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PubMed1999

Volume (three-dimensional) fast spin-echo imaging of the lumbar spine.

RATIONALE AND OBJECTIVES: The purpose of this study was to prospectively evaluate a proton-density-weighted, three-dimensional (3D) volume fast spin-echo (SE) pulse sequence in the assessment of the lumbar spine for suspected spondylosis. MATERIALS AND METHODS: Twenty-eight patients referred for low back or lower extremity pain were imaged with both a two-dimensional (2D) protocol and a proton-density-weighted 3D volume fast SE imaging. The spinal canal, conus medullaris, intervertebral disks, neural foramina, bone marrow, and spinal alignment shown with the 3D volume fast SE pulse sequence were independently assessed by two neuroradiologists. These findings were compared with those of the routine 2D studies. RESULTS: Interpretation of disk protrusions and stenoses of the neural foramina were concordant between both protocols. No instance of cord abnormality was detected with either protocol. CONCLUSION: A 3D volume fast SE proton-density-weighted pulse sequence may provide information comparable to that of routine 2D imaging. Advantages of volume imaging include thinner sections, the capability of reconstruction into any plane, and the potential to decrease imaging time.

Adult↗
PubMedDate not supplied

Measurements of lumbopelvic lordosis using the pelvic radius technique as it correlates with sagittal spinal balance and sacral translation.

BACKGROUND CONTEXT: Maintenance of normal lumbar lordosis is important in the treatment of spinal disorders. Many attempts have been made to quantify normal sagittal spinal alignment and lordosis using a C7 plumb line and segmental angulations of the spinal vertebrae. Little attention has been given to pelvic compensation as it correlates to lumbar lordosis and overall sagittal spinal alignment. Better methods of measuring lordosis, which correlate with sagittal spinal balance and pelvic compensation, are needed in treating patients with spinal disorders. PURPOSE: To determine the correlation between lumbopelvic lordosis, pelvic rotation and sagittal spinal balance and standardize a method for measuring lumbopelvic lordosis, sacral translation, and sagittal spinal alignment. STUDY DESIGN: Sagittal alignments using the C7 plumb line, Cobb angles, sacral plumb line and the pelvic radius (PR) technique were used to measure standing 36-inch lateral radiographs of patients with various spinal disorders. PATIENT SAMPLE: A review of the records identified 62 patients with various spinal pathologies presenting to the (RGW) spine clinic that had standing lateral spine radiographs. Only radiographs that allowed positive identification of the C7 vertebral body, the entire thoracolumbar spine, the sacrum and both femoral heads were studied. These criteria allowed inclusion of 28 subjects in this study. The final population had 12 women and 16 men with an average age of 52 years (SD, 16.6 years; range, 20 to 84 years). OUTCOME MEASURES: No outcomes measures were used in this study. METHODS: Measurements for sagittal spinal balance and lumbopelvic lordosis were made on 36-inch standing lateral radiographs of adult patients. Measurements included the C7 plumb line, segmental angulations of spinal vertebrae (Cobb angles), sacral translation and the PR technique for lumbopelvic lordosis. Data were analyzed for significant correlation between lumbopelvic lordosis, sagittal spinal balance, sacral translation and total segmental lumbar lordosis using the Cobb method. RESULTS: Our population averaged 50 degrees of total segmental lumbar lordosis from L1 to S1 (SD, 14.3; maximum, 89.5; minimum, 17.9). Nearly 75% of total segmental lumbar lordosis measured from L1 to S1 can be accounted for through the L4 to S1 superior end plates and 47% through L5 to S1 superior end plates in our population. Total segmental lumbar lordosis correlated with total thoracic kyphosis (r=0.45, p=.008). Total segmental lumbar lordosis measured by the Cobb method significantly correlated with sagittal spinal balance (r=-0.35, p=.022) and sacral translation (r=0.41, p=.016). Measurements for lumbopelvic lordosis significantly correlated with sagittal spinal balance (r=-0.33, p=.042), sacral translation (r=-0.70, p=.00002) and total segmental lumbar lordosis (r=0.82, p<.000001). Measurements for sacral translation and sagittal spinal balance also correlated significantly (r=0.35, p=.034). CONCLUSIONS: Sacral translation, the C7 plumb line and lumbopelvic lordosis are useful measures for sagittal spinal balance. Lumbopelvic lordosis and sacral translation can be correlated to the sagittal spinal balance. Understanding these measurements and the range of lumbopelvic compensation can be extremely helpful in treating patients with spinal pathology and in avoidance of flatback deformity. Application of these measures would be especially helpful in the treatment of patients with spinal fusion, degenerative spondylosis, disc disease, fractures, and in the prevention of sagittal malalignment.

