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PubMed1986

Comparison of nuclear magnetic resonance imaging and computed tomography in the diagnosis of upper cervical spinal cord compression.

Because of its ability to visualize soft-tissue structures in greater detail than any previous radiographic modality, nuclear magnetic resonance (NMR) has been heralded as one of the greatest advances in recent years. It is particularly well suited in diagnosis of spinal disorders since it can visualize the spinal cord and cerebrospinal fluid without intrathecal contrast agents. This is a preliminary report of our experience of NMR examination in 106 patients studied since November 1982 at Case Western Reserve University Hospital. One of the best applications of NMR is for compressive lesions of the upper cervical spine because "functional" images can be obtained. The information from NMR was compared with computed tomography (CT) in 14 patients with various etiologies of neural compression--atlanto-occipital subluxation in Down's syndrome, fixed post-traumatic atlantoaxial subluxation, rheumatoid atlantoaxial subluxation and basilar impression of the odontoid, ossification of the posterior longitudinal ligament, Klippel-Feil syndrome, congenital spinal stenosis, cervical spondylosis, Arnold-Chiari malformation, etc. Unlike CT, NMR can directly image in the sagittal plane without computer reformatting of axial cuts. This readily provides direct images of the spinal cord in neutral, flexion, and extension to show the mechanism of neural compression. Disadvantages of NMR compared with CT include poorer image resolution, slightly increased imaging time, and no patients with intracranial aneurysm clips or cardiac pacemakers can be studied. Advantages include no radiation exposure, no intrathecal contrast agent is required to differentiate CSF from neural tissue, and direct sagittal, coronal, and oblique images can be obtained. As a result of this preliminary experience, computed tomography and nuclear magnetic resonance imaging appear to be complimentary studies--CT provides better osseous detail, whereas NMR offers superior soft tissue resolution.

Adult↗
PubMed1986

Causes of neurologic deterioration following surgical treatment of cervical myelopathy.

Neurologic deterioration was analyzed in 110 patients with surgically treated cervical myelopathy secondary to soft disc hernia or spondylosis. Follow-up periods ranged from 2 to 14 years, with an average of 6 years. Of 110 patients, 29 suffered neurologic deterioration. In most of the patients, deterioration occurred within the first year after surgery. Causes of deterioration were divided into three categories: direct trauma to neural tissue during surgery (a preventable complication); instability of the spine, progression of spondylotic changes above or below the level of fusion, and non-union (apparently unpreventable but treatable); and nonsurgery-related accidental trauma (unavoidable and often irreversible). Countermeasures for the deterioration are discussed.

Cervical Vertebrae↗
PubMed1986

Interspinous wiring without bone grafting for nonunion or delayed union following anterior spinal fusion of the cervical spine.

Nine patients who had unsuccessful anterior interbody fusion or subtotal spondylectomy and fusion for cervical spondylosis were treated by interspinous wiring without bone grafting. Bone union was confirmed during a mean postoperative period of 2 years and 2 months in seven patients by the disappearance of clear zones observed preoperatively in the disc space, and by continuity of the trabeculae in radiograms. One of the two patients in whom the procedure failed to unite the site of nonunion had received technically inadequate wiring with slight mobility at the wiring site; in the other patient, the grafted bone had collapsed and no sclerotic shadow of the nonunion site was seen at the time of surgery. Both patients underwent wiring after considerable intervals from the time of the initial anterior spinal fusion. We found that satisfactory bone union can be obtained for nonunion or delayed union following anterior cervical spinal fusion by interspinous wiring without further bone grafting if applied to properly selected patients.

Adult↗
PubMed1986

A comparative analysis of the interpretations of lumbar spinal radiographs by chiropractors and medical doctors.

