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PubMed2004

Superior sensitivity of motor over somatosensory evoked potentials in the diagnosis of cervical spondylotic myelopathy.

Myelopathy secondary to cervical spondylosis is often a difficult clinical diagnosis. Furthermore, with the introduction of magnetic resonance imaging (MRI) an increasing number of patients are identified with spondylotic cervical spinal cord compression. We analyzed the value of functional assessment of the spinal cord by motor and sensory evoked potentials (MEP and SEP) in the detection of myelopathy, with special emphasis on the correlation of clinical and electrophysiological findings. Fifty-one patients with at least some degree of spinal cord compression because of cervical spondylosis, as shown by MRI, were included in the study, grouped according to clinical symptoms. We found that patients who had no clinical symptoms whatsoever indicating myelopathy (they were referred to MRI examination mostly because of cervical radiculopathy), had in the large majority normal MEP and SEP findings. Patients with slight, unspecific and non-confirmative symptoms without pyramidal signs had mostly abnormal MEP but normal SEP findings. This points to the superior sensitivity of MEP over SEP in detecting myelopathy in its early stages. Patients with obvious clinical signs of myelopathy, including pyramidal signs had both abnormal MEP and SEP findings. Altogether these findings may help clinicians in interpreting MRI signs of cervical spinal cord compression.

Adult↗
PubMed1985

Skeletal changes in dentists and farmers in Finland.

Two groups were studied: dentists and farmers from the Turku area. Radiologic examination of both groups included the spinal column, rib cage and shoulder joint. Spondylosis of the cervical spine was present in 68 (52.1%) of the dentists and 59 (19.2%) of the farmers. Lumbar spondylosis was more common among farmers than among dentists in the corresponding age group. Changes in the shoulder joint occurred significantly more often in dentists than in farmers. The findings in this study indicate that dentists appear to belong to the group doing heavy work.

Adult↗
PubMed1987

Prevalence rates and odds ratios of shoulder-neck diseases in different occupational groups.

The aim of the present study was to evaluate the association and impact of occupational exposure and diseases of the shoulder and neck. Prevalence rates, odds ratios, aetiological fractions, and their confidence intervals were computed for pooled and non-pooled data of previous published reports. By comparison with office workers and farmers, dentists had an increased odds ratio for cervical spondylosis (two studies) and for shoulder joint osteoarthrosis. Meat carriers, miners, and "heavy workers" also had significantly higher rates of cervical spondylosis compared with referents. Compared with iron foundry workers, civil servants had a significant odds ratio (4.8) of cervical disc disease and a 0.79 aetiological fraction. Whether this was due to exposure or healthy worker effect was not clear. In four occupational groups with high shoulder-neck load an odds ratio of 4.0 was found for thoracic outlet syndrome with an aetiological fraction of 0.75. Rotator cuff tendinitis in occupational groups with work at shoulder level (two studies) showed an odds ratio of 11 and an aetiological fraction of 0.91. Keyboard operators had an odds ratio of 3.0 for tension neck syndrome (five studies). Unfortunately, owing to the scanty description of the work task, the exposure could be analysed only by job title. Examination of published reports shows clearly that certain job titles are associated with shoulder-neck disorders. High rates and aetiological fractions for rotator cuff tendinitis and tension neck syndrome suggest that preventive measures could be effective. Although job descriptions are brief, the associations noted suggest that highly repetitive shoulder muscle contractions, static contractions, and work at shoulder level are hazardous exposure factors. In reports of cross sectional studies of occupational shoulder-neck disorders presentation of age, exposure, and effect distribution may help for future meta-analysis.

Adult↗
PubMed2004

Clinical assessment of usefulness, effectiveness and safety of jackyakamcho-tang (shaoyaogancao-tang) on muscle spasm and pain: a case series.

This study is a retrospective single case series. Two hundred and thirty-seven patients were treated with jackyakamcho-tang (JKT) for relief of muscle spasm and pain; 81 of them were included in analysis. (The others were excluded because of insufficient medical records to confirm the diagnosis or assess the response.) There were 29 patients with nocturnal leg cramps, 28 with cervical spondylosis, 13 with thalamic pain and 11 with carpal tunnel syndrome, for which the effectiveness was assessed as 86.2%, 60.7%, 45.5% and 72.8%, respectively. Adverse effects (indigestion, diarrhea or edema) were seen in 11.1% of the total patients, but severe cases were only 3.7%. Taking the effectiveness and the safety into consideration, the usefulness was assessed as 86.2%, 57.1%, 53.9% and 72.8% for treating nocturnal leg cramps, cervical spondylosis, thalamic pain and carpal tunnel syndrome, respectively. In conclusion, we suggest that JKT is a useful herbal medicine with analgesic and anti-spasmodic effects.

