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PubMed1991

[A 3-dimensional reconstructive procedure in lumbar computed tomography].

In this study, 50 patients were examined by a Siemens' "Somatom Plus"; continuous 2 mm sections between the third lumbar and first sacral vertebra were obtained. The accuracy of the 3-D reconstruction software programme was checked by measuring a polyethylene phantom of a second lumbar vertebra. Reconstruction was carried out with a threshold definition of 150 Hu. In each case, four standard projections and medio-sagittal, medio-lateral and coronary sections were reconstructed, photographed and compared with axial CT sections and conventional radiographs. All these imaging procedures were suitable for the diagnosis of osteochondrosis and chondrosis. Spondylosis was diagnosed more frequently on 3-D CT. Spondylarthrosis, with narrowing of the intervertebral foramina and root canals is shown particularly well by 3-D CT, since the entire extent of these structures can be seen. 3-D surface reconstruction of the lumbar spine is useful in the diagnosis of lumbar spondylarthrosis with narrowing of the root canals and of the spinal canal. This method of axial Ct is superior to conventional radiography of the lumbar spine in the usual two planes.

Adult↗
PubMedDate not supplied

[Bone density measurements of the proximal femur in relation to torsion of the femoral neck].

The DEXA-method allows for bone mineral density measurements of different regions of the skeletal system. It is known that results obtained from the spine with this two-dimensional method may be biased in cases of spondylosis, spondylarthritis, and compression fractures; similarly biased results can be expected at the proximal femur due to morphometric peculiarities. The influence of anteversion and rotation of the femoral neck has been investigated in the present study. The results indicate that errors due to rotation as occurring in incorrect positioning or in arthrogenic variabilities mainly have effects on measurements of Ward's triangle: The average measurement error at 20 degrees external rotation amounts to 33.8% with a maximum of 66.5%. Measurements of the trochanteric region and of femoral neck region show a variation of 6.2% and 9.7%, respectively.

Absorptiometry, Photon↗
PubMed1989

Instability and falling in elderly patients.

Falls and instability in elderly patients may result from a single disease process or from the accumulated effect of multiple diseases and impairments. Therefore the first step in evaluating an elderly patient with a history of falling or instability is to identify single, potentially treatable diseases, such as normal pressure hydrocephalus, cervical spondylosis, or lumbar stenosis. The next step, regardless of whether or not a single disease process is identified, is to determine all factors possibly contributing to instability. This step involves a careful history and examination using the checklist approach already described. Careful recreation of the fall situation including location, activity engaged in, how the patient was feeling, and any environmental hazards present is an important part of the fall history. Re-creating the fall situation may provide important clues toward etiology as well as prevention. Interventions aimed at ameliorating identified impairments should be considered. Obviously, interventions need to be considered within the context of overall patient health and well-being rather than merely fall prevention. Fall preventive interventions may be medical, surgical, rehabilitative, or educational, or may involve environmental manipulations. Examples include surgery and good lighting for subjects with cataracts, adaptive footwear or surgery for patients with severe foot deformities, or physical therapy, appropriate walking aids, and raised seats for subjects with difficulty or unsteadiness in getting up. Instability and falling are not inevitable accompaniments of aging, but are problems that result from identifiable disabilities and impairments.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidental Falls↗
PubMed1994

Oblique transcorporeal drilling to treat anterior compression of the spinal cord at the cervical level.

Oblique transcorporeal drilling is a new surgical technique in which the transverse foramina with the vertebral artery and lateral aspects of the bodies of the cervical vertebrae are exposed; it allows to drill out obliquely from the antero-lateral to the opposite postero-lateral corner, half of one or several cervical vertebral bodies. The technique is shortly described and its indications are discussed. It can mainly be applied to release osteophytic compression and to remove anteriorly developed tumors. The advantages are to work in a wide field with all important structures kept medially and protected and to keep a sufficient portion of the vertebral bodies to preserve the spine stability. This technique has been used in 39 cases with spondylosis in 27 cases, tumor in 11 cases and kyphosis in 2 cases including one with neurofibroma. Results in term of decompression were excellent in all cases. Mortality was none and morbidity was limited to a transient Horner's syndrome in almost all cases and to a CSF leak in three cases. This technique is therefore alternative to the anterior transcorporeal approach. In our experience, the oblique transcorporeal drilling provides a wider and safer access to lesions located anterior to the spinal cord.

Adult↗
PubMed1990

[Segmental instability and lumbar spinal canal stenosis. Theoretical, clinical and surgical aspects].

