729
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• 2022

Objective : The ossification of the ligamentum flavum (OLF) is one of the major causes of thoracic myelopathy. Surgical decompression with or without instrumented fusion is the mainstay of treatment. However, few studies have reported on the added effect of instrumented fusion. The objective of this study was to compare clinical and radiological outcomes between surgical decompression without instrumented fusion (D-group) and that with instrumented fusion (F-group). Methods : A retrospective review was performed on 28 patients (D-group, n=17; F-group, n=11) with thoracic myelopathy due to OLF. The clinical parameters compared included scores of the Japanese Orthopedic Association (JOA), the Visual analogue scale of the back and leg (VAS-B and VAS-L), and the Korean version of the Oswestry disability index (K-ODI). Radiological parameters included the sagittal vertical axis (SVA), the pelvic tilt (PT), the sacral slope (SS), the thoracic kyphosis angle (TKA), the segmental kyphosis angle (SKA) at the operated level, and the lumbar lordosis angle (LLA; a negative value implying lordosis). These parameters were measured preoperatively, 1 year postoperatively, and 2 years postoperatively, and were compared with a linear mixed model. Results : After surgery, all clinical parameters were significantly improved in both groups, while VAS-L was more improved in the F-group than in the D-group (-3.4±2.5 vs. -1.3±2.2, p=0.008). Radiological outcomes were significantly different in terms of changes in TKA, SKA, and LLA. Changes in TKA, SKA, and LLA were 2.3°±4.7°, -0.1°±1.4°, and -1.3°±5.6° in the F-group, which were significantly lower than 6.8°±6.1°, 3.0°±2.8°, and 2.2°±5.3° in the D-group, respectively (p=0.013, p<0.0001, and p=0.037). Symptomatic recurrence of OLF occurred in one patient of the D-group at postoperative 24 months. Conclusion : Clinical improvement was achieved after decompression surgery for OLF regardless of whether instrumented fusion was added. However, adding instrumented fusion resulted in better outcomes in terms of lessening the progression of local and regional kyphosis and improving leg pain. Decompression with instrumented fusion may be a better surgical option for thoracic OLF.

• Journal of Korean Neurosurgical Society
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• 제30권10호
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• pp.1237-1240
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• 2001

Spontaneous herniation of the spinal cord is a very rare. It's clinical symptom presents with progressive myelopathy. A 42-year old male patient who presented the progressive left leg weakness and Brown-Seqaurd syndrome is presented. MRI showed a typical finding of dural defect and herniation of the cord on the level of T3-4. Repair of dural defect using an artificial dura and reposition of cord herniation were undertaken after three level laminectomies with SSEP monitoring. Postoperatively, symptoms were improved rapidly. In our knowledgement, this is first case being reported in Korea. This entity, although rare, should be considered in the differential diagnosis of myelopathy in the absence of a mass lesion.

• The Korean Journal of Pain
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• 제22권3호
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• pp.245-248
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• 2009

Ossification of the yellow ligament (OYL) is a pathologic condition that causes spinal stenosis, which is a form of ectopic ossification. OYL causes compressive myelopathy and radiculopathy. Although the pathogenesis of OYL is still unclear, diffuse mechanical stresses and degenerative changes caused by extreme ranges of motion may be related to the development of OYL in young sportsmen. Here we report an interesting case of thoracic radiculopathy due to OYL in a 35-year-old male amateur judo player who was successfully treated with continuous thoracic patient controlled epidural analgesia and epidural adhesiolysis.

• Journal of Korean Neurosurgical Society
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• 제40권1호
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• pp.58-62
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• 2006

Objective : Development of diagnostic tools has resulted in early detection of thoracic disc herniations[TDH] even when the herniated disc is soft in consistency. In some of the cases, it is considered better not to opt for surgical treatment due to the unduly high morbidity and potential complications associated with conventional approaches. The authors have applied percutaneous endoscopic thoracic discectomy[PETD] technique to soft TDHs in order to avoid the morbidity associated with conventional approaches. Methods : Eight consecutive patients [range, 31 to 75 years] with soft lateral or central TDH [from T2-3 to T11-12] underwent PETD between May 2001 and June 2004. The patient was positioned in a prone position with intravenous sedation and local anesthetic infiltration. The authors introduced a cannula into the thoracic intervertebral foramen using endoscopic foraminoplasty technique. Discectomy was performed with mechanical tools and a laser under continuous endoscopic visualization and flu oroscopic guidance. Functional status was assessed preoperatively and postoperatively using the Oswestry Disability Index[ODI]. Results : The mean ODI scores improved from 52.8 before the surgery to 25.8 at the final follow-up. In cases of myelopathy, long tract signs showed improvement. The mean operative time was 55 minutes, and no patient required conversion to open surgery. Conclusion : The technique allows a smaller incision and less morbidity. Soft TDH is amenable to this minimally invasive approach in selected patients with myeloradiculopathy.

