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PubMedDate not supplied

Manipulation in the presence of cervical spinal cord compression: a case series.

OBJECTIVE: The purpose of this study is to present information from a series of patients with imaging findings of encroachment on the cervical spinal cord who were treated with chiropractic cervical manipulation. CASE SERIES: There were 27 patients (18 females, 9 males; age range, 23-65, mean age, 44.3 years) with neck and/or arm pain with findings of cervical spinal cord encroachment on magnetic resonance imaging. None of these patients had severe or acute myelopathy or advanced signal changes in the spinal cord indicative of myelomalacia. These patients were treated with a variety of approaches that included some form of cervical manipulation. The mean number of treatments that included manipulation was 12 (range, 2-32). Nineteen patients were treated with high-velocity, low-amplitude "thrust" manipulation, 9 patients were treated with low-velocity muscle energy technique, and 1 patient was treated with both methods. The mean patient-rated subjective improvement at the last follow-up reexamination was 70.0% (range, 10%-100%). From baseline to the last follow-up examination, the mean improvements in outcome measures were as follows: Bournemouth Neck Disability Questionnaire, 23.7 points (31%); Neck Disability Index, 6.4 points; and Numerical Pain Rating Scale, 3.9 points. In 3 patients, there was increased pain after manipulation that lasted from 1 to 4 days. There were no major complications, and in no patient did any increased pain after treatment last more than 4 days. No new neurologic symptoms or signs were seen in any of these patients. CONCLUSION: The finding of cervical spinal cord encroachment on magnetic resonance imaging, in and of itself, should not necessarily be considered an absolute contraindication to manipulation. However, because radicular and myelopathic complications to cervical manipulation have been reported in the literature, great care should be taken in all cases, particularly those in which anatomic conditions such as cord encroachment are present.

Adult↗
PubMed2006

Spinal cord compression from traumatic anterior cervical pseudomeningoceles. Report of three cases.

Pseudomeningoceles rarely develop after cervical trauma; in all reported cases the lesions have extended outside the spinal canal. The authors report the first known cases of anterior cervical pseudomeningoceles contained entirely within the spinal canal and causing cord compression and neurological injury. The authors retrospectively reviewed the cases of three patients with traumatic cervical spine injuries and concomitant compressive anterior pseudomeningoceles. The lesion was recognized in the first case when the patient's neurological status declined after he sustained a severe atlantoaxial injury; the pseudomeningocele was identified intraoperatively and decompressed. After the decompressive surgery, the patient's severe tetraparesis partially resolved. In the other two patients diagnoses of similar pseudomeningoceles were established by magnetic resonance imaging. Both patients were treated conservatively, and their mild to moderate hemiparesis due to the pseudomeningocele-induced compression abated. The high incidence of anterior cervical pseudomeningoceles seen at the authors' institution within a relatively brief period suggests that this lesion is not rare. The authors believe that it is important to recognize the compressive nature of these lesions and their potential to cause devastating neurological injury.

Adult↗
PubMed1976

Ankylosing hyperostosis with cervical spinal cord compression.

This report describes a patient whose clinical and radiological features conform to those of ankylosing hyperostosis. Posterior bridging osteophytes were also apparent and these have not been previously described in ankylosing hyperostosis. We have considered alternative explanations for this finding and concluded that they were manifestations of the hyperostotic process. This unusual feature occurring in the presence of a comparatively narrow spinal canal resulted in cord compression and a spastic tetraparesis and we would therefore suggest that ankylosing hyperostosis may sometimes have serious neurological consequences.

Aged↗
PubMed2002

Development and characterization of a novel, graded model of clip compressive spinal cord injury in the mouse: Part 1. Clip design, behavioral outcomes, and histopathology.

In order to take advantage of various genetically manipulated mice available to study the pathophysiology of spinal cord injury (SCI), we adapted an extradural clip compression injury model to the mouse (FEJOTA mouse clip). The dimensions of the modified aneurysm clip blades were customized for application to the mouse spinal cord. Three clips with different springs were made to produce differing magnitudes of closing force (3, 8, and 24 g). The clips were calibrated regularly to ensure that the closing force remained constant. The surgical procedure involved a laminectomy at T3 and T4, followed by extradural application of the clip at this level for 1 min to produce SCI. Three injury severities (3, 8, and 24 g), sham (passage of dissector extradurally at T3-4), and transection control groups were examined (n = 12/group). Quantitative behavioural assessments using the Basso, Beattie, and Bresnahan (BBB; H > 46; df = 4; p < 0.001; Kruskal-Wallis one-way ANOVA) and inclined plane (IP; F = 123; df = 4; p < 0.0001; two-way repeated measures ANOVA) tests showed a significant graded increase in neurological deficits with increasing severity of injury. By day 14, the motor recovery of the mice plateaued. Qualitative examination of the injury site morphology indicated that microcystic cavitation, degenerating axons, and robust astrogliosis were characteristic of the murine response to clip compressive SCI. Morphometric analyses of H&E/Luxol Fast Blue stained sections at every 50 microm from the injury epicenter indicated that with greater injury severity there was a progressive decrease in residual tissue (F = 220, df = 3; p < 0.0001; two-way ANOVA). In addition, statistically significant differences were found in the amount of residual tissue at the injury epicenter between all of the injury severities (p < 0.05, SNK test). This novel, graded compressive model of SCI will facilitate future studies of the pathological mechanisms of SCI using transgenic and knockout murine systems.

Animals↗