Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “SPONDYLOSIS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,117 records · Page 62Linked to original sources
PubMed2005

Predictors for the immediate responders to cervical manipulation in patients with neck pain.

Cervical manipulation has been considered an effective treatment for managing neck pain. However, clinical observation showed that cervical manipulation was not effective for every patient. Development of clinical prediction rules for identifying patients with neck pain who are likely to respond to cervical manipulation may improve clinical decision-making and the treatment success rate. The purpose of the study was to identify predictors for the immediate responders to cervical manipulation treatment in patients with neck pain. One hundred patients with neck pain (34 males and 66 females, mean age = 46 +/- 11 years) participated in the study. Patient's demographic data, symptom aggravating or easing factors, pain, and disability level were obtained through an initial assessment. A series of physical examinations were also administered. After receiving a single session of cervical manipulation, the patient was re-evaluated immediately to determine if a successful response to treatment was obtained. The successful response was determined by improvements seen in one of the three outcome variables that included reduction of pain intensity, significant perceived improvement, and high satisfaction level. From these judgment criteria, patients were classified into either responders or nonresponders to the cervical manipulation. Univariate analyses were used to assess if the treatment responders and nonresponders were different in their clinical presentations. The clinical factors that showed significant differences between two groups were then entered into a stepwise multiple logistic regression analysis to identify significant predictors and the prediction rule for treatment responders. Six predictors including "initial scores on Neck Disability Index < 11.50", "having bilateral involvement pattern", "not performing sedentary work > 5 h/day", "feeling better while moving the neck", "without feeling worse while extending the neck", and "the diagnosis of spondylosis without radiculopathy" were identified to significantly predict the immediate responders. The presence of four or more of these predictors increased the probability of success with manipulation to 89%. We concluded that using favourable predictors to identify treatment responders before administering cervical manipulations could significantly increase the probabilities of a successful treatment. This study finding may enhance the efficacy of clinical decision-making in using cervical manipulation intervention.

Adult↗
PubMed2006

Spine disorder case studies.

Spine and limb pain related to degenerative, wear-and-tear changes of the disks, joints, and soft tissues of the spine (spondylosis) is exceedingly common. Identical spine and limb pain can be caused by fracture, tumor, or infection. Patients who have a history of significant trauma, signs or symptoms of systemic disease, neurologic impairment, and profound pain require further evaluation, and some may require surgical intervention to decompress the spinal nerves, spinal cord, or cauda equina or to stabilize adjacent spinal segments. The discovery of red flags in the history or on examination can identify patients who should have imaging and possibly surgical intervention. Neurologic assessment is required to determine which patients could benefit from surgery. The natural history for most acute spondylotic conditions is favorable. Treatment for acute and chronic spine-related pain syndromes is available.

Adult↗
PubMed2005

Adjacent level degeneration after anterior cervical fusion: a clinical review.

Anterior cervical discectomy and corpectomy for the treatment of cervical spondylosis,cervical disc herniation, and ossification of the posterior longitudinal ligament enjoy favorable rates of fusion and successful clinical outcomes. Although the complications from these procedures have been well described, the pathogenesis and clinical development of adjacent segment degeneration (ASD) are not fully understood. The definition of symptomatic ASD is the development of radicular or myelopathic signs and symptoms referable to a motion segment adjacent to prior cervical arthrodesis. The incidence, pathogenesis, prevalence, and potential treatment strategies for symptomatic ASD are discussed in this article.

Cervical Vertebrae↗
PubMed2005

Degenerative disorders of the lumbar and cervical spine.

Degenerative disorders in the spine are normal, age-related phenomena and largely asymptomatic in most cases. Conservative management of lumbar and cervical spondylosis is the mainstay of treatment, and most patients with symptomatic degenerative changes respond appropriately with nonsurgical management. Surgical intervention can be considered an appropriate and viable option when conservative measures have failed. Treatment options should always be directed toward the specific nature and location of the patient's individual pathology. Although current standards in the surgical management of lumbar and cervical degenerative disorders include discectomy, neural decompression, and instrumented spinal arthrodesis, new approaches that address this often-challenging clinical entity are on the horizon.

