Concomitant intramedullary arteriovenous malformation and a vertebral hemangioma of cervical spine discovered by a pathologic fracture during bicycle accident

Superselective Anesthesia Functional Examination of the Diaphragm during Endovascular Embolization of Spinal Cord Arteriovenous Malformation

Superselective anesthesia functional evaluation (SAFE) is an adjunct to the Wada test. It is performed to rule out unintentional positioning of the tip of the embolization catheter proximal to the origin of a normal artery supplying eloquent region of spinal cord. We report a case of a 36-year-old male with cervical intramedullary spinal cord arteriovenous malformation (SCAVM) at C3 level. In this patient, we monitored motor-evoked potentials (MEPs) of bilateral upper and lower limbs along with diaphragm. Electrodes for compound muscle action potential of diaphragm were placed under fluoroscopy guidance. Through this case, we want to emphasize that intraprocedural diaphragmatic MEPs enhance the safety margin during endovascular embolization of cervical intramedullary SCAVMs. Placement of electrodes under fluoroscopy guidance ensures proper positioning into the diaphragm muscle.

Novel Intervertebral Technologies

Surgical procedures, such as spinal fusion and disk replacement, are commonly used for treatment following failure of conservative treatment in degenerative spine disease. However, there is growing consensus that currently available surgical technologies may have long-term inefficacy for successful management. Intervertebral disk degeneration is the most common manifestation of degenerative spine disease, hence, replacement/repair of this tissue is an important component of surgical treatment. Restoration of spinal alignment and preservation of natural kinematics is also essential to a good outcome. This article reviews novel intervertebral implant technologies that have the potential to significantly impact elective spine surgery for degenerative spine disease.

Prevalence of benign osseous lesions of the spine and association with spinal pain in the general population in whole body MRI

Background

Benign osseous lesions of the spine are common but precise population prevalence estimates are lacking. Our study aimed to provide the first population-based prevalence estimates and examine association with back and neck pain.

Materials and methods

We used data from the population-based Study of Health in Pomerania (SHIP). Whole-body MRI examinations (1.5 Tesla: T1, T2, and TIRM weightings) were available from 3,259 participants. Readings of the spinal MRI images were conducted according to a standardized protocol by a single reader (JS). The intra-rater reliability was greater than Kappa values of 0.98. Pain measures included the seven-day prevalence of spine pain and neck pain, and average spine pain intensity due to spine pain during the past three months.

Results

We found 1,200 (36.8%) participants with at least one osseous lesion (2,080 lesions in total). Osseous lesions were less common in men than in women (35.5% vs 38.9%; P = .06). The prevalence of osseous lesions was highest at L2 in both sexes. The prevalence of osseous lesions increased with age. Up to eight osseous lesions were observed in a single subject. Hemangioma (28%), and lipoma (13%) occurred most often. Sclerosis (1.7%), aneurysmal bone cysts (0.7%), and blastoma (0.3%) were rare. Different osseous lesions occurred more often in combination with each other. The association with back or neck pain was mostly negligible.

Conclusion

Osseous lesions are common in the general population but of no clinical relevance for spinal pain. The prevalence of osseous lesions varied strongly across different regions of the spine and was also associated with age and gender. Our population-based data offer new insights and assist in judging the relevance of osseous lesions observed on MRIs of patients.