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[Clinical significance of cervical arthropathy in patients with vertigo].

We performed a thorough neuro-otological evaluation and a radiological study of the cervical spine in 102 patients with vestibular symptoms. A group of 20 asymptomatic subjects served as control. Some degree of cervical spondylosis was found in 121 of 122 patients but also in the majority of control subjects. No relationship was observed between the degree of cervical spondylosis and vestibular abnormalities. Instead, the latter were strongly related to age. Thus, an age dependent microvascular damage may be more likely as an etiological factor for vestibular symptoms in the elderly.

Age Factors↗

Orthopaedic problems in old dogs.

With advancing years a dog may suffer from a variety of conditions of its musculoskeletal system which adversely affect its ability to exercise and may cause it to be retired from activities in work and sport for which it has been trained. Arthritis is common, and in many cases arises from developmental errors suffered in puppyhood, such as hip dysplasia, osteochondrosis and growth plate disorders. Trauma to joints (ligament ruptures, dislocations and fractures) may also be the precursor of degenerative joint changes later in life. It is important, therefore, for all such conditions to be corrected as effectively as possible if joint disease is to be minimised as the dog grows older. Preventive action is also required for some conditions for which correction may not be entirely feasible, so the identification of modes of inheritance is important if those are to be controlled by breeding. Certain spinal disorders also tend to increase in prevalence with age, particularly spondylosis deformans, neoplasms and chronic degenerative radiculomyelopathy. As it happens, spondylosis in mild to moderate degree affects pet dogs very little, but a reduction in spinal flexibility can cause problems for dogs required to be agile in work or sport. In common with other body tissues, neoplasm of the locomotor system increases in occurrence in older dogs, and although the overall incidence of tumours of bones, joints, nervous tissue and muscle is relatively low, these are the most serious of all the limb and spinal conditions encountered because of their life threatening propensities. The treatment required covers a wide range from simple changes of management in order to reduce exercise, to the use of analgesics and anti-inflammatory drugs and to surgery to remove diseased tissue, stabilise joints or reduce pain with forms of arthroplasty or arthrodesis.

Aging↗

[An autopsy case of amyotrophic lateral sclerosis associated with cervical syringomyelia].

An autopsied case of amyotrophic lateral sclerosis complicated by cervical syringomyelia was reported. The case was a 59-year-old man, who first noticed weakness of both lower extremities at 54-year-old. The weakness spread to both upper extremities within 2 years. Cervical myelography revealed multi-level cervical spondylosis and anterior fusion of C5-C7 was done. But the weakness and atrophy of proximal muscle, diminished deep tendon reflex on upper extremities, hyperreflexia and pathological reflexes on both legs, tongue fasciculation and respiratory muscle weakness developed successively, and the patient died of respiratory distress at 59-year-old. Autopsy revealed multiple independent four syrinxes located at the level between C2-C7. One of these syrinxes had ependymal cell lining and thought to be idiopathic syringomyelia. The other three syrinxes were considered to be the cavitation in association with cervical spondylotic myelopathy. Degeneration and decreasing of spinal anterior horn cells, atrophy of medullary pyramis and Bunina bodies were observed as features of typical amyotrophic lateral sclerosis. Cervical spondylosis as causative lesion of multiple syrinxes was discussed, and relationship between ALS and the syrinxes was not indicated clearly.

Amyotrophic Lateral Sclerosis↗

[Percutaneous electric and magnetic stimulation of the motor cortex in man. Physiological aspects and clinical applications].

