BACKGROUND: Wilms tumor (WT), also known as nephroblastoma, is rare in adults, accounting for merely 3% of all nephroblastomas or 0.2 cases per million individuals. Extrarenal Wilms tumor (ERWT) emerges outside the renal boundaries and comprises 0.5 to 1% of all WT cases, with even rarer incidences in adults. Oncogenic mutations associated with ectopic nephrogenic rests (NR) may contribute to ERWT development. Diagnosis involves surgical resection and pathology examination. Due to scarce cases, adults often rely on pediatric guidelines. We thoroughly searched PubMed, Scopus, and Web of Science databases to establish our case\'s uniqueness. To the best of our knowledge, this is the first documented incidence of extrarenal Wilms tumor within the spinal canal in the adult population.
METHODS: A 22-year-old woman with a history of congenital lipo-myelomeningocele surgery as an infant presented with a 6-month history of back pain. This pain gradually resulted in limb weakness, paraparesis, and loss of bladder and bowel control. An MRI showed a 6 × 5 × 3 cm spinal canal mass at the L4-S1 level. Consequently, a laminectomy was performed at the L4-L5 level to remove the intramedullary tumor. Post-surgery histopathology and immunohistochemistry confirmed the tumor as ERWT with favorable histology without any teratomatous component.
CONCLUSIONS: This report underscores the rarity of extrarenal Wilms tumor (ERWT) in adults, challenging conventional assumptions about its typical age of occurrence. It emphasizes the importance of clinical awareness regarding such uncommon cases. Moreover, the co-occurrence of spinal ERWTs and a history of spinal anomalies warrants further investigation.

OBJECTIVE: The efficacy of medical treatments and the changes in radiologic imaging before and after treatment have consistently remained pivotal factors. This is particularly critical for surgical procedures, where precise evaluation of disparities pre and postsurgery or the accuracy of implantation is paramount. Based on three-dimensional morphological interests, we provide an automatic quantification evaluation method that delivers an evident base for assessing the outcomes of a widely employed surgical technique, cervical laminoplasty.
METHODS: The sample study included patients who underwent cervical laminoplasty for cervical spondylotic myelopathy/ossification of the longitudinal ligament. We present a superimposition method that facilitates a unique and precise assessment between pre and postsurgery. The degree of expansion was evaluated by the canal volume increase and canal expansion rate after surgery.
RESULTS: There were 31 patients with 112 vertebral segments measured. The target cervical\'s pre and postoperative canal areas were 122.63 ± 30.34 and 196.50 ± 37.10 mm2, respectively (P < 0.001). The average cervical canal expansion rate was 64.42%. The expansion effect of C5 cervical laminoplasty was the maximum (71.01%), and the canal volume of other segments expanded by approximately 60%. The functional outcomes demonstrated significant improvements in symptoms.
CONCLUSIONS: The quantification evaluation method can be utilized for any morphology changes before and after laminoplasty, as it does not lead to errors or variations from different inspection machines or human factors. The automatic method delivers an evident base for assessing the outcomes of a widely employed surgical technique.

OBJECTIVE: No standardized magnetic resonance imaging (MRI) parameters have defined the 3-dimensional morphoanatomy and relevant spinal cord occupation ratios (occupation of spinal cord dimensions/similar dimensions within the spinal canal) in congenital cervical stenosis (CCS).
METHODS: A retrospective, comparative analysis was conducted on 200 patients >18 years of age with myelopathy and CCS (mean age, 52.4 years) and 200 age-matched controls with no myelopathy or radiculopathy. The variables assessed from high resolution MRI included sagittal and axial spinal canal dimensions (MRI Torg-Pavlov ratios) from C3 to C7. Morphometric dimensions from the sagittal retrodiscal and retrovertebral regions as well as axial MRI dimensions were compared. Sagittal and axial spinal cord occupation ratios were defined and correlated with spinal canal dimensions.
RESULTS: Multivariate analyses indicated reduced sagittal and axial anteroposterior (AP) spinal canal dimensions and a large reduction in transverse spinal canal dimensions at all spinal levels. There was a small significant correlation between AP sagittal spinal canal dimensions and axial transverse spinal canal dimensions at C3-C5, but not at C5-C6. Small correlations were noted between AP sagittal spinal canal dimensions and AP axial spinal cord and axial cross-sectional area occupation ratios at C3-C6, but there was no correlation with axial mediolateral spinal cord occupation ratios.
CONCLUSIONS: The stenosis effect can involve any dimension, including the transverse spinal canal dimension, independent of other dimensions. Owing to the varied observed morphoanatomies, a classification algorithm that defines CCS specific phenotypes was formulated. Objectivizing the stenosis morphoanatomy may allow for data-driven patient-focused decompression approaches in the future.