Adult↗
PubMed2003

Diffusion-weighted MR imaging with apparent diffusion coefficient and apparent diffusion tensor maps in cervical spondylotic myelopathy.

PURPOSE: To evaluate diffusion-weighted magnetic resonance (MR) imaging in patients with cervical spondylosis and/or myelopathy. MATERIALS AND METHODS: A multishot echo-planar imaging sequence with calculation of apparent diffusion coefficient (ADC) and apparent diffusion tensor (ADT) was applied in 36 patients with symptomatic cervical spondylosis. Diffusion-weighted images read by two neuroradiologists were compared with T2-weighted fast spin-echo images read independently by three neuroradiologists with regard to clinical status (n = 36). MR findings in a selected subgroup of 20 patients whose clinical status was confirmed by electrophysiologic examination also were compared. Sensitivity, specificity, positive predictive value, and negative predictive value of both T2-weighted imaging and diffusion-weighted imaging (ADC and ADT) were calculated and compared. RESULTS: Patients with myelopathy had abnormal ADC (17 of 21) and ADT (15 of 19) maps with increased ADC and ADT values and decreased anisotropy. For the detection of myelopathy, diffusion-weighted ADC maps had a sensitivity of 80% (17 of 21), while T2-weighted images had a sensitivity of 61% (13 of 21). The negative predictive value was 63% (seven of 11) and 60% (12 of 20) for ADC maps and T2-weighted images, respectively. Conversely, the specificity of diffusion-weighted images (53%; seven of 13) was lower than that of T2-weighted images (92%; 12 of 13). In patients with myelopathy confirmed at electrophysiologic examination, the sensitivity of diffusion-weighted images increased to 92% (12 of 13) and the negative predictive value increased to 75% (three of four), while T2-weighted images had a 53% (seven of 13) sensitivity and a 50% (six of 12) negative predictive value. CONCLUSION: Diffusion weighting improved the sensitivity of imaging in cervical spondylotic myelopathy.

Adult↗
PubMed1990

Cervical myelography: survey of modes of practice and major complications.

A total of 68 major complications of cervical myelography were reported by 220 neuroradiologists in a mail survey. Two-thirds of the complications were attributed to cervical spine hyperextension and one-third to lateral C1-2 puncture. Narrow sagittal diameter of the spinal canal and severe cervical spondylosis were frequent contributing factors to hyperextension injury of the cervical spinal cord. Clinical and radiographic premyelography screening is suggested, with magnetic resonance imaging performed first in patients with spinal canal stenosis, severe spondylosis, and/or myelopathy of any cause. Neck extension should be minimal during myelography. All C1-2 punctures should be monitored with lateral fluoroscopy for accurate needle positioning and prevention of contrast medium injection into the spinal cord.

Cervical Vertebrae↗
PubMed2002

Does the neurologist contribute to the care of patients with chronic back pain?

OBJECTIVE: To review the disposition and outcome of patients with back pain seen in a neurology clinic, and determine the value of the neurologist's input. BACKGROUND: Back pain is a common cause of referral to the neurology clinic, but it is not clear how much the neurologist contributes to the care of such patients. DESIGN/METHODS: We reviewed all new patients and new consultations seen for the following reasons: low back pain; 'sciatica'; 'back and leg pain', and 'spinal stenosis'. Patients were evaluated by a single attending neurologist at a general neurology clinic over a 2-year period (January 1997 through December 1998). RESULTS: During the 2-year period, there were 97 patients seen for the above reasons. The chief complaint was low back pain alone in 73, while it was combined with another symptom in 24 (leg pain in 18, buttock or hip pain in 6). Thirty-three patients were self-referred, 56 were referred by a healthcare professional, 3 were referred by attorneys, and the referral source was unclear in 5. Median age was (range 25-90) years. Forty-eight were males. Based on the clinical data (history and examination), clinical diagnoses were radiculopathy in 28, myelopathy in 2, uncomplicated spondylosis in 27, and other non-neurologic conditions in 45. Tests performed after the visit included X-rays in 31, CT in 1, MRI in 16, and EMG in 17. 'Final' diagnoses were radiculopathy in 29 patients, myelopathy in 2 (total neurologic n = 30), uncomplicated spondylosis in 27, and other non-neurologic diagnoses in 41 (total non-neurologic n = 67). The non-neurologic diagnoses included periarticular pain, bursitis, muscle strain, soft tissue injury, and vertebral compression fractures. Final dispositions in the non-neurologic group (n = 67) were: nonsteroidal anti-inflammatories (NSAIDs) in 34 patients; analgesics or muscle relaxants in 37; physical therapy for 19, and none (including rest and observation) for 22. Four patients were referred for epidural blocks. (Many patients had more than one final disposition.) Final dispositions in the neurologic group (n = 39) were: physical therapy (n = 9); NSAIDs (n = 12); analgesics or muscle relaxants (n = 12), and epidural blocks (n = 3). Three patients were referred for surgery, but only 1 had an operation. CONCLUSIONS: Of patients with back pain and related symptoms seen in a neurology clinic, about two thirds have non-neurologic conditions. These patients are usually treated symptomatically with medications, rest, and physical therapy, all of which could be managed by primary care physicians. In the neurologic group, the vast majority is treated in the same way as the non-neurologic group. When more specific measures are needed, such as surgery or pain management procedures (e.g., epidural blocks), then the patients could be evaluated directly by the proper specialist (pain management or spine surgery) rather than the neurologist. The neurologist's input does not significantly affect the diagnosis or the management, so that the neurologist appears to have no useful role in the management of such patients.