Aged↗
PubMedDate not supplied

Comparison of clinical and radiographic outcome in instrumented anterior cervical discectomy and fusion with or without direct uncovertebral joint decompression.

BACKGROUND CONTEXT: Anterior cervical discectomy and fusion (ACDF) is an established procedure for the operative treatment of cervical disc disease in patients with radiculopathy resulting from impingement from uncovertebral joint osteophytes. Studies demonstrate that direct decompression of the lesion provides good result. However, known complications include vertebral artery injury, dural tears, nerve root injury, loss of biomechanical stability and increased operative time. Other studies suggest that disc space distraction may play an important role by indirectly decompressing neural elements. Therefore, if equivalent functional outcomes can be achieved without sacrificing the uncovertebral joint, then potential morbidity and mortality could be decreased. PURPOSE: To assess and compare clinical and radiographic outcomes of patients with neck pain and cervical radiculopathy who underwent instrumented ACDF with or without direct uncovertebral joint decompression. STUDY DESIGN/SETTING: Retrospective clinical chart and radiographic review to assess clinical outcome and graft fusion in 109 patients who underwent one- or two-level ACDF with rigid anterior plate fixation. PATIENT SAMPLE: Radiographs and clinical charts for 109 patients (mean, 46 years; range, 27 to 83) who underwent ACDF with rigid anterior plate fixation were retrospectively reviewed at a single institution. Patients with radiculopathy resulting from herniated disc, spondylosis or a combination of both refractory to conservative treatment underwent surgery using a standard Smith-Robinson left-sided approach. Seventy-one patients who received direct uncovertebral joint decompression (Group 1) were compared with 38 patients without direct decompression but indirect decompression by disc space distraction (Group 2). In Group 1, 37 one-level and 34 two-level ACDFs were performed. In Group 2, 11 and 27 were one-level and two-level ACDFs, respectively. Smoking and work-related injuries involved 26.7% and 38.0% of Group 1 and 28.9% and 28.9% of Group 2, respectively. Autologous iliac crest grafts were used in 51 patients, whereas 58 patients received allograft. OUTCOME MEASURES: Independent blinded analyses of plain lateral neutral, flexion and extension radiographs were conducted to assess fusion, evaluate graft and plate and screw integrity (mean, 12 months). Clinical outcomes were reported as excellent, good, fair or poor (mean, 23 months) based on Odom's criteria. METHODS: Postoperative clinical outcome and radiographic studies of graft and instrument integrity were assessed in 71 patients undergoing ACDF with uncovertebral joint decompression and 38 patients without uncovertebral joint decompression, but with indirect decompression through disc space distraction. RESULTS: Fusion occurred in 95.8% of Group 1 and 100% of Group 2. In Group 1, 26.8% of the patients reported excellent results, 57.7% reported good results, 12.7% reported fair results and 2.8% reported poor results. In Group 2, 23.7% of the patients reported excellent results, 60.5% reported good results and 15.8% reported fair results. All nonunions reported good outcomes. Postoperative respiratory distress developed in one patient and dysphagia developed in another both from Group 1. No other complications were noted. The presence or absence of direct uncovertebral joint decompression and clinical outcome was not statistically significant (p>.05). The use of graft-type, operative level, presence of smoking and work-related injury in relation to clinical outcome was not found to be significant (p>.05). CONCLUSION: Good to excellent results were obtained in 84.5% and 84.2% of patients for Groups 1 and 2, respectively. Indirect foraminal decompression through distraction remains somewhat controversial during ACDF. However, sacrificing the uncovertebral joint can increase operative time and potentially increase complication rates. This study demonstrates that ACDF with or without direct uncovertebral joint decompression can provide good clinical results for neck pain with cervical radiculopathy. Therefore, routine direct uncovertebral joint decompression should not be undertaken during ACDF.

Cervical Vertebrae↗
PubMedDate not supplied

The Prestige cervical disc replacement.