Adult↗
PubMedDate not supplied

Cervical myelopathy. current diagnostic and treatment strategies.

Cervical myelopathy is a varied clinical syndromes resulting from spinal cord dysfunction. Underlying causes are numerous, but spondylosis at one or more levels is the most common etiology. Natural history studies have demonstrated a variable clinical course with gradual neurologic deterioration in a majority of patients. While prospective clinical comparisons are limited, existing literature suggests that operative management reliably arrests the progression of myelopathy and may lead to functional improvement in a majority of patients. The selection of surgical procedures must be carefully individualized based on specific clinical and radiographic factors. Whereas anterior decompression and fusion procedures at one or two motion segments have predictable results, procedures involving three or more levels are associated with increased morbidity. Newer techniques for the treatment of multilevel cervical myelopathy include anterior decompression with 360-degree fusion, hybrid corpectomy/anterior cervical discectomy and fusion techniques and the use of dynamic anterior cervical plates. An alternative technique for patients with a lordotic sagittal alignment is laminoplasty, which has a proven track record of long-term good to excellent results.

Cervical Vertebrae↗
PubMed2003

Preliminary experience with anterior interbody titanium cage fusion for treatment of cervical disc disease.

This study evaluated the efficacy and safety of titanium cage implants in cervical reconstruction to treat cervical spondylosis. Surgical data covered a 4-year period from January 1999 to December 2002 and included 34 consecutive patients, 20 men and 14 women, with ages ranging from 27 to 84 years (mean, 57 years). Patients underwent anterior cervical microdiscectomy followed by interbody fusion with a titanium cage implant (rather than an autogenous iliac crest bone graft) at a single level ranging from C3 to C7. Twenty-one patients had a herniated intervertebral disc, nine had degenerative disc disease, and four had previous failed autograft fusion surgery that required revision. At clinical presentation, 26 patients had neck pain, 23 had radiculopathy, and nine had myelopathy. Diagnostic imaging studies included spinal dynamic roentgenography, computerized tomography, and magnetic resonance imaging. Lesions were located at C3-4 in seven cases, C4-5 in 14 cases, C5-6 in nine cases, and C6-7 in four cases. The follow-up period ranged from 7 to 48 months (mean, 26 months). Results revealed that the procedure was technically feasible. There were no intra- or postoperative complications. The most commonly used cage was 9 mm high. Imaging studies showed no cage instability, migration, or pseudarthrosis. Although mild subsidence (< 5 mm) was observed in three cases, these patients preserved adequate postoperative cervical lordosis and the subsidence did not preclude a good clinical result. The advantages of this procedure over a similar operation using traditional tricorticate bone graft are: no graft morbidity; shorter operation time (mean time saved, 35 minutes); reduced blood loss (average blood loss, 75 mL); and early postoperative ambulation (mean, 4.7 hospital days). Nearly all patients rapidly lost their neck pain (92%, 24/26) and radicular symptoms (87%, 20/23) after surgery. The recovery rate from myelopathy was 44% (4/9). Progressive bony shield formation over the anterior/posterior cortex (sentinel sign) indicated fusion in five cases.

Adult↗
PubMed1988

Personality in torticollis: a controlled study.

