Seminars in Spine Surgery
Volume 18, Issue 3 , Pages 138-147 , September 2006

Assessment and Characteristics of Intraspinal Cystic Lesions

  • T. Glenn Pait, MD, FACS

      Affiliations

    • Corresponding Author InformationAddress reprint requests to T. Glenn Pait, MD, F.A.C.S., University of Arkansas for Medical Sciences, Neurosurgery Department, 4301 W. Markham, Slot 826, Little Rock, Arkansas 72205.
  • ,
  • Ali I. Raja, MD, MS
  • ,
  • Carlos A. Guererro, MD

References 

  1. Rubin JM , Aisen AM , DiPietro MA . Ambiguities in MR imaging of tumoral cysts in the spinal cord . J Comput Assist Tomogr . 1986;10:395–398
  2. Kochan JP , Quencer RM . Imaging of cystic and cavitary lesions of the spinal cord and canal (The value of MR and intraoperative sonography) . Radiol Clin North Am . 1991;29:867–911
  3. Singhal BS , Parekh HN , Ursekar M , et al.   Intramedullary neurenteric cyst in mid thoracic spine in an adult: a case report . Neurol India . 2001;49:302–304
  4. Bejjani GK , Wright DC , Schessel D , et al.   Endodermal cysts of the posterior fossa (Report of three cases and review of the literature) . J Neurosurg . 1998;89:326–335
  5. Fortuna A , Mercuri S . Intradural spinal cysts . Acta Neurochir (Wien) . 1983;68:289–314
  6. Guilburd JN , Arieh YB , Peyser E . Spinal intradural enterogenous cyst: report of a case . Surg Neurol . 1980;14:359–362
  7. Brooks BS , Duvall ER , el Gammal T , et al.   Neuroimaging features of neurenteric cysts: analysis of nine cases and review of the literature . Am J Neuroradiol . 1993;14:735–746
  8. Odake G , Yamaki T , Naruse S . Neurenteric cyst with meningomyelocele (Case report) . J Neurosurg . 1976;45:352–356
  9. LeDoux MS , Faye-Petersen OM , Aronin PA , et al.   Lumbosacral neurenteric cyst in an infant (Case report) . J Neurosurg . 1993;78:821–825
  10. Fuse T , Yamada K , Kamiya K , et al.   Neurenteric cyst at the craniovertebral junction: report of two cases . Surg Neurol . 1998;50:431–436
  11. Agnoli AL , Laun A , Schonmayr R . Enterogenous intraspinal cysts . J Neurosurg . 1984;61:834–840
  12. Prasad VS , Reddy DR , Murty JM . Cervico-thoracic neurenteric cyst: clinicoradiological correlation with embryogenesis . Childs Nerv Syst . 1996;12:48–51
  13. Rivierez M , Buisson G , Kujas M , et al.   Intramedullary neurenteric cyst without any associated malformation (One case evaluated by RMI and electron microscopic study) . Acta Neurochir (Wien) . 1997;139:887–890
  14. Kim CY , Wang KC , Choe G , et al.   Neurenteric cyst: its various presentations . Childs Nerv Syst . 1999;15:333–341
  15. Eynon-Lewis NJ , Kitchen N , Scaravilli F , et al.   Neurenteric cyst of the cerebellopontine angle: case report . Neurosurgery . 1998;42:655–658
  16. Alrabeeah A , Gillis DA , Giacomantonio M , et al.   Neurenteric cysts—a spectrum . J Pediatr Surg . 1988;23:752–754
  17. Bollini G , Cottalorda J , Jouve JL , et al.   Closed spinal dysraphism . Ann Pediatr (Paris) . 1993;40:197–210
  18. Chhang WH , Kak VK , Radotra BD , et al.   Enterogenous cyst in the thoracic spinal canal in association with a syringomeningomyelocele . Childs Nerv Syst . 1992;8:105–107
  19. Lee SH , Dante SJ , Simeone FA , et al.   Thoracic neurenteric cyst in an adult: case report . Neurosurgery . 1999;45:1239–1242 discussion 1242-1233
  20. Puca A , Cioni B , Colosimo C , et al.   Spinal neurenteric cyst in association with syringomyelia: case report . Surg Neurol . 1992;37:202–207
  21. Whiting DM , Chou SM , Lanzieri CF , et al.   Cervical neurenteric cyst associated with Klippel-Feil syndrome: a case report and review of the literature . Clin Neuropathol . 1991;10:285–290