BACKGROUND CONTEXT: Anterior cervical discectomy and arthrodesis is the preferred treatment for a large number of patients with symptomatic cervical spondylosis. This management strategy is successful for the majority of patients, and the short-term results are very good. There is the potential to further improve patient outcome and the long-term success rate. PURPOSE: The purpose of this report is to review the rationale for cervical arthroplasty and describe the development of the Prestige cervical disc replacement (Medtronic Sofamor Danek, Inc., Memphis, TN). STUDY DESIGN/SETTING: This report reviews the literature concerning the need for cervical arthroplasty and details the basic and clinical work on the Prestige cervical disc replacement. METHODS: The key publications concerning the shortcomings of cervical arthrodesis and the clinical and basic studies on the Prestige cervical disc implant are discussed. New long-term clinical data on the Prestige device are reported. RESULTS: Cervical arthrodesis perturbs normal cervical spinal biomechanics and appears to be associated with accelerated degeneration of the adjacent segments. The Prestige cervical disc replacement is successful in preserving normal spinal motion, both experimentally and clinically. The device is durable, and the clinical outcomes have been excellent. CONCLUSIONS: The Prestige cervical disc replacement is an effective means of reconstructing the cervical spine after anterior discectomy. It preserves normal motion and may decrease the incidence of adjacent segment disease.

Arthroplasty, Replacement↗
PubMedDate not supplied

Iatrogenic vertebral artery injury during anterior cervical spine surgery.

BACKGROUND CONTEXT: Iatrogenic injury to the vertebral artery during an anterior cervical decompression is a rarely mentioned but potentially catastrophic complication. PURPOSE: This study was designed to examine the incidence and management of iatrogenic vertebral artery injury (IVAI) in a large database. STUDY DESIGN/SETTING: This was a retrospective study performed at a large teaching institution over a 7-year period (1994-2001). PATIENT SAMPLE: All anterior cervical spinal procedures performed for herniated or degenerative disc disease, or cervical spondylosis were identified, as were incidences of IVAI. Anterior cervical procedures performed for trauma, neoplasia, or infection were excluded from this study. OUTCOME MEASURES: Neurological and associated morbidity as well as mortality were recorded. METHODS: Data were accessed through an institution-wide electronic medical record search through the operative reports of 10 spine surgeons. Hospital and clinical charts of IVAI cases were subsequently reviewed. Demographic data and intraoperative strategies for repair were recorded. RESULTS: A total of 1,976 patients underwent anterior cervical spinal procedures in the review period. Six cases of IVAI were identified. In three of the six patients, arterial bleeding was controlled with hemostatic agents. Of these three, two suffered complications. The initial management of controlling arterial bleeding is by hemostatic agents; however, one must also consider repair or ligation. The remaining three patients were treated with primary repair or ligation, and no complications were noted. CONCLUSIONS: IVAI is a rare complication (0.3%) of anterior cervical procedures. The arterial bleeding can usually be controlled with topical hemostatic agents, but mortality may occur in instances where it cannot be adequately addressed in a timely fashion.

Cervical Vertebrae↗
PubMedDate not supplied

Laminoplasty: a review of its role in compressive cervical myelopathy.

BACKGROUND CONTEXT: The currently accepted surgical treatments for compressive cervical myelopathy include both anterior and posterior decompression. Anterior approaches including multilevel discectomy with fusion or vertebral corpectomy with strut grafting, both with and without instrumentation, have enjoyed successful outcomes, but have been associated with select postoperative complications. Laminoplasty has been developed to decompress the spine posteriorly while avoiding the spinal destabilization seen after laminectomy. PURPOSE: The purpose of this article is to provide a review of the various techniques, biomechanical basis, predictive value of imaging modalities, clinical outcomes, and postoperative complications associated with cervical laminoplasty. STUDY DESIGN: A review of the literature. METHODS: A comprehensive literature review using Medline was performed identifying relevant articles that addressed the techniques, clinical outcomes, and complications after cervical laminoplasty, as well as preoperative radiographic predictors of outcome. RESULTS: The various modifications of cervical laminoplasty have generally been associated with excellent clinical outcomes when used for myelopathy secondary to cervical spondylosis or ossification of the posterior longitudinal ligament (OPLL). Recent long-term studies have identified issues with this technique including axial neck pain, canal restenosis, nerve root palsy, diminished cervical motion, and loss of cervical lordotic alignment. CONCLUSIONS: Cervical laminoplasty remains a reliable procedure for posterior decompression of the spine, but the optimal approach to cervical myelopathy must take into account both patient and disease characteristics, as well as the capabilities and experience of the surgeon.

