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PubMed1978

Cervical myelopathy due to ossification of the posterior longitudinal ligament: a clinicopathologic study.

A clinicopathologic study was done of a Japanese patient with symptomatic ossification of the posterior longitudinal ligament in the cervical spine. Post-mortem specimen showed characteristic distribution of degenerations at C5-6 segments similar to chronic cervical spondylosis or disk protrusion. The degenerative changes were confined to the ventral two thirds of the posterior and lateral columns. In addition to demyelination, loss of axons, and neuronal cell death, thickening of venular wall and fine capillary neovascularization strongly suggested chronic circulatory insufficiency. Spinal immobilization produced by the ossified ligament may have contributed to the long clinical course, lasting for 30 years. Review of literature showed that the myelopathy can be distinguished clinically and radiographically from that produced by cervical spondylosis.

Aged↗

PubMed1990

Multimodality evoked potentials in motor neuron disease.

We performed median and tibial nerve somatosensory evoked potentials (SEPs), pattern-shift visual evoked potentials (PSVEPs), and brain-stem auditory evoked potentials (BAEPs) on 27 patients with motor neuron disease (MND). Median and tibial nerve SEPs were abnormal in 8 (30%) of 27 and 3 (14%) of 21 patients tested, respectively. Central and peripheral abnormalities were recorded in the absence of spondylosis. As a group, patients with MND and no evidence of cervical spondylosis had normal conduction to Erb's point following median nerve stimulation, but conduction times beyond this point were prolonged. The PSVEPs and BAEPs were within normal limits in all patients, excluding abnormalities attributable to other disease, but the group P100 latency was significantly prolonged in the group with MND. The BAEPs were normal in the group with MND. This study provides neurophysiological evidence of sensory system involvement in MND.

Brain Stem↗

PubMed1976

Narrow lumbar spinal canal with "vascular" syndromes.

Symptoms suggestive of vascular origin, both venous and arterial, may be the presenting complaints in patients with lumbar spondylosis. Fourteen patients suspected of having vascular intermittent claudication were found to be free of vascular disease, but had cauda equina compromise from herniated disk, osteoarthritis, and hypertrophic ligaments. Complete follow-up data were available for seven patients. In three, claudication seemed typical; in four, atypical. At operation, herniated intervertebral disks, osteophytic bone, or hypertrophied ligamenta flava, or a combination, were found. All benefited from lumbar laminectomy. When patients with vascular-like symptoms are found to be free of arterial or venous disease, lumbar spondylosis (narrow lumbar canal syndrome) should be considered. Chronic incapacitation pain without vascular disease provides a clue, as does electromyography. Plain X-ray films of the lumbar spine do not show the abnormality; thus, myelography should be carried out even in the absence of neurologic signs.

Aged↗

PubMed1987

Reasons for failure of L5-S1 intervertebral disc excisions.

This study reviews 247 patients who still had preoperative complaints six months to two years after disc excision. In over half, spondylosis of the L5-S1 facets was present, concurrently associated with a pelvic obliquity. A number of other organic causative factors were identified in 18% of the patients. Nonorganic reasons accounted for failure in only 13%. Over 70% of patients with associated spondylosis were improved by treatment directed at this condition.

Adult↗

PubMed1993

Spondylectomy, microsurgical decompression and osteosynthesis in the treatment of complex disorders of the cervical spine.

