Spinal cord disease in West Nile virus infection.
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Aged↗
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Results for “SPINAL DISEASES”
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[Dorsal spinal cord disease caused by ossification of the ligamentum flavum and D10-D11 posterior arthrosis].
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Aged↗
[Transesophageal ultrasonography of the spinal canal].
Transoesophageal ultrasound imaging of the spinal canal through an intervertebral disc was successfully achieved in 44 of 50 adults (18 women and 32 men; mean age 56 years, range 22-79) who, for cardiological indications had transoesophageal echocardiography. On average, five (range 1-11), usually sequential, segments were visualized. In 37 patients pulse-synchronous sagittal displacement of the spinal cord was noted, presumably caused by cerebrospinal fluid pulsation. In one woman, with known syringomyelia, the spinal cord cavity was well shown. Real-time demonstration of dynamic events in the spinal canal opens up new possibilities for the diagnosis and follow-up monitoring of spinal diseases.
Adult↗
Spine surgery in geriatric patients.
AIM: Many elderly patients are crippled by degenerative spine conditions. Operative treatment is often not offered due to fear of complications and consideration of life span. The objective of this study was to look at the diagnosis, surgical results and post-operative complications of elderly patients who underwent spinal surgery. METHODS: A cohort of 44 patients, 65 years and older, who had surgery in Tan Tock Seng Hospital from January 1990-August 1995 were reviewed. Twenty-five of them had spinal stenosis, II had tumour and 9 had traumatic fracture/dislocation/subluxation. There were 3 patients each with disc herniation, infection and spondylolisthesis. Nine patients had more than one diagnosis. All patients were investigated post-operatively. The data was entered into a computer-coded protocol. The diagnosis was determined intraoperatively. Type of surgery, co-morbid conditions and results were looked into. Patient's opinion on relief symptoms was graded on a 5-point scale. Functional improvement was tabulated as the patient's ambulatory status. RESULTS: The analysis of results was divided into two groups, patients with tumour and those without tumour. Twenty-seven of the 33 patients without tumour were alive at follow-up. Twenty-six of these patients had improvement of symptoms and 18 of 27 had improved functional status post-operatively. In the group with tumours, 2 had worsening symptoms and 3 had decreased function. CONCLUSION: Surgical intervention should be a treatment option in elderly patients with spinal disease.
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Surgical management of spinal metastases.
Metastatic spread to the spinal column is a growing problem in patients with cancer. It can cause a number of sequelae including pain, instability, and neurologic deficit. If left untreated, progressive myelopathy results in the loss of motor, sensory, and autonomic functions. Except in rare circumstances, treatment is palliative. Traditionally, conventional fractionated external beam radiotherapy has been the treatment of choice. "Surgery" for metastatic spinal disease was, and generally continues to be, equated with laminectomy by many physicians. However, there has been a remarkable evolution in surgical techniques over the last 20 years. Today, the goal of surgery is to achieve circumferential decompression of the neural elements while reconstructing and immediately stabilizing the spinal column. This has been made possible by the use of different surgical approaches and the exploitation of a burgeoning array of internal fixation devices. More recently, minimally invasive surgical techniques, such as endoscopy, kyphoplasty/vertebroplasty, and stereotactic radiosurgery, have been added to the surgeon's armamentarium. As the number of treatment options for metastatic spinal disease grows, it has become clear that effective implementation of treatment can only be achieved by a multidisciplinary approach. This will provide the surest means of maximizing the quality of the remainder of the patient's life.
Humans↗
Contemporary spinal CT applications.
Despite the widespread availability of MR imaging, CT remains a vital modality for the evaluation of disorders of the spine, offering superior assessment of bone abnormalities, as well as calcification. Advances in technology have enhanced the capabilities of CT, providing exciting new options for data rendering and display. Depending on the clinical indication, either CT or MR may be the modality of choice in the evaluation of spinal disease.
Calcinosis↗
[Diagnosis and differential diagnosis of back pain from the neurological point of view].
