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PubMed1987

Total body replacement with iliac bone graft and metal plate stabilization in lower cervical spine.

15 patients presented with cervical spine dislocation and kyphotic spondylosis due to traumatic fracture and vertebral body tumour underwent surgical decompression and fixation via the anterior approach in one stage. Decompression was achieved by resection of the body of the vertebra while fixation meant implantation of iliac bone graft with metal plate fixation. Early reduction of the dislocation was impossible or insufficient in most of the cases. Therefore the majority of operations were "late decompression". Patients with root or partial cord lesions had the most significant improvement. In some selected cases, however, who suffered from a total cord lesion due to C6 or C7 fracture-dislocation, surgical decompression of the C7 and/or C8 roots by resection of the C6 or C7 vertebral bodies could lead to useful motor improvement in the hands and the fingers.

Adolescent↗
PubMed1982

A comparative study of the treatment of cervical spondylotic myeloradiculopathy. Experience with 50 cases treated by means of extensive laminectomy, foraminotomy, and excision of osteophytes during the past 10 years.

This paper reviews management by means of the posterior approach of 50 patients with cervical myeloradiculopathy caused by spondylosis and stenosis of the spinal canal seen in the past 10 years. Careful selection of patients is an absolute necessity since a primary cause of failure occurred in individuals who subsequently proved to have motor neurone disease. Older individuals with long-standing neurological deficits, especially long tract signs indicative of fixed lesions, were benefited primarily by a lack of further progression of their disorder and occasional improvement in hand function and gait. Diagnostic evaluation should include electromyography, nerve conduction studies, and sensory evoked cortical potentials. With the introduction of the fourth generation CAT scanning equipment, additional diagnostic information is available regarding the internal configuration of the spinal canal, its contents, and the amount of available space at various levels. Supplementary myelography remains of basic importance. Laminectomy includes two levels above and below the areas of significant canal encroachment. Foraminal decompression with removal of only the innermost third of the foramen permits mobilization of the nerve roots, removal of osteophytes and untethering of the dural sac. A great deal of importance is attached to the preservation of the cervical lordotic curve since, with an adequate decompression and an intact dura, the cord moves dorsally into an expanded canal, rising above the ventrally situated osteophytes. In those patients with reversal of the cervical curve and swan neck deformities, posterior decompression has not been of value. Recent more radical procedures in such cases, such as vertebrectomy, remain to be evaluated. Any procedure which will permit further kyphotic deformity, such as laminectomy, is contraindicated. Eighty-five percent of the patients operated upon by the recommended surgical approach improved.

Adult↗
PubMed1982

Anterior cervical discectomy without fusion. Microsurgical technique.

Between March 1977 and November 1980 25 patients underwent anterior cervical discectomy (11 patients at 2 levels at one time) under the operating microscope for treatment of cervical disc herniation. The selection of the patients and the right level of discectomy are discussed. The results of discectomy without fusion are excellent. Only in cases of severe spondylosis or posttraumatic instability we still perform a fusion after discectomy.

Cervical Vertebrae↗
PubMed1994

Diseases preceding colon cancer. A case-control study among veterans.

Patients with regular use of nonsteroidal antiinflammatory drugs (NSAIDs) appear to have a reduced mortality from colon cancer. As NSAID use is associated with gastrointestinal bleeding, endoscopic exploration of patients on NSAID may lead to more efficient screening and frequent detection of colon cancer. A case-control study was conducted among 12,304 veterans with a colon cancer diagnosed between 1988 and 1992. Four controls were matched by age, sex, and race to each case. The frequency distributions of previous discharge diagnoses in cases and controls were compared. Arterial embolism and thrombosis, spondylosis, peripheral vascular disease, angina, osteoarthrosis, and ischemic heart disease protected against future development of colon cancer. On the other hand, atrial fibrillation and flutter, as well as phlebitis and thrombophlebitis, were associated an increased occurrence of colon cancer after 5-10 years. The study contrasts diseases that are treated with aspirin with those that are treated with other anticoagulants. Both cause bleeding, but the reduced risk of colon cancer was seen only in conditions treated with aspirin. The difference between the two disease groups from the same VA patient population suggests that chronic use of NSAID truly protects against future development of colon cancer.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1985

Problems of etiology in femoral neuropathies.