In 44 patients with complex degenerative, traumatic, neoplastic and infectious disorders of the cervical spine an aggressive surgical approach was used, consisting of spondylectomy, radical microsurgical decompression and osteosynthesis. The patient group consisted of 23 patients with multisegmental cervical spondylosis, 9 patients with primary or metastatic malignant tumour disease spread along the cervical spine, 6 patients with complex cervical trauma and 6 patients with infection affecting one or more cervical segments. Considering the heterogeneity of the group of patients treated, a multitude of neurological symptoms and signs were present. Excruciating pain was the predominant symptom in 84% of the patients, followed by sensory and motor signs of varying degrees in 77% and 65% respectively. Involvement of the long tracts was present in 51%, gait disturbance in 49% and bladder disfunction in 28%. Considering the nature of the underlying disease, in the group with multisegmental cervical spondylosis (MSCS), advanced cervical myelopathy was the predominant clinical symptom, whereas in those patients with trauma, tumour or infection, pain was the leading symptom, followed by disturbed motor and/or sensory function. Altogether 59 vertebrae have been removed in the 44 patients. In 28 patients spondylectomy was performed at one level, in 15 patients at two levels and in one female tumour patient at three levels. In 34 patients an iliac crest bone graft was used and in 10 patients bone cement. Within the observation period, solid fusion was achieved in all patients. In one tumour patient screw loosening was demonstrable at follow-up, but the fusion remained stable. 2 patients with infectious disease required re-operation due to significant loosening of screws and plates. However, after re-stabilization solid fusion was achieved. Considering amelioration of specific pre-operative symptoms and signs, excruciating pain responded best to the stabilizing procedure, with improvement in over 90% of the patients, followed by improvement of sensory and motor deficits in 85% and 82% respectively. Improvement in pre-operative gait disturbance could be achieved in 81% of the patients, while disturbance of bladder function is less likely to improve after surgery with a positive response in only 58%. None of the patients became neurologically worse after surgery. With regard to the underlying disease, patients with MSCS and tumour had the best results with overall improvement in 62% and 75% respectively. While in patients with infection improvement could be achieved in 58%, improvement in trauma patients was demonstrable in only 34% while in 66% the pre-operative clinical status remained unchanged.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1986

Comparative investigations on vitamin A level of plasma in some rheumatic diseases.

The vitamin A levels in the plasma of patients suffering from rheumatoid arthritis, ankylosing spondylitis, spondylosis, ankylosing hyperostosis (whether or not connected with diabetes) were investigated. Somatically healthy neurotic patients and patients suffering from diabetes without rheumatological problems served as controls. It was found that the retinol level of plasma decreased in patients of both sexes suffering from rheumatoid arthritis and clinically active ankylosing spondylitis, but increased in female patients suffering from ankylosing hyperostosis connected with diabetes, and also in the diabetes group. The retinyl-esters content of plasma decreased in the rheumatoid arthritis group and increased in female patients suffering from spondylosis and in the clinically inactive ankylosing spondylitis group. The total vitamin A content changed only in the rheumatoid arthritis group where a lower level was found compared to a somatically healthy control group.

Adult↗

PubMed2001

Cervical spine injury in the elderly: imaging features.

An increase in the elderly population has resulted in an increased incidence of cervical spine injury in this group. No specific type of cervical spine trauma is seen in the elderly, although dens fractures are reported to be common. Hyperextension injuries due to falling and the resultant central cord syndrome in the mid and lower cervical segments due to decreased elasticity as a result of spondylosis may be also characteristic. The imaging features of cervical spine injury are often modified by associated spondylosis deformans, DISH and other systemic disorders. The value of MR imaging in such cases is emphasized.

Aged↗

PubMed2003

Intra-individual variation in lumbar bone mineral density as a measure of spondylotic deformity in the elderly.

In an attempt at quantitative assessment of spondylotic deformity, the intra-individual variation in L(1)-L(4) bone mineral density (BMD) was calculated, as the standard deviation (SD) and coefficient of variation (CV), obtained by dividing the SD by mean L(1)-L(4) BMD, in 463 subjects. The subjects ranged in age from their second to tenth decades. Dual-energy X-ray absorptiometry (DXA), using the Lunar DPX-L, was employed to assess the BMD. The SD of lumbar (L)BMD increased with advancing age in males, but not in females, whereas the CV of LBMD increased with age in both males and females, along with the radiographically assessed degree of severity of spondylosis deformans. Both the intra-individual SD and CV of L(1)-L(4) BMD showed a highly significant correlation with the radiological degree of severity of spondylosis deformans, and SD, but not CV, showed a strong dependence on the mean L(1)-L(4) BMD on a multiple regression test. Multiple regression test revealed no significant correlation between on body height, weight, fracture, and intra-individual variation in L(1)-L(4) projected area, reflecting compression fracture, one hand and SD or CV of L(1)-L(4) BMD on the other. Intra-individual variation in lumbar bone mineral density, expressed as a coefficient of variation, is suggested as an index of spondylotic deformity.

