Spinal canal stenosis after vertebroplasty.
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Three patients with Paget's disease of the spine presented a non-characteristic lumbar syndrome with minor neuromuscular dysfunction. It is proposed that this be called a premyeloneuropathic syndrome since it is an early stage of an imminent severe myelopathic syndrome. The suspected lumbar canal stenosis in Paget's disease is diagnosed by computerised tomography and successfully reversed by calcitonin.
Problems of early diagnosis of space-occupying intraspinal lesions are discussed in relation to 335 patients on whom surgery had been carried out. Advances in neuroradiological methods are considered. The development of new contrast media has resulted in a reduction of the risk of invasive procedures and this should lead to diagnosis of space-occupying spinal lesions at a very early stage. It is now possible to diagnosis small tumours before they cause compression of the cord or of nerve roots.
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Clinical finding, X-ray and MR imagings in 47 patients who underwent operation for degenerative cervical stenosis were correalatively studied. JOA score was used for evaluation and it varied from 6 to 14 points, with an average of 10.13 points. All Torg ratios were smaller than normal value and that of C4 was the smallest. The reserve space, sagittal diameter of spinal cord decreased, especially in the diseased segments. Sagittal diameter of spinal cord showed on T2 weighted imaging and Torg ratio were in good correlation with JOA score (P < 0.01, r = 0.4815, r = 0.0993), MRI being superior to X-ray (P < 0.01). The MRI characteristic changes of degenerative cervical stenosis were subarachnoid space decrease or vanish, compression deformation of spinal cord and abnormal signal in spinal cord. MRI classification was established according to the segments involved, compression direction. compression degree and abnormal changes in spinal cord, can indicate clinical changes and guide diagnosis and operation.
The hypothesis that somatotype and cervical spine developmental canal stenosis may be associated has been investigated by anthropometry and measurement of lateral projection cervical spine radiographs. A significant association of canal size with somatotype has been found such that those with developmentally narrow canals are more likely to have relatively shorter long-bones, particularly in the upper arm, and longer trunks.
The transverse and sagittal diameters of the lumbar vertebral bodies have been compared in patients with symptoms and myelographic findings consistent with stenosis of the lumbar canal, in patients with some narrowing of the lumbar canal, and in patients without clinical or myelographic indication of stenosis. No significant difference in the measured diameters was found.
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The authors report a case of a 52-year old male patient with asymptomatic course of neurinoma of the vertebral canal. Sudden appearance of massive neurological signs was caused by intratumour haemorrhage.
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The technique of obliquely drilling out the postero-lateral part of the cervical vertebral bodies is described. It uses the antero-lateral (retro carotico-jugular) approach to control and displace the vertebral artery postero-laterally and to expose the lateral aspect of the vertebral bodies. It provides, through a wide field and with minimal retraction of the carotid artery and the internal jugular vein, an extensive view of the anterior aspect of the spinal cord. It has already been used to treat 15 anterior lesions compressing the spinal cord including neurinomas and osteophytes.
The results of 6-month follow-up morphologic and immunomorphologic studies on 34 rabbits after the implantation of an autologous intervertebraldisk cartilage into the epidural space are presented. The data indicate of the reactive inflammatory process with a specific two-phase course of development. The cellular structure and the change of immunocompetent cell populations in the inflammation foci suggest the formation of hypersensitivity reaction 3 weeks after implantation. Inflammatory reactions in the vertebral canal tissues in response to disk fragment prolapse result in wide-spread cicatrix changes.
Methods which produce findings relevant to diagnosis and therapy of cervical vertebral canal stenosis are described. Especially MRI provides insights into the structure of the myelon; abnormal image signals may possibly correlate with cervical myelopathy based on disorders of microcirculation.
The validity and anatomical basis of increased MR-signal intensity of the cord in cervical canal stenosis is discussed with respect to our own data of 32 patients (including results of clinical, CSF and other imaging technique findings) and previous reports. A shear-stress hypothesis with edematous tissue changes is favoured.
A thoracic intradural extramedullary enterogenous cyst in association with a syringomeningomyelocele in a 5-year-old boy is presented. The pathogenesis of this rare association is discussed and the pertinent literature reviewed.