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At least 1,027 records · Page 57Linked to original sources
PubMed2001

Surgery for cervical radiculomyelopathy.

BACKGROUND: Cervical spondylosis causes pain and disability by compressing the spinal cord or roots. Surgery to relieve the compression may reduce the pain and disability, but is associated with a small but definite risk. We sought to assess the balance of risk and benefit from surgery. OBJECTIVES: To determine whether: 1) surgical treatment of cervical radiculopathy or myelopathy is associated with improved outcome, compared with conservative management and 2) timing of surgery (immediate or delayed upon persistence/progression of relevant symptoms and signs) has an impact on outcome. SEARCH STRATEGY: We searched Medline (between 1966 and 1998), Embase (between 1980 and 1998) and the Cochrane Controlled Trials Register. Authors of the identified randomised controlled trials were contacted to detect any additional published or unpublished data. SELECTION CRITERIA: All unconfounded truly or quasi-randomised controlled trials allocating patients with cervical radiculopathy or myelopathy to 1) "best medical management" or "decompressive surgery (with or without some form of fusion) plus best medical management" 2) "early decompressive surgery" or "delayed decompressive surgery". DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials for inclusion, assessed trial quality and extracted the data. MAIN RESULTS: Two trials involving a total of 130 patients were included. One trial with 81 patients compared surgical decompression with either physiotherapy or cervical collar immobilization in patients with cervical radiculopathy. The short-term effects of surgery, in terms of pain, weakness or sensory loss were superior, however, at one year no significant differences between groups were present. One trial with 49 patients compared the effects of surgery with those of conservative treatment in patients with mild functional deficit associated with cervical myelopathy. No significant differences were observed between groups, up to two years following treatment.

Cervical Vertebrae↗
PubMed2004

Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease.

BACKGROUND: The number of surgical techniques for decompression and solid interbody fusion as a treatment for cervical spondylosis has increased rapidly, but the rationale for the choice between different techniques is unclear. OBJECTIVES: The goal of this study was to determine which method of anterior cervical interbody fusion at a single or double-level provides the best clinical and radiological outcome in patients with degenerative disc disease. SEARCH STRATEGY: Studies were identified with a computer-assisted search of electronic databases in the Cochrane Central Register of Controlled Trials (Issue 1, 2004), MEDLINE (1966 to 2004), EMBASE (1980 to 2004), and Current Contents (1996 to 2004). We also searched references of selected articles. SELECTION CRITERIA: With the aid of a checklist, two reviewers independently screened the identified references. Consensus was reached through negotiation. A third reviewer was consulted if consensus could not be reached. Inclusion criteria included: articles were reports of randomised comparative studies; treatments compared anterior cervical decompression and interbody fusion techniques, participants were individuals scheduled for surgery for a chronic (longer than 12 weeks) diagnosis of degenerative disc disease. DATA COLLECTION AND ANALYSIS: Methodological quality was assessed independently by two reviewers, using the van Tulder list of criteria. With the aid of a data extraction form, data was extracted independently by two reviewers on group characteristics, intervention details and outcome measures. MAIN RESULTS: Fourteen studies with 939 patients evaluated three comparisons of different fusion techniques. From these comparisons it appears that discectomy alone has a shorter operation time, hospital stay, and post-operative absence from work than discectomy with fusion, while there is no statistical difference for pain relief and rate of fusion. It also appears that fusion techniques that use autograft give a better chance for fusion than interbody fusion techniques that use a cage, but other outcome variables could not be combined. REVIEWERS' CONCLUSIONS: The low quality of the trials prohibits extensive conclusions from this review. More studies with better methodology and reporting are needed. There should be a more general agreement between researchers on which outcome parameters should be used in the evaluation of anterior cervical fusion procedures.

Cervical Vertebrae↗
PubMed1992

New variant of cytochrome b5 reductase deficiency (b5RKurashiki) in red cells, platelets, lymphocytes, and cultured fibroblasts with congenital methemoglobinemia, mental and neurological retardation, and skeletal anomalies.

