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PubMed2005

Surgery for degenerative lumbar spondylosis: updated Cochrane Review.

STUDY DESIGN: An updated Cochrane review. OBJECTIVE: To review current scientific evidence on the effectiveness of surgical interventions for degenerative lumbar spondylosis. SUMMARY OF BACKGROUND DATA: There is still limited scientific evidence on spinal surgery. METHODS: Use of standard Cochrane review methods to analyze all randomized controlled trials published to March 31, 2005. RESULTS: A total of 31 randomized controlled trials were identified. Most of the earlier trials reported mainly surgical outcomes; more of the recent trials also reported patient-centered outcomes of pain or disability. There is still very little information on occupational outcomes or long-term outcomes beyond 2-3 years. Seven heterogeneous trials on spondylolisthesis, spinal stenosis, and nerve compression permitted limited conclusions. There were two new trials on fusion that showed conflicting results. One trial showed that fusion gave better clinical outcomes than conventional physiotherapy, and the other showed that fusion was no better than a modern exercise and rehabilitation program. There were 8 trials that showed that instrumented fusion produces a higher fusion rate, but any improvement in clinical outcomes is probably marginal. CONCLUSIONS: No conclusions are possible about the relative effectiveness of anterior, posterior, or circumferential fusion. The preliminary results of three small trials of intradiscal electrotherapy suggest it is ineffective, except possibly in highly selected patients. Preliminary data from three trials of disc arthroplasty do not permit firm conclusions.

Arthroplasty↗
PubMed2005

A traumatic central cord syndrome occurring after adequate decompression for cervical spondylosis: biomechanics of injury: case report.

STUDY DESIGN: Case report with review of the literature. OBJECTIVES: To present the first case of a central cord syndrome occurring after adequate decompression, and review the mechanics of the cervical spinal cord injury and postoperative biomechanical and anatomic changes occurring after cervical decompressive laminectomy. SUMMARY OF BACKGROUND DATA: Cervical spondylosis is a common pathoanatomic occurrence in the elderly population and is thought to be one of the primary causes for a central cord syndrome. Decompressive laminectomy with or without fusion has been a primary treatment for spondylotic disease and is thought to be protective against further injury. To our knowledge, there are no cases of a central cord syndrome occurring after adequate decompression reported in the literature. METHODS: Case study with extensive review of the literature. RESULTS: The patient underwent C3-C7 cervical laminectomy without complications. After surgery, the patient's spasticity and gait difficulties improved. She was discharged to inpatient rehabilitation for further treatment of upper extremity weakness. The patient fell in the rehabilitation center, with a central cord syndrome despite adequate decompression of her spinal canal. The patient was treated conservatively for the central cord and had minimal improvement. CONCLUSIONS: Decompressive laminectomy provides an immediate decompressive effect on the spinal cord as seen by the dorsal migration of the cord, however, the biomechanics of the cervical spine after decompressive laminectomy remain uncertain. This case supports the ongoing research and need for more intensive research on postoperative cervical spine biomechanics, including decompressive laminectomies, decompressive laminectomy and fusion, and laminoplasty.

Accidental Falls↗
PubMed1983

Is cervical spondylosis an occupational hazard for urologists?

Amongst 248 urologists who spend a substantial amount of their operative work performing endoscopic procedures and who were surveyed with reference to symptoms of cervical spondylosis, 118 admitted that they were, or had been, troubled by such symptoms (47.6%). A control group of 113 General Practitioners matched for age at qualification had no significantly fewer symptoms (43.4%). Similar numbers in each group had a history of neck injury, often of a sporting nature, and also had similar incidences of symptoms including pain down the arm. Significantly more urologists have current severe symptoms and more frequent attacks of trouble. Urologists offered a variety of advice on how to ameliorate these symptoms, which included attention to posture, the need for self-controlled motorised endoscopic tables, an endoscopic stool with wheels and the limitation of the number of transurethral prostatectomies per operating list.

Adult↗
PubMed1988

Nerve conduction studies in upper limbs of patients with cervical spondylosis and motor neurone disease.