Adult↗

PubMed1994

Cervical radiculopathy.

The history, pathoanatomy and pathophysiology, clinical picture, differential diagnosis, diagnostic evaluation, and treatment of cervical radiculopathy are reviewed. The review is based on a 10-year Medline literature search, review of bibliographies in textbooks, and bibliographies in articles obtained through the search. Cervical radiculopathy, although recognized early in the 20th century, was first associated with disc pathology in the mid-1930s. It is most commonly caused by disc herniation or cervical spondylosis. History and physical examination using pain location, manual muscle testing, and specialized testing (Spurling's maneuver) will usually suffice to diagnose the radiculopathy and determine the root level involved. Diagnostic imaging such as magnetic resonance imaging, computed tomography, or myelography should be used as presurgical evaluative tools or when tumor or other etiology besides disc herniation or spondylosis is suspected. Electromyography is of benefit in distinguishing various entities that clinically present similar to cervical radiculopathy and can also help to "date" the lesion. Treatment of this disorder has not been systematically studied in a controlled fashion. However, using a variety of different treatments, the radiculopathy usually improves without the need for surgery. Indications for surgery are unremitting pain despite a full trial of non-surgical management, progressive weakness, or new or progressive cervical myelopathy. Prospective studies evaluating the various treatment options would be of great benefit in guiding practitioners toward optimum cost-effective evaluation and care of the patient with cervical radiculopathy.

Activities of Daily Living↗

PubMed1993

Magnetic stimulation in the determination of lumbosacral motor radiculopathy.

Magnetic stimulation was utilised to diagnose lumbosacral motor radiculopathy non-invasively. Magnetic coil stimulation estimated peripheral motor nerve conduction time (MNCT) which, used in combination with F response, allowed calculation of "motor root conduction time (MRCT)," response being recorded from abductor hallucis. Twenty-five normal controls and 26 patients with lumbar spondylosis were studied. The mean interside difference (left minus right) of MRCT in the control was +0.06 msec (range: -0.88 to +0.74 msec). On clinical and radiological grounds, patients with spondylosis were grouped into those with: (I) no lumbosacral root compression, (II) root compression without motor sign, and (III) root compression with motor deficit. All patients in group III and 36% of cases of group II had MRCT significantly prolonged on the affected side.

Adult↗

PubMedDate not supplied

MR visualization and clinical significance of the anterior longitudinal epidural venous plexus in cervical extra-axial lesions.

A thin band of intermediate signal intensity behind the cervical vertebral bodies, demonstrated on sagittal MR images, was attributed to the anterior longitudinal epidural venous (AEVP). Percentage visualization and clinical significance of this structure were evaluated in extra-axial lesions of the spinal cord. In review of 50 normal controls, the percentage visualization of this structure at each cervical vertebral level was 25.5% on T1 weighted sagittal SE images, while that of T2 or proton density weighted SE images was 26.0%. AEVP was demonstrated by sagittal MRI in 29 of 128 extra-axial lesions of the cervical cord (22.7%), including cervical spondylosis, ossification of the posterior longitudinal ligament (PLL), herniated disk and spondylosis at a single level. AEVP in these conditions was often thickened compared with normal controls, probably due to venous engorgement and contribution of the dura mater and PLL. Posterior displacement of this structure or "lifted band appearance" indicated herniated disk or posteriorly protruding osteophyte, demonstrating true anteroposterior diameter of the spinal canal. Demonstration of AEVP on sagittal MRI was important in the diagnosis of extra-axial lesions of the cervical cord.