A Japanese man with cytochrome b5 reductase (b5R) deficiency in various blood cell lineages (red cells, platelets, and lymphocytes) and in cultured fibroblasts demonstrated congenital methemoglobinemia associated with mental and neurological retardation, and various skeletal anomalies, such as spondylosis deformans and finger joint deformations, which have never been described in association with this enzyme deficiency. Cytochrome b5 reductase deficiency was most severe in red cells (0.3-4%) and less marked in platelets (13-27%), lymphocytes (18-31%), and fibroblasts (50%). The present case appears to be a new variant of cytochrome b5 reductase deficiency (b5RKurashiki).

Adult↗
PubMed1982

Intervertebral osteochondrosis in ancient and modern populations.

Skeletal collections are often useful for determining the frequency and distribution of lesions that would otherwise go unnoticed in the living. This study examines a rather common spinal lesion for which there is little clinical or paleopathologic literature available. In such cases, the anterior aspect of the lower thoracic and lumbar vertebral plates display crescent-shaped lesions suggestive of a form of degeneration known as intervertebral osteochondrosis. A total of 2,628 skeletons from three early American Indian sites and one 20th-century medical-school cadaver population are examined for this lesion. Variables such as age, sex, weight, race, activity patterns, and other biocultural information are considered in relation to the frequency of this lesion. It is suggested that physical stress during the second and third decades of life is largely responsible for this condition. With advancing age the lesions are obliterated and, in effect, become indistinguishable from spondylosis deformans. Familiarity with this condition is necessary in order to better understand degenerative spinal disease and avoid confusion with other spinal diseases such as tuberculosis.

Adolescent↗
PubMed1978

The cervical myelopathy associated with rheumatoid arthritis: analysis of patients, with 2 postmortem cases.

The clinical findings in a group of 32 rheumatoid patients with symptomatic myelopathy are described. The myelopathy appeared in late middle age after many years of rheumatoid disease (average duration, 18 years). The most common radiological abnormality was anterior subluxation of C1. Other patterns occurred in about half the cases. The most common neurological findings were those of a mild to moderate spastic paraplegia, often with atrophy of muscles of the hands and sensory changes in the hands. Symptoms originating above the foramen magnum (nystagmus, diplopia, slurred speech) appeared to have a vascular cause and were sometimes associated with upward as well as posterior movement of the odontoid process. Root pain into the arms was not present, and its absence helped to distinguish these disorders from cervical spondylosis. Root pain into the territory of the C2 root was common. Medical or conservative therapy was not effective, and the preferred approach was use of a halo traction device followed by posterior fusion, with or without laminectomy. Pathologically, in 2 autopsy cases, the maximal change had occurred in the central gray matter and adjacent posterior and lateral columns. We postulate that direct pressure caused intermittent compression and narrowing of distal transverse branches of the anterior spinal artery.

Arthritis, Rheumatoid↗
PubMed1987

Examination of motor function in lesions of the spinal cord by stimulation of the motor cortex.

Electrical stimulation of the motor cortex was performed in 3 patients with cervical cord trauma and in 3 with cervical myelopathy caused by cervical spondylosis. Abnormal conduction in central motor tracts was demonstrated in 5 of the 6 patients; yet in 4 of these, cortical somatosensory evoked potentials from the same limb were of normal latency. In the remaining patient who had normal motor latencies, the somatosensory evoked potentials were delayed on one side. Electrophysiological examination of the motor pathways by cortical stimulation may therefore be of considerable value in the assessment and management of patients with traumatic and compressive disease of the spinal cord.

Adult↗
PubMed1975

Cervical spinal interbody fusion with Kiel bone.

Experience with the use of the Kiel bone graft in anterior cervical interbody fusion in cervical spondylosis is reported. The survey reviews the results of operations on 73 disc spaces in 65 consecutive patients, from 2 to 5 years after the operation. We have failed to confirm that any bony fusion in the true sense occurs with Kiel bone in anterior cervical interbody fusion. However, the aims of the operations are achieved, namely removal of the disc and osteophyte, fixation of the spine to prevent compression of the neural tissues, distraction of the adjacent vertebral bodies providing increased room in the intervertebral foramina and stability of the spine.

Aged↗
PubMed1984

Spontaneous degenerative spinal disease in the laboratory rabbit.