Affections of the vertebral body, the intervertebral disc, the epidural and subdural space, the nerve root, and the spinal cord may have back pain as the main symptom. Initially a topical diagnosis is established in the light of the neurologic symptoms and signs (segmental "beltlike" pain, radicular motor and sensory signs, central mono-, para-, and tetraparesis, as well as sensory signs and bladder dysfunction). Degenerative changes and herniated discs are the most frequent causes of cervical and lumbar spinal disease with neurologic signs, followed by extramedullary tumors. In the extradural space metastases, plasmocytoma, lymphomas and primary bone tumors are the most common, and neurinomas and meningiomas in the intradural space. In the spinal cord ependymomas and astrocytomas are found, as well as benign cavities (syringomyelia). Conditions which are rare, but very important because treatable at an early stage, are spinal epidural hematomas with anticoagulation and spinal epidural abscesses. Vertebral osteomyelitis must also be considered in differential diagnosis. Inflammatory nerve root lesions seldom cause pain, except for subacute demyelinating polyneuropathy responding to corticosteroid treatment, and radiculitis caused by borrelia and herpes zoster.
Adult↗
Importance of myelography in early diagnosis of spinal epidural disease.
Epidural metastasis is potentially one of the most disabling complications encountered in oncology. Once paraplegia has been established, only one patient in ten responds to treatment. A series of 16 patients is presented in which early diagnosis and treatment led to improvement in 13 of 16 patients. Most patients present with pain for varying periods (mean 2.2 months) before neurological signs appear. Myelography alone establishes the diagnosis. Spinal radiography correlates well with the block level in two thirds of cases. Radiotherapy, alone or with steroids, increasingly is used in the management of this condition.
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[Blood circulation disorders of the spinal cord in diseases of the spine].
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Cardiovascular System↗
Medical and surgical treatment of seronegative spondyloarthropathies.
Advances in the treatment of the seronegative spondyloarthropathies are reviewed here. The search for effective disease-modifying agents in this group of disorders has continued. Recent attention has focused primarily on sulfasalazine and different immunosuppressive agents. Sulfasalazine has been evaluated by several groups of investigators in ankylosing spondylitis and psoriatic arthritis. Results have been variable, but data suggest that sulfasalazine is less effective for spinal disease than for peripheral joint involvement. Preliminary studies have shown that cyclosporine and other immunosuppressive agents are beneficial in patients with psoriasis and Behçet's disease. Azathioprine appears to be highly effective in Behçet's disease.
Anti-Inflammatory Agents, Non-Steroidal↗
[Radiological imaging in lumbago and sciatica].
Low back pain and sciatica are among the most common medical problems in Western countries, affecting up to 80% of the population at some time during their lives. Plain radiography is still a sensitive method in degenerative spinal disease and for the identification of spondylolysis and destructions as well as transitional vertebra and other anomalies in the lumbosacral region. In lumbar disk herniation, CT and MR have higher sensitivity than lumbar myelography, and should be used as the primary imaging methods. Myelography is still the method of choice in lumbar spinal stenosis. Myelography should also be considered in patients with poor consistency between CT or MR findings and the clinical presentation. Postoperatively, MR is superior to CT and myelography for distinguishing between scar tissue and recurrent disk herniation.
Epidural Space↗
An assessment of back pain and the prevalence of sacroiliitis in sarcoidosis.
OBJECTIVES: Sarcoidosis is a chronic granulomatous multisystem disease in which arthritis is relatively common. Arthritis of the sacroiliac joints (sacroiliitis) has been described in sarcoidosis but is thought to be rare. The objective of this study was to determine the prevalence of sacroiliitis in a secondary-care population of patients with sarcoidosis. METHODS: Patients attending a specialist secondary-care sarcoidosis clinic underwent evaluation of spinal symptoms using a standard back pain questionnaire, examination of spinal mobility, and laboratory measurements of erythrocyte sedimentation rate, C-reactive protein, serum angiotensin-converting enzyme, and neopterin/creatinine ratio. Tissue typing for the presence of the human leukocyte antigen (HLA)-B27 allele was undertaken. Radiographs of the sacroiliac joints were obtained in each patient and reviewed independently by two observers; a further observer reviewed disputed radiographs. RESULTS: Sixty-one patients completed the assessments (80.3% of all patients invited to participate). Forty-nine of 61 patients (80.3%) reported having back pain at some point in their lives. Thirty-one of 61 patients (50.8%) had a score on the back pain questionnaire suggestive of inflammatory spinal disease, but only 3 of these patients had erosive damage of the sacroiliac joints on radiography indicating sacroiliitis. One further patient had erosive damage on radiography, making a total of four individuals with evidence of sacroiliitis, a prevalence of 6.6%. Four patients (one patient with sacroiliitis) were positive for HLA-B27. The back pain questionnaire had a sensitivity of 75% and a specificity of 51% for sacroiliitis in this population. CONCLUSION: The prevalence of spondyloarthropathy in the normal population has been estimated to be 1.9%. In the sarcoid population studied the prevalence was 6.6% suggesting a possible association between these two conditions. The standard back pain questionnaire for the identification of inflammatory spinal disease had a low sensitivity and specificity in this population.
