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PubMed1989

Complications and demographic characteristics of patients undergoing lumbar discectomy in community hospitals.

We determined the incidence of acute, major complications in a population of 28,395 patients who underwent lumbar laminectomy for discogenic radiculopathy in the United States in 1980. This population was drawn from a broad cross-section of community hospitals and represented 31% of all patients who underwent laminectomy that year for this condition. Our cohort excluded patients with a) operations exceeding two disc levels, b) fusion, c) previous lumbar laminectomy, or d) coexistent discitis, spondylosis, spinal stenosis, myelopathy, or arachnoiditis. The incidence of death was 5.9 per 10,000. The causes of death were septicemia, myocardial infarction, and pulmonary emobolus. The incidence of at least one major complication was 157 per 10,000. The incidences of specific complications were as follows: infection requiring intravenously administered antibiotics, 30.7; major neurological deficit, 29.8; pulmonary embolus, 10.7; and myocardial infarction, 5.6. We studied four additional categories of complication. Patients were counted only when a second operation was required to treat the complication. The categories and incidence per 10,000 were as follows: incisional hematoma, 8.7; cerebrospinal fluid fistula, 10.5; ventral perforation, 1.6; and retention of a foreign body, 0.7. Among the patients whose hospitalizations were otherwise normal, 6.7% received a blood transfusion; of the patients whose hospitalizations were complicated, 24% required transfusion. The demographic characteristics of transfusion. The demographic characteristics of patients with a normal hospitalization were tabulated separately from those whose hospitalizations were complicated. Neurosurgeons performed 60% of the operations, and orthopedic surgeons performed 40%. The speciality of the surgeon was not a factor in determining the risk involved in surgery. Spinal anesthesia was used in 7% of the cases, and no pattern of complications emerged that was uniquely related to that technique.

Demography↗
PubMed1998

Cervical myelopathy caused by hypoplasia of the atlas: two case reports and review of the literature.

OBJECTIVE AND IMPORTANCE: Congenital anomalies of the posterior arch of the atlas (C1) are uncommon. They range from partial clefts to total agenesis of the posterior arch. Developmental cervical canal stenosis is a congenital anomaly that may cause cervical myelopathy. Myelopathy caused by cervical stenosis at the level of the atlas has been reported in only three cases. We present two cases of nontraumatic cervical myelopathy caused by spinal stenosis at the level of the atlas associated with a hypoplastic but complete posterior arch of C1. CLINICAL PRESENTATION: Two elderly Chinese men developed cervical myelopathy gradually during months to years, without preceding trauma. Imaging revealed a hypoplastic but complete posterior C1 arch associated with changes of spondylosis in both patients, producing severe spinal stenosis and spinal cord compression. Posterior decompression was achieved in both by the removal of the posterior arch of C1 with its surrounding thickened posterior ligaments. Symptoms and clinical findings improved in the two patients during the follow-up period. CONCLUSION: The anomaly presented in our two cases differs from the established classification of congenital abnormalities of the posterior arch of the atlas, suggesting a different embryological defect. The hypoplastic posterior C1 arch created a congenitally narrowed spinal canal in our patients, rendering the spinal cord more susceptible to compression related to degenerative changes of the spine. Surgical removal of the shortened posterior C1 arch and surrounding degenerative ligaments is an effective treatment for symptomatic patients with this condition.

Aged↗
PubMed1999

Cervical spondylotic myelopathy: patterns of neurological deficit and recovery after anterior cervical decompression.

OBJECTIVES: We evaluated the specific pattern of pre- and postoperative neurological signs and symptoms and functional results in patients with cervical spondylotic myelopathy who underwent anterior decompressive operations. Additionally, we sought to determine which findings had predictive value for surgical outcome. METHODS: We retrospectively reviewed the records of 76 patients with cervical spondylotic myelopathy caused by osteophytic ridge or intervertebral disc herniation who underwent anterior cervical decompression and fusion performed by one surgeon. The patients were evaluated postoperatively by office visits and/or telephone interviews. Outcome was assessed by objective neurological examination and scoring with multiple functional rating scales. RESULTS: The most common preoperative symptoms were deterioration of hand use (75%), upper extremity sensory complaints (82.9%), and gait difficulties (80.3%). In the upper extremities, preoperative weakness was most common in the hand intrinsic muscles (56.6%) and triceps (28.9%), and in the lower extremities, preoperative weakness was most common in the iliopsoas (38.8%) and quadriceps (26.3%). In the lower extremities, individual muscle groups had strength improvement rates from 79.1 to 88.1 %; somewhat higher rates, from 81.3 to 90.9%, were observed in the upper extremities. When evaluated by using the Cooper myelopathy scale, lower extremity functional improvement occurred in 46.7% of the patients and upper extremity functional improvement in 75.4%. Overall functional improvement, evaluated by using a modification of the Japanese Orthopedic Association Scale, was noted in 79.7% of the patients who had abnormal scores preoperatively. CONCLUSION: Strength improved at rates of approximately 80 to 90% in individual muscle groups after anterior cervical decompression. However, fewer than half of all patients experienced functional improvement in the lower extremities, a discrepancy that was probably caused by persistent spasticity rather than muscle weakness. Postoperative dysfunction in the upper extremities was caused by residual weakness as well as sensory loss. Recurrent symptomatic spondylosis at unoperated levels was calculated to occur at an incidence of 2% per year.