• Journal of Korean Neurosurgical Society
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• 제50권4호
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• pp.392-395
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• 2011

Idiopathic hypertrophic spinal pachymeningitis (IHSP) is a rare inflammatory disease characterized by hypertrophic inflammation of the dura mater and various clinical courses that are from myelopathy. Although many associated diseases have been suggested, the etiology of IHSP is not well understood. The ideal treatment is controversial. In the first case, a 55-year-old woman presented back pain, progressive paraparesis, both leg numbness, and voiding difficulty. Initial magnetic resonance imaging (MRI) demonstrated an anterior epidural mass lesion involving from C6 to mid-thoracic spine area with low signal intensity on T1 and T2 weighted images. We performed decompressive laminectomy and lesional biopsy. After operation, she was subsequently treated with steroid and could walk unaided. In the second case, a 45-year-old woman presented with fever and quadriplegia after a spine fusion operation due to lumbar spinal stenosis and degenerative herniated lumbar disc. Initial MRI showed anterior and posterior epidural mass lesion from foramen magnum to C4 level. She underwent decompressive laminectomy and durotomy followed by steroid therapy. However, her conditions deteriorated gradually and medical complications occurred. In our cases, etiology was not found despite through investigations. Initial MRI showed dural thickening with mixed signal intensity on T1- and T2-weighted images. Pathologic examination revealed chronic nonspecific inflammation in both patients. Although one patient developed several complications, the other showed slow improvement of neurological symptoms with decompressive surgery and steroid therapy. In case of chronic compressive myelopathy due to the dural hypertrophic change, decompressive surgery such as laminectomy or laminoplasty may be helpful as well as postoperative steroid therapy.

• Annals of Clinical Neurophysiology
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• 제10권2호
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• pp.109-111
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• 2008

Ossification of the ligamentum flavum (OLF) usually occurs in the lower thoracic spine, and is rare in the cervical region. We report the case of a 67-year-old woman who presented a seven month's history of progressive weakness and paresthesia in her right upper extremity. MRI and CT scans of the spine revealed the presence of ossified ligamentum flavum from C3-C4. A cervical laminectomy resulted in a good post-operative improvement of muscle strength.

• Journal of Korean Neurosurgical Society
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• 제54권3호
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• pp.257-260
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• 2013

A 61-year-old woman with a very rare case of totally ossified large thoracic spinal metaplastic meningioma, showing progressing myelopathy is presented. Computed tomographic images showed a large totally ossfied intradural round mass occupying the spinal canal on T9-10 level. Magnetic resonance imaging revealed a large T9-10 intradural extramedullary mass that was hypointense to spinal cord on T1- and T2-weighted sequences, partial enhancement was apparent after Gadolinium administration. The spinal cord was severely compressed and displaced toward the right at the level of T9-10. Surgical removal of the tumor was successfully accomplished via the posterior midline approach and the histological diagnosis verified an ossified metaplastic meningioma. The clinical neurological symptoms of patient were improved postoperatively. In this article we discuss the surgical and pathological aspects of rare case of spinal totally ossified metaplastic meningioma.

• Journal of Korean Neurosurgical Society
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• 제58권4호
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• pp.389-392
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• 2015

Brown tumors also called as osteoclastomas, are rare nonneoplastic lesions that arise in the setting of primary or secondary hyperparathyroidism. Parathyroid adenomas or hyperplasia constitute the major Brown tumor source in primary hyperparathyroidism while chronic renal failure is the leading cause in secondary hyperparathyroidism. Most of the patients with the diagnosis of primary hyperparathyroidism present with kidney stones or isolated hypercalcemia. However, nearly one third of patients are asymptomatic and hypercalcemia is found incidentally. Skeletal involvement such as generalized osteopenia, bone resorption, bone cysts and Brown tumors are seen on the late phase of hyperparathyroidism. The symptoms include axial pain, radiculopathy, myelopathy and myeloradiculopathy according to their locations. Plasmocytoma, lymphoma, giant cell tumors and metastates should be ruled out in the differential diagnosis of Brown tumors. Treatment of Brown tumors involve both the management of hyperparathyroidism and neural decompression. The authors report a very rare spinal Brown tumor case, arisen as the initial manifestation of primary hyperparathyroidism that leads to acute paraparesis.

• Journal of Korean Neurosurgical Society
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• 제29권12호
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• pp.1642-1649
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• 2000

Objectives : Transverse myelitis(TM) is characterized by bilateral motor, sensory, and autonomic dysfunction of the spinal cord in the absence of pre-existing neurologic disease. It is an uncommon but not rare condition. But it remains as poorly understood syndrome not only etiologically but also in terms of its clinical behavior. Neurosurgically, It is often quite difficult to distinguish from other surgical intramedullary lesions. We present our clinical experiences of TM in order to assess its clinical behavior and to define the radiological characteristics that can distinguish TM from other intramedullary lesions. Methods : From June 1991 to May 1997, twenty-nine patients with transverse myelitis were admitted to our department. All cases revealed acute or subacute syndrome of non-compressive myelopathy and intramedullary lesions in the MRI. We analyze the radiological data and medical records retrospectively. Results : Patients ranged in age from 16 to 66 years, with 22 males and 7 females. Mean follow-up period was 53 months. For the offending levels, cervical was 5, thoracic 21, and lumbar 3 in number. The patients who presented the return of symptoms after a diminution or abatement of initial symptoms were 7(24%). In the MRI, TM showed typical characteristics of high signal intensity lesions in the center of spinal cord in T2 weighted images and low- to iso-signal intensity in T1 weighted images. A focal nodular enhancement pattern was observed in 58.6%(17/29) of the patients. MR follow-up studies were done in the 21 patients and radiological improvement were verified. Biopsies were done in 3 patients. Normal to good outcome was achieved in 62% of the patients. Conclusion : Transverse myelitis has characteristic radiological findings that can be distinguished from other intramedullary lesions. In our series, it is associated with significant recurrence rates thus, should not be considered a selflimiting disease with good prognosis.