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PubMed1980

H-reflex of the upper extremities in cervical myelopathy.

A study was made of the H-reflex in the upper extremities to express objectively the degree of spastic paralysis in cases of cervical myelopathy. This reflex cannot normally be elicited in healthy persons. The H-reflex was elicited in 63 out of 80 patients with advanced symptoms of cervical myelopathy and was most frequently recorded from the median nerve. The H/M amplitude ratio is used to express the degree of spastic paralysis, the higher the ratio the more severe the dysfunction. The longer the clinical history the greater the tendency for the H-type of reflex to change to the HF-type and the higher the H/M amplitude ratio. The decrease rate of the pre- and post-operative H-reflex was high amongst soft disc cases whilst that in spondylosis and ossification of the posterior longitudinal ligament was low compared to the improvement in symptoms. It is concluded that the H-reflex in the upper extremities is a good method of expressing the degree of spastic paralysis in cervical myelopathy.

Aged↗
PubMed1993

Chronic compression of the cervical myelon as complication of anterior interbody fusion (AIF): neurological improvement after late anterior decompression. Case report.

Severe neurological deficits directly related to intraoperative injury of the spinal cord and the nerve roots is a rare complication of anterior interbody fusion (AIF) in cervical spondylosis. A case of radiculopathy and Brown-Séquard Syndrome caused by a bone fragment following AIF in which a late anterior decompression and fusion of the cervical spine was performed four years after the initial operation is presented. Immediate relief of the radicular pain, improvement of the spasticity, and better sphincter control could be achieved. Therefore, patients with chronic anterior compression of an incomplete spinal cord injury after AIF may benefit from a late anterior decompression and fusion.

Female↗
PubMed1982

Iopamidol vs metrizamide: a double blind study for cervical myelography.

A double-blind study was performed on 20 patients comparing the safety and efficacy of Iopamidol and Metrizamide in cervical myelography. The radiographic qualities of the Iopamidol and Metrizamide examinations were equivalent when using the same volume (12 to 13 ml), concentration (200 mg I/ml), and a C1-2 route of administration. The performance of a CT scan on selected patients in specified areas of interest provided additional diagnostic information in some patients (e.g syringomyelia, degenerative spondylosis). The adverse reactions were mild in the Iopamidol group with 4 of the 10 patients experiencing no adverse reactions. The more severe reactions, including disorientation, agitation, dysarthria, asterixis, hyperreflexia and EEG abnormalities were limited to the Metrizamide group with one or more occurring in 2 of the 10 patients studied. Only one Metrizamide patient experienced no adverse reactions. In this study containing a limited number of patients, Iopamidol was shown to be a diagnostically effective and safer contrast medium for performing cervical myelography.

Chemical Phenomena↗
PubMed1987

Increased MR signal intensity secondary to chronic cervical cord compression.

Magnetic resonance images of 128 patients with compressive lesions of the cervical spinal canal were reviewed to determine whether a high signal intensity lesion within the spinal cord was present on T2 and proton density weighted spin echo images. Such high signal intensity was observed in 24 cases or 18.8%. The incidence was higher in herniated disk (32.4%), atlanto-axial dislocation (28.6%), and ossification of the posterior longitudinal ligament (22.7%), whereas the abnormality was found sporadically in cervical spondylosis and vertebral body tumors. The high intensity lesion on T2 weighted images was generally observed in patients with constriction or narrowing of the spinal cord. The lesion was not demonstrated on T1 weighted spin echo images. Spinal cord constriction or localized narrowing seemed to be the most important predisposing factor in producing such a high signal intensity. The pathophysiologic basis of such an abnormality was presumed to be myelomalacia or cord gliosis secondary to a long-standing compressive effect of the spinal cord.

Atlanto-Axial Joint↗
PubMed1982

Gout in the spine and sacro-iliac joints: radiological manifestations.