The new techniques of percutaneous electric and magnetic stimulation of the motor cortex in conscious man provide a unique opportunity of functional testing of the central motor pathways. These techniques seem to be safe and no immediate or delayed adverse reactions have been reported. The physiological studies so far performed suggest that the structures which are preferentially excited by these methods are the fast conducting pyramidal neurones. It has been shown that a single cortical stimulus is able to activate spinal motoneurones repeatedly. This phenomenon can easily be explained if the cortical stimulus generates multiple descending volleys in the central motor pathways. By comparison with experiments of stimulation of the exposed motor cortex in animals, it is likely that electric brain stimulation directly activates the axons of the pyramidal neurons at their origin and to a lesser extent also recruits these neurons transsynaptically, via some cortical interneurones. Magnetic stimulation of the brain at the vertex seems to act mostly by the latter mechanism. These different modes of action of the two methods of cortical stimulation explain the latency differences of the EMG responses obtained with either technique. Increased excitability of the spinal motoneurones and the existence of multiple descending volleys in response to a single cortical stimulus result in shortening of the latencies and greater amplitude of the responses recorded during voluntary contraction of the target muscle. Stimulation of the motor cortex has been used in pilot studies conducted on patients suffering from various disorders of the central motor pathways, such as multiple sclerosis, cervical spondylosis, motor neurone disease or stroke. The sensitivity of the technique looks promising. In M.S., the EMG responses usually show an increased central conduction latency, a reduced amplitude and a prolonged duration. The severity of the electrophysiological abnormalities is not very well correlated with clinical weakness, but the correlations seems to be better with hyperreflexia and the presence of brisk finger flexor jerks. The same abnormalities are observed in cervical spondylosis, although to a lesser extent. In motor neurone disease, the responses have a moderately increased latency and their size and duration are markedly reduced. Patients with acute hemispheric stroke usually show absent responses on the contralateral side. Finally, electric cortical stimulation can be very useful in monitoring the functional integrity of descending motor tracts during surgical operations performed on the spinal cord.

Central Nervous System Diseases↗

[The value of spinal CT in the planning of spinal surgery].

The diagnostic information gained by spinal CT for the planning of surgery of spinal disease is discussed under clinical aspects. For discogenic disease CT has replaced myelography in significance and as primary investigation, except for unclear complaints, that cannot be attributed to a specific segment. Here myelography still is the prime investigation. With CT degenerative peripheral appendages turned out to be significant for secondary stenosis syndromes of the spinal canal. In future it seems advisable, to differentiate between the facultatively pathogenetic important dorsal spondylosis and ventro-lateral spondylosis, which is unimportant for the spinal complaints. If surgical correction of congenital spinal malformations is considered, apparent or silent dysraphia must be ruled out in order to prevent neurological complications. Here CT can improve diagnostic safety significantly. For the resection of tumourous or inflammatory destructions CT provides an excellent means for preoperative statements on the necessary resection area, the size of the graft and the strength of adjacent soft tissues for the graft, the required stabilisation instruments, possible effects on adjacent organs, lumen reduction of the spinal canal, and the appropriate surgical entrance. The exploration of traumatic conditions of the spinal column by CT is of value especially for a detailed preoperative investigation, since it facilitates a quantification of the destruction of the vertebral body and the arches, the condition of the posterior body surface and the stenosis of the spinal canal.

Humans↗

Magnetic susceptibility artifacts in gradient-recalled echo MR imaging.

Artifacts related to magnetic susceptibility differences between bone and soft tissue are prevalent on gradient-recalled echo images, particularly when long echo delay times are used. These susceptibility artifacts spatially distort and artifactually enlarge bone contours. This can alter the apparent shape of the spinal canal and exaggerate the degree of spinal stenosis seen in patients with cervical spondylosis. The effects of magnetic susceptibility artifacts in gradient echo imaging were studied in a phantom model and the results were correlated with MR images obtained in patients with cervical spondylosis.

Cervical Vertebrae↗

Vitamin E content and lipid peroxidation of blood in some chronic inflammatory diseases.

Patients suffering from rheumatoid arthritis, spondylosis, coxarthrosis, ankylosing spondylitis, chronic active and chronic alcoholic hepatitis were studied. The plasma vitamin E content remained unchanged. The TBA-reactive plasma substances (malondialdehyde) content of plasma increased in all patients except those with ankylosing spondylitis. Catalase activity of plasma increased in patients of both sexes suffering from rheumatoid arthritis and spondylosis and coxarthrosis, but decreased in the two hepatitis groups. The glutathione-peroxidase activity of RBC (1:9 haemolysate) increased in female rheumatoid arthritis patients and decreased in those suffering from chronic alcoholic hepatitis. The results showed that chronic inflammatory processes affect the rate of lipid peroxidation and the activity of the biological antioxidant mechanism.