29 cases of femoral mononeuropathy are reported. While the clinical features of the femoral neuropathy are easily identified, the etiology is often hard to establish. The cases reported tend to fall into three general categories: 1) cases without major diagnostic difficulties (e.g. diabetic neuropathy); 2) those in which the definite diagnosis results from combined evidence of laboratory and instrumental data (degenerative changes in the lumbar spine, compressions, entrapments, etc.); 3) those in which the negative result of the investigations prevents a positive diagnosis and hence a presumptive etiology (spondylosis, inflammatory process, ischemia of the nerve) may be formulated. Attention is drawn to the favorable course of the condition in the patients of this group.

Aged↗
PubMed1989

Elevated levels of the alpha subunit of GTP-binding protein Go in cerebrospinal fluid of patients with neurological disorders.

By employing a highly sensitive immunoassay method, concentration of the alpha subunit of GTP-binding protein, Go (Go alpha), recently shown to be localized mainly in nervous tissues and neuroendocrine cells, was determined in cerebrospinal fluids (CSF) of 192 patients with various neurological disorders and 50 control subjects. The results were compared with CSF levels of neuron-specific enolase (NSE) and S-100b protein (S-100b) in the same samples. Normal levels of Go alpha were 51.9 +/- 21.7 pg/ml. The levels of Go alpha, as well as NSE and S-100b, in CSF were enhanced in some patients with acute conditions, e.g., meningitis (48%), encephalitis (100%), and cerebral infarct (56%). In these disorders, cases with enhanced Go alpha levels were more frequent than those with enhanced NSE or S-100b. Three patients with encephalitis whose Go alpha levels were more than 1000 pg/ml all died; the remaining two patients with encephalitis and slightly elevated Go alpha levels had a good prognosis. Concentration of Go alpha in CSF correlated well with that of NSE but poorly with that of S-100b. However, cervical spondylosis and demyelinating diseases, CSF levels of Go alpha were generally lower than those of NSE or S-100b. These results suggest that Go alpha in CSF is a useful marker for monitoring patients with acute neuronal damage. Since these three proteins are distributed differently in the central nervous system, simultaneous determination of Go alpha, NSE, and S-100b levels in CSF might provide valuable information about the pathophysiology of neurological disorders.

Biomarkers↗
PubMed1992

Debrisoquine metabolism in Chinese patients with Alzheimer's and Parkinson's diseases.

We determined the oxidative phenotype and metabolic ratio of debrisoquine in 96 Chinese patients with Alzheimer's disease (n = 12), Parkinson's disease (n = 55), and using patients with stroke and cervical spondylosis as controls (n = 29). We did not find any difference in debrisoquine metabolic phenotype among Parkinson's disease, Alzheimer's disease, and control patients as judged by chi-square analysis. In addition, the metabolic ratio of all our patients was less than 12.6. The result suggested that Chinese patients with Parkinson's disease and Alzheimer's disease metabolize debrisoquine at a velocity not different from that of their Western counterparts even though the frequency distribution of debrisoquine metabolism phenotyping in these two populations is quite different.

Aged↗
PubMed1998

[Status of knowledge in expert assessment of occupational disease 2108-2110].

Necessary precondition for acceptance of spine disorders as occupational disease is an excessive occupational exposition, its compatibility with and and an explicit causal relation to this disorders. The latter may be assumed in case of multisegmental spondylosis of the column, combined with local impairment of function and pain, if the vertebral disorders of the occupationally exposed column-segment are significantly worse than those of other vertebral segments. Finally non-occupational, preexisting discrete vertebral disorders (e.g. scoliosis, spondylolisthesis) have to been excluded. So far there are no alternatives or rejections to this consensus, called "Hamburg formula". It should be used as long as no other valid, positive markers of occupationally caused disorders can be defined on the basis of reliable epidemiological investigations.