Adult↗
PubMed1975

Skeletal effects of cholesterol feeding.

The effect of a 4% supplement of cholesterol to a standard diet on knee joints and vertebral columns was investigated in male mice of strain C57B1. The experimental diet was fed from the time of weaning through the 18-month period of observation or from the age of 1 year to the end of the experiment at 18 months of age. The incidence of osteoarthrosis was increased in mice fed cholesterol from the age of 12 months on. The incidence of spondylosis was increased after lifelong feeding as well as after feeding of cholesterol during the second year of life. This increase involved both, spondylosis associated with or uncomplicated by prolapse of intervertebral discs. The incidence of simple disc prolapse was not affected by the experimental diet.

Animals↗
PubMed2004

Increased expression of hepatocyte growth factor in cerebrospinal fluid and intracranial artery in moyamoya disease.

BACKGROUND AND PURPOSE: The etiology of moyamoya disease still remains unknown. This study was aimed to explore the role of hepatocyte growth factor (HGF), a strong inducer of angiogenesis, in development of moyamoya disease. METHODS: We studied cerebrospinal fluid (CSF) from 39 patients with moyamoya disease (24 children and 15 adults), 6 control patients with cervical spondylosis, and 7 control patients with internal carotid artery occlusion. CSF level of HGF was determined by enzyme-linked immunosorbent assay technique. We also evaluated the distribution of HGF and its cellular receptor c-Met in the carotid fork obtained from 2 patients with moyamoya disease and 2 control patients. RESULTS: CSF level of HGF was 408.2+/-201.6 pg/mL and 443.2+/-193.5 pg/mL in patients with cervical spondylosis and internal carotid artery occlusion, respectively (mean+/-SD). On the other hand, CSF level of HGF was 820.3+/-319.0 pg/mL in patients with moyamoya disease, being significantly higher than those in 2 control groups (P<0.01). Both HGF and c-Met were widely distributed in the media and thickened intima of the carotid fork in patients with moyamoya disease but not in control patients. CONCLUSIONS: This study revealed that HGF is densely found in the carotid fork, and its CSF level is markedly elevated in moyamoya disease, suggesting that HGF may be a key protein for pathogenesis of moyamoya disease.

Adolescent↗
PubMed1982

Assessment of vertebral osteopenia. Comparison of spinal radiography and dual-photon absorptiometry.

A comparison of radiographic morphology and dual-photon (153Gd) absorptiometry was carried out in 132 women. Films of the lumbar spine were graded for osteopenia, spondylosis, and calcification of the abdominal aorta according to definite morphologic criteria. The radiographic grade of osteopenia and the bone mineral content of the 2nd, 3rd, and 4th lumbar vertebrae showed a highly significant inverse correlation. However, the mineral content at each radiographic grade of osteopenia differed considerably. Disproportionately high levels occurred in patients with spondylosis and severe calcification of the abdominal aorta. Spinal radiography and dual-photon absorptiometry must be regarded as complementary rather than alternative diagnostic procedures in clinical practice.

Absorptiometry, Photon↗
PubMed1988

Acute cervical spondylytic myelopathy.

Myelopathy is a common consequence of cervical spondylosis. Typically, the syndrome develops gradually over a long period. Rapidly progressive deterioration in the absence of trauma or other precipitating factors is exceptional. We report a case of a rapidly progressive acute myelopathy secondary to cervical spondylosis without identifiable precipitating cause. The importance of recognizing this syndrome lies in the fact that rapid operative intervention may result in significant neurological recovery. The value of magnetic resonance imaging preoperatively and postoperatively is emphasized.