Adult↗

[Personality structure of chronic rheumatically ill females].

80 female patients were tested for personality differences by the Freiburg Personality Inventory and the Giessen Test Self Image. They were divided into four groups with 20 patients each, suffering from rheumatoid arthritis, ankylosing spondylitis, spondylosis and coxarthrosis. While RA patients did not significantly differ from AS patients, nor spondylosis patients from coxarthrosis patients, certain personality differences were detected between the patients with inflammatory and those with degenerative rheumatic diseases. These results, however, do not allow us to draw the conclusion that a "degenerative or inflammatory rheumatic personality" exists. Besides the Giessen Test Self Image the Giessen Test Self Ideal was also administered to all of the patients. In all four groups the desire for a better basic mood and less depression was prevailing. RA patients also wanted more "social resonance" and "predominance". AS patients wanted significantly less "control" and more "responsiveness". These components should be given special consideration in the psychological care of rheumatic patients.

Arthritis, Rheumatoid↗

[The arthritic narrow lumbar canal. Anatomoradiologic study - technical considerations].

The Narrowing of the lumbar canal by spondylosis appears as a frequent factor of cauda equina compression. There is a wide range of symptomatology : common low back pain and sciatalgia; neurogenic claudication with sensitive, motor or sphincter disturbance; radicular deficit at one or several levels. Radiological measurement of the anterior-posterior diameter of the lumbar canal does not give a good evaluation of the lesion. Qualitative analysis of spondylosis must be performed by special radiological investigation : plain X ray film and tomography shows the osteophytics spurs and articular hypertrophy; sacco-radiculography (Dimer X) with tomography and flexion-extension films shows the changes on the dural sac. Three types of lesions can be distinguish on anatomical and radiological grounds which carry a special operative management : the anterior type should be treated by discectomy, at one or more level; the posterior type needs facetectomy with or without laminectomy; the mixed type must be treated by combined operative procedures. Laminectomy only does not permit the cure of lateral radicular entrapment. Our results seem much better in our series since this diagnostic and therapeutic attitude is considered.

Aged↗

Comparison of truncal and caudal lesions in the vertebral column of the sand rat (Psammomys obesus).

Caudal vertebrae of sand rats (Psammomys obesus) of two age-groups were examined histologically, and the findings were compared with those obtained previously in the truncal spines of these animals. Degenerative processes were basically similar in both locations, although they were somewhat attenuated in the tail. By contrast, the incidences of disk herniation and of spondylosis were much more common in the trunk than in the tail. We concluded that in the sand rat there is a common, probably systemic, denominator for disk degeneration at all sites, and suggest that this factor is related to the peculiar water and/or electrolyte metabolism of these desert animals. Factors causing herniation of the degenerated disk and spondylosis seem to be related to local stresses which, in the presence of marked disk degeneration, may not exceed physiological limits.

Age Factors↗

Hyperextension trauma in the elderly: an easily overlooked spinal injury.

The diagnosis of hyperextension injury to the cervical spinal cord after a fall is easily overlooked in the elderly. This is because the pattern of neurologic deficit, usually that of the 'central cord syndrome,' is complex and because no radiologic signs of trauma are present apart from changes of cervical spondylosis. The case history of a patient who had delayed onset of paralysis after a fall and in whom the correct diagnosis was initially overlooked is presented. In older patients hyperextension injuries may result in serious damage to the spinal cord due to preexisting weakness of the intervertebral discs, which are fragmented and fissured as a result of degeneration. In such patients, radiologic evidence of spondylosis and a posterior osteophyte at C4/C5 or C5/C6 often go unnoticed. This injury is usually caused by indirect cervical spine trauma resulting from head or face injury. A lateral X-ray view of the area with the patient supine is safe, quick, and inexpensive.