Adult↗
PubMed2001

Diseases of the spine in South American mummies.

OBJECTIVE: The skulls and spinal columns of people from ancient civilizations, which frequently are found in a preserved state at archeological sites, can provide a large amount of information about these individuals' physical condition through paleopathological investigation. METHODS: This study represents the examination of more than 700 human remains dating back more than 8000 years that were recovered from archaeological excavations in the Andean region of southern Peru and northern Chile. RESULTS: Examples of congenital malformations, degenerative processes, infectious diseases, neoplasias, and traumatic diseases were discovered. Congenital anomalies such as spina bifida occulta were relatively common in these populations. No cases of meningomyelocele were discovered. The most common pathological findings were degenerative changes of the vertebral bodies. Large cervical and lumbar osteophytes were identified in some remains. Several cases of cervical spondylosis were determined to be the result of an occupational disease resulting from carrying heavy loads on the back. These heavy loads were supported by wearing around the forehead a tumpline, known as a capacho. The most common infectious disease process in the spine was due to tuberculosis. The diagnosis was made by radiological and histopathological studies, and in several cases the organism Mycobacterium tuberculosis was identified in the soft tissues. Metastatic lesions on the vertebral bodies were identified in a single case. Examples of traumatic spinal injury were rare. Compression fractures were noted infrequently. CONCLUSION: Diseases of the spinal column in the ancient inhabitants of the Andean region of South America were similar to those that affect the present-day population of that area.

Adult↗
PubMed2002

Quantitative assessment of surgical decompression of the cervical spine with cine phase contrast magnetic resonance imaging.

OBJECTIVE: We measured cerebrospinal fluid flow velocity by use of cine phase contrast magnetic resonance imaging to quantitate the effectiveness of surgical decompression in patients with cervical myelopathy. METHODS: Forty-seven patients with cervical myelopathy attributable to either spondylosis or ossification of the posterior longitudinal ligament were studied. Thirty-five patients underwent anterior cervical decompression and fusion; 12 others underwent expansive laminoplasty. Patients were examined preoperatively and postoperatively by use of a 1.5-T scanner with a pulse-gated cine phase contrast sequence. Cerebrospinal fluid flow direction and velocity in the ventral subarachnoid space were determined at the C1 and T1 levels. Forty-four healthy control subjects were examined to determine normal flow velocity parameters. Severity of cervical myelopathy was evaluated preoperatively and postoperatively by use of Japan Orthopedic Association scores to calculate the extent of recovery. RESULTS: Preoperatively, cerebrospinal fluid flow velocity in the caudal direction was significantly lower at both C1 and T1 than velocities measured in healthy controls. Both decompressive procedures essentially returned patient velocities to control values. Clinical recovery from myelopathy did not differ between anterior and posterior decompression. Postoperative increase in flow velocity correlated with clinical recovery after posterior (P < 0.0008) but not anterior decompression. CONCLUSION: Cine phase contrast magnetic resonance imaging provides quantitative assessment of cervical spine decompression, with particularly good clinical applicability to posterior procedures.

Adult↗
PubMed1976

Transient ischemic attacks not produced by extracranial vascular disease: a plea for complete and early angiographic investigation.

Six patients with classical transient ischemic attacks that were not directly related to extracranial carotid disease are presented. These cases were selected to include a variety of pathologic conditions: one case each of brain tumor, arteriovenous malformation, chronic subdural hematoma, cervical spondylosis, and two cases of giant intracranial aneurysms. These case histories are significant because they illustrate that without complete angiographic investigation, tragic results could have and did occur in some cases. Transient ischemic attacks should be considered as a symptom of various possible pathologic conditions, and a careful search for the cause must be pursued aggressively.

Adult↗
PubMed1997

Posttraumatic cervical osteophytosis causing progressive dysphagia.