Proximal conduction studies by F-wave technique, with conventional distal motor and sensory conduction were performed along the ulnar nerves of 20 patients each with cervical spondylotic radiculopathy and/or myelopathy and with classical motor neurone disease (MND). Such F-wave parameters as shortest F-latency, F-conduction velocity, conduction time and F-ratio were calculated. Twenty-five age- and sex-matched healthy volunteers acted as controls. Proximal slowing associated with sensory conduction abnormalities and normal distal motor conduction favored cervical spondylosis (CS). Distal slowing with a normal proximal motor and sensory conduction was associated with motor neurone disease.

Cervical Vertebrae↗
PubMed1997

Decreased sympathetic outflow to muscles in patients with cervical spondylosis.

To clarify the pathogenesis of neurologic symptoms of a vascular nature that may accompany cervical spondylosis (CS), we measured the sympathetic outflow to muscles (muscle sympathetic nerve activity: MSNA) in 8 ambulatory patients with CS and 10 healthy volunteers (controls). The burst rate and incidence of MSNA at rest were significantly lower in patients with CS than in controls (P < 0.01). There were no differences between the 2 groups in either resting heart rate or blood pressure. During a head-up tilting, the changes in MSNA were slightly greater in CS patients than controls due to reduced baseline levels of MSNA in CS patients. The burst incidence of MSNA in CS was significantly negatively correlated with the severity of pyramidal tract symptoms (P < 0.05). The decreased MSNA at rest in CS patients may be due to a spinal cord compression resulting from posterior spondylotic changes in the cervical spine.

Aged↗
PubMed1971

The posterior operation in treatment of cervical spondylosis with myelopathy: a long-term follow-up study.

An analytical study of 59 patients who underwent the posterior operation for cervical spondylosis with myelopathy at the London Hospital between 1945 and 1960 has been made. The postoperative period of observation ranged from five to 20 years with an average of 10 years. Initially 36 patients were improved by the operation, 24 considerably so, and in 15 patients further deterioration was prevented. Five years after operation 33 patients were still improved and in five patients co-existent disease had become apparent. Ten years after operation 30 patients had maintained their initial improvement; progression of the disease accounted for a drop of 10% in the success rate initially achieved. No patient in this series developed postoperative instability of the cervical spine. Patients with less than two years' duration of symptoms and with less neurological disability fared better. The importance of a long follow-up period for the proper assessment of results is thus emphasized. It is suggested that the posterior operation has stood the test of time and will continue to maintain a useful place in the treatment of this condition. Some points are outlined for the successful practice of this operation.

Adult↗
PubMed1973

Surgical treatment of myelopathy with cervical spondylosis.

The results of treatment over a period of 10 years of 102 cases of cervical spondylosis with myelopathy are presented, with a complete follow-up in all cases to two years after the end of that period. Results similar to those previously recorded were obtained with treatment by a light Minerva plaster collar, or laminectomy, but the best results, 73% sustained improvement, were obtained in 65 cases treated from an anterior approach, by Cloward's operation. Of 48 patients showing sustained improvement, 38 returned to, and remained at work. Cloward's operation was first undertaken at the beginning of the 10 year period, and was increasingly adopted as a primary procedure. It became evident that benefit from any treatment in cases with symptoms of long duration was likely to be limited, and the best results were in cases with less than a year's history who had Cloward's operation (86% sustained improvement). The necessity for careful clinical and radiological diagnosis, and operative technique, is emphasized, also the desirability of careful scrutiny of assessments in series of this disorder.

Aged↗
PubMed1975

Upper limb involvement in cervical spondylosis.

Analysis of 200 cases reveals that the two neurological syndromes, brachial neuritis and myelopathy, associated with cervical spondylosis are distinct with relatively little overlap. While upper limb motor and sensory loss are doubtless due to nerve root compression in cases of "pure' brachial neuritis, they are more likely to be due to cord damage in cases with myelopathy (with spastic paraparesis of lower limbs). In either group of cases, neurological features in the upper limbs are not very helpful in localizing the level of significant intervertebral disc pathology. Contrast radiology (myelography and possibly discography) is a reliable guide judging by the excellent results obtained by anterior route (Cloward's) operation at specific disc levels in a series of cases with longstanding complaints unrelieved by conservative treatment. Pathological data provide a rational basis for interpretation of clinical observations and for surgical treatment.