Cervical Vertebrae↗

PubMed1994

Cervical spondylotic stenosis and myelopathy: evaluation with computed tomographic myelography.

OBJECTIVE: To determine which components of cervical spondylosis are most frequently present in patients with myelopathy. DESIGN: We reviewed the findings in 93 patients who underwent surgical decompression for cervical spondylotic myelopathy between January 1986 and December 1989 at Mayo Clinic Rochester. MATERIAL AND METHODS: All 93 patients (72 men and 21 women) underwent computed tomographic (CT) myelography. In addition, magnetic resonance imaging scans were available in 25 patients, and plain CT scans were obtained in 2. RESULTS: A review of CT myelograms revealed that all neurocompressive intraspinal spondylotic changes were reflected in the shape of the spinal cord. Among the 93 patients with myelopathy, the configuration of the spinal cord could be categorized into primarily three dominant types: A (severe encroachment that compressed the cord into the shape of a banana; N = 40), B (moderate encroachment that produced less prominent compression; N = 23), and C (moderate bilateral uncovertebral spurs; N = 12). As a comparison group, 30 patients with similar spinal cord deformities but without progressive myelopathy were analyzed. Correlation of the two groups showed that myelopathy was present in up to 98% of patients with type A spinal cord, in 75% with type B, and in 71% with type C. The findings on magnetic resonance imaging were similar to those on CT myelography, but the bony spondylotic components were less readily seen. CONCLUSION: The precise pathophysiologic mechanism of myelopathy in spondylosis remains an enigma. Although the bulk of the data on our patients supports direct compression, we believe that the cause is multifactorial.

Adult↗

PubMed2005

[Enhancing awareness of the modalities in the management of chronic inflammatory diseases].

From an epidemiologic point of view, the incidence of rheumatoid arthritis in the French regions we studied appears relatively stable and about the same as the prevalence of rheumatoid spondylosis. The incidence of Crohn's disease, among the chronic inflammatory bowel diseases, is currently increasing. Treatment for rheumatoid arthritis, other than symptomatic and maintenance treatments, now includes various specific forms of "biotherapy". Their development was made possible through the decoding of the pathophysiological mechanisms of inflammation and joint destruction, basically involving pro-inflammatory cytokines. Currently, it appears that these treatments should be limited to severe or active progressive rheumatoid arthritis that is resistant to maintenance therapy. For rheumatoid spondylosis, the prescription of anti-TNF alpha agents requires early diagnosis and prognostic assessment of the disease, together with the implementation of an individualized therapeutic strategy for the global multidisciplinary management of each patient. The introduction of immunosuppressors and anti-TNF alpha agents for chronic inflammatory bowel diseases constitutes a major advance in the management of their severe forms, but nevertheless raises the issues of whether their use should be systematic or depend on the severity of the disease. They also require the training of practitioners in their use and monitoring. Patients' groups have requested more collegial decision-making, decompartmentalization of practices, widespread development of health care networks, the development of clinical trials and improved communication. The regional disparities in patient management stem from epidemiologic variations in the demand for care and from social and demographic differences in the populations. They also depend on the overall health-care supply. Health networks can be defined as structures of coordination and non-mandatory, non-hierarchical services to patients that help to improve care and/or prevention by the appropriate involvement of various healthcare professionals. Regional particularities are observed, as is shown by the studies conducted in Brittany, the Loire Valley and Nord Pas-de Calais. The questions regarding the networks do not concern their effectiveness in the management of chronic inflammatory diseases, but their structure, day-to-day operations, and financing.

Arthritis, Rheumatoid↗

PubMedDate not supplied

The degenerative cervical spine: pathogenesis and rehabilitation concepts.