Acute Disease↗
PubMed2005

Incidence and characteristics of spinal decompression surgery after the onset of symptoms of amyotrophic lateral sclerosis.

OBJECTIVE: The high incidence of spondylosis in patients at the mean age of onset (55.7 yr) of amyotrophic lateral sclerosis (ALS) can make recognition of ALS as a cause of weakness difficult. METHODS: To assess the impact of this diagnostic dilemma on neurosurgical practice, we performed a retrospective analysis of a database of more than 1500 patients with motor neuron disease. RESULTS: Of 1131 patients with typical, sporadic ALS, 47 (4.2%) underwent decompressive spinal surgery after the onset of retrospectively recognized symptoms of ALS. Among 55 operations in 47 ALS patients, 86% yielded no improvement, 9% produced minor improvement, and only 5% provided significant benefit. Cervical decompression was performed in 56%, lumbar in 42%, and thoracic in 2%. Foot drop was a symptom prompting surgery in 11 patients, and in 10, this finding was subsequently attributed solely to ALS. No differences between ALS patients who underwent spinal decompression and other ALS patients were noted regarding age at symptom onset, severity of impairment at time of diagnosis, or rate of disease progression. Not surprisingly, patients who had spinal surgery tended to have a longer interval between retrospectively recognized symptom onset and diagnosis of ALS. CONCLUSION: A small but significant number of patients with unrecognized ALS undergo spinal surgery that in retrospect may be inappropriate. The possibility of ALS must be considered in the evaluation of patients with weakness even in the presence of radiographic evidence of spondylosis and nerve root or spinal cord impingement.

Age Factors↗
PubMed2006

Cervical spine injuries in ocean bathers: wave-related accidents.

OBJECTIVE: Spine injuries can occur secondary to several aquatic recreational activities. A series of cases of patients who experienced cervical spine injuries secondary to ocean waves accidents is presented. A description and analysis of this kind of injury is performed. METHODS: Sixteen patients were treated from January 1999 to May 2005. The mechanism of accident, mechanism of injury, neurological status, radiographic findings, associated injuries, and treatment were analyzed. RESULTS: These injuries are common among older patients. More severe and devastating injuries occurred in young patients. The most common mechanism of injury is hyperextension associated to spondylosis, which usually caused central cord syndrome. CONCLUSION: Wave-related accidents in ocean bathers are secondary to lack of experience of swimming in the ocean and underestimating the danger of waves. Although different types of mechanism of injury occurred, hyperextension was the most common. High-risk patients are older people with preexisting cervical spondylosis.

Accidents↗
PubMed2007

Surgery for neck pain.

Axial neck pain is a common finding that typically represents a spectrum of clinical Arlington Orthopedic Associates, disorders affecting the cervical spine. Controversy exists concerning the ultimate treatment of the patient who presents with cervical spondylosis and primarily axial neck pain without radicular symptoms or myelopathy and who has failed to respond to extensive nonoperative treatment methods. Cervical discography has been used to assist in determining the specific level or levels causing the neck pain and, potentially, which levels to fuse; however, controversy regarding the specificity of cervical discograms has also been debated in the literature. Los Angeles, California We recommend exhausting all conservative means of treatment of axial neck pain. Surgery is offered only after conservative treatment fails and appropriate psychological testing is performed, as well as diagnostic imaging and discography that confirm a specific level or levels as the pain source. Cervical fusion may demonstrate good results in appropriately chosen patients with cervical spondylosis and axial neck pain.

Cervical Vertebrae↗
PubMed2007

Decision making process: problem-based decision making.

Clinical problems are often complex. Problems of great complexity are usually associated with a commensurately greater degree of difficulty with respect to the decision making process. This is most certainly true regarding the management of cervical spondylosis. Usually, clinicians make clinically appropriate decisions. However, more often than realized, suboptimal decisions may be made. Therefore, an assessment of the types of errors regarding clinical decision making are worthy of consideration. In this article, a scheme for decision making regarding the management of cervical spondylosis is presented.

Cervical Vertebrae↗
PubMed1999

Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis.

