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PubMed1997

The surgical management of patients with rheumatoid cervical spine disease.

Rheumatoid arthritis is an inflammatory disease that commonly affects the cervical spine. This article reviews the incidence of spinal involvement, the clinical manifestations of spinal disease, and the types of instability patterns that may occur and their radiographic diagnosis. Appropriate guidelines for obtaining imaging studies and for surgical referral is also described. Finally, the role of surgical stabilization is discussed.

Arthritis, Rheumatoid↗
PubMed1997

Suitability of cerebrospinal fluid as a signal-intensity reference on MRI: evaluation of signal-intensity variations in the lumbosacral dural sac.

The suitability of the cerebrospinal fluid (CSF) in the lumbosacral dural sac as an internal signal-intensity reference was studied on magnetic resonance imaging (MRI) of the lumbar spine using a surface coil and motion artefact suppression technique. A signal-intensity reference is needed when signal is compared between images, studies or subjects. Homogeneity of the CSF was estimated visually on T2-weighted images of 60 subjects at 1.5 T and of another 60 subjects at 0.1 T. Spines with a severely narrowed dural sac or marked scoliosis were excluded from the study to avoid partial volume effect. CSF was homogeneous in 82% and 73% of the examinations at 1.5 T and 0.1 T, respectively. The type and location of the local inhomogeneities did not relate to local narrowings of the dural sac. The signal intensity of CSF was measured in 108 examinations at 0.1 T after correcting the spatially-dependent signal-intensity non-uniformities with a phantom-based method. The signal-intensity difference between the CSF in the upper and lower lumbar dural sac was less than 10% in 73% of the examinations. The CSF in the lumbosacral dural sac can be a useful signal-intensity reference for estimation of the signal of the adjacent structures in patients without severe narrowing of the dural sac or marked scoliosis. It may contribute to assessing spinal disease processes.

Adult↗
PubMed1989

CSF TRAP: a procedure to improve laboratory testing with myelography.

CSF TRAP (Transport and Rapid Accessioning for Additional Procedures) is a procedure that provides storage of and rapid access to cerebrospinal fluid (CSF) specimens and allows clinicians to review initial findings before ordering low-yield CSF studies. The cost-effectiveness of routinely using the CSF TRAP procedure with myelography is examined in a study group of 819 patients, 74% with disc diseases, spinal stenosis, spondylolisthesis, or pain syndromes, 10% with cancer, and 16% with neuropathies and miscellaneous conditions. Routine studies on CSF obtained during myelography provided little additional clinical information, except for patients with cancer (of 80 patients with cancer, the results of cytological examination of the CSF were positive in 12) and patients with multiple sclerosis, for whom oligoclonal band and IgG analysis provided supportive diagnostic data. The utilization of the CSF TRAP procedure with elimination of unnecessary culture and cytological studies on patients with disc diseases, spinal stenosis, spondylolisthesis, and pain syndromes, reduces myelographic CSF procedures by 20%, for a savings exceeding $14,000. The CSF TRAP procedure allows for a more cost-efficient analysis of CSF obtained using myelography, while providing fluid for analysis in patients with unexpected findings.

Adult↗
PubMed2005

Hydatid cyst of the craniocervical junction: case report.

OBJECTIVE AND IMPORTANCE: Although rare in developed countries, hydatid disease is a serious parasitic infection in endemic areas. Spinal disease most commonly involves the thoracic region, and involvement of the upper cervical spine is extremely rare. In this report, a case of hydatid disease involving the craniocervical junction is presented, along with a review of the literature. CLINICAL PRESENTATION: A 44-year-old man presented with the complaint of neck pain. The results of his physical and neurological examinations were within normal ranges, except for pain exacerbated by neck motion and spasm of the cervical musculature. Magnetic resonance imaging demonstrated a cystic lesion involving the odontoid process and body of C1 and C2, with thin and regular cyst walls and cyst contents similar in intensity to that of cerebrospinal fluid. The results of serological tests performed with the suspected diagnosis of hydatid disease were positive. INTERVENTION: The patient initially underwent surgery to provide stabilization of the craniocervical junction, using autogenous bone graft and sublaminar wiring from the occiput to C3 via a posterior approach. The cyst was approached via a transoral route, using a U-shaped pharyngeal incision. There were no neurological deficits after surgery. Postoperative magnetic resonance imaging scans confirmed complete excision of the cyst, and the patient was discharged on the 12th postoperative day. He received six cycles of albendazole treatment, each consisting of 28 days with an intervening drug-free period of 2 weeks. Magnetic resonance imaging scans performed 1 year after surgery revealed the patient was still disease-free. CONCLUSION: Hydatid disease should be considered in the differential diagnosis of spinal cord compression, especially in endemic areas. Although the chance of obtaining a cure is unlikely, radical surgery coupled with antihelminthic therapy seems to provide long-lasting relief.