The degenerative process associated with spondylosis in the cervical spine has been reviewed. The two compressive syndromes commonly associated with spondylosis, radiculopathy and myelopathy, are briefly reviewed. Except for more severe, multilevel degenerative changes producing neurologic compromise, correlation between degenerative changes and patient symptoms or functional limitations is generally poor. A conceptual scheme for guiding rehabilitation of mechanical neck pain, based on irritability level and the effects of mechanical stress on symptoms, is proposed. Further research is required to test the reliability and validity of categorization schemes like the one proposed. Such schemes based on history and effects of mechanical stresses, rather than solely on degenerative radiographic findings, are necessary to classify patients in meaningful ways that help guide specific rehabilitation strategies and tactics. When meaningful classification schemes exist, treatments matched with specific categories of dysfunction can be tested for effectiveness.

Cervical Vertebrae↗

PubMed2005

[Role of surgery in spinal degenerative disease. Analysis of systematic reviews on surgical and conservative treatments from an evidence-based approach].

INTRODUCTION: The lifetime prevalence of invalidating back pain in general population caused by Spinal Degenerative Disease (SDD) is about 70-80%. Global costs related to this disease are enormous (1-2% gross domestic product). From an Evidence-based point of view, there is a striking discrepancy between the use of many available surgical techniques (especially for spinal fusion) and the lack of scientific support. METHODS: The authors carefully reviewed all published metaanalysis on SDD therapies up to December 2003. Treatment recommendations were classified according to levels of evidence (strong, moderate, mild or lack of evidence) for both surgical and conservative measures. RESULTS: Forty-four metaanalysis were selected (nine on lumbar surgery, three on cervical surgery and thirty-two on other therapies). Relating surgery, there is strong evidence favouring early laminectomy in cauda equina syndrome secondary to lumbar disc herniation; discectomy or microdiscectomy are superior to chemo-nucleolysis in lumbar prolapse and spondylosis; and fusion surgery (probably noninstrumented) in adult isthmic spondylolysthesis or degenerative spondylolysthesis with spinal stenosis. In cervical spondylosis and radiculomyelopathy, discectomy seems as effective as discectomy plus fusion, which does not seem to be better than untreated SDD beyond 24 months. Preoperative antibiotics seem to prevent infection in spinal surgery. No benefit of surgery is demonstrated in discogenic pain. None of conservative therapies are supported by strong evidence. Antidepressants improve pain perception but do not influence the functional status. DISCUSSION: Although lumbar instrumented surgery has nearly doubled over two decades and the annual growth is about 20%, clinical results do not seem to have improved, not even global fusion rates. The increasing use of fusion surgery for cases other than spinal deformities, spondylolysthesis or spinal stenosis plus lysthesis may be related to multiple technical and clinical-epidemiological factors where huge financial and commercial interests must be considered. It is crucial to differentiate subsets of patients prone to benefit from surgery. It is discussed whether randomized trials incorporating sham operations are ethically justifiable, because of the lack of sound evidence for many spinal procedures. The efficacy of most conservative treatments is mild or moderate (mainly transient) and they should be probably used in combination. CONCLUSIONS. There is no strong evidence favouring most of surgical procedures for SDD from an evidence-based approach. It seems necessary that scientific organizations studying SDD create clinical guidelines relating its multidisciplinary and integral management, recognizing that, up to now, few interventions positively modify in the long-term the natural history of the disease.

Diskectomy↗

PubMed2002

Osteophyte-induced dysphagia: report of three cases.

Dysphagia is a common complaint of patients seen by physicians. Osteophyte compression due to diffuse idiopathic skeletal hyperostosis (DISH) or Forestier's disease and cervical spondylosis has been identified as a cause of dysphagia. We report three elderly male cases of whom two had dysphagia due to DISH and one had dysphagia due to osteophyte compression associated with severe cervical spondylosis. Clinical and radiographical findings including barium oesophagogram and computed tomography are presented. Endoscopy should be carefully performed to rule out additional pathology in such patients. Medical treatment preferably with liquid forms of NSAIDs and diet may cause satisfactory improvement.

Aged↗

PubMedDate not supplied

Short-term complications and long-term results of expansive open-door laminoplasty for cervical stenotic myelopathy.