Disability Evaluation↗
PubMed1996

[Symptoms and pathological anatomy of the degenerative cervical spine].

Clinical symptoms and patho-anatomic changes in cervical myelopathy due to spondylotic changes are described. The leading symptoms are numbness and clumsiness of upper and lower extremity, mostly combined with gait disturbances. Muscle wasting primarily on the upper extremity leads to the myelopathic hand. Cervical myelopathy can be classified into five main groups: 1. Spastic tetraparesis with numbness and hyperreflexivity of upper and lower extremity. The majority of patients present with the myelopathic hand. 2. Spastic paraparesis with lesion below C6. 3. Spastic tetraparesis, mild or moderate, with deltoid muscle paresis. 4. Amyotrophic myelopathic hand with mild long tract signs. 5. Central cord syndrome due to cervical spondylosis combined with trauma. From the therapeutic aspect, conservative treatment is often unsuccessful. It is important to relieve pressure on the spinal cord, and decompressive procedures, especially posterior laminoplasty techniques, are required. Earlier surgery provides better results.

Aged↗
PubMed1996

[Degenerative changes of the cervical spine. Imaging].

Standard radiography of the cervical spine is still the first imaging procedure applied in degenerative disease of the cervical spine. Spondylosis deformans, osteochondrosis and uncovertebral arthrosis are well depicted by such images. Whether or not additional imaging is needed depends on the clinical symptoms. Special projections (anteroposterior oblique radiographs, lateral radiographs in flexion and extension) may be the next step. For many abnormalities, mainly of the intervertebral discs and the myelon, MR imaging has become the standard procedure, largely because of its multiplanar capabilities and its excellent contrast resolution. CT can be used instead of MR imaging if the latter method is not available, and its strength lies in the depiction of bone abnormalities. Scintigraphy is suitable for early detection of abnormalities with unclear clinical symptoms and may then indicate the correct level of the cervical spine for MR imaging or CT. Myelograms and myelo-CT can no longer be considered routine imaging methods. A number of imaging abnormalities are not strictly related to clinical findings and should therefore always be discussed in the clinical context.

Cervical Vertebrae↗
PubMed2005

Camurati-Engelmann disease (progressive diaphyseal dysplasia) in a Moroccan family.

We report on a 46-year-old mother of Moroccan origin, suffering mainly from painful, swollen legs, and her 26-year-old son who had experienced intense pain in his legs, without fever, for approximately 3 years. They did not have dysmorphic features or abnormal gaits. Radiographic studies of the mother revealed diaphyseal sclerosis of the tibia and spondylosis of the thoracal and lumbar vertebrae. The son had sclerosis of the diaphyses of the metacarpalia of the left hand, the femur and the fibula. The other parts of the skeleton were normal. Several osteosclerotic/hyperostotic disorders, such as melorheostosis (present mostly in sporadic cases and affecting lower extremities) and van Buchem's disease (autosomal recessive and commonly affecting the mandible) were considered as a diagnosis in the proposita. However, similar symptoms in the son of the proposita suggested an autosomal dominant inheritance pattern. This brought us to the diagnosis of progressive diaphyseal dysplasia (PDD) or Camurati-Engelmann disease (CED), an autosomal dominant disorder characterized by limb pain, reduced muscle mass, weakness, a waddling gait, progressive periosteal and endosteal sclerosis of the diaphyses of the long bones and sclerosis of the skull base. Mutations in the transforming growth factor (TGF)-beta1 gene on chromosome 19q13.1 have been reported to cause this disorder. The diagnosis of PDD/CED in this family was confirmed at the molecular level by detection of a C-to-T transition at position 466, leading to an arginine-to-cysteine amino acid change (position 156) in exon 2 of the transforming growth factor-beta1 (TGFB1) gene.