Adult↗
PubMed1977

Sexual functioning and the physically disabled adult.

A person's sexual readjustment following a physical disability has traditionally been ignored by health care professionals. Since the occupational therapist often facilitates a person's resumption of activities of daily living, the therapist is in a special position to provide counseling. Understanding, support, and correct information are needed most. As derived from a search of the literature, sexual functioning is discussed in relation to the following disabilities: stroke, heart disease, diabetes mellitus, muscular dystrophy, multiple sclerosis, renal disease, spinal cord injury, pulmonary disease, arthritis, and alcoholism.

Adult↗
PubMed1986

Magnetic resonance imaging compared with computed tomography and myelography in the diagnosis of spinal masses.

Magnetic resonance imaging (MRI) is superior to computed tomography (CT) and myelography in the demonstration and delineation of the extent of syringomyelia. In the detection of intramedullary tumors MRI is more sensitive than CT and myelography. MRI provides additional information on the sagittal and frontal planes regarding the extent of tumors. In the diagnosis of disc prolapse MRI seems to be as accurate as CT or myelography. Additional information is available with MRI in the diagnosis of degenerated disc tissue. Spinal stenosis is easily recognizable. CT was superior in the differentiation of bony and disc protrusion. The results show that MR has opened up new possibilities in the diagnosis of spinal diseases and will lead to a reorientation of the diagnostic approach.

Diagnosis, Differential↗
PubMed1991

Imaging modalities for evaluation of the spine.

The spine can be evaluated by a number of different imaging modalities. Although magnetic resonance imaging has assumed the dominant role in the diagnosis of spinal disease, the individual clinical situation still determines the procedure of choice. This review discusses the different imaging techniques and their currently accepted indications.

Angiography↗
PubMed1985

Palaeopathology of spinal osteophytosis, vertebral ankylosis, ankylosing spondylitis, and vertebral hyperostosis.

Five hundred and sixty intact skeletons and several thousand disarticulated vertebrae have been examined with special reference to spinal fusion. In period they ranged from a 21st dynasty Egyptian mummy to a mid-19th century skeleton. Osteophytes were found in about half of the specimens, as reported previously. Fifteen skeletons with extensive blocks of spinal fusion were also identified. Sacroiliitis was present in two, but the asymmetrical spinal disease and peripheral joint changes suggested Reiter's disease or psoriatic spondylitis rather than ankylosing spondylitis. The remaining 13 had typical features of Forrestier's disease, and extraspinal findings indicative of diffuse idiopathic skeletal hyperostosis (DISH) were also common. A review of the available literature suggests that many palaeopathological specimens previously reported as anklylosing spondylitis are examples of DISH or other seronegative spondylarthropathies. The antiquity and palaeopathology of AS needs reappraisal.

Adult↗
PubMed2003

Rupture of tuberculous spinal abscess resulting in tuberculous empyema and chylothorax.

STUDY DESIGN: Case report with a review of scientific literature. OBJECTIVE: To describe the course of tuberculous spinal disease (Pott's disease) complicated by pyogenic and tuberculous empyema, and chylothorax as there has been an increase in the numbers of notified cases of tuberculosis in the UK(1). To the best of our knowledge, a similar case has not been reported previously in the UK, although there has been a report of bilateral chylothorax associated with Pott's disease. SETTING: A national spinal injuries unit in a Scottish university teaching hospital. METHODS: Review of literature on the chemotherapy of spinal tuberculosis and the role of streptokinase in the treatment of empyema and the relation between spinal tuberculosis, empyema and chylothorax. RESULTS: Although spinal tuberculosis was recognised and treated appropriately with chemotherapy, the patient sustained pleural involvement with later development of both empyema and chylothorax. CONCLUSION: The case highlights the difficulties in the treatment of tuberculosis of the spine inspite of the presence of fully sensitive organisms and early institution of appropriate chemotherapy. In the absence of surgical debridement, the duration and dosage of chemotherapy as practised in the initial period may have to be prolonged into the continuation phase. The thoracic duct can be damaged either because of extension of the tuberculosis itself or because of instillation of intrapleural streptokinase for treatment of pleural empyema leading to chylothorax. There is a need for randomised trials of intrapleural streptokinase treatment in tuberculous empyema.