It is well known that deposits of urates in soft tissues occur commonly in gout, particularly in para-articular areas and in articular cartilages of the limbs. Involvement of the spine and sacro-iliac joints by such deposits, however, has been regarded as being relatively unusual and has attracted little attention in the literature. As we were impressed by the frequency of episodes of acute back pain in our patients with gouty arthritis, established definitely on clinical and biochemical grounds, we undertook a radiological investigation of the spine and sacro-iliac joints in a series of 54 subjects. It was suspected that their episodes of pain were clinical manifestations of gout, and 12 of the group had suffered one or more attacks. Of these 12 subjects, eight were found to have radiological abnormalities. In six subjects, evidence of sacro-iliitis was demonstrated, which is comparable to the report of Resnick and Reinke [8], and in two patients vertebral lesions corresponded to those describe by Jaffe [5]. Hyperostotic spondylosis was present in no fewer than 29 of the series. Although lacking histological confirmation of the lesions demonstrated radiologically, we believe that our suspicions have been confirmed.

Adult↗
PubMed1986

Roentgenographic findings following anterior cervical fusion.

We reviewed the pre- and postoperative lateral cervical roentgenograms in 90 patients who had anterior fusions and compared their findings with age and sex-matched people without neck problems. The average interval from surgery to review was 5 years. Preoperatively, all patients had a higher incidence of degenerative spondylosis at the levels to be fused than their asymptomatic counterparts. Postoperatively, there was no difference in the incidence of degenerative change between the operated and the control group at the levels above and below the fusion with the exception of anterior osteophyte formation which was more frequent in those with fusions.

Cervical Vertebrae↗
PubMed1980

Complete destruction of both femoral heads following idiopathic necrosis of the femoral heads in a diabetic patient with hyperuricemia and hyperlipoproteinemia.

A practically complete destruction of both femoral heads including the femoral necks and acetabula was encountered in a 69-year-old patient with diabetes, which varied in intensity. This destruction, documented by radiographs which had been taken 8 years prior, had started as the typical picture of "idiopathic femoral head necrosis". In addition to diabetes, hyperuricemia and hyperlipoproteinemia were present at the time when the femoral head necrosis was first evidenced. One episode of gout was recorded. In recent years, following therapy, the hyperurecemia and hyperlipoproteinemia had normalized. The question is raised, as to whether or not the present radiological findings represent a complication of aseptic femoral head necrosis, combined with a diabetic arthropathy of the hip joints. Details of the angiographic findings and a spondylopathy, which have all the characteristics of a neuropathic spondylopathy, would favor this hypothesis. When associated with a diabetic condition, generalized osteoporosis and hypertrophic spondylosis of such a particular nature require special mention.

Aged↗
PubMed1985

Instability of the cervical spine after anterior interbody fusion. A study on its incidence and clinical significance in 21 patients.

Twenty-one patients suffering from cervical spondylosis and peripheral symptoms underwent uncomplicated anterior interbody fusion of the cervical spine and were re-examined clinically and radiologically at 27 +/- 15 months (mean +/- SD) after the operation. Translatory displacement of the segment adjacent to the fusion level was noted in 14 patients. Its incidence could not be related to the age and sex of the patient, to extent of the fusion, or to postoperative time. Anterior slippage did not correlate with persistent or recurring pain.

Adult↗
PubMed1986

Computed tomography in cervical spondylotic myelopathy and radiculopathy: visualisation of structures, myelographic comparison, cord measurements and clinical utility.

Sixty-nine patients with cervical spondylotic myelopathy (CSM), radiculopathy (CSR), or both (CSMR) were studied with computed tomography (CT). Computer-assisted myelography (CAM) accurately determines the site and nature of spondylotic protrusions and provides good visualisation of the subarachnoid space and cord deformities even in areas with dilute metrizamide. However, excessive vertebral movement and bulging ligamenta flava with their effects on cord deformity, so easily visualised in myelograms, are completely or partially missed. In the assessment of CSM, metrizamide myelography (MM) followed by CAM should be performed, particularly when the myelographic images are unsatisfactory due to contrast dilution or blockage, when cord compression cannot be ascertained with MM and when cord atrophy is suspected. In CSR, the diagnostic information from MM and CAM is comparable. The diagnostic criteria in CAM are, however, less direct and since MM is adequate in uncomplicated cases, CAM is generally not necessary. The APD, APD/TD ratio, area and circularity are sensitive indices of cord deformity and the first two should be used more often to assist visual assessment of cord deformity. The relation between cord parameters and treatment response is better reflected in CSM cases managed conservatively and the results suggest that the degree of cord deformity is helpful in determining the outcome and hence the choice between surgical and conservative treatment. In plain CT, the osteophytes and calcified discs are adequately visualised and canal dimensions measured with accuracy, but the cervical cord and roots cannot be properly assessed and the diagnosis of CSM or CSR cannot be ascertained. At present, its role in cervical spondylosis is therefore limited.