  22. Nathan MT . Cysts and duplications of neurenteric origin . Pediatrics . 1959;23:476–484
  23. Orstavik KH , Steen-Johnsen J , Foerster A , et al.   VACTERL or MURCS association in a girl with neurenteric cyst and identical thoracic malformations in the father: a case of gonosomal mosaicism? . Am J Med Genet . 1992;43:1035–1038
  24. Stevenson RE , Kelly JC , Aylsworth AS , et al.   Vascular basis for neural tube defects: a hypothesis . Pediatrics . 1987;80:102–106
  25. Brunberg JA , DiPietro MA , Venes JL , et al.   Intramedullary lesions of the pediatric spinal cord: correlation of findings from MR imaging, intraoperative sonography, surgery, and histologic study . Radiology . 1991;181:573–579
  26. Harris CP , Dias MS , Brockmeyer DL , et al.   Neurenteric cysts of the posterior fossa: recognition, management, and embryogenesis . Neurosurgery . 1991;29:893–897 discussion 897-898
  27. Rivierez M , Buisson G , Kujas M , et al.   Intramedullary neurenteric cyst without any associated malformation (One case evaluated by RMI and electron microscopic study) . Acta Neurochir (Wien) . 1997;139(9):887–890
  28. Harriman DG . An intraspinal enterogenous cyst . J Pathol Bacteriol . 1958;75(2):413–419
  29. Mann KS , Khosla VK , Gulati DR , et al.   Spinal neurenteric cyst (Association with vertebral anomalies, diastematomyelia, dorsal fistula, and lipoma) . Surg Neurol . 1984;21(4):358–362
  30. Gardner WJ , Breuer AC . Anomalies of heart, spleen, kidneys, gut, and limbs may result from an overdistended neural tube: a hypothesis . Pediatrics . 1980;65(3):508–514
  31. Stevenson RE , Kelly JC , Aylsworth AS , et al.   Vascular basis for neural tube defects: a hypothesis . Pediatrics . 1987;80(1):102–106
  32. Akwari OE , Payne WS , Onofrio BM , et al.   Dumbbell neurogenic tumors of the mediastinum (Diagnosis and management) . Mayo Clin Proc . 1978;53(6):353–358
  33. Brooks BS , Duvall ER , el Gammal T , et al.   Neuroimaging features of neurenteric cysts: analysis of nine cases and review of the literature . Am J Neuroradiol . 1993;14(3):735–746
  34. D’Almeida AC , Stewart DH . Neurenteric cyst: case report and literature review . Neurosurgery . 1981;8(5):596–599
  35. Inoue T , Matsushima T , Fukui M , et al.   Immunohistochemical study of intracranial cysts . Neurosurgery . 1988;23(5):576–581
  36. Kjos BO , Brant-Zawadzki M , Kucharczyk W , et al.   Cystic intracranial lesions: magnetic resonance imaging . Radiology . 1985;155:363–369
  37. Chaynes P , Bousquet P , Sol JC , et al.   Recurrent intracranial neurenteric cysts . Acta Neurochir (Wien) . 1998;140:905–911
  38. Perry A , Scheithauer BW , Zaias BW , et al.   Aggressive enterogenous cyst with extensive craniospinal spread: case report . Neurosurgery . 1999;44:401–404 discussion 404-405
  39. Mackenzie IR , Gilbert JJ . Cysts of the neuraxis of endodermal origin . J Neurol Neurosurg Psychiatry . 1991;54:572–575
  40. Schelper RL , Kagan-Hallet KS , Huntington HW . Brainstem subarachnoid respiratory epithelial cysts: report of two cases and review of the literature . Hum Pathol . 1986;17:417–422
  41. Slowinski J , Stomal M , Zajecki W , et al.   Endodermal cyst of the cervical spinal cord with associated partial fusion of the vertebrae . Neuropathology . 2004;24(4):326–329
  42. Wilkinson N , Reid H , Hughes D . Intradural bronchogenic cysts . J Clin Pathol . 1992;45(11):1032–1033
  43. Devkota UP , Lam JM , Ng H , et al.   An anterior intradural neurenteric cyst of the cervical spine: complete excision through central corpectomy approach—case report . Neurosurgery . 1994;35(6):1150–1153