Ninety-nine anteroposterior and lateral lumbar radiographs taken of men, 18 to 55 years of age, were randomly selected from participants in a population survey of low-back pain. Thirty-one (31%) had never had low-back pain; 44 (44%) had or were having mild low-back pain; and 24 (24%) had or were having severe low-back pain. Three chiropractors assessed 56 radiographic variables, which included determinations of disc space height, vertebral malalignments and subluxations, spondylosis, postural disturbances, relationships among pelvis and spine and other congenital or acquired abnormalities. Interobserver reliability measurements showed that 6 of the 56 variables analyzed produced a high interobserver reliability. Sixteen additional variables showed a fair interobserver reliability. Comparison of the observations made by the chiropractors and a radiologist showed minimal agreement except for disc space height assessments at L3-4 and L4-5. Few of the radiographic variables discriminated between the current or prior history of low-back and leg complaints, although a few variables (most notably disc space narrowing) were statistically associated with back or leg complaints (P = .025). The conclusion was reached that spinal radiographs, whether analyzed by measurements, by a radiologist, or by chiropractors, have minimal value in determining the presence or absence of low-back complaints and, in particular, have no value in epidemiologic studies.

Adult↗
PubMedDate not supplied

Spinal deformity and instability after multilevel cervical laminectomy.

Sixty-four patients who had undergone multilevel cervical laminectomy were studied for postoperative spinal deformity and instability. Special attention was given to patients with cervical spondylosis (CS), ossification of the posterior longitudinal ligament (OPLL), and spinal cord tumors. Twenty-three (36%) of 64 patients showed postoperative changes in curvature type and 9 (14%) had developed spinal deformity (kyphotic or meandering-type curvature). In two juvenile patients, the deformity developed soon after operation and spinal fusion was required to prevent neurologic complications. In the adult cases, contrary to the hitherto accepted concept, long-term follow-up revealed the tendency of the deformity to develop more frequently in OPLL cases than in CS cases. Mobility of the cervical spine was reduced considerably after laminectomy, both in CS and OPLL cases. There was no adult patient who required further operation for severe deformity or instability after laminectomy. Extensive laminectomy, even including the C2 lamina, seemed to have no adverse effect on the stability of the cervical spine.

Cervical Vertebrae↗
PubMed1988

Histologic and morphometric observations on vertebral bone of aging sand rats.

The trabecular bone of the vertebrae of 30 male and 30 female sand rats (Psammomys obesus) aged 13 to 33 months was examined histologically and morphometrically. The usual age-linked decline of bone mass failed to occur in females and was statistically not significant in males. A few changes with age were noted at the cellular level. Sex differences were statistically significant only in animals living into the third year of life, males having a smaller bone mass than females. This abnormality of the vertebral spongiosa is attributed to pathologic local stresses caused by the numerous instances of disc degeneration and herniation. Differences in size, location, and age of the herniations are thought to account for the wide fluctuations in the individual bone parameters examined. Whereas the spine of the sand rat provides an excellent model for the study of spondylosis, it is unsuited as a model for age-linked osteoporosis.

Aging↗
PubMed1988

A comparison of anterior cervical fusion, cervical laminectomy, and cervical laminoplasty for the surgical management of multiple level spondylotic radiculopathy.

The risks and success of surgery for multiple level cervical spondylotic radiculopathy differs from that of single level disease. The problems associated with multiple level anterior fusion over single level fusion include higher pseudoarthrosis rates than that associated with single level disease. Bilateral and multiple level laminectomy carries the risk of potential instability. Cervical laminoplasty, until recently, has only been performed for myelopathy secondary to ossification of the posterior longitudinal ligament (OPLL) or cervical stenosis. The purpose of this report is to compare the results and complications of 45 patients with a least a 2-year follow-up who had undergone anterior fusion, cervical laminectomy, or cervical laminoplasty for the surgical management of multiple level cervical radiculopathy due to cervical spondylosis. 18 patients (58 levels) underwent anterior fusion, 12 patients (38 levels) had a cervical laminectomy, and 15 patients (57 levels) underwent a cervical laminoplasty. Roentgenograms indicated spinal stenosis (sagittal diameter less than 12 mm) at 28 levels (15 patients) for the anterior fusion group, 14 levels (9 patients) in the laminectomy group, and 24 levels (13 patients) in the laminoplasty group. Subluxation (2 mm or less) was present at 14 levels (13 patients) in the anterior fusion group, nine levels (9 patients) in the laminectomy group, and 15 levels (8 patients) in the laminoplasty group. Loss of lordosis was present in eight patients undergoing anterior fusion, six patients undergoing laminectomy, and six patients who had a laminoplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

Cervical Vertebrae↗
PubMed1988

Anterior cervical fusion using the free vascularized fibular graft.