The Eysenck Personality Questionnaire, the trait scales of the Leyton Obsessional Inventory, the Spielberger State Trait Anxiety Inventory, and a questionnaire assessing marital status and harmony were completed by 100 torticollis patients and a control group of 49 cervical spondylosis sufferers. Information regarding employment status, and events preceding onset of their complaint was also obtained. The two groups did not differ in terms of any of the personality dimensions evaluated, or in their self-reports of events prior to onset of their illness. The groups differed significantly with regards to marital status (a higher proportion of the torticollis patients were single) but not marital harmony. A significantly higher proportion of the torticollis patients were in the permanently sick category of employment status. Findings of previous studies evaluating personality in torticollis and in sufferers of other disabling physical conditions are considered, and the results are discussed in terms of the effects of disabling chronic physical disorders.

Cervical Vertebrae↗
PubMed1988

Depression in torticollis: a controlled study.

Eighty-five patients with idiopathic, persistent spasmodic torticollis were compared to a control group of 49 patients with cervical spondylosis to assess (1) the prevalence of psychiatric disorder prior to and following the onset of their physical complaint, and (2) to establish the effect of torticollis on self-reports of depression on the Beck Depression Inventory, and self-rated hopelessness on the Hopelessness Scale. The prevalence of psychiatric disorder in the two groups did not differ. The torticollis patients had significantly higher mean scores on the Beck Depression Inventory, but did not differ from the control group in terms of hopelessness. Self-referent negative cognitions such as self-blame, self-accusation, self-punitive thoughts, and negative body-image emerged as the prominent component of depression in torticollis, which has implications for the management of depression in torticollis.

Adolescent↗
PubMed2004

Controversies in cervical discectomy and fusion: practice patterns among Canadian surgeons.

OBJECTIVE: Optimal fusion technique and peri-operative management of patients undergoing anterior cervical discectomy (ACD) is unclear. We document current practice patterns among Canadian spinal surgeons regarding the surgical management of single level degenerative cervical spondylosis. METHODS: We conducted a web-based survey of neurosurgeons and spinal orthopedic surgeons in Canada. We asked questions pertaining to the management of single level cervical degenerative disc disease causing radiculopathy and/or myelopathy, including frequency of fusion following single-level discectomy, preferred fusion technique, indications and frequency of use of anterior plating, and use of an external cervical orthosis following surgery. Demographic factors assessed included training background, type and length of practice. RESULTS: Sixty respondents indicated that their practice involved at least 5% spine surgery and were included in further analysis. Neurosurgeons comprised 59% of respondents, and orthopedic surgeons 41%. Fusion was employed 93% of the time following ACD; autologous bone was the preferred fusion material, used in 76% of cases. Neurosurgeons employed anterior cervical plates in 42% of anterior cervical discectomy and fusion cases, whereas orthopedic surgeons used them 70% of the time. External cervical orthoses were recommended for 92% of patients without plates and 61% of patients with plates. Surgeons who had been in practice for less than five years were most likely to be performing spinal surgery, using anterior cervical plates, and recommending the postoperative use of cervical orthoses. CONCLUSION: Practice patterns vary among Canadian surgeons, although nearly all employ fusion and many use instrumentation for single-level ACD. Training background, and type and length of practice influence practice habits.

Adult↗
PubMed1987

Hand wasting due to mid-cervical spinal cord compression.

Three patients presented with hand wasting and weakness secondary to mid-cervical spinal cord compression. This was due to cervical spondylosis in two patients and a meningioma in one case. This phenomenon is probably similar to that seen with foramen magnum lesions and may be due to spinal cord ischemia distal to the compression, secondary to venous stasis.

Adult↗
PubMed2003

Evidence favoring the involvement of CC chemokine receptor (CCR) 5 in T-lymphocyte accumulation in optic neuritis.

OBJECTIVE: To define the relationships between levels of chemokine receptor (CCR)5+ T-cells in blood and cerebrospinal fluid (CSF) of optic neuritis (ON) and control patients (CON). MATERIALS AND METHODS: Expression of CCR5 and related receptors CCR1 and CCR3 on CD4- and CD8-positive T-cells in peripheral blood mononuclear cells (PBMC) and CSF was determined by flow cytometry in 20 patients with ON, 16 control patients with lumbar spondylosis, 20 healthy controls (HC) and 16 patients with rheumatoid arthritis (RA). RESULTS: CCR5+CD4+ and CD8+ T-cells were enriched in CSF, compared with PBMC, in both ON and CON patients (all P < 0.001), and the percentages of CD4+/CCR5+ (r = 0.917) and CD8+/CCR5+ (r = 0.828) cells in PBMC and CSF were strongly and directly correlated. CCR5+ T-cells produce high amounts of tumor necrosis factor-alpha (TNF-alpha) and very low amounts of interleukin-5 (IL-5). Closely related receptors (CCR1, CCR3) were not altered. CONCLUSIONS: Our data suggest an involvement of CCR5 in T-cell accumulation in the inflamed central nervous system.