Cervical Vertebrae↗

[A case of cerevical canal stenosis accompanied with congenital cervical fusion and extracranial occlusion of vertebral artery--a clinical and embryological study (author's transl)].

A case of cervical canal stenosis accompanied by congenital cervical fusion and extracerebral occlusive disease of the verebral artery was reported. A 39-year-old male was admitted to our hospital on June 5, 1976, because of his shoulder strain, motor weakness and numbness of his left hand, and gait disturbance for a couple of months. Neurological examination disclosed spastic paraparesis with positive pyramidal signs in the four extremities which was greater on the left side, and the superficial and deep sensations were diminished below C-4 dermatomes bilaterally. Spinal tap revealed crystal clear fluid under an initial pressure equivalent to 120 mm of water with a protein content of 20 mg/dl. Plain X-P and laminogram of the cervical spine showed congenital fusion of C 2-3, cervical canal stenosis and cervical spondylosis. Posterior spurring of C 3-4 was demonstrated only on the laminogram. Myelogram showed incomplete myelographic block at the site of C 3-4-5. The left retrograde brachial angiogram disclosed occlusion of the vertebral artery at the site of C3-4. where the proxymal vertebral artery anastomosed with the well developed muscular branch of the vertebral artery, taking a tortuous course at the leve of the transverse foramen of the atlas, and were opacified the distal vertebral artery and basilar artery. Each collateral flow extending from the deep cervical artery and ascending cervical artery anastomosed with the proxymal and distal portion of the occluded vertebral artery. In spite of conservative treatment for two weeks, the cord compression syndromes rather deteriorated. Posterior decompression, that is, C 2-7 laminectomy and C 3-4 partial facetectomy were performed for relieving the symptoms. The postoperative course was uneventfull and there was progressive improvement of the sensory, motor and gait disturbance. The relationship betwen the cervical canal stenosis and cervical spondylosis and their clinco-radiological problem were discussed. The close embryological relationship was very suggestive of the pathogenesis between the cervical bony lesion and congenital cervical fusion and the occlusive vascular lesion of the vertebral artery.

Adult↗

Rheumatic diseases other than rheumatic fever.

A total of 101 cases of rheumatic diseases collected during a period of six months from a hospital population have been analysed. These did not include rheumatic fever. Paediatric age group up to age of 12 years was not included in the series. Rheumatoid arthritis has been found to be the commonest condition, constituting 60 cases. Cervical spondylosis was next in common (24 cases). Ankylosing spondylitis and osteoarthritis constituted nine and six cases respectively. Emphasis has been laid on the bizarre manifestation of cervical spondylosis. The study, in spite of limitations throws some light on the relative frequency of rheumatic diseases other than rheumatic fever in Bangladesh.

Adolescent↗

Review of 119 cases of cervical interbody fusion by Cloward's method.

The long term results (not less than two years) of 119 out of 178 operations for cervical interbody fusion by Cloward's technique, performed at the Istituto Ortopedico Toscano between 1965 and 1978, are presented. The great majority of cases were cervical and root pain due to postero-lateral disc prolapse. In this group of cases the results were classified as excellent in 60 per cent of cases. The results were also rewarding in central disc prolapse with cord compression syndromes. They were less satisfactory in cervical spondylosis and in myelopathy due to spondylosis. In these groups, some arrest of the symptoms was achieved, but no effective regression. One indication for Cloward's operation is post-traumatic instability following trauma, or after biopsy and evacuation of lesions of the vertebral bodies.

Adult↗

Diagnostic imaging algorithm for cervical soft disc herniation.