Biomechanical Phenomena↗
PubMedDate not supplied

Pathophysiology of cervical myelopathy.

BACKGROUND CONTENT: Cervical myelopathy is a group of closely related disorders usually caused by spondylosis or by ossification of the posterior longitudinal ligament and is characterized by compression of the cervical spinal cord or nerve roots by varying degrees and number of levels. The decrease in diameter of the vertebral canal secondary to disc degeneration and osteophytic spurs compresses the spinal cord and nerve roots at one or several levels, producing direct damage and often secondary ischemic changes. PURPOSE: Clinicians who treat cervical myelopathy cord injuries should have a basic understanding of the pathophysiology and the processes that are initiated after the spinal cord has been injured. STUDY DESIGN/SETTING: Literature review. METHODS: Literature review of human cervical myelopathy and clinically relevant animal models to further our understanding of the pathological mechanisms involved. RESULTS: The pathophysiology of cervical myelopathy involves static factors, which result in acquired or developmental stenosis of the cervical canal and dynamic factors, which involve repetitive injury to the cervical cord. These mechanical factors in turn result in direct injury to neurons and glia as well as a secondary cascade of events including ischemia, excitotoxicity, and apoptosis; a pathobiology similar to that occurring in traumatic spinal cord injury. CONCLUSIONS: This review summarizes some of the significant pathophysiological processes involved in cervical myelopathy.

Apoptosis↗
PubMedDate not supplied

Surgical management of cervical myelopathy: indications and techniques for multilevel cervical discectomy.

BACKGROUND CONTEXT: Surgery is usually required for treatment of cervical myelopathy to decompress the neural elements, restore lordosis, and stabilize the spine. By addressing these problems, the neurological deterioration may be halted. PURPOSE: Multilevel cervical discectomy and fusion offers several advantages over other approaches. The authors describe the technique, discuss the indications, and present the potential complications associated with it. METHODS: Decompression is achieved via discectomy and subsequent removal of the osteophytes using a curetting technique. Preparation of end plates in a parallel fashion allows for gapless grafting of allograft bone for enhancement of fusion. A dynamic plate and screw system strengthens the construct. RESULTS: A high rate of fusion can be obtained using the technique of multilevel cervical discectomy and fusion with acceptable levels of complications. It is especially useful in cases of spondylosis that have a kyphotic deformity because, in addition to anterior decompression, it allows reconstruction of the spine to help restore a lordotic curvature. CONCLUSIONS: Multilevel cervical discectomy and fusion has proven to be very effective in decompressing and stabilizing the spine for treatment of cervical myelopathy.

Bone Plates↗
PubMed2004

Clinical outcomes following cervical laminoplasty for 204 patients with cervical spondylotic myelopathy.

BACKGROUND: Laminoplasty is a well-recognized technique for decompressing the cervical spine in cases of spondylotic myelopathy and ossification of the posterior longitudinal ligament. This technique, originally popularized in Asia, is becoming more widespread, but to date there have been few reports of clinical series from North American centers. METHODS: Retrospectively we reviewed (1986-2001) 204 cases of open door laminoplasty. All patients presented with symptoms and magnetic resonance imaging (MRI) findings consistent with myelopathy secondary to multisegmental cervical stenosis with spondylosis and underwent decompression from C3 to C7. Improvement in myelopathy was assessed with the Nurick Score. RESULTS: Average age was 63 years (range 36 to 92). Follow-up averaged 16 months. Postoperatively, Nurick scores improved by 1 point in 78 patients, 2 points in 37 patients, 3 points in 7 patients, and 4 points in 5 patients; 74 patients experienced no improvement, and 3 patients deteriorated by one point. There was no statistical difference in myelopathy outcomes when comparing patients older and younger than 75 years of age. In two patients there was radiographic progression of kyphosis, but in no case was subsequent fusion required. Six patients without neck pain preoperatively developed new intractable neck pain after surgery. CONCLUSIONS: Open door expansile laminoplasty is a safe and effective method for treating cervical spondolytic myelopathy. Laminoplasty is thus an alternative to anterior surgery that can be accomplished quickly with minimal blood loss, minimizing risks in elderly patients.