Dysphagia is a commonly encountered patient complaint. The differential diagnosis for dysphagia is extensive. One long-recognized etiology of dysphagia is cervical osteophytosis. Degenerative joint disease, ankylosing spondylosis, and diffuse idiopathic skeletal hyperostosis (DISH) can all cause cervical osteophyte formation. We describe a patient with dysphagia and a large cervical osteophyte. Our case illustrates cervical osteophytosis associated with a history of previous cervical spine trauma. Evaluation and management strategies are discussed.

Aged↗
PubMed1978

Odontoid fracture complicating ankylosing hyperostosis of the spine.

Ankylosing hyperostosis of the spine (Forestier's disease) is a distinct clinical entity which must be differentiated from ankylosing spondylitis (Marie-Strumpell's disease) and hypertrophic spondylosis. In the case presented, the distinction was made by clinical, roentgenographic, and postmortem pathologic findings. This case had the unique and previously unreported feature of complication by a fracture of the odontoid. The patient's particular circumstances led to the decision to treat the fracture by posterior arthrodesis, though this is not necessarily recommended for all spinal fractures occuring in this disease.

Aged↗
PubMedDate not supplied

Symptomatic lumbar scoliosis with degenerative changes in the elderly.

Lumbar scoliosis with degenerative changes in the elderly presents with spondylosis, variable apophyseal joint arthrosis, laminar hypertrophy, and marginal osteophytos most prominent within the scoliotic apex. Resultant lumbar stenosis, alone or with ventral spurs and herniated discs as isolated or associated lesions, can produce disabling low-back and lower extremity pain, weakness, and neurogenic claudication relievable by appropriate decompressive surgery. Myelography is essential as a preoperative measure. Whether such scoliosis is superimposed on adolescent thoracolumbar scoliosis or arises anew in later life remains an open question.

Adult↗
PubMedDate not supplied

Analysis of failures and poor results of lumbar spine surgery.

The failures and poor results of lumbar spine surgery are analyzed in a retrospectively study of 105 consecutive patients referred to the authors for evaluation during 1976. Those who had a history of industrial or vehicular accident outnumbered others by about two to one. Review of histories, physical findings, and myelograms in most of the patients failed to substantiate the diagnosis of ruptured disc or nerve root compression. Many of the failures occurred in thos patients in whom little if any evidence of nerve root compression was found. The indications for surgery were poor in this group. Other failures occurred in patients who had improper, incomplete, or inadequate operations, especially those with lumbar spondylosis, a retained fragment of disc, or surgery at the wrong level. In addition to failure, poor results were recorded in patients who had significant nerve root or cauda equina injury from surgery, associated "arachnoiditis" which is thought to result from surgical trauma in many instances, or multiple operations leading to a hopelessly disabled state.

Evaluation Studies as Topic↗
PubMedDate not supplied

Radiographic changes following anterior cervical fusion.

In nine patients who underwent anterior cervical fusions for cervical spondylosis, preoperative cervical spine films were compared with radiographs taken seven to 15 years after fusion. Eight of the nine patients were found to have radiographic evidence of increased degenerative diseases located primarily below the level of fusion but occasionally occurring both above and below the fusion. Whether these degenerative changes are the body's response to altered mechanical forces on joints next to a now immobile spinal segment or whether these changes merely represent the natural progression of the degenerative disease process could not be ascertained from this study. Perhaps both factors contributed.

Adult↗
PubMedDate not supplied

Traumatic myelopathy in patients with cervical spinal stenosis without fracture or dislocation: methods of diagnosis, management, and prognosis.

The New York University Spinal Cord Trauma Center recently completed an evaluation of 200 patients seen over a period of four years, from 1974 to 1978. A unique group of 23 patients with cervical spinal stenosis and myelopathy without fracture or dislocation was isolated. The presence of a narrow canal significantly influenced morbidity and prognosis. Based on a review of plain roentgenograms and myelograms, there were seven patients with an average age of 41 who had absolute low levels of narrowing of the spinal canal without evidence of degenerative changes. The remaining 16 patients, averaging 61 years of age, had superimposed spondylosis. In both groups, patients with the lowest anteroposterior diameters of the spinal canal had the most severe myelopathy after trauma. Patients with absolute stenosis were more susceptible to traumatic myelopathy than were those with relative stenosis. Varying the dose of steroids to maximal levels had no effect on prognosis. Patients showing improvement during the initial 48 hours had the greatest degree of eventual recovery.

Adult↗
PubMedDate not supplied

Dynamic measurement of intraosseous pressures in lumbar spinal vertebrae with reference to spinal canal stenosis.