Arthritis↗
Anterior cervical fusion with the Orion locking plate system.
STUDY DESIGN: This study was conducted to evaluate an anterior cervical fusion plate system, the Orion locking plate, regarding its surgical handling, hardware-related failures, and short-term and long-term results. OBJECTIVES: A comprehensive evaluation of the implant in a broad range of patients with cervical spine diseases. SUMMARY OF BACKGROUND DATA: Locking plates are the most recent devices for achieving anterior cervical spinal fusion and offer considerable advantages such as faster and easier implantation and fewer implant-related failures than older plate systems. METHODS: Ninety-six patients were investigated. All underwent anterior cervical plate fusion as a component of the surgical treatment for symptomatic degenerative cervical spinal disease or for vertebral destruction caused by trauma, tumor, or inflammation. Besides plate fixation, 6 of the 96 patients had a combined ventrodorsal fusion. In 28 cases, one or more vertebral bodies were removed and replaced with titanium place-holders. The remaining 62 patients were first treated by intervertebral inlay placement, and the fused segments were subsequently plated. Neurologic signs and symptoms were evaluated before and after surgery and during a follow-up period of at least 1 year. RESULTS: The rate of neurologic improvement was highest in radiculopathy patients and lowest in patients with severe myelopathy. In all cases, control radiographs demonstrated a solid bony fusion. Clinical deterioration after surgery was seen in four cases of severe myelopathy in which considerable neurologic deficits existed before surgery, possible because of rapid decompression of the cord and associated microvascular alterations. In two of these cases, there was long-term improvement. Additional general complications caused by surgical retraction included temporary swallowing disturbance in seven patients and a large wound hematoma in one. Hardware failures were encountered in three cases, all of them caused by improper implantation technique and not material failure, per se. CONCLUSION: In the study group, the Orion locking plate was easy to use, failure-free if properly implanted, safe for the patient and supported solid bony fusion in every case.
Adolescent↗
[Meningomyelitis disclosing Behçet's disease].
The authors report a patient who developed a meningo-myelitis attributed to Behçet disease. Spinal MRI assessed spinal involvement. Among neurological manifestations of Behçet disease, isolated spinal cord involvement is infrequent. Dramatic improvement of neurological symptoms was obtained after steroid and immunosuppressive treatment.
Adolescent↗
[Our experience with laminectomy in the treatment of spinal cord disease caused by cervical arthrosis: apropos of 42 cases].
Cervical spondylotic arthRosis may lead to a myelopathy and the question which can rise is: posterior surgical decompression is adequate regarding the others surgical technics discussed? In this paper the authors describe the postoperative results of 42 patients who have been operated on by laminectomy from 1971 to 1995 at Fann Hospital in Dakar. The median age was 42 years and the median delay between the onset of neurological disorders and operation was 5.9 months. All patients showed symptoms of spinal cord and root disturbances. Neuro-imaging studies with plan X-rays and myelography reveal arthrosis and the impact of this arthrosis on nervous system. With a follow up of 6 months we found a mortality rate of 4.7% (two cases of death), 66.8% of good results and 28.5% of fail. Eighteen months post surgery results were respectively 52.3% and 45.7% of good and poor results. The complications of the laminectomy were peri operative hemorrhage (19%); sepsis (21.4%); spine cord traumatic injuries (9.5%) spondylolisthesis (4.7%). Laminectomy has been found to improve "spine syndrome"; paresthesia; fasciculations, and sensory deficits. Also three level laminectomy and surgery which can take place before six months are good prognosis factors. The authors stressed on laminectomy because of our low medical care situations particularly that no other surgical procedures through the modern literature leads to better results.