Adult↗
PubMed1977

Cervical spine stenosis.

Increased knowledge of the anatomy, physiology and biomechanics of the cervical spine and the enclosed neural and vascular elements is leading to a better understanding of the importance of cervical spine stenosis, as certain clinical syndromes may ensue and may respond well to operative decompression. The present study was designed to investigate the incidence of cervical spine stenosis in patients who have required surgical treatment for cervical spondylosis, and to evaluate the clinical results.

Adult↗
PubMed1977

Cervical ankylosis with acute spinal cord injury.

Twenty-three cases of acute spinal cord injury in persons with cervical ankylosis are presented. Certain characteristics of major sub-groups are described: ankylosing spondylitis (N = 8), degenerative spondylosis (N = 9) and congenital fusion (congenital non-segmentation) (N = 6). The ankylosing spondylitic group presented a grim prognosis for survival (death rate 50 per cent within 60 days) and for loss of neurological function. Five out of eight cases had permanent neurological loss subsequent to their injuries. Both the ankylosing spondylitic and degenerative spondylotic groups presented problems in diagnosis and medical management. The basic principle is immobilisation of the fracture and mobilisation of the patient. The halo is the technique of choice for fracture immobilisation. An integrated intensive respiratory management programme is essential. Patients with ankylosed spines, particularly those with ankylosing spondylitis, should be educated in simple measures to prevent fracture of their spines.

Adult↗
PubMed1987

The long-term results of localised anterior cervical decompression and fusion in spondylotic myelopathy.

A retrospective analysis is presented of 46 patients with cervical spondylotic myelopathy treated by anterior cervical decompression and fusion. In each case the spondylosis was localised and a maximum of two intervertebral levels was fused. Operation had been carried out 7.0 to 14.4 years (mean 10.0 years) previously and the mean age at surgery was 60 years. Disability was such that no patient was able to work prior to operation and only 10 patients (22%) could walk unaided. The functional results, in terms of walking ability, show that 36 patients (78%) have been improved, six (13%) remain unchanged and in 4 patients (9%) the disease has progressed. Twenty nine patients (63%) were able to walk without aid at the time of review. On a subjective basis 30 patients (65%) felt that they had benefitted from surgery.

Adult↗
PubMed1995

Early cystic thoracic cord cavity complicating decompressive surgery for spondylotic spinal canal stenosis. Case report.

This is a report of a patient who developed thoracic cystic myelopathy immediately following an otherwise successful decompression operation for spondylotic stenosis secondary to osteophyte formation of the thoracic spinal canal. As this case shows, thoracic laminectomy is not without risks, and cystic myelopathy is a potential complication that should be borne in mind when surgery for spondylosis is being planned. Cavitation of the spinal cord may be associated with trauma secondary to extramedullary cord compression.

Humans↗
PubMed1996

Degenerative disease of the thoracic spine in central India.

Thoracic spondylosis, better termed 'degenerative thoracic spine disease', is rare and failure to recognize it is mainly due to its rarity and to the complexity of symptomatology which can lead to prolonged and continued morbidity. During the past 4 years, the authors have treated 28 patients with thoracic spine degeneration with varied clinical manifestations, ranging from local pain, radiculopathy to radiculomyelopathy. In six patients, myelopathy developed gradually, four showing features of pseudoclaudication. Two had an acute onset of myelopathy after minor trauma. Radiological examination, including CT scans in a few patients, demonstrated facetal hypertrophy, ossification of the ligamentum flavum and ossification of the posterior longitudinal ligament. One patient had posterior osteophytosis of thoracic spine at multiple level. Surgical decompression for localised stenosis yields good results, but the prognosis for those with diffuse or segmental stenosis is guarded.