Dynamic measurements of intraosseous pressures in lumbar vertebrae were performed to determine the effects of positional change on lumbar vertebral circulation. The data collected are applicable to the question of spinal canal stenosis. The measurements were made in 23 patients, 12 of whom had spinal canal stenosis and 11 of whom had spondylosis deformans. The pressures within the spinous processes of L3 and L5 were measured continuously while the patients were prone, lying in the lateral position, and standing. The pressures ranged from approximately 10 to 30 mm Hg in the prone position and showed substantial changes with changes in position. In each subject, they were lowest in the prone, intermediate in the lateral, and highest in the standing position.

Adult↗
PubMedDate not supplied

Manipulation for chronic neck pain. A double-blind controlled study.

Twenty-one with symptomatic cervical spondylosis or nonspecific neck pain were given an amnesic dose of diazepam before manipulation of the cervical spine. Eighteen patients served as controls and also received diazepam but no manipulation. Results were obtained in a randomized, double-blind fashion. Statements of outcome by patients and mean visual analog scales for pain and activity showed no significant differences between manipulation and control groups, though both tests favored manipulation. Control subjects subsequently treated by manipulation showed no consistent favorable response. Questionnaires dealing with personality, life events, social and medical histories, etc., provided no correlations with outcome, nor did radiographic findings. Diffuse local tenderness correlated with high pain scores after treatment. The authors conclude that the value of a single manipulation of the cervical spine has not been established and that further exploration of indications is needed. The use of intravenous diazepam should be considered because it allows a double-blind experimental design.

Adult↗
PubMed1983

Expansive open-door laminoplasty for cervical spinal stenotic myelopathy.

Although the operative results have been improving since the air drill was introduced for cervical laminectomy instead of an ordinary rongeur, post-laminectomy complications, such as postoperative fragility of the cervical spine to acute neck trauma, posterior spur formation at the vertebral body, and malalignment of the lateral curvature have still remained as unsolved problems. In order to avoid these disadvantages, a new surgical technique called "expansive open-door laminoplasty" was devised by the author in 1977, which is relatively easier, safer, and better than the ordinary laminectomy from the standpoint of structural mechanics of the cervical spine. The operative procedure is described in detail. Operative results in the patients with cervical OPLL, spondylosis, and canal stenosis were satisfactory, and optimal widening of the AP diameter of the spinal canal is considered to be over 4 mm. From this procedure a bilateral, open-door laminoplasty has been devised for extensive exploration at the intradural space.

Animals↗
PubMed1985

The radiographic evaluation of the symptomatic postoperative lumbar spine patient.

The diagnostic evaluation of patients with previous lumbar surgery presents a problem clinically and radiographically. The authors evaluated radiographically 75 patients with previous lumbar surgery who had persistent lumbar symptomatology. From their series, they found that a combination of two modalities (1) plain radiographs of the lumbar spine and (2) CT with intrathecal metrizamide and/or intravenous contrast provided the most complete and useful diagnostic information. The findings are presented with an emphasis on the pathologic changes demonstrated on the CT scans of the lumbar spine of which the most persistent findings were granulation tissue at the surgical site, lumbosacral spondylosis, recurrent or residual herniated disc, and arachnoiditis.

Adult↗
PubMed1985

Choice of surgical treatment for multisegmental cervical spondylotic myelopathy.

Three surgical procedures for multisegmental cervical spondylotic myelopathy were evaluated on the basis of a follow-up study (12-157 months) of 95 patients. Twenty-four patients were treated by extensive laminectomy, 50 by anterior interbody fusion by the Cloward and/or Smith-Robinson techniques, and 21 by subtotal spondylectomy and fusion. Results of subtotal spondylectomy were significantly (P less than 0.01) better when compared with those of the other two procedures. It was concluded that spondylosis up to three disc levels should be treated by subtotal spondylectomy and fusion regardless of the canal diameter. When involvement extended four or more levels, extensive laminectomy was recommended.

Cervical Vertebrae↗
PubMed1985

Technical improvements and results of laminoplasty for compressive myelopathy in the cervical spine.

The laminoplasty reported in Spine 1982 by the author (H.T.) was modified by a technical improvement to obtain a more reliable enlargement of the cervical spinal canal. The technical improvements and results are described in detail. The osteotomized laminae that floated en bloc like a hinged door must be stabilized by bone blocks with wire ligatures. Thirty patients with severe cervical myelopathy due to multisegmental spondylosis or ossification of posterior longitudinal ligament underwent surgery. The extent of the enlargement of the canal was 4.1 mm on the average in the anteroposterior diameter, and in no case was a significant reduction in the diameter of the canal noted during the follow-up period. A stable and thorough decompression of the spinal canal was noted on the postoperative computed tomograms with satisfactory surgical results.

Adult↗