Clinical, radiological, surgical and experimental observations make it possible to construct a rational theory of the segmental lumbar instability which explains the pathogenesis of spondylosis, of stenosis and of several cases of disc displacement as well. This theory helps us to choose the right surgical procedure. Spinal stenosis, degenerative spondylolisthesis and some cases of disc displacement are seen as part of a degenerative process with its starting point in regressive changes of the intervertebral disc and lateral joint. This leads to a marked instability of the affected mobile segment. Signs and symptoms of unstable lumbar spine are discussed. In such cases, if decompression of the roots by laminectomy, facetectomy or discectomy is performed without fusion, the consequences are usually treated but not the main cause of the trouble, namely the instability. Finally, we describe a procedure which we prefer as the safest and best of all, using selected decompression by means of joint screws (spondylodesis) as suggested by F. Magerl (41-44).

Humans↗
PubMed1993

[Ischemic lesions in the vertebral artery blood flow area as a rare complication of lumbar disk surgery].

We report on the case of a 61-year old man who developed a reversible Brown-Sequard syndrome immediately after an uncomplicated lumbar discectomy. Magnetic resonance imaging showed ischaemic lesions in the upper cervical medulla, the caudal part of the medulla oblongata, and in the cerebellum. Vertebral artery compression due to spondylosis and hyperflexion of the cervical spine during operation is discussed as a possible pathogenetic mechanism.

Brain Ischemia↗
PubMed1989

Periarthropathia humeroscapularis and cervical disc herniation.

Periarthropathia humeroscapularis (PHS) is a malfunction of the shoulder girdle due primarily to diseases of the periarticular tissue and the joint capsule. Clinically a primary and a secondary syndrome are defined. Spondylogenous cervical spine conditions play an important role as causative factors in secondary PHS, among them cervical disc herniation. Among 141 patients operated on for cervical disc herniation 14 presented with a PHS-syndrome prior to surgery, and 31 patients developed the syndrome postoperatively. The patients belong to a fairly young population and showed no high incidence of a particularly severe cervical spondylosis.

Adult↗
PubMed1989

[Ventral operations in cervical disk hernia. Neurosurgical experiences in 400 surgical patients].

The indications for simple ventral discectomy as well as for the classical Cloward's operation, together with the surgical techniques employed and the results obtained, are compared in a group of 400 patients treated operatively for cervical disc hernia. The ventral approach is sparing for both the spinal cord and the nerve roots and gives satisfactory results from the point of view of stability. In more than one-half of the patients, luxated fragments of the nucleus pulposus were found epidurally, so that fairly frequent exploration of the epidural space was necessary. Simple microsurgical discectomy (performed in a total of 158 cases) is now more often used than the classical Cloward's operation (242 cases). In 1987 we carried out simple discectomy in 75% of cases. Cloward's operation with extirpation and bone grafting is, however, advantageous in patients with severe spondylosis as well as in cases of traumatic or degenerative instability.

Adult↗
PubMed1994

Work-related persistent neck impairment: a study on former steelworks grinders.

The possibility of a work-acquired acceleration of the physiologic degenerative process affecting the cervical spine was studied in 15 Swedish former steelworks grinders. They were compared clinically with 15 age- and sex-matched white collar workers and radiographically compared with another reference group of matched individuals with light work. The now obsolete grinding machine placed extremely heavy load on the neck and shoulders, to the extent that all grinders had to retire after varying numbers of years and take a disability pension, or take up light work because of persistent pain and stiffness in the neck-shoulders; in this series after on average 8 (2-16) years. At follow-up 18 (11-29) years later, their mean age was 56 (48-62) years. All had persistent neck pain and stiffness and widespread paresthesia. Goniometric recordings showed impairment of active neck motion range as well as motion speed in all three planes and an altered motion pattern. Vibration sense was decreased in all extremities. Radiographically, foraminal encroachment was significantly increased both from spondylosis and spondylarthrosis, while disc height, lordosis, and alignment did not differ from that in the reference group of individuals with light work.

Humans↗
PubMed2000

Intermittent vertebral artery compression caused by C1-root schwannoma: case report.