BACKGROUND: Lumbar disc herniation was regarded as an age-related degenerative disease. Nevertheless, emerging reports highlight a discernible shift, illustrating the prevalence of these conditions among younger individuals.
METHODS: This study introduces a novel deep learning methodology tailored for spinal canal segmentation and disease diagnosis, emphasizing image processing techniques that delve into essential image attributes such as gray levels, texture, and statistical structures to refine segmentation accuracy.
RESULTS: Analysis reveals a progressive increase in the size of vertebrae and intervertebral discs from the cervical to lumbar regions. Vertebrae, bearing weight and safeguarding the spinal cord and nerves, are interconnected by intervertebral discs, resilient structures that counteract spinal pressure. Experimental findings demonstrate a lack of pronounced anteroposterior bending during flexion and extension, maintaining displacement and rotation angles consistently approximating zero. This consistency maintains uniform anterior and posterior vertebrae heights, coupled with parallel intervertebral disc heights, aligning with theoretical expectations.
CONCLUSIONS: Accuracy assessment employs 2 methods: IoU and Dice, and the average accuracy of IoU is 88% and that of Dice is 96.4%. The proposed deep learning-based system showcases promising results in spinal canal segmentation, laying a foundation for precise stenosis diagnosis in computed tomography images. This contributes significantly to advancements in spinal pathology understanding and treatment.

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UNASSIGNED: The developmental size of the cervical spinal canal varies considerably. Neural compression and injury are more likely with a developmentally small spinal canal. This study was designed to develop a population reference range for developmental cervical spinal canal size for the Hong Kong population.
UNASSIGNED: Prospective study of 522 ambulatory patients (256 males, 266 females, mean age 55±18 years; range, 20-89 years) who underwent computed tomography (CT) neck examinations. Using a manually operated segmentation program, spinal canal, and vertebral body cross-sectional area (CSA), anteroposterior (AP) sagittal diameter, and width were measured at each level from C3-C7. Patient height and weight were measured.
UNASSIGNED: Considerable variation in spinal canal size existed with, for example, a 164-168% variation exists for males and females between the largest and smallest spinal canal CSA at C5. All spinal canal measurements increased slightly with height (r=0.25-0.36, P<0.001), while vertebral body AP sagittal diameter increased with age (r=0.48-0.51, P<0.001). All spinal canal measurements were larger (<0.0001) in males. Although spinal canal CSA was larger in males (at C5, males 276.0±41.5 mm2; females 252.6±38.4 mm2), relative to vertebral body CSA, spinal canal CSA was larger in females. Arbitrary population thresholds indicating the smallest 25% spinal canal CSA and AP sagittal diameter as well as other parameters were defined.
UNASSIGNED: There is a large variation in developmental cervical spinal canal size within the Hong Kong population. A reference range of developmental spinal canal size was developed which will enable an objective assessment of an individual\'s cervical spinal canal size relative to the wider population.

Thoracolumbar intervertebral disc disease (IVDD) is the most common cause of spinal injury in dogs. MRI has been considered the gold standard for neurologic diagnosis, but studies focusing on the thoracolumbar spinal canal and spinal cord using MRI in small-breed dogs are limited. Therefore, this study aimed to establish an MRI reference range for the spinal cord and canal measurements (height, width, cord-to-canal ratio of height, width, cross-sectional area (CSA)) of each intervertebral disc level from T11 to L5 (total of seven levels) on transverse T2-weighted images in normal small-breed dogs. We hypothesized that the spinal cord and spinal canal measurements might vary according to the body weight and age. The width and height of the spinal cord and canal increased as the body weight increased at all levels (p < 0.05). The cord-to-canal ratio of the width showed a negative correlation to the body weight at all levels. The cord-to-canal ratio of the height did not show any correlation to the body weight at all levels. All measurements (height, width, cord-to-canal ratio of height, width, CSA) did not show any statistical correlation between the groups subdivided by age. These measurements could serve as a morphometric baseline for thoracolumbar spinal diseases and clinical research in small-breed dogs.