  44. Chaynes P , Bousquet P , Sol JC , et al.   Recurrent intracranial neurenteric cysts . Acta Neurochir (Wien) . 1998;140(9):905–911
  45. Agnoli AL , Schonmayr R , Laun A . Intraspinal arachnoid cysts . Acta Neurochir (Wien) . 1982;61(4):291–302
  46. Nugent GR , Odom GL , Woodhall B . Spinal extradural cysts . Neurology . 1959;9(6):397–406
  47. Nabors MW , Pait TG , Byrd EB , et al.   Updated assessment and current classification of spinal meningeal cysts . J Neurosurg . 1988;68:366–377
  48. Fortuna A , La Torre . Arachnoid diverticulae: a unitary approach to spinal cyst communicating with the arachnoid space . Acta Neurochir . 1977;39:259–268
  49. Cilluffo JM , Gomez MR , Reese DF , et al.   Idiopathic (“congenital”) spinal arachnoid diverticula (Clinical diagnosis and surgical results) . Mayo Clin Proc . 1981;56(2):93–101 Feb
  50. Rabb CH , McComb JG , Raffel C , et al.   Spinal arachnoid cysts in the pediatric age group: an association with neural tube defects . J Neurosurg . 1992;77(3):369–372 Sep
  51. Hoffman EP , Garner JT , Johnson D , et al.   Traumatic arachnoidal diverticulum associated with paraplegia (Case report) . J Neurosurg . 1973;38(1):81–85 Jan
  52. Rohrer DC , Burchiel KJ , Gruber DP . Intraspinal extradural meningeal cyst demonstrating ball-valve mechanism of formation (Case report) . J Neurosurg . 1993;78:122–125
  53. McCrum C , Williams B . Spinal extradural arachnoid pouches (Report of two cases) . J Neurosurg . 1982;57(6):849–852 Dec
  54. Evans A , Stoodley N , Halpin S . Magnetic resonance imaging of intraspinal cystic lesions: a pictorial review . Curr Probl Diagn Radiol . 2002;31:79–94
  55. Tarlove IM . Cysts (perineurial) of the sacral nerve roots: another cause of the sciatic or sacral cauda equina syndrome . J Neuropathol Exp Neurol . 1952;11(1):88–89 Jan
  56. Tarlov IM . Cysts of the sacral nerve roots; clinical significance and pathogenesis . AMA Arch Neurol Psychiatry . 1952;
  57. Rexed A , Wennstrom KG . Arachnoidal proliferation and cystic formation in the spinal nerve-root pouches of man . J Neurosurg . 1959;16(1):73–84
  58. Dickenman RC , Chason JL . Cysts of dorsal root ganglia (Report of 29 cysts and review of literature) . Arch Pathol . 1964;77:366–369
  59. Strully KJ . Meningeal diverticula of sacral nerve roots (perineurial cysts) . J Am Med Assoc . 1956;161(12):1147–1152
  60. Smith DT . Multiple meningeal diverticula (perineurial cysts) of the cervical region disclosed by pantopaque myelography (Report of a case) . J Neurosurg . 1962;19:599–601
  61. Voyadzis JM , Bhargava P , Henderson FC . Tarlov cysts: a study of 10 cases with review of the literature . J Neurosurg . 2001;95(suppl 1):25–32
  62. Nishiura I , Koyama T , Handa J . Intrasacral perineurial cyst . Surg Neurol . 1985;23(3):265–269
  63. Foreman SM , Centeno R , Kerber CW . Diagnosis of perineurial arachnoid cysts using computed tomography: technical and clinical considerations . J Manipulative Physiol Ther . 1986;9(1):23–26
  64. Siqueira EB , Schaffer L , Kranzler LI , Gan J . CT characteristics of sacral perineural cysts (Report of two cases) . J Neurosurg . 1984;61(3):596–598
  65. Tabas JH , Deeb ZL . Diagnosis of sacral perineural cysts by computed tomography . J Comput Tomogr . 1986;10(3):255–259
  66. Rodziewicz GS , Kaufman B , Spetzler RF . Diagnosis of sacral perineural cysts by nuclear magnetic resonance . Surg Neurol . 1984;22(1):50–52