Adult↗
PubMed1979

Delayed cervical somatosensory potentials in cervical spondylosis.

The cervical somatosensory evoked potential after median nerve stimulation was recorded in 14 patients with cervical spondylosis with radiculopathy and, in 10 cases, myelopathy. Four patients had normal potentials, five showed delayed potentials, and in five others no potential could be seen.

Adult↗
PubMed1980

Somatosensory conduction times and peripheral, cervical and cortical evoked potentials in patients with cervical spondylosis.

Peripheral, cervical and cortical somatosensory evoked potentials after median or ulnar nerve stimulation were recorded in 21 patients with cervical spondylosis with radiculopathy or myelopathy. The test was normal when pain and paraesthesias were the only symptoms, while pathological in radiculopathy with objective neurological signs. The results varied in patients with cervical myelopathy.

Adult↗
PubMed1986

The surgical treatment of cervical myelopathy due to spondylosis and disc degeneration.

A personal prospective study of the surgical treatment of cervical myelopathy due to spondylosis and disc protrusion is presented. One hundred and thirty-seven patients with severe disability have undergone surgery according to a protocol involving both the anterior approach of Cloward and decompressive laminectomy. Fifty-two percent of patients have returned to full employment, 39% to light employment and 9% remained disabled though improved from their pre-operative status. The pathenogenesis, natural history and treatment are discussed and reasons advanced to suggest that the disability resulting from severe forms of the condition may be alleviated in the majority of cases.

Adult↗
PubMed1987

F-response frequency in motor neuron disease and cervical spondylosis.

During a train of 200 stimuli, F-response frequency, frequency of identical responses, and F-response shape were studied in the ulnar nerve of 17 patients with motor neuron disease (MND) and 16 patients with cervical spondylosis (CS). In MND patients, F-response frequency varied between 5% and 96% with a median of 39% which was significantly lower than controls (p less than 0.001), and showed a significant rank correlation with the M-response amplitude (r = 0.62, p less than 0.004). Identical responses occurred more frequently than in controls (median 30.8%, p less than 0.001). F-response frequency was normal in CS patients (median 76.3%, range 35% to 97%), but the frequency of identical responses (median 6.3%) was higher than normal (p less than 0.01). Reduced F-response frequency in MND was thought to reflect loss of lower motor neurons, while the presence of spasticity was probably the major factor underlying the increased frequency of identical responses in both disorders. F-response shape tended to be simpler in MND and rather more complex in CS patients than controls.

Adult↗
PubMed1991

Magnetic stimulation of the motor cortex in cervical spondylosis.

We report a new technique of transcranial magnetic stimulation of the motor cortex to measure conduction within central motor pathways of 67 patients with cervical spondylosis or disk herniation. There were upper motor neuron signs in 34 patients (51%) and x-ray evidence of cervical cord compression in 44 (66%). Muscle action potentials (MAPs) to cortical stimulation were abnormal in 84% of patients with, and 22% of those without, radiologic signs of cervical cord compression. Median nerve somatosensory evoked potentials were altered in only 25% of patients. The frequency of MAP alterations correlated with upper motor neuron signs. In 5 (11%) of the 44 patients with x-ray evidence of cervical cord compression, subclinical cord compression was disclosed by cortical stimulation. In 10 patients restudied 3 months after surgical decompression, normalization of central motor conduction time did not occur, indicating permanent damage to the cervical cord.

Action Potentials↗
PubMed2007

Minimally invasive surgery for the management of cervical spondylosis.

Dorsal surgical procedures have a well-established role in the treatment of both radiculopathy and myelopathy caused by cervical spondylosis. Laminectomy and laminoplasty procedures can both lead to postoperative kyphosis because of the removal of the dorsal supporting structures of the neck. Minimally invasive or minimal-access spinal surgery procedures of the dorsal cervical spine are evolving techniques with the goal of decompressing the neural structures with minimal disruption of the dorsal supporting structures. We think that this will lead to less postoperative pain and a decreased incidence of post-decompression kyphotic deformity. Patient selection, techniques, and results are discussed for both minimally invasive cervical laminoforaminotomy and stenosis decompression.