BACKGROUND: Pneumorrachis is presence of air in the epidural space. It could be the result of trauma, barotrauma, iatrogenic or spontaneous. The pneumorrachis per se is an underdiagnosed entity as most of the patients are asymptomatic or have subclinical symptoms. The spontaneous occurrence of pneumorrachis has been reported in literature but giant spontaneous occurrence causing cauda equina syndrome has not been reported so far.
METHODS: We report a case of 56-year-old male patient who came to our OPD on wheelchair with complains of difficulty in walking for 6 months with dribbling of urine for 2 months with on and off back pain. His perianal sensation was reduced with absent voluntary anal contraction. Imaging revealed giant air pockets in the spinal canal of L5-S1 extending upto L4-L5. It was managed surgically wherein laminectomy without fusion was done. The patient responded well to the treatment.
CONCLUSIONS: There are many causes of pneumorrachis described in literature. Most of the cases of pneumorrachis are asymptomatic and incidentally diagnosed. With the improvement in radio-diagnostic modalities, the diagnosis of pneumorrachis can be easily established. When symptomatic, they can be managed conservatively. Those presenting with neurological deficit may require surgical intervention or other invasive intervention.

OBJECTIVE: The aim of the present study was to investigate how canal area size changed from before surgery and up to 2 years after decompressive lumbar surgery lumbar spinal stenosis. Further, to investigate if an area change postoperatively (between 3 months to 2 years) was associated with any preoperative demographic, clinical or MRI variables or surgical method used.
METHODS: The present study is analysis of data from the NORDSTEN- SST trial where 437 patients were randomized to one of three mini-invasive surgical methods for lumbar spinal stenosis. The patients underwent MRI examination of the lumbar spine before surgery, and 3 and 24 months after surgery. For all operated segments the dural sac cross-sectional area (DSCA) was measured in mm2. Baseline factors collected included age, gender, BMI and smoking habits. Furthermore, surgical method, index level, number of levels operated, all levels operated on and baseline Schizas grade were also included in the analysis.
RESULTS: 437 patients were enrolled in the NORDSTEN-SST trial, whereof 310 (71%) had MRI at 3 months and 2 years. Mean DSCA at index level was 52.0 mm2 (SD 21.2) at baseline, at 3 months it increased to 117.2 mm2 (SD 43.0) and after 2 years the area was 127.7 mm2 (SD 52.5). Surgical method, level operated on or Schizas did not influence change in DSCA from 3 to 24 months follow-up.
CONCLUSIONS: The spinal canal area after lumbar decompressive surgery for lumbar spinal stenosis increased from baseline to 3 months after surgery and remained thereafter unchanged 2 years postoperatively.

OBJECTIVE: To establish the finite element model of spinal canal reconstruction and internal fixation,analysis influence of spinal canal reconstruction and internal fixation on spinal stability,and verify the effectiveness and reliability of spinal canal reconstruction and internal fixation in spinal canal surgery.
METHODS: A 30-year-old male healthy volunteer with a height of 172 cm and weight of 75 kg was selected and his lumbar CT data were collected to establish a finite element model of normal lumbar L3-L5,and the results were compared with in vitro solid results and published finite element analysis results to verify the validity of the model. They were divided into normal group,laminectomy group and spinal canal reconstruction group according to different treatment methods. Under the same boundary fixation and physiological load conditions,six kinds of activities were performed,including forward bending,backward extension,left bending,right bending,left rotation and right rotation,and the changes of range of motion (ROM) of L3-L4,L4-L5 segments and overall maximum ROM of L3-L5 were analyzed under the six conditions.
RESULTS: The ROM displacement range of each segment of the constructed L3-L5 finite element model was consistent with the in vitro solid results and previous literature data,which confirms the validity of the model. In L3-L4,ROM of spinal canal reconstruction group was slightly increased than that of normal group during posterior extension(>5% difference),and ROM of other conditions was similar to that of normal group(<5% difference). ROM in laminectomy group was significantly increase than that in normal group and spinal canal reconstruction group under the condition of flexion,extension,left and right rotation. In L4-L5,ROM in spinal canal reconstruction group was similar to that in normal group(<5% difference),while ROM in laminectomy group was significantly higher than that in normal group and spinal canal reconstruction group(>5% difference). In the overall maximum ROM of L3-L5,spinal canal reconstruction group was only slightly higher than normal group under the condition of posterior extension(>5% difference),while laminectomy was significantly higher than normal group and spinal canal reconstruction group under the condition of anterior flexion,posterior extension,left and right rotation(>5% difference). The changes of each segment ROM and overall ROM of L3-L5 showed laminectomy group>spinal canal reconstruction group>normal group.
CONCLUSIONS: Laminectomy could seriously affect biomechanical stability of the spine,but application of spinal canal reconstruction and internal fixation could effectively reduce ROM displacement of the responsible segment of spine and maintain its biomechanical stability.