Humans↗
PubMed1992

Acute traumatic central cord syndrome: MRI-pathological correlations.

The acute traumatic central cord syndrome (ATCCS) is commonly stated to result from an injury which affects primarily the center of the spinal cord and is frequently hemorrhagic. To test the validity of this widely disseminated hypothesis, the magnetic resonance images [MRI] of 11 consecutive cases of ATCCS caused by closed injury to the spine were analyzed and correlated with the gross pathological and histological features of 3 cervical spinal cords obtained at post mortem from patients with ATCCS, including 2 of patients studied by MRI. The MRI studies were performed acutely (18 h to 2 days after injury) in 7 patients and subacutely (3-10 days after injury) in 4. Ten of the 11 patients had pre-existing spondylosis and/or canal stenosis. The 11th suffered a cervical fracture. All patients exhibited hyperintense signal within the parenchyma of the cervical spinal cord on gradient echo MRI. None showed MRI features characteristic of hemorrhage on T1-weighted spin echo or T2-weighted gradient echo studies. Gross and histological examination of the necropsy specimens showed no evidence of blood or blood products within the cord parenchyma: the primary finding was diffuse disruption of axons, especially within the lateral columns of the cervical cord in the region occupied by the corticospinal tracts. The central gray matter was intact. In patients with ATCCS, the predominant loss of motor function in the distal muscles of the upper limbs may reflect the importance of the corticospinal tract for hand and finger function in the primate. In this study, the MRI and pathological observations indicate that ATCCS is predominantly a white matter injury and that intramedullary hemorrhage is not a necessary feature of the syndrome; indeed, it is probably an uncommon event in ATCCS. We suggest that the most common mechanism of injury in ATCCS may be direct compression of the cervical spinal cord by buckling of the ligamenta flava into an already narrowed cervical spinal canal; this would explain the predominance of axonal injury in the white matter of the lateral columns.

Adult↗
PubMed1995

Dysphagia caused by an anterior cervical osteophyte: case report.

Cervical spondylosis and ankylosing hyperostosis of the cervical vertebrae are commonly asymptomatic. Dysphagia caused by cervical osteophyte formation is rare. We report a case of spondylotic dysphagia with striking radiographic findings. A massive anterior cervical hyperostosis was resected via the anterior cervical approach with excellent relief of dysphagia.

Cervical Vertebrae↗
PubMed1996

Two-dimensional MRI at 1.5 and 0.5 T versus CT myelography in the diagnosis of cervical radiculopathy.

A prospective comparison was made of standard two-dimensional MRI sequences, at both high and midfield strength, with CT myelography in 23 patients with cervical spondylosis. MRI is adequate for assessment of cord compression, where high field strength is superior to midfield strength. MRI using 4-mm sections is inadequate for presurgical assessment of root compression. It remains to be proven whether thin-section white-CSF volume sequences or gadolinium-enhanced volume studies can replace CT myelography.

Adult↗
PubMed1984

Glial bundles in spinal nerve roots. An immunocytochemical study stressing their nonspecificity in various spinal cord and peripheral nerve diseases.

Glial bundles (GBs) in spinal nerve roots in 86 autopsy cases with various spinal lesions were examined using the peroxidase-antiperoxidase technique for glial fibrillary acidic protein (GFAP). In 19 of 22 cases of Werding-Hoffmann disease (WHD), GBs were present in the anterior roots (ARs) but absent in the youngest age group (age less than 1.5 months at death). GBs were numerous in classical cases (age 3-24 months), accompanying severe damage of the anterior horns and roots, but were less prominent in most cases of protracted course (age 2-8.5 years). Thus, development of GBs in the ARs of motor neuron disease at a young age seems to depend on the clinical type (age at onset and disease duration) and degree of damage to motor neurons and ARs. Varying numbers of GBs were found also in the posterior roots (PRs) of 12 cases of WHD. In 13 patients with amyotrophic lateral sclerosis (ALS), few GBs were observed in the ARs of two and PRs of five cases without apparent relation to other clinicopathologic data. GBs in the PRs of both WHD and ALS might indicate spreading of the degenerative process to sensory neurons despite the absence of pathology detectable by routine histological stains. Numerous GBs were found also in adults affected with polymyelitis in childhood. Varying numbers of GBs were present, however, in many different diseases, such as Friedreich ataxia, Guillain-Barré syndrome, various polyneuropathies, cervical spondylosis, ataxia telangiectasia, metachromatic leukodystrophy, and Leigh syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1997

[Occupationally-induced degenerative discopathies in the area of the lumbar spine].