Adult↗
PubMed2001

Investigation of vertebral "end plate sclerosis".

OBJECTIVE: To evaluate the association between vertebral "end plate sclerosis" and neck pain. DESIGN: A retrospective study was carried out of lateral cervical spine radiographs with a Picture Archive and Communication System (PACS). PATIENTS: Two hundred patients' files were randomly assessed, comprising four equal groups, A to D. The mean ages of the patients were 62+/-7.4 years, 61+/-7.5 years, 40+/-5.6 years and 23+/-5.6 years respectively. In group A, all patients had symptoms of neck pain and a radiographic diagnosis of "end plate sclerosis" of the cervical spine. In groups B to D, asymptomatic patients were recruited and their age groups were 50-69, 30-49 and 10-29 years respectively. Using the PACS, the radiographic density and the sagittal diameter, thickness and area of the end plates at the C5 level were measured. RESULTS AND CONCLUSIONS: No significant differences were found in the radiographic density of the end plates either between the symptomatic and asymptomatic groups (groups A and B), or between different age groups (groups B, C and D). A significant increase in end plate area and thickness was found, however, in both group B (P<0.005) and group C (P<0.01) in comparison with group D. This indicates that the extent of end plate sclerosis increases with age. Our results suggest that the radiographic density of cervical vertebral end plates correlates neither with neck pain nor with increasing age. The radiological sign of "end plate sclerosis" may be over-reported, further limiting its value in the assessment of patients with cervical spondylosis.

Adolescent↗
PubMed1996

Cervical spondylotic radiculopathy involving two adjacent nerve roots. Anterior decompression through a single level intervertebral approach.

We describe a single level intervertebral approach to decompress two adjacent involved nerve roots in cases of cervical spondylosis. The operation was undertaken in 4 patients. We carried out discectomy, partial excision of the vertebral body with removal of the anteromedial part of the pedicles, removal of osteophytes and excision of the posterior longitudinal ligament, followed by an anterior interbody fusion. Fusion was achieved with the spine in normal lordosis and without complications. Pain and motor weakness was relieved in every case. This procedure can maintain movement at one additional disc level and has a better fusion rate than multilevel inter-body fusion.

Adult↗
PubMed2001

A case of ochronosis: upper extremity involvement.

We present an ochronotic patient with spondylosis and upper extremity involvement. We also evaluated radiologic findings of joints that were involved and MRI features of the lumbar spine.

Follow-Up Studies↗
PubMed2001

Spondylolysis and spondylolisthesis in the pediatric and adolescent population.

This article is a review of spondylolysis and spondylolisthesis in younger age groups. Since Herbinaux first described the pathology (1782), many classifications and theories of etiopathogenesis have been proposed. The congenital and isthmic types, as classified by Wiltse, are the most frequent in younger age groups, but the postsurgical progressive forms (3-5%) have been described as increasing in frequency secondary to neoplastic surgery in children. The general incidence is 4-5% at the age of 6 years, and in 30-50% of cases these types do not progress to spondylolisthesis. Most cases are asymptomatic (80%). Standard radiographic examinations (A-P, L, Oblique) are helpful in diagnosis and can suggest what the prognosis will be in terms of the evolution, and also what treatment is indicated (degree of slippage, slip angle, lumbar and lumbosacral index, SPTI). A bone scan (PBS and SPECT) is useful in the early stages of spondylolysis (pre-spondylosis). Although the CT scan is the most accurate examination, MRI is becoming important for diagnosis because of the frequency with which it is used as a primary investigation method. Depending on patient age, progression, degree of slippage, and symptoms, different therapeutic approaches have been proposed and are described in this paper.

Adolescent↗
PubMed2006

Corticobasal degeneration with focal, massive tau accumulation in the subcortical white matter astrocytes.