BACKGROUND: We studied the incidence, prevalence, and radiographic progression of symptomatic adjacent-segment disease, which we defined as the development of new radiculopathy or myelopathy referable to a motion segment adjacent to the site of a previous anterior arthrodesis of the cervical spine. METHODS: A consecutive series of 374 patients who had a total of 409 anterior cervical arthrodeses for the treatment of cervical spondylosis with radiculopathy or myelopathy, or both, were followed for a maximum of twenty-one years after the operation. The annual incidence of symptomatic adjacent-segment disease was defined as the percentage of patients who had been disease-free at the start of a given year of follow-up in whom new disease developed during that year. The prevalence was defined as the percentage of all patients in whom symptomatic adjacent-segment disease developed within a given period of follow-up. The natural history of the disease was predicted with use of a Kaplan-Meier survivorship analysis. The hypothesis that new disease at an adjacent level is more likely to develop following a multilevel arthrodesis than it is following a single-level arthrodesis was tested with logistic regression. RESULTS: Symptomatic adjacent-segment disease occurred at a relatively constant incidence of 2.9 percent per year (range, 0.0 to 4.8 percent per year) during the ten years after the operation. Survivorship analysis predicted that 25.6 percent of the patients (95 percent confidence interval, 20 to 32 percent) who had an anterior cervical arthrodesis would have new disease at an adjacent level within ten years after the operation. There were highly significant differences among the motion segments with regard to the likelihood of symptomatic adjacent-segment disease (p<0.0001); the greatest risk was at the interspaces between the fifth and sixth and between the sixth and seventh cervical vertebrae. Contrary to our hypothesis, we found that the risk of new disease at an adjacent level was significantly lower following a multilevel arthrodesis than it was following a single-level arthrodesis (p<0.001). More than two-thirds of all patients in whom the new disease developed had failure of nonoperative management and needed additional operative procedures. CONCLUSIONS: Symptomatic adjacent-segment disease may affect more than one-fourth of all patients within ten years after an anterior cervical arthrodesis. A single-level arthrodesis involving the fifth or sixth cervical vertebra and preexisting radiographic evidence of degeneration at adjacent levels appear to be the greatest risk factors for new disease. Therefore, we believe that all degenerated segments causing radiculopathy or myelopathy should be included in an anterior cervical arthrodesis. Although our findings suggest that symptomatic adjacent-segment disease is the result of progressive spondylosis, patients should be informed of the substantial possibility that new disease will develop at an adjacent level over the long term.

Adolescent↗
PubMed2001

Laminoplasty improves respiratory function in elderly patients with cervical spondylotic myelopathy.

Respiratory insufficiency after acute cervical trauma is well documented, but the relationship between respiratory function and chronic lesions, such as cervical spondylosis, has received scant attention. This clinical study investigated the effect of cervical spondylosis on respiratory function in 12 patients over 65 years of age who underwent expansive laminoplasty. Functional and neurological status were assessed using the Japanese Orthopaedic Association (JOA) scale and Neurosurgical Cervical Spine Scale (NCSS). To assess the effect of laminoplasty on respiratory function in patients with cervical spondylotic myelopathy, lung volumes including vital capacity, tidal volume (TV), inspiratory reserve volume, expiratory reserve volume, inspiratory capacity, and forced expiratory volume were measured by spirometer before surgery and 6 months after surgery. The arterial blood gas values were also measured before and after surgery. All patients showed functional improvement after surgery, and neurological examination 6 months after surgery revealed a significant improvement in both JOA scale and NCSS scores (p < 0.001). There were no significant differences in most lung volumes, but TV (p = 0.039) at 6 months after surgery showed a significant increase compared to before surgery. PCO2 also showed a significant reduction after surgery (p = 0.047). This limited study revealed that laminoplasty improved respiratory function in patients over 65 years of age with cervical spondylotic myelopathy. Lung volume measurement may be one method to estimate spinal cord function after a surgical procedure.

Aged↗
PubMed1988

Comparison of MR and CT myelography in imaging the cervical and thoracic spine.

MR imaging and CT myelography were compared in a retrospective study of 38 patients with suspected lesions of the cervical and thoracic spinal canal and cord. Twenty-eight abnormal cases were found, including spondylosis (9), tumors (8), intramedullary cavities (3), arachnoiditis (3), disk-space-centered infection or osteomyelitis (2), nonneoplastic cord swelling (2), and CSF-borne metastasis (1). MR was equal or superior to CT myelography in depicting cases of cord enlargement, cord compression, and cord atrophy, providing better tissue characterization, no shoulder artifact, and no limitation caused by CSF block. CT myelography was superior to MR in depicting cases of spondylosis and arachnoiditis. It showed superior spatial resolution, which was most pronounced when comparing axial images and hence particularly superior in detecting the lateral extent of disk herniation. Use of surface coils and thin imaging sections is essential for accurate and complete MR evaluation of the cervical and thoracic spine.

Arachnoiditis↗