  67. Tarlov IM . Spinal perineurial and meningeal cysts . J Neurol Neurosurg Psychiatry . 1970;33(6):833–843
  68. Patel MR , Louie W , Rachlin J . Percutaneous fibrin glue therapy of meningeal cysts of the sacral spine . AJR Am J Roentgenol . 1997;168(2):367–370
  69. Paulsen RD , Call GA , Murtagh FR . Prevalence and percutaneous drainage of cysts of the sacral nerve root sheath (Tarlov cysts) . AJNR Am J Neuroradiol . 1994;15(2):293–297
  70. Lee HJ , Cho DY . Symptomatic spinal intradural arachnoid cysts in the pediatric age group: Description of three new cases and review of the literature . Pediatric Neurosurg . 2001;35:181–187
  71. Osborn AG . Tumors, cysts, and tumor-like lesions of the spine and spinal cord . In:  Osbornt AG editors. Diagnostic Neuroradiology . St. Louis, MO: Mosby Year Book, Inc; 1994;p. 876–918
  72. Kazan S , Özdemir O , Akyüz M , et al.   Spinal intradural arachnoid cysts located anterior to the cervical spinal cord: report of two cases and review of the literature . J Neurosurg Spine . 1999;2(91):211–215 (suppl)
  73. Endo H , Takahashi T , Shimizu H , et al.   Thoracic intradural arachnoid cyst associated with surgical removal of epidural hematoma: case report . Neurol Med Chir (Tokyo) . 2004;44(11):607–610
  74. Chan RC , Thompson GB , Bratty PJA . Symptomatic anterior spinal arachnoid diverticulum . Neurosurgery . 1985;16:663–665
  75. Palmer JJ . Spinal arachnoid cyst: report of six cases . J Neurosurg . 1974;41:728–735
  76. Teng P , Rudner N . Multiple arachnoid diverticulae . Arch Neurol . 1960;2:348–356
  77. Fakhr FSA , Kanaan SV , Youness FM , et al.   Thoracic spinal intradural arachnoid cyst: report of two cases and review of literature . Eur Radiol . 2002;12:877–882
  78. Ciftci E , Diaz-Marchan PJ , Hayman LA . Intradural-extramedullary spinal cysticercosis: MR imaging findings . Comput Med Imaging Graph . 1999;23:161–164
  79. Pushparaj K , Sundararajan M , Madeswaran K , et al.   Primary spinal intradural hydatid cyst: a short report . Neurol India . 2001;49:203–204
  80. Aarabi B , Pasternak G , Hurko O , et al.   Familiar intradural arachnoic cyst: report of two cases . J Neurosurg . 1979;50:826–829
  81. Brian T , Andrews MD , et al.   Intradural arachnoid cysts of the spinal canal associated with intramedullary cysts . J Neurosurg . 1988;68:544–549
  82. Kokmen E, Marsh WR: Magnetic resonance imaging in syringomyelia. Neurosurgery 17:267-270, 2985
  83. Zuccarello M , Powers G . Chronic post-traumatic lumbar intradural arachnoid cyst with cauda equine compression: Case report . Neurosurgery . 1987;20:636–638
  84. Jensen F , et al.   Recurrent intraspinal arachnoid cyst treated with shunt procedure . Acta Neurochir . 1977;39:127–129
  85. Guidetti B , Gagliardi FM . Epidermoid and dermoid cysts (Clinical evaluation and late surgical results) . J Neurosurg . 1977;47:12–18
  86. Lunardi P , Missori P , Gagliardi FM , et al.   Long-term results of the surgical treatment of spinal dermoid and epidermoid tumors . Neurosurgery . 1989;25:860–864
  87. Toglia JU , Netsky MG , Alexander E . Epidermoid tumors of the cranium: their common nature and pathogenesis . J Neurosurg . 1965;23:384–393
  88. Yoshizato K , Kai Y , et al.   Intramedullary epidermoid cyst in the brain stem: case report . Surg Neurol . 1996;45:537–540
  89. Choremis C , Economos D , Papadatos C , et al.   Intraspinal epidermoid tumors in patients treated for tuberculous meningitis . Lancet . 1958;2:437–439
  90. Gibson T , Morris W . Skin fragments removed by injection needles . Lancet . 1958;2:983–985
  91. Boyd HR . Iatrogenic intraspinal epidermoid: report of a case . J Neurosurg . 1966;24:105–107
