Herpes zoster (HZ) is a common clinical condition caused by the reactivation of the latent varicella-zoster virus (VZV). Neurological complications after HZ have been described, including a rare condition of segmental zoster paresis (SZP), which results in unilateral motor impairment in the extremities. Only two cases of HZ patients with radiculopathy and MRI findings of neuritis have been reported. We present a 62-year-old male with a HZ rash in the right calf and low back pain radiating to the right leg accompanied by a right leg great toe weakness for one week. Neurological examination revealed 4/5 dorsiflexion of the right great toe. Also, the patient's rash was distributed on the L5 dermatome. The lumbar MRI showed a contrast enhancement of the right L5 nerve root with enlargement diagnosed as neuritis. The patient was treated with valacyclovir. The neuromotor deficit and the cutaneous rash started to improve on the third day of treatment. This case emphasizes the necessity of considering SZP in the differential diagnosis of elderly patients presenting with muscle weakness in the lower extremity with or without a rash. MRI evaluations of HZ patients with radiculopathy may include contrast-enhanced sequences.

The purpose of the study was to provide a 15-year natural history evaluation of the radiographic appearance of uninstrumented compensatory lumbar curves in patients who had undergone selective thoracic fusion (STF) for scoliosis, measure any changes in health-related quality of life scores (HRQoL) and compare them with controls matched for age, gender and body-mass index (BMI). STF group included 43 female adolescent idiopathic scoliosis (AIS) patients who underwent STF with mean age 33(27–42) years and a mean follow-up of 18.7 (15–28) years, mean BMI 22(18–29). Preop, early postop and follow-up radiographs were reviewed for behavior of lumbar curves. Control group included a random selection of healthy volunteers with no history of back pain and with mean age 33(27–41), and mean BMI 22(17–33). HRQoL scores were compared between two groups in latest f/up. Radiographs including low dose biplanar imaging with EOS were used to measure disc heights and assess for radiographic evidence of degenerative changes. Various parameters were statistically compared. Posterior fusion was performed in all 43, with all pedicle screws used in 41 and all-hook constructs in 2. Main thoracic curve correction was improved from pre-op to early-post-op and maintained at latest f/up (55.6°–16.1°–16.9°). Spontaneous lumbar curve correction (SLCC) was also maintained beyond 15 years (39.9°–16.6°–17.1°). Two patients developed coronal decompensation following surgery, but improved with time and were well compensated at final follow-up. Mean HRQoL scores, self-image and mental health scores were higher in STF group than control group (p < 0.05). SRS-22r pain and function, Oswestry Disability Index and Numeric Rating Scale, marital status, number of children were similar between the groups(p > 0.05). All disc heights except L5-S1 were significantly lower in STF group (p < 0.05). There was no significant difference between the groups for degenerative changes in the latest radiographs. In this group of patients, the uninstrumented lumbar curve spontaneously corrected and the correction was maintained after 18 years following surgery using STF. Mild degenerative changes were seen radiographically and HRQoL scores suggest that the psychological-functional well-being are quite good in the long term in AIS patients who have undergone STF when compared with an age–gender–BMI-matched population.

Agents that slow bone resorption (antiresorptive) and increase bone formation (anabolic) are used as medical treatment modalities in osteoporosis. Bisphosphonates (BP) are antiresorptive drugs that suppress osteoclastic activity and slow bone resorption and are recommended to be used as first-line therapy in osteoporosis treatment guidelines. For two decades, these drugs have been prescribed in our country and worldwide to treat osteoporosis and reduce the risk of fractures. However, according to the literature, atypical femoral fractures (AFF) are encountered in patients who have been using these drugs for more than five years. In this case report, we present the diagnosis, treatment, and recovery process of a patient who developed AFF after discontinuing long-term use of BP.

