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Potential misinterpretation of cervical spondylosis with cord compression caused by metallic artifacts in magnetic resonance imaging of the postoperative spine.

Tiny metallic particles produced by the contact of untempered surgical instruments with a diamond drill produce magnetic susceptibility artifacts that can both limit the diagnostic quality of postoperative magnetic resonance imaging of the cervical spine and cause diagnostic error. A case of cervical pseudospondylosis with apparent cord compression due to such an artifact is presented. The source of these metallic particles is considered, and the nature of the susceptibility artifact is discussed.

Female↗

A new surgical technique: open-window corpectomy in the treatment of ossification of the posterior longitudinal ligament and advanced cervical spondylosis: technical note.

OBJECTIVE: To achieve satisfactory cervical spinal cord decompression with minimal removal of bone. METHODS: The open-window corpectomy technique is designed to remove a minimal amount of bone and achieve satisfactory decompression. With the use of a high-speed drill under a surgical microscope, only the dorsal surface of the corpus is removed after appropriate microdiscectomies. This leaves the anterior and the lateral portions of the vertebral corpus intact. RESULTS: In a 15-month period, a total of 11 patients were treated with this technique. Five patients improved, and the remaining six patients remained the same neurologically during a mean follow-up period of 8.3 months. No complications were observed in any patients. CONCLUSION: The open-window corpectomy provides satisfactory spinal cord decompression in a biomechanically sound manner.

Adult↗

The surgical management of cervical spinal stenosis, spondylosis, and myeloradiculopathy by means of the posterior approach.

No firm statistical evidence exists establishing the superiority of the anterior or the posterior approach in the management of spondylostenosis, although some sense of order is evolving. In general the consensus suggests that in spondylostenosis, the anterior approach may be preferred for disc or segmental osteophyte intrusions limited to one or two levels. Laminectomy is the preferred procedure in patients with a narrowed canal and multiple level involvement. The surgeon's personal preference and experience remains the dominant factor. Patients with congenital stenosis involving all of the major segments, with or without superimposed developmental changes, require more extensive laminar decompression with proper attention to the craniocervical junction where anomalies may occur. The success of laminectomy is dictated by the preservation of cervical lordosis. In patients with major dorsally located abnormalities such as hyperlordosis, shingling, and arthrosis with hypertrophy of the yellow ligaments, posterior decompression is essential. Subsequent stabilization is rarely required with proper surgical and postoperative care. Both an anterior and posterior approach may be indicated in unique circumstances of spondylostenosis complicated by subluxation and instability.

Humans↗

Cervical myelopathy caused by C3-C4 spondylosis in elderly patients: a radiographic analysis of pathogenesis.

STUDY DESIGN: A radiographic analysis of elderly patients with cervical spondylotic myelopathy, particularly those with involvement of the C3-C4 level. OBJECTIVES: To elucidate the potential contributors to the higher incidence of pathology at C3-C4 in the elderly. SUMMARY OF BACKGROUND DATA: In this study, the elder patients showed a greater predilection for involvement of the C3-C4 lesion compared with their younger counterparts. No previous study has addressed C3-C4 pathology in elderly patients. METHODS: This study included 18 patients, 10 men and 8 women, with cervical spondylotic myelopathy caused by C3-C4 disorders (group I). For the purpose of comparison, 18 younger patients (less than 50 years of age) with myelopathy (group II) and 30 volunteers over the age of 65 (group III) were also investigated. Mean age at admission was 73.5 years for group I, 42.4 years for group II, and 73.4 years for group III. Radiographic analysis, using static and dynamic radiographs, was performed to evaluate the morphologic features. RESULTS: The mean spinal canal diameter for groups I and II was significantly smaller than that for group III. Group I exhibited greater C2-C7 lordosis. The aged population, group I and group III, showed greater C3-C4 angulation associated with C4 forward inclination in neutral standing position as compared with younger patients. Regarding dynamic factors, group I showed the largest segmental motion at C3-C4, and, conversely, the smallest mobility at the lower segments, with significant differences. CONCLUSIONS: Using radiographic analysis, morphologic features that predispose patients to disorders of the C3-C4 motion segment were evaluated. These features included 1) greater C3-C4 angulation associated with age-related postural change and 2) hypermobility at the C3-C4 segment compensating for decreased mobility at the lower segments.

Adult↗

Pathomechanism of myelopathy and surgical results of laminoplasty in elderly patients with cervical spondylosis.

STUDY DESIGN: Clinical and radiologic analyses in elderly patients with cervical myelopathy. OBJECTIVE: To investigate the pathomechanism of cervical myelopathy and the surgical results of laminoplasty in elderly patients older than 70 years old. SUMMARY OF BACKGROUND DATA: To date, there have been no reports on the pathomechanism of cervical myelopathy in elderly patients. Further, the surgical results and postoperative complications of laminoplasty have not been fully evaluated in elderly patients. METHODS: Eighty-nine patients who underwent cervical laminoplasty were reviewed. The patients were divided into 2 groups according to the age at the time of operation (the elderly patient group: 20 patients who were older than 70 years old, and the control group: 69 patients who were younger than 69 years old). Pre- and postoperative neurologic status (the Japanese Orthopedic Association score) and postoperative complications were compared between the two groups. Radiologic features were also examined. RESULTS: There was no statistical difference in the recovery rate of Japanese Orthopedic Association score between the elderly patient group and the control group. Activities of daily living improved in the elderly patients. Several complications, such as delirium and worsening hypertension, were found in the elderly patient group. In the preoperative radiographs, the incidence of either retrolisthesis or anterolisthesis in the elderly patient group was significantly higher than that in the control group. CONCLUSIONS: Retrolisthesis and anterolisthesis are often the cause of myelopathy in elderly patients. Surgical decompression for cervical myelopathy was beneficial even in elderly patients older than 70 years old. Laminoplasty achieves stability of the cervical spine, and this procedure is reasonable for the treatment.

Aged↗