  92. Halcrow SJ , Crawford PF , Craft AW . Epidermoid spinal cord tumor after lumbar puncture . Arch Dis Child . 1985;60:978–979
  93. Toro VE , Lacy C , Binet EF . MRI of iatrogenic spinal epidermoid tumor . J Comp Assist Tomogr . 1993;17:970–972
  94. Visciani A , Savoiardo M , Balestrini MR , et al.   Iatrogenic intraspinal epidermoid tumor: myelogram-CT and MRI diagnosis . Neuroradiology . 1989;31:273–275
  95. Teksam M , Casey SO , Michel E , et al.   Intraspinal epidermoid cyst: diffusion-weighted MRI . Neuroradiology . 2001;43:572–574
  96. Cobbs CS , Pitts LH , Wilson CB . Epidermoid and dermoid cysts of the posterior fossa . Clin Neurosurg . 1997;44:511–528
  97. Yasargil MG , Abernathey CD , Sarioglu AC . Microneurosurgical treatment of intracranial dermoid and epidermoid tumors . Neurosurgery . 1989;24:561–567
  98. Bailey IC . Dermoid tumors of the spinal cord . J Neurosurg . 1970;33:676–681
  99. Shirakura Y , Kokai S . Multiple spinal dermoid cysts with thoracic rachischisis (A case report) . Ortho Surg . 1962;13:304–308
  100. Tytus JS , Pennybacker J . Pearly tumors in relation to the central nervous system . J Neurol Neurosurg Psychiatry . 1956;19:241–259
  101. Mohasseb G . Intraspinal dermoid cyst communicating with a dermal sinus . Neurol India . 1969;17(1):16–17
  102. Sachs E , Horrax G . A cervical and lumbar pilonidal sinus communicating with a intraspinal dermoids (Report of 2 cases and review of the literature) . J Neurosurg . 1949;6:97–112
  103. Saunders RL . Intramedullary epidermoids cyst associated with a dermal sinus (Case report) . J Neurosurg . 1969;31:83–86
  104. Mazzola CA , Albright AL , Sutton LN , et al.   Dermoid inclusion cysts and early spinal cord tethering after fetal surgery for myelomeningocele . N Engl J Med . 2002;347(4):256–259
  105. Kirsch WM , Hodges FJ . An intramedullary epidermal inclusion cyst of the thoracic cord associated with a previously repaired meningocele (Case report) . J Neurosurg . 1966;24(6):1018–1020
  106. Garza-Mercado R . Diastematomyelia and intramedullary epidermoid spinal cord tumor combined with extradural teratoma in an adult (Case report) . J Neurosurg . 1983;58:954–958
  107. Manno NJ , Uihlein A , Kernohan JW . Intraspinal epidermoids . J Neurosurg . 1962;19:754–765
  108. Pear BL . Epidermoid and dermoid sequestration cysts . Am J Roentgenol Radium Ther Nucl Med . 1970;110:148–155
  109. Abramson RC , Morawetz RB , Schlitt M . Multiple complications from an intracranial epidermoid cyst: case report and literature review . Neurosurgery . 1989;24:574–578
  110. Berger MS , Wilson CB . Epidermoid cysts of the posterior fossa . J Neurosurg . 1985;62:214–219
  111. Caldarelli M , Massimi L , Kondageski C , et al.   Intracranial midline dermoid and epidermoid cysts in children . J Neurosurg . 2004;100:473–480
  112. Fornari M , Solero CL , Lasio G , et al.   Surgical treatment of intracranial dermoid and epidermoid cysts in children . Childs Nerv Syst . 1990;6:66–70
  113. Eekhof JL , Thomeer RT , Bots GT . Epidermoid tumor in the lateral ventricle . Surg Neurol . 1985;23:189–192
  114. Awwad EE , Backer R , Archer CR . The imaging of an intraspinal cervical dermoid tumor by MR, CT, and sonography . Comput Radiol . 1987;11:169–173
  115. Benzil DL , Epstein MH , Knuckey NW . Intramedullary epidermoid associated with an intramedullary spinal abscess secondary to a dermal sinus . Neurosurgery . 1992;30:118–121
  116. Arseni C , Danaila L , Constantinescu A , et al.   Spinal dermoid tumours . Neurochirurgia (Stuttg) . 1977;20:108–116