Study Design: Retrospective study. Objective: The aim of this study is to evaluate the clinical, neurological, and radiological outcomes of posterior vertebral column resection (PVCR) technique for treatment of thoracic and thoracolumbar burst fractures. Methods: Fifty-one patients (18 male, 33 female) with thoracic/thoracolumbar burst fractures who had been treated with PVCR technique were retrospectively reviewed. Preoperative and most recent radiographs were evaluated and local kyphosis angle (LKA), sagittal and coronal spinal parameters were measured. Neurological and functional results were assessed by the American Spinal Injury Association (ASIA) Impairment Scale, visual analogue scale score, Oswestry Disability Index, and Short Form 36 version 2. Results: The mean age was 49 years (range 22-83 years). The mean follow-up period was 69 months (range 28-216 months). Fractures were thoracic in 16 and thoracolumbar in 35 of the patients. AO spine thoracolumbar injury morphological types were as follows: 1 type A3, 15 type A4, 4 type B1, 23 type B2, 8 type C injuries. PVCR was performed in a single level in 48 of the patients and in 2 levels in 3 patients. The mean operative time was 434 minutes (range 270-530 minutes) and mean intraoperative blood loss was 520 mL (range 360-1100 mL). The mean LKA improved from 34.7° to 4.9° (85.9%). For 27 patients, the initial neurological deficit (ASIA A in 8, ASIA B in 3, ASIA C in 5, and ASIA D in 11) improved at least 1 ASIA grade (1-3 grades) in 22 patients (81.5%). Solid fusion, assessed with computed tomography at the final follow-up, was achieved in all patients. Conclusion: Single-stage PVCR provides complete spinal canal decompression, ideal kyphosis correction with gradual lengthening of anterior column together with sequential posterior column compression. Anterior column support, avoidance of the morbidity of anterior approach and improvement of neurological deficit are the other advantages of the single stage PVCR technique in patients with thoracic/thoracolumbar burst fractures.

BACKGROUND:Computed tomography (CT)-guided cervical nerve injections are broadly being used in the treatment of cervical radiculopathy; however, catastrophic complications have been reported. Herein, we aimed to evaluate the efficacy, feasibility, and safety of a novel CT-guided cervical injection technique. MATERIALS AND METHODS:We prospectively performed cervical injections in 28 patients with cervical radiculopathies using a novel CT-guided cervical transforaminal injection technique; lateral peri-isthmic approach in which the tip of the needle advanced to the lateral cortex of the isthmus instead of the foraminal area. Patients' pain reduction rates were evaluated using visual analog scores (VAS) at pre-treatment, immediately after treatment, at 3 weeks and 6 months after the treatment. Intra-vascular contrast medium injections and distribution of the contrast material into the foraminal, epidural or extraforaminal area during the procedure were noted. RESULTS:Pre-treatment pain scores were reduced by 4.2 ± 1.4 (p < 0.001), 3.9 ± 1.37 (p < 0.001) and 3.25 ± 1.53 (p < 0.001) immediately after the treatment, 3 weeks and 6 months after the treatment respectively. The number of patients with >50% pain relief as measured by VAS were 21 (75%) immediately after the procedure, 19 (67.8%) at 3 weeks and 17 (60%) at 6 months after the procedure. The injected contrast material was dispersed into the neural foramen in 9 cases (32.1%), the foraminal and epidural area in 14 cases (50%) and the extraforaminal area in 5 cases (17.9%). CONCLUSION:The CT-guided lateral peri-isthmic approach seems to be a secure and feasible method for cervical injections with satisfactory pain reduction.

Brachial plexus magnetic resonance (MR) examination of an adult female synchronized swimmer, who was suffering from right-sided arm pain and weakness while making a stroke, showed an aberrant "subclavius posticus muscle" in the parascapular region on the right side. The muscle had an attachment anteriorly on the first rib and posteriorly on to the scapula. The belly of this aberrant muscle showed proximity to the brachial plexus. Presence of such an anomalous muscle has been recognized as a possible cause of neurovascular compression or thoracic outlet syndrome (TOS). Radiologists and surgeons should be familiar with this rare entity and consider it in the differential diagnosis of TOS.

The subclavius posticus muscle (SPM) is an aberrant muscle, and the presence of the SPM has a clinical significance, since the SPM might lead to thoracic outlet syndrome (TOS). To date, no radiological study has been evaluated the prevalence of the SPM in the adult population. In this study, we aimed to assess the prevalence of the SPM using magnetic resonance imaging (MRI).