MR imaging with surface coils is currently the preferred method for the evaluation of cervical soft disc herniation. However, the differentiation between soft disc herniation and osteophytic spurs in the neural foraminal canal is not always obvious on a 0.5 Tesla unit. Therefore the specificity for neural foraminal canal pathology has been reported not to be very high. We evaluated MRI in selected patients without major foraminal spurs or important spondylosis on plain radiography. This prospective study includes 100 patients with cervical radicular symptoms, not subsiding after conservative treatment. All patients underwent plain radiograms. Patients without spinal instability, spondylosis or major osteophytes on plain radiograms and without clinical findings of myelopathy underwent MRI (n = 59) on a 0.5 Tesla superconducting system. All 41 other patients underwent CT myelography. On MRI, a cervical soft disc herniation was observed in 55 out of 59 investigated patients and the localization corresponded well with the clinical symptoms. CT myelography demonstrated a foraminal herniation in 1 of 4 selected patients with negative MRI. Fifty out of 55 patients underwent anterior cervical discectomy without fusion. All herniations were confirmed at operation, but in two patients there were important foraminal spurs, not seen on MRI. The specificity of MRI in this study is 94%. It is concluded that 0.5 T MRI, combined with plain films offers an accurate, noninvasive test in the assessment of selected patients with cervical radiculopathy.

Adult↗

MR imaging and radiography of patients with cervical hyperextension-flexion injuries after car accidents.

Fifty-two patients underwent MR imaging and conventional radiography of the neck within 4 days after a hyperextension-flexion injury. The patients also had follow-up investigations during the first 2 years. The images did not reveal any serious lesions in any of them. Based on the main MR and radiographical findings the patients were divided into 4 groups; no findings, posture abnormalities, spondylosis and disc pathology (from MR images) or reduced intervertebral space (from the radiographs). The outcomes of the different groups were compared with reference to neck stiffness, neck pain and headache during a 2-year follow-up period. The patient groups did not correspond completely when diagnosed from MR imaging and radiography. However, patients with pre-existing spondylosis had more symptoms when examined by both modalities. Based on the radiographs, the group with posture abnormalities had significant fewer symptoms than the other groups.

Accidents, Traffic↗

Combined form of developmental cervical-lumbar stenosis of the spinal canal in two young patients.

Symptomatic combined cervical and lumbar developmental spinal canal stenosis without spondylosis in young patients has rarely been reported. Two such cases are presented here. The symptoms appeared at 21 and 18 years of age and progressed gradually for each patient. The main clinical manifestations included lower back pain, intermittent claudication, polyradiculopathy and myelopathy. Myelogram and computed tomography scanning showed developmental spinal canal stenosis without evidence of spondylosis in either the cervical or lumbar spine. Both of the patients underwent a canal expansive laminoplasty at the cervical level and a decompressive laminectomy at the lumbar level. They both showed satisfactory improvement after surgery. The pathologic features consisted mainly of thin and flat laminae at the cervical spine, and thick, hard laminae and facet joints at the lumbar spine. The mechanism of early onset of symptoms was probably due to the additive effects of irritation of both the spinothalamic tract at the cervical level and the nerve roots at the lumbar level. A one-staged operation is considered to be the most suitable treatment for this disease entity.

Adult↗

[The relationship between experimental changes in the stress-strain distribution and the tissues structural abnormalities of the cervical column].

Using 45 rabbits, the authors made a research on the relationship between the experimental change of the stress-strain distribution and the tissues structural abnormalities of the cervical column. After having changed the stress and strain distribution on the rabbits' cervical vertebrae by letting them bow their heads, we measured the strain distribution in Vivo with resistant strain gauges, inspected the pathological changes of the cervical vertebrae, the nuchal ligaments, the capsular ligaments, the neck muscles and the attachments of the capsular ligament to bones, by ligh microscope and electron microscope. We found that the greater the level of the strain and the longer time the strain was loaded, the more evident the morphological abnormalities of the cervical vertebrae. The increase of the stress and strain could also cause degeneration of the nuchal ligaments, capsular ligaments and neck muscles. We believe that the abnormalities of the of the soft tissues around the cervical vertebral bones play an important part in the development of the cervical spondylosis. We think that the morphological changes of the cervical column is the basis of the biomechanical pathogenesis of the cervical spondylosis.

Animals↗