  117. Yarde WL , Arnold PM , Kepes JJ , et al.   Synovial cysts of the lumbar spine: diagnosis, surgical management, and pathogenesis (Report of eight cases) . Surg Neurol . 1995;43:459–464 discussion 465
  118. Pendleton B , Carl B , Pollay M . Spinal extradural benign synovial or ganglion cyst: case report and review of the literature . Neurosurgery . 1983;13:322–326
  119. Swartz PG , Murtagh FR . Spontaneous resolution of an intraspinal synovial cyst . Am J Neuroradiol . 2003;24:1261–1263
  120. Hsu KY , Zucherman JF , Shea WJ , et al.   Lumbar intraspinal synovial and ganglion cysts (facet cysts) (Ten-year experience in evaluation and treatment) . Spine . 1995;20:80–89
  121. Onofrio BM , Mih AD . Synovial cysts of the spine . Neurosurgery . 1988;22:642–647
  122. Mercader J , Munoz-Gomez J , Cardenal C . Intraspinal synovial cyst: diagnosis by CT (Follow-up and spontaneous remission) . Neuroradiology . 1985;27:346–348
  123. Trummer M , Flaschka G , Tillich M , et al.   Diagnosis and surgical management of intraspinal synovial cysts: report of 19 cases . J Neurol Neurosurg Psychiatry . 2001;70:74–77
  124. Kao CC , Winkler SS , Turner JH . Synovial cyst of spinal facet (Case report) . J Neurosurg . 1974;41:372–376
  125. Doherty PF , Sherman BA , Stein C , et al.   Bilateral synovial cysts of the thoracic spine: a case report . Surg Neurol . 1993;39:279–281
  126. Goffin J , Wilms G , Plets C , et al.   Synovial cyst at the C1-C2 junction . Neurosurgery . 1992;30:914–916
  127. Houser OW , Onofrio BM , Miller GM , et al.   Cervical neural foraminal canal stenosis: computerized tomographic myelography diagnosis . J Neurosurg . 1993;79:84–88
  128. Lopes NM , Aesse FF , Lopes DK . Compression of thoracic nerve root by a facet joint synovial cyst: case report . Surg Neurol . 1992;38:338–340
  129. Budris DM . Radiologic case study (Intraspinal lumbar synovial cyst) . Orthopedics . 1991;14(613):618–620
  130. Kao CC , Uihlein A , Bickel WH , et al.   Lumbar intraspinal extradural ganglion cyst . J Neurosurg . 1968;29:168–172
  131. Sakas DE , Farrell MA , Young S , et al.   Posterior thecal lumbar disc herniation mimicking synovial cyst . Neuroradiology . 1995;37:192–194
  132. Jackson DE , Atlas SW , Mani JR , et al.   Intraspinal synovial cysts: MR imaging . Radiology . 1989;170:527–530
  133. Knox AM , Fon GT . The appearances of lumbar intraspinal synovial cysts . Clin Radiol . 1991;44:397–401
  134. Schulz EE , West WL , Hinshaw DB , et al.   Gas in a lumbar extradural juxta-articular cyst: sign of synovial origin . AJR Am J Roentgenol . 1984;143:875–876
  135. Silbergleit R , Gebarski SS , Brunberg JA , et al.   Lumbar synovial cysts: correlation of myelographic, CT, MR, and pathologic findings . AJNR Am J Neuroradiol . 1990;11:777–779
  136. Maheshwaran S , Davies AM , Evans N , et al.   Sciatica in degenerative spondylolisthesis of the lumbar spine . Ann Rheum Dis . 1995;54:539–543
  137. Liu SS , Williams KD , Drayer BP , et al.   Synovial cysts of the lumbosacral spine: diagnosis by MR imaging . AJR Am J Roentgenol . 1990;154:163–166
  138. Apostolaki E , Davies AM , Evans N , et al.   MR imaging of lumbar facet joint synovial cysts . Eur Radiol . 2000;10:615–623
  139. Sauvage P , Grimault L , Ben Salem D , et al.   Lumbar intraspinal synovial cysts: imaging and treatment by percutaneous injection (Report of thirteen cases) . J Radiol . 2000;81:33–38

PII: S1040-7383(06)00050-5

doi: 10.1053/j.semss.2006.06.005

Seminars in Spine Surgery
Volume 18, Issue 3 , Pages 138-147 , September 2006