Adult↗
Sex difference in the validity of vertebral deformities as an index of prevalent vertebral osteoporotic fractures: a population survey of older men and women.
Morphometric methods have been developed for standardized assessment of vertebral deformities in clinical and epidemiologic studies of spinal osteoporosis. However, vertebral deformity may be caused by a variety of other conditions. To examine the validity of morphometrically assessed vertebral deformities as an index of osteoporotic vertebral fractures, we developed an algorithm for radiological differential classification (RDC) based on a combination of quantitative and qualitative assessment of lateral spinal radiographs. Radiographs were obtained in a population of 50- to 80-year-old German women (n = 283) and men (n = 297) surveyed in the context of the European Vertebral Osteoporosis Study (EVOS). Morphometric methods (Eastell 3 SD and 4 SD criteria, McCloskey) were validated against RDC and against bone mineral density (BMD) at the femur and the lumbar spine. According to RDC 36 persons (6.2%) had at least one osteoporotic vertebral fracture; among 516 (88.9%) nonosteoporotics 154 had severe spondylosis, 132 had other spinal disease and 219 had normal findings; 14 persons (2.4%) could not be unequivocally classified. The prevalence of morphometrically assessed vertebral deformities ranged from 7.3% to 19.2% in women and from 3.5% to 16.6% in men, depending on the stringency of the morphometric criteria. The agreement between RDC and morphometric methods was poor. In men, 62-86% of cases with vertebral deformities were classified as nonosteoporotic (severe spondylosis or other spinal disease) by RDC, compared with 31-68% in women. Among these, most had wedge deformities of the thoracic spine. On the other hand, up to 80% of osteoporotic vertebral fractures in men and up to 48% in women were missed by morphometry, in particular endplate fractures at the lumbar spine. In the group with osteoporotic vertebral fractures by RDC the proportion of persons with osteoporosis according to the WHO criteria (T-score < -2.5 SD) was 90.0% in women and 86.6% in men, compared with 67.9-85.0% in women and 20.8-50.0% in men with vertebral deformities by various methods. Although vertebral deformities by most definitions were significantly and inversely related to BMD as a continuous variable in both sexes [OR; 95% CI ranged between (1.70; 1.07-2.70) and (3.69; 1.33-10.25)], a much stronger association existed between BMD and osteoporotic fractures defined by RDC [OR; 95% CI between (4.85; 2.30-10.24) and (15.40; 4.65-51.02)]. In the nonosteoporotic group individuals with severe spondylosis had significantly higher BMD values at the femoral neck (p < 0.01) and lumbar spine (p < 0.0004) compared with the normal group. On the basis of internal (RDC) and external (BMD) validation, we conclude that assessment of vertebral osteoporotic fracture by quantitative methods alone will result in considerable misclassification, especially in men. Criteria for differential diagnosis as used within RDC can be helpful for a standardized subclassification of vertebral deformities in studies of spinal osteoporosis.
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[Nuclear magnetic resonance tomography of the spine].
The present paper deals with the results of 48 MR examinations of known spinal abnormalities. The use of a method strictly related to the individual problem helps to reduce the duration of the examination. Sagittal cuts are particularly useful for demonstrating much of the spinal canal. The spin-echo method is used for all examinations. Demonstration of the cord was performed by using short repetition and echo times (TR, TE). For showing the outer margin of the spinal canal, longer TR and TE should be selected. Surface coils are important for demonstrating spinal disease, since the larger images can be performed without increasing the duration of the examination.
Humans↗
Use of data from nonrandomized trial designs in evidence reports: an application to treatment of pulmonary disease following spinal cord injury.
Evidence reports summarize the evidence pertaining to various health-related topics. Including evidence from nonrandomized studies into such reports involves a trade-off between availability and bias. We describe a general framework by which information from nonrandomized studies might be integrated reasonably into evidence reports and illustrate its application to a recent evidence report on preventing pulmonary complications among patients with spinal cord injury. The proposed framework, which is based upon the premise that producing a fair summary of the evidence requires only a level of evidence judged by clinical experts to be sufficient to the task at hand, may help focus scarce resources, strengthen the quality and documentation of decisions including evidence from nonrandomized studies, and suggest high-priority areas for future research.
Evidence-Based Medicine↗