Extradural schwannomas of the C1-root are extremely rare. As the tumor grows in size, it may compress surrounding neurovascular structures and cause symptoms. In the present case report, the left vertebral artery (VA) was severely compressed by the tumor, eliciting severe vertigo on turning the head to the right side and with neck extension. We report a 52-year-old man who presented with a history of intermittent episodes of severe vertigo on head movement that was caused by a C1-root schwannoma. The lesion was exposed through an extreme lateral transcondylar approach. At exposure the lesion was yellowish in color and was extradural in location lying between the markedly eroded C1-posterior arch and the compressed vertebral artery (V3) on the left side. The medial portion of the tumor was attached to the C1-nerve root. The tumor was excised enbloc with decompression of the VA. The patient's symptoms completely resolved immediately following surgery, with no recurrence of the symptoms at one year follow up. The vertebral artery may frequently be compressed by osteophytes in cervical spondylosis or due to other causes in the cervical spinal canal, but compression of the artery by C1 extradural schwannoma with vascular insufficiency is rare. Removel of the tumor and the resultant decompression of the artery can be facilitated by the extreme lateral approach as demonstrated by this case.

Constriction, Pathologic↗
PubMed2003

Follow-up after cervical laminectomy, with special reference to instability and deformity.

Misalignment and instability after cervical laminectomy, performed to treat spondylotic myelopathy, has been described as possible adverse effects. Forty-six consecutively patients on whom laminectomy had been performed in a 4-year period were identified; 7.7 +/- 0.6 years after operation, 11 patients had died and 27 patients were available for follow-up. Postoperative static subluxation was observed in 26% of the patients with an average slip of 3.7 +/- 3.1 mm; 7% had abnormal intervertebral movement displaying 1-2 mm movement from full flexion to full extension. Seventy-four per cent of the patients showed abnormal spinal curvature as judged from radiographs. However, no correlation with outcome was observed. Seventy-four per cent of the patients thought of the result of the operation as either good or fair; objectively, the best long-term effect of the operation was upon arm function. Although some patients develop postural anomaly, laminectomy remains, in terms of instability, a justifiable procedure in the elderly patient with spondylosis.

Adult↗
PubMed1995

Swallowing performance following anterior cervical spine surgery.

The aim of this study was to assess the incidence and severity of dysphagia following anterior cervical spine surgery for cervical spondylosis. One-hundred patients were contacted 12-22 months following cervical spine surgery. Those reporting persistent swallowing impairment were invited to attend for further investigation. Of 73 respondents, 33 (45%) experienced postoperative dysphagia. This persisted for longer than 6 months in nine (12% of respondents). Of five subjects attending for investigation, none had a definite radiological abnormality. In contrast, manometry suggested hyperactivity of the pharyngo-oesophageal segment in these patients, although with normal co-ordination. Surgeons should warn of the risk of transient dysphagia in 45% of patients postoperatively and of its persistence in around 10%. Radiological examination may be normal and manometry is the investigation of choice. Persistent, severe dysphagia may be ameliorated by cricopharyngeal myotomy or pharyngeal dilatation.

Adult↗
PubMed1997

Craniocaudal motion velocity in the cervical spinal cord in degenerative disease as shown by MR imaging.

PURPOSE: To investigate, by means of MR phase imaging, the effects of compression on the velocity of craniocaudal motion in the spinal cord. MATERIAL AND METHODS: Spin-echo pulse sequences with velocity encoding gradients were used to examine 12 patients with cervical spondylosis and 6 normal volunteers. Oblique-axial phase images at 3 levels (cranial, middle and caudal), were obtained with prospective electrocardiogram gating. The middle level was set at the site where the spinal cord was most severely compressed, and the cranial and caudal sections were set where it was not compressed. Time-velocity curves were generated at these 3 levels and focal velocity change was correlated with motor function in the lower extremities. RESULTS AND CONCLUSION: The cord showed a higher motion velocity at the compression level than at noncompression levels. This paradoxical increase in velocity was observed in 7 out of 8 patients whose lower extremity motor function was impaired. Four patients with normal lower extremity motor function did not demonstrate this increase in velocity. An increase in motion velocity was therefore found to correlate with impaired lower extremity motor function.

Adult↗
PubMed2002

Thyroid cancer after X-ray treatment of benign disorders of the cervical spine in adults.

While there is very good epidemiological evidence for induction of thyroid cancer by radiation exposure in children, the risk for adults after exposure is still uncertain, especially when concerning relatively small radiation doses. A cohort of 27,415 persons which in 1950 through 1964 had received x-ray treatment for various benign disorders in the locomotor system (such as painful arthrosis and spondylosis) was selected from three hospitals in Northern Sweden. A proportion of this cohort, consisting of 8 ,44 persons (4,075 men and 4,069 women), had received treatment to the cervical spine and thereby received an estimated average dose in the thyroid gland of about 1 Gy. Standard incidence rates (SIR) were calculated by using the Swedish Cancer Register. In the cervical spine cohort, 22 thyroid cancers were found versus 13.77 expected (SIR 1.60, CI 1.00-2.42). The corresponding figures for women were 16 observed cases versus 9.60 expected cases (SIR 1.67: Cl 0.75-2.71). Most thyroid cancers (15 out of 22) were diagnosed > 15 years after the exposure. In the remaining part of the total cohort, i.e. those without cervical spine exposure, no increased risk of thyroid cancer was found (SIR 0.98, CI 0.64-1.38). The study strongly suggests that external radiation exposure of adults at relatively small doses increases the risk of thyroid cancer but also that this increase is very much lower than that reported after exposure in children.

