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Yamada T, Ueno T, Kato F, Matsuyama Y, Yamada H, Yukawa Y. Intraforaminal cervical gas cyst with vacuum disc treated by anterior cervical discectomy and fusion: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21638. [PMID: 36273861 PMCID: PMC9379676 DOI: 10.3171/case21638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/27/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The authors report an extremely rare presentation of a patient with an intraforaminal cervical gas cyst with radiculopathy. The patient’s condition was refractory to conservative treatment, and he was treated by anterior cervical discectomy and fusion (ACDF). Several intraspinal gas cysts with lumbar disc herniation have been treated surgically. However, no cases of intraforaminal cervical gas requiring ACDF have been reported. OBSERVATIONS A 70-year-old male patient presented with right-sided neck and shoulder pain, aggravating in the supine position. Cervical radiography showed vacuum disc phenomenon at C4–5, and multiplanar computed tomography showed intraforaminal gas along the right C5 nerve root. The patient experienced severe pain with impaired sleep and daytime fatigue. After confirming C5 radiculopathy using an echo-guided technique using ultrasonography guidance, the authors performed C4–5 ACDF. Postoperatively, the patient’s neck and shoulder pain disappeared immediately. There was no recurrence at the 2-year follow-up. LESSONS This is the first case report of an intraspinal cervical gas cyst with radiculopathy treated by ACDF surgery. The vacuum disc had been implicated as the genesis of the intraforaminal cervical gas cyst, leading to radiculopathy. ACDF surgery provides favorable outcomes in cases of intraspinal gas refractory to conservative therapy.
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Affiliation(s)
- Tomohiro Yamada
- Department of Orthopedic Surgery, Nagoya Kyoritsu Hospital, Aichi, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan; and
| | - Takeru Ueno
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Nagoya Kyoritsu Hospital, Aichi, Japan
| | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan; and
| | - Hiroshi Yamada
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Yasutsugu Yukawa
- Department of Orthopedic Surgery, Nagoya Kyoritsu Hospital, Aichi, Japan
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
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Kudo S, Kawasumi Y, Usui A, Igari Y, Funayama M, Ueda T, Ishibashi T, Saito H. Cervical intervertebral separation caused by trauma on post-mortem computed tomography: Possibility of a diagnosis based on intervertebral gas. Forensic Sci Int 2021; 330:111049. [PMID: 34844118 DOI: 10.1016/j.forsciint.2021.111049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 09/28/2021] [Accepted: 10/05/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Gas is a common finding in cervical intervertebral separation. However, intervertebral gas is also found in many decedents without intervertebral separation. Here, we quantified intervertebral gas and examined its value in the diagnosis of cervical intervertebral separation. METHODS We retrospectively reviewed data from 1118 decedents who underwent post-mortem computed tomography (CT) and autopsy from May 2011 to July 2016 and selected those with cervical intervertebral gas with or without intervertebral separation. These data comprised 56 cervical intervertebral spaces with gas [intervertebral separation in 19 (33.9%)] in 43 subjects [intervertebral separation in 17 (39.5%)]. We categorised the decedents according to gas volume, position, and shape and determined the significance of the differences between the decedents with and without separation. RESULTS The gas volume did not differ significantly between decedents with and without separation (p = 0.063). However, there were significant differences in the gas position between decedents with and without separation. In the sagittal plane: gas was seen in the "centred" position in the ventral-to-dorsal direction in more decedents without separation than in those with separation (p = 0.018). Gas was seen in the ventral-to-dorsal positions in more decedents with separation than in those without separation (p = 0.049). In the cranio-caudal direction, gas in the upper position was more common in decedents with separation than in those without separation in the sagittal plane (p = 0.03). In the coronal plane: gas was seen in the upper position more frequently in decedents with separation in the cranio-caudal direction than in those without separation (p = 0.001). A significant difference in gas shape was observed only in the coronal plane (p = 0.024); irregular gas was associated with decedents without separation. CONCLUSION Gas in the ventral-to-dorsal and upper positions in the sagittal plane and in the upper position in the coronal plane was rather indicative of cervical intervertebral separation. An irregular gas shape in the coronal plane was indicative of degenerative changes.
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Affiliation(s)
- Seina Kudo
- Tohoku University Graduate School of Medicine, Department of Clinical Imaging, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan.