Aged↗
PubMed1992

[Imaging of the spine].

Modern imaging techniques allow early and precise diagnosis of spinal diseases. Their sensitivity and specificity are variable, but in general they are more complementary than competitive. After emphasizing the different patterns which characterize the late evolution of diagnostic imaging, the author reviews the indications and limits of plain films, bone scintigraphy, computed tomography, and in particular of magnetic resonance, in trauma, degenerative lesions, inflammations, infections and tumors of the spine.

Diagnostic Imaging↗
PubMed1995

Disc degeneration of pediatric patients in lumbar MRI.

Magnetic resonance imaging (MRI) is widely used in pediatric spinal disorders, but the prevalence of associated lumbar disc degeneration (DD) has not been evaluated previously. In this study we investigated whether children with suspected spinal disease had increased tendency to early DD. We analyzed lumbar MRI scans of 32 patients and 49 control subjects under 15 years old. Only four patients (13%) had DD on T2-weighted MRI and they were all over 10 years old. Eleven subjects (22%) in the control group had DD. It seems that disc degeneration is seldom found in patients under 10 years old.

Case-Control Studies↗
PubMedDate not supplied

[Remuscularization of the bladder in traumatic spinal cord disease].

A topographic anatomical study of 80 cadavers has suggested a new method of surgical treatment for paralytic neurogenic bladder developing as a result of an injury of lumbosacral regions of the spine or horse-tail roots. The method consists in the remuscularization of neurogenic bladder by grafts, tailored from the outer parts of abdominal musculus rectus with supplying lower epigastric vessels. Twenty-one operations were performed using this method. Controlled micturition was recovered within 3 or 4 weeks. The volume of residual urine never exceeded 50 ml. Pyelonephritic attacks ceased.

Abdominal Muscles↗
PubMed1991

Surgical palliation of spinal oncologic disease: a review and analysis of current approaches.

The clinical problem of primary and secondary vertebral tumours is encountered with increasing frequency throughout North America as oncologic management protocols evolve and the population continues to age. These lesions can present problems of pain, instability and paralysis. Optimal surgical palliation is often of benefit when more conservative methods have been unsuccessful. Vertebral tumours can be approached either anteriorly or posteriorly. These alternatives have led to the evolution in the clinical community of two "camps" championing their respective approaches. The authors have reviewed the accumulated literature up to December 1988 and have found that anterior approaches offer improved clinical outcome without substantially increased morbidity.

Humans↗
PubMed1991

New clinical and radiographic features of the seronegative spondyloarthropathies.

This article reviews new data supporting the hypothesis that the clinical spectrum of the seronegative spondyloarthropathies is wider than previously realized. It describes the literature in general and specific reports on the prevalence and clinical features of seronegative spondyloarthropathies in a number of different populations from America and Asia. Undifferentiated or unclassified spondyloarthropathies are now recognized more frequently. There is an extensive analysis of new proposals for nomenclature and criteria for classification that need to be validated. The normal appearance and biomechanics of the sacroiliac joints as well as new imaging techniques to approach them in several diseases are also discussed. Clinical, radiographic, and histopathologic findings in spinal disease and further observations on gut inflammation and intestinal permeability are also presented here. A long list of clinical associations of the seronegative spondyloarthropathies is also given.

Humans↗
PubMedDate not supplied

[CDH--preliminary report on a primary stable ventral lumbar spine instrumentation].

CDH-instrumentation was developed by the principles of an improved stability in ventral operation procedure and by the possibility of treating all anterior spinal diseases. The implantation of anterior plates and drawers, the use of rods fixed within the implant in non-parallel directions thus automatically providing for a locking mechanism against displacements, the prevention of dislocation of the cancellous bone screws and the DDT-principle were further requirements. The spine can be corrected according to the three-dimensional anatomy by distraction-, compression and rotational forces, a postoperative external support is unnecessary. After the application of the method in 50 patients (mono- and multisegmental) the excellent stability could be proved.

Adolescent↗
PubMed1999

Evaluation of pedicle screw position in thoracic and lumbar spine fixation using plain radiographs and computed tomography. A prospective study of 35 patients.