Adolescent↗
PubMed1997

Tetraparesis following dental extraction: case report and discussion of preventive measures for cervical spinal hyperextension injury.

This concerns a patient with compression myelopathy following passive hyperextension of the cervical spine during a dental procedure. Although he had been asymptomatic prior to the procedure, subsequent cervical spinal imaging revealed advanced spondylosis and spinal stenosis. Spinal stenosis is often asymptomatic for a long time. However, when radiculomyelopathy occurs after minor trauma to the head or neck, the patient is often found to have spinal stenosis. Specifically, hyperextension of a cervical spine with spondylotic changes can lead to compression myelopathy. Acquired spinal stenosis correlates positively with aging. As the size of the elderly population continues to increase the prevalence of cervical spondylotic radiculo-myelopathy will likely increase as well. Since appropriate precautions against potential neurologic damage can be undertaken, we suggest radiographic screening for pre-existing spinal stenosis prior to a procedure requiring hyperextension of the neck. Preventive measures for individuals with asymptomatic spondylotic changes and education of all health-care professionals to avoid abrupt or prolonged hyperextension of the cervical spine is emphasized.

Aged↗
PubMed2000

Difficulty of early diagnosis of amyotrophic lateral sclerosis: Japanese case studies.

An early diagnosis of amyotrophic lateral sclerosis can be difficult to establish in patients with atypical features such as unilateral crural amyotrophy or showing motor symptoms and signs of overlapping conditions like cervical spondylosis, unless these patients are followed over long periods of time. Here we describe three such cases from our hospital in Japan.

Aged↗
PubMed2002

A comparison of sympathetic outflow to muscles between cervical spondylotic amyotrophy and ALS.

To confirm the diagnostic usefulness of muscle sympathetic nerve activity (MSNA) in differentiation between cervical spondylotic amyotrophy (CSA) and amyotrophic lateral sclerosis (ALS) with cervical spondylosis (CS), MSNA, heart rate (HR) and blood pressure (BP) were recorded in 10 patients with CSA and ALS with CS, and age-matched healthy volunteers at rest and during head-up tilting. There were no differences in age, disability scores, pulmonary function, and HR or BP at rest between ALS and CSA groups. Resting MSNA was significantly greater in patients with ALS with CS than in comparison groups (P<0.001) with virtually no overlap between ALS and the CSA groups. During head-up tilting, changes in BP and MSNA were significantly less in patients with ALS than in patients with other subjects. MSNA at rest clearly differentiated CSA from ALS with CS, suggesting diagnostic utility.

Age Factors↗
PubMed1994

Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990.

An epidemiological survey of cervical radiculopathy in Rochester, Minnesota, 1976-90, through the records-linkage system of the Mayo Clinic ascertained 561 patients (332 males and 229 females). Ages ranged from 13 to 91 years; the mean age +/- SD was 47.6 +/- 13.1 years for males and 48.2 +/- 13.8 years for females. A history of physical exertion or trauma preceding the onset of symptoms occurred in only 14.8% of cases. A past history of lumbar radiculopathy was present in 41%. The median duration of symptoms prior to diagnosis was 15 days. A monoradiculopathy involving C7 nerve root was the most frequent, followed by C6. A confirmed disc protrusion was responsible for cervical radiculopathy in 21.9% of patients; 68.4% were related to spondylosis, disc or both. During the median duration of follow-up of 4.9 years, recurrence of the condition occurred in 31.7%, and 26% underwent surgery for cervical radiculopathy. A combination of radicular pain and sensory deficit, and objective muscle weakness were predictors of a decision to operate. At last follow-up 90% of our population-based patients were asymptomatic or only midly incapacitated due to cervical radiculopathy. The average annual age-adjusted incidence rates per 100,000 population for cervical radiculopathy in Rochester were 83.2 for the total, 107.3 for males and 63.5 for females. The age-specific annual incidence rate per 100,000 population reached a peak of 202.9 for the age group 50-54 years.

Adolescent↗