| | - Yusuke Kawasumi
- Tohoku University Graduate School of Medicine, Department of Clinical Imaging, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Akihito Usui
- Tohoku University Graduate School of Medicine, Department of Diagnostic Image Analysis, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Yui Igari
- Tohoku University Graduate School of Medicine, Department of Forensic Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Masato Funayama
- Tohoku University Graduate School of Medicine, Department of Forensic Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Takuya Ueda
- Tohoku University Graduate School of Medicine, Department of Clinical Imaging, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Tadashi Ishibashi
- Tohoku University Graduate School of Medicine, Department of Clinical Imaging, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Haruo Saito
- Tohoku University Graduate School of Medicine, Department of Diagnostic Image Analysis, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
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Evirgen Ş, Yüksel HT, Yüksel G, Kaki B, Kamburoğlu K. Assessment of intravertebral pneumatocysts, degenerative joint disease, and ponticulus posticus in the cervical spine through cone beam computed tomography examination. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 129:531-538. [DOI: 10.1016/j.oooo.2019.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/28/2019] [Accepted: 10/05/2019] [Indexed: 10/25/2022]
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Stäbler A, Eck J, Penning R, Milz SP, Bartl R, Resnick D, Reiser M. Cervical spine: postmortem assessment of accident injuries--comparison of radiographic, MR imaging, anatomic, and pathologic findings. Radiology 2001; 221:340-6. [PMID: 11687673 DOI: 10.1148/radiol.2212010336] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the ability of postmortem radiography and magnetic resonance (MR) imaging to depict occult cervical spine injuries as compared with anatomic and pathologic findings. MATERIALS AND METHODS The cervical spines of 10 adult accident victims underwent radiography and MR imaging, with T1-weighted, fast spin-echo T2-weighted, and four gradient-echo pulse sequences. The frozen specimens were cut into 3-mm-thick slices (sagittal plane) and photographed, and microfocus radiographs were obtained. Imaging findings were compared with the anatomic and pathologic findings. RESULTS Eight of the 10 specimens had 28 posttraumatic lesions: three fractures (two missed at the initial MR imaging reading), 10 facet joint capsule lesions with bleeding, five soft-tissue and ligament lesions, eight disk lesions, and two spinal cord lesions. Radiography depicted one lesion (4%). Two partial ruptures of the anterior annulus fibrosus were depicted at only MR imaging. Initially, 11 of 28 lesions were detected on MR images; retrospectively, 17 of 28 lesions were correlated with anatomic findings. CONCLUSION Soft-tissue and intervertebral disk and ligament injuries account for 89% (25 of 28) of posttraumatic cervical spine lesions detected on postmortem images. Occult lesions, including apophyseal joint injuries, were found in clinically noninjured cervical spines. MR imaging was limited in the depiction of discrete lesions when T1-weighted non-fat-saturated, fast spin-echo T2-weighted, and gradient-echo pulse sequences were used.
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Affiliation(s)
- A Stäbler
- Department of Clinical Radiology, University Hospital Ludwig-Maximilians-University Munich, Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany.
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Fornasier VL, Garaffo G, Denaro L, Denaro V. Intervertebral disc degeneration - an autopsy study. ACTA ACUST UNITED AC 2000. [DOI: 10.1007/bf01682308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Boutin RD, Steinbach LS, Finnesey K. MR IMAGING OF DEGENERATIVE DISEASES IN THE CERVICAL SPINE. Magn Reson Imaging Clin N Am 2000. [DOI: 10.1016/s1064-9689(21)00620-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Intervertebral disc degeneration of any etiology may be associated with the formation of spaces or clefts within the disc. Gas collects within these spaces and can be seen roentgenographically. A case is presented in which intradiscal gas herniated into a connective tissue capsule, displacing the left S-1 nerve root and producing symptoms and signs identical to those of a herniated nucleus pulposus. The pathophysiology of gas within a disc space and the possibility that it may herniate much like the nucleus pulposus is discussed.
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Affiliation(s)
- G F Ricca
- Department of Neurosurgery, University of Tennessee, Memphis
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Harris JH, Yeakley JS. Radiographically subtle soft tissue injuries of the cervical spine. Curr Probl Diagn Radiol 1989; 18:161-90. [PMID: 2666030 DOI: 10.1016/0363-0188(89)90016-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- J H Harris
- Department of Radiology, University of Texas Medical School, Houston
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Abstract
Thirty-eight annulus vacuums in 27 patients were analyzed with regard to location, configuration, and associated vertebral abnormalities such as degenerative changes, absent and compressed anterosuperior vertebral body corners, and annulus calcification. It is concluded that most annulus vacuums are a degenerative phenomenon at the attachment of the annulus to bone. These vacuums may be associated with other degenerative changes such as osteophytes and annulus calcification. Vacuums have a strong association with compressed anterosuperior corners. These deformed corners are thought to be early osteophytes and may be related to previous trauma, a vertebra with an absent corner, and/or normal motion. Small annulus vacuums adjacent to vertebral corners with a normal appearance are more likely to result from acute trauma.
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Affiliation(s)
- S P Bohrer
- Department of Radiology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27103
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Abstract
An annulus vacuum sign at the anterosuperior or anteroinferior margin of a cervical interspace in extension may be due to an acute hyperextension injury with tearing of Sharpey fibers allowing the annulus fibrosus to separate from the adjacent bone. The sign is not pathognomonic of this injury as has been implied in the literature. It can be due to an old hyperextension injury and is seen in degenerative disease of the annulus without any acute trauma. In addition, a pseudovacuum sign may be very difficult to distinguish from a true vacuum sign.
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Hahn PF, Rosenthal DI, Ehrlich MG. Case report 286: gas within a solitary bone cyst of the proximal end of the left humerus. Skeletal Radiol 1984; 12:214-7. [PMID: 6494941 DOI: 10.1007/bf00361091] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Isu T, Miyasaka K, Iwasaki Y, Ito T, Tsuru M, Takei H, Abe S. Computed tomographic findings of vacuum phenomenon in cervical intervertebral disks. SURGICAL NEUROLOGY 1983; 19:528-31. [PMID: 6857482 DOI: 10.1016/0090-3019(83)90377-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A gaseous collection in the intervertebral space, or the vacuum phenomenon, was observed on computed tomograms in as many as 30% of the patients with cervical disk disease. The condition most frequently occurred at the level of C5-6. The gas tended to accumulate more often at the marginal region of the intervertebral disks, the level at which marked degeneration was seen; thus, it may be related to cracks within not only the nucleus pulposus, but also in the annulus fibrosus.
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Abstract
Failure to diagnose a fracture of the spine may lead to spinal cord damage due to incorrect handling of the patient. The three most common causes of failure to radiologically diagnose a fracture of the cervical spine after injury are: (1)inadequate demonstration of the entire cervical spine on the lateral view; (2) Failure to X-ray the cervical spine after head injury; (3) Incorrect interpretation of the radiological appearances. The relevant radiological features are discussed.
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