STUDY DESIGN: This was a prospective study of 35 consecutive patients in whom pedicle screw position was assessed after surgery, using lateral radiographs and computed tomography. OBJECTIVE: To evaluate the accuracy of plain radiographs and computed tomography in assessment of pedicle screw position. SUMMARY OF BACKGROUND DATA: Imaging techniques, such as postoperative anteroposterior and lateral plain radiographs and computed tomography, are currently the primary means of assessing pedicle screw placement. METHODS: Postoperative radiographs and computed tomographic scans were used to evaluate the position of 220 pedicle screws inserted in the spines of 35 consecutive patients who underwent thoracic and lumbar spine fusion and instrumentation. No recognized neurologic complication resulted from pedicle screw placement. Screw position was graded as in, out, or questionable. All observations were performed independently by three observers. The authors also analyzed the position of the screws according to the underlying spinal disease. RESULTS: More misplaced screws were clearly seen on computed tomographic scans than on plain radiographs; however, this difference was not statistically significant. Interobserver differences were not statistically significant. Intraobserver differences approached statistical significance when the results of the two test were compared. CONCLUSIONS: Although the accuracy of computed tomographic imaging is better than that of plain radiographs, the difference does not reach statistical significance. Postoperative use of plain radiographs remains a reliable method for evaluation of pedicle screw insertion in the absence of neurologic deficit.

Bone Screws↗
PubMed1991

Calcitonin gene-related peptide immunoreactivity in spinal spheroids in motor neuron disease.

The spinal cords from seven autopsy cases of sporadic motor neuron disease (MND) and two controls were immunohistochemically examined using antibodies directed to calcitonin gene-related peptide (CGRP) and to neurofilament proteins (Nf). CGRP immunoreactivity was observed in the posterior horns, especially in the laminae I and II, of all the spinal cords examined. In MND cases, in addition, a considerable number of spheroids in the anterior horns were labelled with the antibody. In some spheroids, their entire area was homogeneously immunostained, whereas in others the immunoreactivity was confined to a focal area(s) within the profile of the spheroids and between these two forms of staining several variations of the staining patterns were seen. The anti-Nf intensely and homogeneously labelled all spheroids and there was no appreciable difference in the Nf-immunoreactive pattern between CGRP-positive and -negative spheroids. It is possible that the accumulation of CGRP in spheroids may result from entrapment of CGRP during the anterograde axonal transport, causing loss of CGRP at the neuromuscular junction and producing weakness and atrophy of the muscles.

Aged↗
PubMed2005

Fluoroscopically assisted percutaneous translaminar facet screw fixation following anterior lumbar interbody fusion: technical report.

STUDY DESIGN: A technical report of fluoroscopically assisted percutaneous translaminar facet screw fixation after anterior lumbar interbody fusion (ALIF). OBJECTIVES: To describe a minimally invasive translaminar facet screw fixation technique that was modified from the Magerl method, and to assess its technical feasibility and clinical efficacy. SUMMARY OF BACKGROUND DATA: There is no previous study in the literature on percutaneous translaminar facet screw fixation assisted only by fluoroscopy without using any specially designed guiding device. Also, there is no previous study involving a screw insertion technique in which the screw is directed to purchase the pedicle while traversing the lamina and transfixing the facet joint. METHODS: A total of 20 patients with degenerative spinal disease underwent ALIF and supplementary percutaneous translaminar facet screw fixation under fluoroscopic guidance from 2001 through 2002. Their clinical and radiologic data were collected and analyzed. RESULTS: A total of 65 screws were inserted. Seven screws (10.8%) were found to have violated laminae walls but none injured or compressed neural structures directly. The purchases of the facet joints were all successful, but insertion into the pedicle in perfect position was successful in 55 screws (84.6%). Radiologic fusion occurred in all fused levels (100%). Estimated blood loss was 222.5 mL (100-520), and no blood transfusions were needed in any of the cases. There was only one complication related to facet screw fixation, in which the distal tip of a superior articular process was fractured caused by repeated drilling with a K-wire. CONCLUSIONS: Percutaneous translaminar facet screw fixation using fluoroscopy is technically feasible. It seems that the fluoroscopically assisted percutaneous translaminar facet pedicle screw fixation is a useful, minimally invasive posterior augmenting method following ALIF.

Adult↗