BACKGROUND CONTEXT: Laminoplasty has been reported to achieve good operative results for treatment of cervical stenotic myelopathy. However, long-term results and prognostic factors have not been well documented. Among postoperative complications, weakness of the shoulder girdle muscles has been reported as a particular complication of laminoplasty, but the cause is still poorly understood. PURPOSE: Our aim was to clarify the short-term complications and long-term operative results after unilateral open-door laminoplasty and to identify the predictors for operative outcome. STUDY DESIGN: We retrospectively reviewed short-term complications and long-term operative results associated with cervical stenotic myelopathy treated by unilateral open-door laminoplasty. PATIENT SAMPLE: There were 162 men and 42 women with an average age of 57 years who were treated by unilateral open-door laminoplasty in the two institutions. Pathogenesis of myelopathy was cervical spondylosis in 88 patients, cervical disk herniation with a narrow spinal canal in 10, and ossification of the posterior longitudinal ligament in 106. OUTCOME MEASURES: Postoperative complications and their outcomes were examined clinically in 204 patients, and causes of motor paresis were sought with postoperative computed tomography after myelography. Postoperative improvement of clinical symptoms was assessed by recovery rate calculated with the scores of the Japanese Orthopaedic Scoring System in 80 patients. METHODS: The occurrence rate of short-term postoperative complications, causes of motor paresis, and their outcomes were reviewed in 204 patients. Clinical condition was assessed with the Japanese Orthopaedic Scoring System, recovery rate was calculated with the score, and prognostic factors for outcome were studied in 80 patients who were followed up for 5 years or longer (average, 8 years; range, 5-17 years). RESULTS: Occurrence rate of complications, such as muscle weakness, deep infection, closure of opened laminae, and others, was 10.8%. Muscle weakness was observed in 7.8% of the patients. However, this rate decreased in recent years. The cause of motor paresis is not known with certainty, but it may be secondary to operative trauma, posterior shift of the spinal cord, or to displacement of the lamina in the hinge side. Recovery rate of clinical symptoms was 62.1% at the final follow-up. Rates were 63.6% for cervical spondylosis, 87.1% for cervical disk herniation, and 61.3% for ossification of the posterior longitudinal ligament. There was no significant difference between pathologies. Patient age younger than 60 years at the time of operation and less than 1 year's duration of symptoms before surgery were significantly associated with recovery rate of clinical symptoms. Recovery rate was not correlated with either preoperative function judged by the Japanese Orthopaedic Association score or spinal sagittal diameter. CONCLUSIONS: The main cause of postoperative motor paresis of upper extremities is thought to be operative trauma, resulting from such procedures as air-drill and Kerrison rongeur handling. Short-term complications may decrease with the use of nontraumatic procedures. Better operative outcomes may be achieved with careful operative procedures and early operative treatment in the patients with myelopathy.

Adolescent↗

PubMedDate not supplied

A case of nontraumatic spinal epidural hematoma caused by extradural varix: consideration of etiology.

BACKGROUND CONTEXT: Many cases of nontraumatic spinal epidural hematoma (SEH) have been reported, although the etiology of SEH remains unclear. PURPOSE: Our purpose was to report a rare case of nontraumatic acute SEH caused by extradural varices and to discuss the etiology of this entity. STUDY DESIGN/SETTING: Case report. PATIENT SAMPLE: A 27-year-old man. OUTCOME MEASURES: Resolution of the patient's paraplegia, and pathological examination of the epidural vein of the patient and three other patients with cervical spondylosis. METHODS: Not applicable. RESULTS: The patient recovered from paresis of both hands, although paraplegia remains complete. Pathological examination of the patient revealed abnormal veins that had thickened walls, varying caliber, and internal elastic lamina. In two of the three patients with cervical spondylosis, abnormally dilated veins resembling those in the SEH patient were observed. CONCLUSIONS: We describe a rare case of SEH caused by extradural varices. It is speculated that spinal epidural veins can possibly develop an abnormal structure and fragility as seen in the present case and in spondylotic cases.

Adult↗