A case-control study comprising 188 male and 160 female cases from an orthopedic's cabin explained occupational risk factors for osteochondrosis, spondylosis, and spondylarthrosis of the lumbar vertebra. The controls (109 men, 130 women) steaming mainly from other physician's offices were free from musculoskeletal symptoms. Age-adjusted odds ratio (OR) were calculated for both sexes. In women elevated ORs were found for working in standing position (OR 2.2 CI 1.31-3.85), for repetitive work (OR 1.9 CI 1.17-3.36), for lifting heavy things up to 20 kg (OR 2.1 CI 1.24-3.67), for working as a secretary (OR 1.8 CI 1.16-3.0) or in a supermarket (OR 2.1 CI 1.05-4.56). Men showed elevated ORs for bending (OR 2.2 CI 1.27-4.08), vibrations of the upper limbs (OR 2.3 CI 1.12-5.02), whole-body-vibrations (OR 2.1 CI 1.14-4.11), working in the metal industry (OR 3.6 CI 1.88-6.89) or as motorists for more than ten years (OR 6.5 CI 1.54-27.99) and working in a humid or cold environment (OR 2.2 CI 1.30-3.72).

Adult↗
PubMed1978

Congenital stenosis of lumbar spinal canal: comparison of results of surgical treatment for this and other causes of lumbar syndrome.

The operative results in 37 consecutive patients suffering from developmental stenosis of the lumbar spinal canal, compared with those in spondylosis and disc herniations, are discussed. The diagnostic certainty of stenosis, suspected on the bases of clinical and radiographic data, is reached only at the operating table. To judge the usefulness of the operation we have considered not only the patients' verdicts, but also the improvements in neurological signs and the appearance of new deficits. Satisfactory results are around 80%, slightly less good with stenosis than with the other causes of lumbar syndrome. Radiographic study with contrast medium is mandatory. Dimer-X has been used with very clear radiographic findings and very few complications. Operating technique is also described: a wide laminectomy with facetectomy is advised. The great importance of early physiotherapy is emphasized.

Adolescent↗
PubMed1978

Redundant nerve roots of the cauda equina.

Two cases of redundant nerve roots syndrome are presented. Both cases displayed coiled and elongated nerve roots of cauda equina, associated with proliferated fibrous tissue on the ligamentum flavum or with spondylosis and disc protrusion compressing the caudal dural sac. The pathogenesis of the syndrome of redundant nerve roots is briefly discussed.

Adult↗
PubMed1979

The results of surgical treatment of spondylotic radiculomyelopathy with complete cervical laminectomy and posterior foramen magnum decompression.

Twenty-six patients with cervical spondylosis and radiculomyelopathy were treated surgically. Eight patients had cervical laminectomy C1--C7, and 16 patients had complete cervical laminectomy C1--C7 with excision of the posterior rim of the foramen magnum. Follow-up of patients was from two months to eight years. The majority of patients improved markedly, and some of them had excellent results.

Adult↗
PubMed1984

Treatment of cervical disc disease using Cloward's technique. The prognostic value of clinical preoperative data in 1,106 patients.

During a fifteen-year period 1,106 patients underwent Cloward's operation due to cervical disc disease. An analysis of the clinical features showed that the diseases had a very complex pattern of symptoms and signs. In young patients a syndrome of herniated disc predominated whereas a clinical picture of "cervical spondylosis" was found more often in the elderly. It was demonstrated that best results were obtained in young patients, patients with slight symptoms and patients with monoradicular symptoms. A short duration of symptoms is essential for a good outcome, and, on the basis of the data presented, operation is recommended 3 months after the onset of symptoms of cervical disc disease, if previous conservative treatment has failed.

Adolescent↗