The spines of 35 rabbits (32 New Zealand white and 3 AC/J), ranging in age from 3 months to 8 1/2 years, were investigated systematically for spontaneous degenerative changes. Three types of lesion were observed. (1) The nucleus pulposus underwent chondroid metaplasia throughout the length of the vertebral column by the age of 2 years. (2) Hydroxyapatite deposition was found in the nucleus pulposus in 12 of 20 animals examined roentgenographically. The lesion occurred principally in the distal thoracic segments and was first observed in 3-month-old rabbits. (3) Spondylosis occurred in each of four macerated spines from animals greater than 24 months old. Portions of the spine spared by disc calcification were affected.

Age Factors↗
PubMed1985

An assessment of the risk of developing hyperparathyroidism and thyroid disorders subsequent to neck irradiation in middle-aged women.

We investigated the occurrence of thyroid and parathyroid disorders in 100 women (age 66-70 years) irradiated for cervical spondylosis on average 25 years previously and in 100 control women of similar age. Hyperparathyroidism (HPT), proven by operation, was diagnosed in one patient of each group, and three additional cases were diagnosed biochemically among irradiated women. The difference in incidence is not significant. Nor was there any significant difference in incidence of thyroid disorders. No thyroid carcinoma was found in either group. Even if there is a moderate increase of HPT after neck irradiation in middle-aged women the risk is not so great as to warrant organised follow-up.

Aged↗
PubMed1998

Neurosurgical intervention for cervical disk disease in dystonic cerebral palsy.

We report five young patients with athetoid-spastic cerebral palsy who had deteriorated neurologically. Magnetic resonance imaging (MRI) was used to investigate suspected compressive cervical spine lesion. Cervical spondylosis with disk protrusions was found in all patients. Four patients underwent surgery by an anterior approach with insertion of a bone graft resulting in substantial clinical improvement. The other patient, diagnosed 8 years after onset of symptoms, was treated conservatively. The availability of MRI makes early recognition of cervical cord compression possible, allowing effective surgical intervention in this special group of patients.

Adult↗
PubMed1984

The clinical role of somatosensory evoked potential studies: a critical appraisal.

The clinical utility and limitations of somatosensory evoked potential (SEP) studies are reviewed. Somatosensory evoked potentials may help to identify a lesion in the sensory pathways, but do not indicate its nature. In multiple sclerosis subjects, the SEP findings may help to establish that there is a multiplicity of lesions, but multimodality evoked potential abnormalities may occur in other disorders. Somatosensory evoked potential abnormalities do not reflect either the severity or the prognosis of cervical spondylosis and do not reliably permit early recognition of the totality of traumatic cord lesions, while the role of SEPs in monitoring cord function intraoperatively awaits definition. Somatosensory evoked potentials do not reliably indicate the individual prognosis after severe head injury, and discrepancies in published findings suggest that their use in the evaluation of brain death is premature. In hereditary spinocerebellar degenerations, SEP abnormalities may reflect central or peripheral pathology. Somatosensory evoked potentials can be used to determine conduction velocity in peripheral nerves and to identify inaccessible proximal lesions of these nerves, but the findings may lead to misleading conclusions about brachial plexus lesions, especially if pre- and postganglionic lesions coexist.

Brain Death↗
PubMed1991

Clinical correlations of anti-GM1 antibodies in amyotrophic lateral sclerosis and neuropathies.

Clinical correlations of antiganglioside GM1 antibodies are important because high titers of these antibodies may have therapeutic significance. To further evaluate this significance, we reviewed our experience with 78 patients who had the following diagnoses: amyotrophic lateral sclerosis (ALS), ALS syndromes in patients with gammopathy or thyroid abnormalities, cervical spondylosis simulating ALS, motor neuropathies, and chronic inflammatory demyelinating polyneuropathies (CIDP). Antiganglioside antibody titers were measured "blind" by ELISA assay at the neuromuscular clinical laboratory, Johns Hopkins School of Medicine. We conclude that anti-GM1 antibodies are found in a wide variety of neuromuscular conditions. Patients with classical ALS had a mean anti-GM1 antibody titer significantly lower than patients with CIDP or motor neuropathy. Patients with ALS associated with gammopathy or thyroid disorders had higher anti-GM1 titers than seen in classical ALS. The highest mean titer occurred in patients with CIDP, a treatable neuropathy.

Amyotrophic Lateral Sclerosis↗
PubMed2006

Bladder sensation in peripheral nerve lesions.