Adult↗
PubMed2005

Acute traumatic central cord syndrome--experience using surgical decompression with open-door expansile cervical laminoplasty.

BACKGROUND: Open-door expansile cervical laminoplasty (ODECL) is an effective surgical technique in the treatment of multilevel cervical spondylotic myelopathy. In the present study, we reviewed the safety and short-term neurological outcome after expansile cervical laminoplasty in the treatment of acute central cord syndrome. METHODS: We retrospectively reviewed our database over a 3-year period (January 1997-January 2001) and identified 69 surgically treated cervical spinal cord injuries, including 29 cases of acute traumatic central cord syndrome (ATCCS). Fifteen of these patients underwent expansile cervical laminoplasty, whereas 14 did not because of radiographic evidence of sagittal instability. We collected data on the preoperative and the immediate postoperative and 3-month neurological examinations. Neurological function was assessed using the Asia Spinal Injury Association (ASIA) grading system. We also reviewed the occurrence of complications and short-term radiological stability after the index procedure. RESULTS: The median age was 56 years. All patients had hyperextension injuries with underlying cervical spondylosis and stenosis in the absence of overt fracture or instability. The average delay from injury to surgery was 3 days. The preoperative ASIA grade scale was grade C, 8 patients, and grade D, 7 patients. There were no cases of immediate postoperative deterioration or at 3 months follow-up. Neurological outcome: 71.4% (10/14) of patients improved 1 ASIA grade when examined 3 months post injury. CONCLUSIONS: Surgical intervention consisting of ODECL can be safely applied in the subset of patients with ATCCS without instability who have significant cervical spondylosis/stenosis. Open-door expansile cervical laminoplasty is a safe, low-morbidity, decompressive procedure, and in our patients did not produce neurological deterioration.

Acute Disease↗
PubMed2003

Complications of fluoroscopically guided interlaminar cervical epidural injections.

OBJECTIVES: To assess the incidence of complications of fluoroscopically guided interlaminar cervical epidural injections. DESIGN: A retrospective cohort design study. SETTING: A multidisciplinary spine care center. PARTICIPANTS: One hundred fifty-seven consecutive patients with cervical radicular pain caused by cervical spondylosis or herniated nucleus pulposus confirmed by magnetic resonance imaging or computed tomography scanning. INTERVENTIONS: Fluoroscopically guided interlaminar cervical epidural injections were performed at the C7-T1 or C6-7 level using an 18-gauge, 9-mm Tuohy needle with 2mL of 1% lidocaine (Xylocaine) and 80-mg of triamcinolone acetonide (Kenalog). All injections were performed consecutively over a 12-month period by 1 of 5 physicians. MAIN OUTCOME MEASURES: An independent observer reviewed medical charts, which included a 24-hour postprocedure telephone call by an ambulatory surgery center nurse who asked a standardized questionnaire about complications after the injections. Also reviewed were physician notes regarding office follow-up consultations 3 weeks or less after the injections and epidurograms. RESULTS: The charts of 157 patients, who received 345 injections, were reviewed. Complications per injection included 23 increased neck pain (6.7%), 16 transient nonpositional headaches that resolved within 24 hours (4.6%), 6 episodes of insomnia the night of the injection (1.7%), 6 vasovagal reactions (1.7%), 5 facial flushing (1.5%), 1 fever the night of the procedure (0.3%), and 1 dural puncture (0.3%). The incidence of all complications per injection was 16.8%. CONCLUSIONS: Because all complications resolved without morbidity and no patient required hospitalization, fluoroscopically guided interlaminar cervical epidural injections may be a safe procedure for use in patients with cervical radicular pain.

Adult↗
PubMed1995

Injury pattern effect on motor recovery after traumatic spinal cord injury.