Cervical Vertebrae↗
PubMed2007

Cervical spondylosis: ventral or dorsal surgery.

Cervical spondylosis is a result of degenerative changes of the cervical spine. Neurological symptoms of myelopathy result from the narrowing of the spinal canal, causing spinal cord compression. Surgical management of cervical stenosis requires an understanding of the interplay between multiple pathological and biomechanical factors contributing to this disease process. Surgical decompression can be addressed from a ventral, dorsal, or combined approach. The authors discuss the technical aspects of the surgical decision making process regarding the decision to approach the spine from a ventral or dorsal orientation.

Cervical Vertebrae↗
PubMed2007

Neurological manifestations of cervical spondylosis: an overview of signs, symptoms, and pathophysiology.

The neurological manifestations of cervical spondylosis include symptomatic compression of the spinal cord (myelopathy), nerve roots (radiculopathy), or a combination of the two (myeloradiculopathy). The term myeloradiculopathy herein defines these often indistinct and inseparable entities. The pathophysiology of myeloradiculopathy is multifactorial in nature, and the natural history of untreated myeloradiculopathy is not clearly defined. We review the signs, symptoms, and clinical findings of cervical myelopathy, radiculopathy, and myeloradiculopathy. Standard grading techniques are also reviewed.

Cervical Vertebrae↗
PubMed2007

The use of rigid internal fixation in the surgical management of cervical spondylosis.

In the surgical management of cervical spondylosis, the application of rigid internal fixation can enhance the immediate stability of the cervical spine. The sophistication of such internal fixation systems and the indications for their use are continuously evolving. A sound understanding of regional anatomy, biomechanics, and kinematics within the cervical spine is essential for the safe and effective application of internal fixation. Numerous options currently exist for anterior cervical plating systems; some lock the screws to the plate rigidly (constrained), whereas others allow for some rotational or translational motion between the screw and plate (semiconstrained). The role of anterior fixation in single and multilevel fusions is still the subject of some controversy. Long anterior cervical reconstructions may require additional posterior fixation to reliably promote fusion. Rigid fixation in the posterior cervical spine can be achieved with lateral mass screws or pedicle screws. Although lateral mass screws provide excellent fixation within the subaxial cervical spine, the regional anatomy of C2 and C7 often make it difficult to place such screws, and pedicle screws at these levels are advocated. Pedicle screws achieve fixation into both the anterior and posterior column and are arguably the most stable form of rigid internal fixation within the cervical spine. Familiarity with these internal fixation techniques can be an extremely valuable tool for the spine surgeon managing these degenerative disorders of the cervical spine.

Cervical Vertebrae↗
PubMed2005

[Somatosensory and motor evoked potentials in patients with cervical spondylosis].

This study investigated 54 patients with cervical spondylosis (CS) with or without symptoms caused by cervical spondylotic myelopathy. Cervical MRI, somatosensory evoked potentials (SEPs) and motor evoked potentials (MEP) from upper and lower limbs of all of these patients were examined retrospectively. Were MRI findings the gold standard and the patients were classified in three groups. Group 1 (absence of spinal cord compression); Group 2 (presence of spinal cord indentation); Group 3 (spinal cord compression with alteration of intraspinal sign). The sensitivity of SEP of four limbs was 61.9%, the same one as the SEP of lower limbs. The sensitivity of MEP of four limbs was 71.4%, of the upper limbs alone was 66.7% and of the lower limbs alone 52.4%, thus showing the importance of using this method in all four limbs when cervical spondylotic myelopathy is suspected. The results shown by the study of the tibial nerve in SEP and of the abductor digiti minimi muscle in MEP were more frequently abnormals than the results shown by the study of the median nerve and extensor digitorum brevis muscle in the three groups, suggesting that exists a onset compromising of them.

Adult↗