OBJECTIVE: To present bladder sensory data of three common peripheral nerve lesions (e.g., distal, intermediate/focal, and proximal). METHODS: We measured first sensation (FS) and bladder capacity (BC) (not exceeding 600 ml) in 71 patients with peripheral nerve lesions: 35 diabetic neuropathy (D group), 6 post-pelvic surgery (S), and 27 cauda equina syndrome due to lumbar spondylosis (L). We excluded those with detrusor overactivity or low compliance that might affect bladder sensation. RESULTS: The mean FS was 301.7 ml (D), 271.3 ml (S), and 189.4 ml (L), with the largest being in the D group (P < 0.05); the mean BC was 495.2, 475.4, and 391.4 ml, with the largest being in the D group (P < 0.05); who commonly had less frequent toileting. The mean post-void residual volume was 106.5, 29.0, and 42.0 ml; the values tended to increase along with BC. In the D group, the mean FS in patients with skin hypoalgesia as detected by pin prick and in those without it was 407.8 and 210.0 ml. The percentage of patients with FS < 100 ml was 5.7%, 0%, and 7.4%, respectively, who commonly had urinary urgency and frequency. CONCLUSIONS: Bladder sensation is affected in diabetic neuropathy more severely than in intermediate/proximal lesions, together with somatic sensory disturbance. Bladder sensory disturbance leads to less frequent toileting, resulting in bladder over-distension and large post-void residuals. A small proportion of patients with peripheral nerve lesions develop urinary urgency, presumably reflecting irritation of the afferent nerve fibers or the urothelium.

Aged↗
PubMed1991

Pustular osteoarthropathy and its differential diagnosis.

A combination of costo-sterno-clavicular hyperostosis and palmo-plantar pustulosis, sometimes with hyperostotic spondylosis and spondylarthritis, is called pustular osteoarthropathy. In the Western hemisphere 40 cases have been reported and in the Far East the condition occurs more commonly. Five cases are described. Diagnosis is difficult because the skin lesions can occur before the costo-sterno-clavicular hyperostoses. The clinical condition is discussed together with the differential diagnosis. Pustular osteoarthropathy seems to be an enthesopathy and the palmoplantar pustulosis is interpreted as a form of psoriasis.

Adult↗
PubMed1993

Anterior cervical fusion with the Caspar instrumentation system.

We reviewed 106 consecutive patients who had undergone anterior cervical fusion with the Caspar instrumentation system between 1984 and 1989. Preoperative diagnoses were cervical spondylosis in 73 patients, a traumatic lesion in 12, ossification of the posterior longitudinal ligament in 9, cervical disc herniation in 6, and tumour or miscellaneous lesions in 6. In the 106 patients, 56 had two levels fused and 27 had three levels fused. At an average duration of follow-up of 4 years and 7 months, nonunion occurred in 3 of the 83 patients with multiple level fusions. Screw loosening occurred in 8 of the 106 patients, but there was no oesophageal perforation.

Adult↗
PubMed1991

Radiographic findings of degeneration in cervical spines of middle-aged soccer players.

Twelve amateur veteran soccer players (average age 40.1 +/- 5.4 years), who began playing in their teens and who were admitted with symptoms most likely to be related to cervical spondylosis, were examined by cervical radiography. Abnormal radiographic findings included: calcification of anterior longitudinal ligament (25%), anterior (75%) and posterior vertebral spurs (75%), ossicle between spinous processes (75%), calcification of nuchal ligament (Barsony) (58%), ossicle on spinous process (25%), and bony spur of Luschka's joints (83%). It was shown in the stress distribution by finite element method analysis that the stress in heading the ball was applied mainly to the lower parts of the cervical spine. The results of this analysis also corresponded well with some of the radiographic findings.

Adult↗
PubMed1980

Foramen arcuale and syndrome of Barre-Lieou. Its surgical treatment.

At the point where the vertebral artery crosses the posterior arch of the atlas it may sometimes be enclosed by a bridge of bone, the so-called foramen arcuale. The foramen limits the normal mobility of the vessel during flexion and extension of the neck and may cause disturbances of arterial flow and of the peri-arterial sympathetic plexus giving rise to symptoms similar to those found in the Barre-Lieou syndrome. The authors describes the angiographic findings in such patients and a technique for the surgical excision of the foramen. The results of the operation in two groups of patients, with and without associated spondylosis of the lower cervical spine, are presented.

Cervical Atlas↗