MRI recovery of the Achilles tendon after percutaneous tenotomy in older children

Background An observational study was conducted to evaluate the recovery of older children with relapsed congenital clubfoot who underwent an Achilles tenotomy for the second time as part of the Ponseti treatment. Methods Thirteen patients (19 feet) with congenital clubfoot underwent Achilles tenotomy where magnetic resonance images of the severed tendons were taken after 1, 3, and 6 weeks post-procedure. The participants were categorized into older children who underwent tenotomy for the first time (group A: mean, 4.9±1.8, and range, 2.8–7 years old) and older children who underwent tenotomy for a second time (group B: mean, 4.9±1.5, and range, 3–6.8 years old). The area of high signal intensity between the severed tendons on MRI scans was computed using Python programming language and compared with clinical assessment. Results Three weeks after Achilles tenotomy, groups A and B had clinically intact tendons in 9 out of 11 and 2 out of 8 feet, respectively, according to both clinical and MRI assessment. From week 1 to week 3 post-tenotomy, computational analysis showed that the mean high signal intensity area of group A decreased by 88.5±15.2%, which was significantly different (P .048 < .05) than the percent reduction of high signal intensity area of group B (69.0±24.9%). Conclusion Children who underwent Achilles tenotomy for the second time showed slower tendon recovery on the third week post-procedure. A possible reason for slower healing times may be due to the location of tenotomy in being further away from the musculotendinous junction where extrinsic healing mechanisms take place.

A midline posterior approach for treatment of os odontoideum via atlantoaxial reduction, bone graft fusion, and internal fixation

Os odontoideum is a rare anomaly of the second cervical vertebra, which can result in the compression and injury of cervical spinal cord. This deformity is surgically challenging. The authors presented a case of a 50-year-old man with a 2-year history of numbness and weakness in four limbs. The x-ray suggested the os odontoideum. MRI demonstrated a dramatic compression of the cervical spinal cord and an abnormally high signal intensity area in this region. The patient underwent a midline posterior approach for the treatment of this lesion. Postoperatively, the reduction results were satisfactory and the compression was relieved.The video can be found here: https://youtu.be/3qDzR2kOz8k.

Intravascular papillary endothelial hyperplasia of the digit: MRI features with histological correlation

To clarify the magnetic resonance (MR) features of the pure form of intravascular papillary endothelial hyperplasia, MR images (MRIs) from five patients were retrospectively reviewed and compared with histological findings. The images showed a heterogeneous, iso- to slightly high signal intensity mass on T1-weighted images and a mass with a central heterogeneous, iso- to slightly high signal intensity area completely or incompletely surrounded by peripheral high signal intensity areas on T2-weighted images. Heterogeneous enhancement was observed after gadolinium administration. Histological studies indicated that the central heterogeneous area on T2-weighted images corresponded to thrombi (organized and/or hyalinized) and/or papillary endothelial proliferation, and also that the peripheral high signal intensity area corresponded to vascular blood space and/or papillary endothelial proliferation. The pure form of intravascular papillary endothelial hyperplasia showed relatively characteristic features on MRIs.

Long-term surgical outcome and risk factors in patients with cervical myelopathy and a change in signal intensity of intramedullary spinal cord on magnetic resonance imaging

Object The goal of this study was to determine the long-term clinical significance of and the risk factors for intramedullary signal intensity change on MR images in patients with cervical compression myelopathy (CCM), an entity most commonly seen with cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament (OPLL). Methods One hundred seventy-four patients with CCM but without cervical disc herniation, severe OPLL (in which the cervical canal is < 10 mm due to OPLL), or severe kyphotic deformity (> 15° of cervical kyphosis) who underwent surgery were initially selected. One hundred eight of these patients were followed for > 36 months, and the 71 patients who agreed to MR imaging examinations both pre- and postsurgery were enrolled in the study (the mean follow-up duration was 60.6 months). All patients underwent cervical laminoplasty. The authors used the Japanese Orthopaedic Association (JOA) score and recovery ratio for evaluation of pre- and postoperative outcomes. The multifactorial effects of variables such as age, sex, a history of smoking, diabetes mellitus, duration of symptoms, postoperative expansion of the high signal intensity area of the spinal cord on MR imaging, sagittal arrangement of the cervical spine, presence of ventral spinal cord compression, and presence of an unstable cervical spine were studied. Results Change in intramedullary signal intensity was observed in 50 of the 71 patients preoperatively. The pre- and postoperative JOA scores and the recovery ratio were significantly lower in the patients with signal intensity change. The mean JOA score of the upper extremities was also significantly lower in these patients. Twenty-one patients showed hypointensity in their T1-weighted images, and a nonsignificant correlation was observed between intensity in the T1-weighted image and the mean JOA score and recovery ratio. The risk factors for signal intensity change were instability of the cervical spine (OR 8.255, p = 0.037) and ventral spinal cord compression (OR 5.502, p < 0.01). Among these patients, 16 had postoperative expansion of the high signal intensity area of the spinal cord. The mean JOA score and the recovery ratio at the final follow-up were significantly lower in these patients. The risk factor for postoperative expansion of the high signal intensity area was instability of the cervical spine (OR 5.509, p = 0.022). No significant correlation was observed between signal intensity on T1-weighted MR images and postoperative expansion of the intramedullary high signal intensity area on T2-weighted MR images. Conclusions Long-term clinical outcome was significantly worse in patients with intramedullary signal intensity changes on MR images. The risk factors were instability of the cervical spine and severe ventral spinal compression. The long-term clinical outcome was also significantly worse in patients with postoperative expansion of the high signal intensity area. The fact that cervical instability was a risk factor for the postoperative expansion of the high signal intensity indicates that this high signal intensity area occurred, not only from necrosis secondary to ischemia of the anterior spinal artery, but also from the repeated minor traumas inflicted on the spinal cord from an unstable cervical spine. The long-term neurological outcome found in the preliminary study of patients with CCM who had cervical instability and intramedullary signal intensity changes on MR images suggests that surgical treatment should include posterior fixation along with cervical laminoplasty or anterior spinal fusion.