Abdominal Pain↗
PubMed1997

A rare neurological presentation due to ossification of the posterior longitudinal ligament of the thoracic spine and ankylosing spondylitis: case report.

Ossification of the posterior longitudinal ligament (OPLL) may be associated with certain rheumatic conditions including ankylosing spondylitis (AS), diffuse idiopathic skeletal hyperostosis (DISH) or spondylosis. More than 95% of all OPLL are localized at the cervical spine. Herein, we report a case of OPLL at the thoracic spine in an HLA-B27-positive female patient with ankylosing spondylitis. The patient was presented to use with spastic paraparesis. The imaging studies included plain roentgenograms, tomograms, myelo-CT and magnetic resonance imaging (MRI). A continuous rod-like ossification along the posterior aspects of the fourth to sixth thoracic vertebrae with spinal cord compression was noted. The patient underwent a laminectomy from T4 to T6. At the second year follow-up examination, residual upper back soreness and mild left thigh pain were noted. However, the patient had resumed a full daily schedule and could walk freely without any support.

Female↗
PubMed1998

Alkaptonuria presenting as lumbar disc prolapse: case report and review of literature.

Alkaptonuria is a rare genetic disorder caused by deficiency of the enzyme homogentisic acid oxidase, resulting in accumulation of homogentisic acid in various body tissue; it produces a multisystemic disorder with a characteristic bluish-black discolouration of the skin and cartilage, termed ochranosis. Ochranosis primarily involves the large joints of the body including the spine. Spinal involvement produces loss of flexibility and ankylosis of the thoracic and lumbar segments. The clinical presentation with spondylosis and canal stenosis is common after the third and fourth decades, but intervertebral disc prolapse is unusual in ochranosis.

Adult↗
PubMed1998

Central cord syndrome: functional outcome after rehabilitation.

Seventy-three spinal cord injured patients with central cord syndrome who had undergone inpatient rehabilitation, were studied retrospectively with regard to their demographic, neurologic and functional characteristics. There were 67 males and six females with a mean age of 53.5 years. Falls was the commonest mechanism of injury (54.8%) followed by motor vehicle accidents. Eleven patients sustained cervical fractures and 41 had radiological evidence of cervical spondylosis. Seventeen patients had sensory impairment and significant spasticity was present in 14 patients. Significant improvements in the admission/discharge ASIA motor scores and Modified Barthel Index (MBI) scores (P < 0.001) were noted after rehabilitation. Ninety-two percent of patients were continent of bladder on discharge compared to 64.4% on admission. Multiple regression analysis revealed three factors associated with a better functional outcome, namely, higher admission MBI scores, absence of spasticity and younger age (P < 0.05).

Adult↗
PubMed2001

Impact of age on the injury pattern and survival of people with cervical cord injuries.

STUDY DESIGN: A retrospective, follow-up study. OBJECTIVES: To differentiate the injury pattern and survival of people with cervical cord injuries with onset at different ages. SETTING: Rehabilitation wards of a university hospital that is a tertiary referral center in Taipei, Taiwan. METHODS: The records of acute and traumatic cervical cord injury patients hospitalized from 1989 to 1997 were reviewed. All subjects received comprehensive rehabilitation programs during hospitalization. Their survival status at the end of follow-up was studied. RESULTS: Forty-seven of 109 (43.1%) people with cervical cord injuries were 50 years or older at onset. Older patients were more frequently injured by minor falls, resulting in more incomplete quadriplegia. They also showed fewer spinal fractures, and more demonstrated associated spondylosis and ossification of the posterior longitudinal ligament. Eleven (10.2%) subjects were deceased, found by a linkage to a death registration database at the end of follow-up. The significant predictor of survival status at follow-up was older age at injury using Cox proportional hazards model. CONCLUSION: Spinal cord injured patients had different injury patterns, demanding different preventative strategies. Those injured at older ages were at higher risk of mortality according to our study. SPONSORSHIP: This study was supported in part by grants from the National Taiwan University Hospital (89S2005), Taipei, Taiwan.

Adolescent↗