OBJECTIVE: To determine whether type of fracture or gunshot injury correlated with extent of motor impairment at 1 month and/or with the amount of motor recovery between 1 month and 1 year. DESIGN: Prospective neurological examinations were performed longitudinally after the recommendations of the American Spinal Injury Association (ASIA). Fractures were classified by the Allen system (cervical spine) or the Denis system (thoracic and lumbar spine). Gunshot injuries were classified based on trajectory and bullet location. SETTING: Subjects were examined at a community medical center. PATIENTS: There were 278 patients with traumatic spinal cord injury who were admitted between 1985 and 1990. MAIN OUTCOME MEASURES: The ASIA motor score was the primary outcome measure. RESULTS: There were no significant differences in motor recovery based on type of injury (penetrating vs nonpenetrating), type of fracture, or bullet location. CONCLUSIONS: Injuries severely disruptive of the spinal canal were more likely to result in complete SCI. Flexion-rotation injuries in the thoracic and lumbar spine, bilateral facet dislocations in the cervical spine, and gunshot wounds in which the bullet passed through the canal were more likely to be complete. Incomplete injuries were more common among patients with preexisting cervical spondylosis who had fallen and patients with gunshot wounds in which the bullet did not penetrate the spinal canal. The primary determinant of motor recovery was completeness of injury at 1 month.

Adult↗
PubMed1995

"Great mimicry" in a patient with tetraparesis: a case report.

The patient is a 63-year-old Chinese man who presented with tetraparesis and urinary incontinence. The initial diagnosis was cord compression from cervical spondylosis. The patient relapsed 3 months after cervical laminectomy. The transverse myelitis picture, left optic atrophy and suggestive brainstem evoked potentials led to treatment of a presumptive demyelinating process. The presence of vitiligo, however, led to detection of high titers of antinuclear antibodies (ANA) and presence of anti-nonhistone antibodies. The patient was then diagnosed to have a lupus (SLE)-like disease, which has not fully evolved. He was prescribed pulsed cyclophosphamide and prednisolone with significant gains both neurologically and functionally up to 1 year of follow-up. This report highlights the befuddling impact the disease process have on the clinicians in terms of diagnosis, treatment, and prognosis. That it can occur in men in the seventh decade of life heightens the need for awareness in our approach to the myelopathic patient.

Cervical Vertebrae↗
PubMedDate not supplied

MRI of cerebrum and cervical columna within two days after whiplash neck sprain injury.

The present study was undertaken to evaluate if MRI within 2 days of a motor vehicle accident could reveal pathology of importance for understanding long-term disability after whiplash neck-sprain injuries. As part of a prospective study cervical and cerebral MRI was performed on 40 neck sprain patients with whiplash injury after car accidents. The imaging was done within 2 days of the injury to make sure that any neck muscle bleeding, oedema or other soft tissue injuries could be detected. The MRI findings from the patients were both correlated to reported symptoms 6 months after the accident and compared to a control group of 20 volunteers. The MRI of both brain and neck revealed no significant differences between the patients and the control group. When the patients were grouped according to the main MRI findings at intake and compared according to the development of subjective symptoms reported by the patients, the only significant difference was more headaches at 6 months in the groups with disk pathology or spondylosis when compared to the group with no pathology. In conclusion, MRI within 2 days of the whiplash neck-sprain injury could not detect pathology connected to the injury nor predict symptom development and outcome.

Accidents, Traffic↗
PubMed1990

Disseminated skeletal lesions associated with pathogenic actinomycetes in a Pygmy hog (Sus salvanius).

The clinical and pathological features of an unusual crippling bone disease in an adult male Pygmy Hog, Sus salvanius, born the smallest in a litter of five and representing the rarest of the known living Suidae, are described. Radiological studies revealed severe spondylosis deformans and focal sharply demarcated radiolucencies in virtually the whole skeleton, but particularly in the bones of the skull, the processes of multiple vertebrae, the ribs, scapulae and parts of the humeri and femora. The clinical chemistry measurements were indicative of pathological lytic processes in the skeleton. The focal bone lesions consisted of caseous necrosis, dystrophic calcification and peripheral fibroblastic demarcation. They contained colonies of filamentous bacteria identified as members of the Order Actinomycetales. Case history evidence suggests that the infection may have resulted from repeated skin trauma inflicted by litter-mates.

Actinomycetales Infections↗