A 56-year-old female, who had accidentaly fell down was admitted with head trauma. An urgent cranial computed tomography (CT) scan showed minor right frontotemporalzygomatic superficial haemorrhage, and more caudal images of cranial CT depicted an abnormal atlas. At the time of admission, physical examination revealed no pathological findings with a full range of cervical movement and a normal neurological status. All laboratory investigations showed normal values. Due to the better demonstration of CVJ, a CT scan of the cervical spine was then performed. Total aplasia of posterior arch and midline cleft of the anterior arch of atlas were detected. There was partially anterior subluxation of right lateral mass of atlas over axis (Fig. 1,2). The pre-vertebral soft tissue at the upper cervical spine was not thickened (measuring about 4.9 mm at the C2 level on the mid-sagittal multiplanar reformat image). The distance between dens and atlas was measured 3 mm as normal. The rest of the cervical spine ABSTRACT A very rare case of the craniovertebral junction (CVJ) anomaly is reported owing to its rarity and clinical significance. Computed tomography (CT) and magnetic resonance imaging (MRI) studies of the cervical spine of a 56 -year-old female patient presented with head trauma, revealed an anterior midline arch cleft of atlas with totally aplastic posterior neural arch, as well as anteriorly subluxed right atlantoaxial joint. The coexistence of a total aplasia of the posterior neural arch and anterior arch cleft of atlas is very rare. Congenital anomalies affecting the craniovertebral junction (CVJ) may mimic traumatic injury in the setting of a previous trauma. In this presented case, the absence of an associated bone and soft-tissue edema on the MR imagings helped us to make a differention between the acute traumatic injury and congenital anomaly.

Évaluer si l’âge à l’apparition du rhumatisme psoriasique (RP) facilite la caractérisation du phénotype de la maladie.Étude rétrospective d’une cohorte de 205 patients consécutifs remplissant les critères CASPAR du RP. Les résultats de l’étude ont été évalués par des analyses univariées et multivariées en fonction de l’âge à l’apparition des atteintes cutanées et articulaires (seuil à 40 ans).Le psoriasis précoce a été associé à une atteinte cutanée plus étendue (OR : 2,3, p = 0,011), un profil axial à l’apparition de la maladie (OR : 4,6, p = 0,009) et mixte au cours de l’évolution (OR : 2,4, p = 0,019), des antécédents familiaux de psoriasis (OR : 3,1, p = 0,003) et de RP (OR : 4,0, p = 0,021) et une prévalence plus élevée de HLA-C06 (OR : 2,03, p = 0,03) et HLA-B27 (OR : 2,7, p = 0,02). L’arthrite précoce s’est caractérisée par davantage d’antécédents familiaux de RP (OR : 2,9, p = 0,007) et par la présence de HLA-B27 (OR : 5,9, p < 0,0001). L’arthrite tardive était plus souvent associée au diabète sucré (DS) (OR : 4,0, p = 0,009), à l’hypertension (OR : 2,5, p = 0,004), à la dyslipidémie (OR : 2,3, p = 0,011) et à l’obésité (OR : 1,7, p = 0,012). Le psoriasis tardif a été associé à un plus grand nombre de cas d’obésité (OR : 1,9, p = 0,035), de DS (OR : 9,4, p < 0,0001), d’hypertension (OR : 4,1, p < 0,0001) et de cardiopathie ischémique au cours du suivi (OR : 5,9, p = 0,021). Dans l’analyse multivariée, le psoriasis tardif était prédictif de la survenue de DS (OR : 12,1, p = 0,006). L’arthrite tardive a été identifiée comme un facteur de risque indépendant de l’hypertension (OR : 5,2, p = 0,039).L’âge à l’apparition de la maladie a une forte influence sur plusieurs paramètres du phénotype du RP. Il serait donc pertinent d’utiliser ce facteur descriptif comme option de stratification dans les études épidémiologiques et génétiques sur le RP.

A very rare case of the craniovertebral junction (CVJ) anomaly is reported owing to its rarity and clinical significance. Computed tomography (CT) and magnetic resonance imaging (MRI) studies of the cervical spine of a 56 -year-old female patient presented with head trauma, revealed an anterior midline arch cleft of atlas with totally aplastic posterior neural arch, as well as anteriorly subluxed right atlantoaxial joint. The coexistence of a total aplasia of the posterior neural arch and anterior arch cleft of atlas is very rare. Congenital anomalies affecting the craniovertebral junction (CVJ) may mimic traumatic injury in the setting of a previous trauma. In this presented case, the absence of an associated bone and soft-tissue edema on the MR imagings helped us to make a differention between the acute traumatic injury and congenital anomaly.

BACKGROUND CONTEXT: The disc and facet degenerations of unfused lumbar spine after surgical treatment of AIS is a debate subject.