We report two sporadic cases of tauopathy with unusual neuropathological features. The ages of the patients at death were 86 and 74 years, and the disease durations were 4 and 3 years, respectively. The former patient showed progressive dementia and amyotrophy (autopsy revealed that severe cervical spondylosis was responsible for the amyotrophy), and the latter showed progressive parkinsonism and dementia. The essential brain pathologies were similar to each other; although ballooned neurons and astrocytic tau lesions (astrocytic plaques) were present in the affected cerebral cortex, the most striking finding was focal, much heavier accumulation of tau in the subcortical white matter. Moreover, double-labeling immunostaining, as well as Gallyas-Braak electron and AT8 immunoelectron microscopic studies strongly suggested that in the affected subcortical white matter, the accumulation of tau occurred mainly in the astrocytic processes. In the latter patient, for whom frozen brain tissue was available, immunoblotting of insoluble tau revealed a pattern compatible with that obtained from brain affected by typical corticobasal degeneration (CBD), and gene analysis of tau revealed no mutations, with a H1 haplotype. Finally, in both cases, the pathological diagnosis of CBD was considered to be appropriate. However, the tau pathology affecting the subcortical white matter astrocytes was very unusual for the disease.

Aged↗
PubMed2006

Phosphaturic mesenchymal tumor (mixed connective tissue variant): a case report with spectral analysis.

We present a further case of a rare mesenchymal neoplasm termed phosphaturic mesenchymal tumor (mixed connective tissue variant). The patient was a 42-year-old man with a long history of osteomalacia of unknown etiology with pathological bone fracture, abnormality of parathyroid glands, kyphosis, scoliosis, and spondylosis. Laboratory investigation disclosed hypophosphatemia, elevated serum alkaline phosphatase activity, and normal serum calcium level. The patient had a soft tissue mass in the right inguinal area, measuring 11 x 6 x 5 cm, which was previously interpreted as a calcified hematoma on sonography. The tumor was surgically removed. Grossly, the tumor was well circumscribed, unencapsulated, and had soft to dense consistency. The cut surface had a variegated appearance due to the presence of large hemorrhagic areas admixed with foci of grey-yellow tissue. Histologically, the tumor was composed of primitive mesenchymal cells, osteoclast-like cells, and cells showing myofibroblastic features without cytologic atypia. There were a well developed vascular network, microcystic areas, and poorly formed cartilaginous foci. Unusual and hitherto unpublished prominent features were flower-like, slate-gray crystals, widespread hemosiderin deposits and large areas of hemorrhages, with the latter comprising approximately 60% of the tumor. A spectral analysis indicated that chemically, the crystals mainly consisted of calcium phosphate and sodium nitrate.

Adult↗
PubMed2006

[Fear Avoidance Beliefs and physical function in elderly individuals with chronic low back pain].

Fear Avoidance Beliefs and physical function in elderly individuals with chronic low back pain This analysis assessed how fear avoidance beliefs (FABs) affected subjective and objective functional parameters as well as pain in elderly individuals. The study comprised 152 elderly patients with low back pain, which was attributed to spondylosis in almost half of the cases. Their average age was 70.1 years (SD=4.3, range 65-84). All of the patients participated in a physiotherapeutic program including data acquisition before treatment (t1), immediately after its completion (t2), and 6 months later (t3). FABs were assessed by a five-item scale with satisfying psychometric properties. The primary outcome criterion was function, which was evaluated as a subjective measure using the Hannover functional disability scale and as an objective measure based on the anteflexion determined by ultrasound topometry. Secondary outcome criteria were pain parameters. At the time o the first measurement (t1), the patients were classified into three groups with strong, intermediate, or weak FABs. Analyses of variance reveal an improvement of subjective functional capacity in every FAB group between t1 and t2. At t3, there is a decline of these values only in the group of the high fear avoiders. High fear avoiders also show lower values in the objective measure at all three measurement points. No influence of the FABs on the pain parameters could be determined. It would be expected that the efficacy of physiotherapy could be improved if the patients' FABs are taken into consideration when planning the treatment regimen.

Activities of Daily Living↗