A free vascularized fibular graft with microvascular anastomoses was applied to six clinical cases of anterior cervical fusion for cervical spondylosis with myelopathy (two patients) and ossification of the posterior longitudinal ligament with myelopathy in four. The numbers of levels fused were three in five patients, and two in one. Their follow-up period ranged from 14 to 42 months (mean, 26 months). Union of the graft occurred between 2.5 and 5 months (mean, 3.4 months) postoperatively. There were no nonunions nor any serious complications. This technique is indicated for multilevel intervertebral fusion in which the nonunion or delayed union rate with conventional bone grafting may be high.

Cervical Vertebrae↗
PubMed1988

Nerves accompanying the vertebral artery and their clinical relevance.

In elucidating the morphologic basis of cervical spondylosis, the nerves accompanying the vertebral artery were studied under an operative microscope and by means of Karnovsky's histochemical method for acetylcholinesterase (AChE). The results show that the nerves arising from the cervical part of the sympathetic trunk and the cervical nerves anastomose with each other around the artery, and are distributed to the vertebral artery and the cervical spine. The nerves accompanying the vertebral artery show different degrees of AChE activity, and may be compressed or stimulated as a result of disease of Luschka's joint and the other degenerated structures, based on their anatomic relationship.

Acetylcholinesterase↗
PubMed1989

Dome-like expansive laminoplasty for the second cervical vertebra.

The second cervical vertebra (C2) is in a pivotal position for the alignment and stability of the cervical vertebrae as a whole. Since its spinal canal is wider at the cranial and narrower at the caudal end, a dome-like excision of the inner side of the spinal canal from the caudal toward the cranial end results in the decompression of the lesion, preserving the dorsal part of the C2. The authors performed this C2 dome-like expansive laminoplasty on 33 patients (25 cases of the ossification of the posterior longitudinal ligament, six of developmental spinal canal stenosis, and two of spondylosis) and kept them under follow-up observation, which ranged from 1 to 7 years (mean, 3.5 years). The result was satisfactory in terms of the decompression and stability of the cervical vertebrae: even 5 years after the operation, no osteogenesis was noted in the expanded spinal canal to induce compression again. It thus may be concluded that this method is good enough to replace conventional laminectomy.

Aged↗
PubMed1990

Motion analysis of the cervical spine in athetoid cerebral palsy. Extension-flexion motion.

Frequently instability and premature onset of spondylosis of the cervical spine are found in athetoid cerebral palsy (CP) patients. These structural abnormalities appear to be related to athetoid motion of the neck in CP. Through motion analysis, the authors aimed to clarify the abnormalities of cervical motion that could precipitate structural abnormalities. The gross characteristic feature of cervical motion in athetoid CP is "whip movement." Both velocity and acceleration during extension-flexion motion were greater than in normal subjects, especially at the upper cervical levels. Also, a sudden increase in velocity and acceleration occurred during rapid motions at certain levels, followed by a larger range of motion of the cervical spine. Such kinematic abnormalities were thought to generate a greater shearing force and bending moment exerted on the corresponding cervical articulations-discs and facets. Olisthetic instability often accompanied disc degeneration at the upper cervical levels. A large range of extension--flexion motion of the cervical spine, analogous to a cantilever, caused a repeated bending moment of extraordinary magnitude and was regarded as a precipitative factor for disc degeneration and osteophytosis common at the middle and lower levels of the disc.

Adult↗
PubMed1990

Coexistence of cervical and lumbar disc disease.

A retrospective analysis of 200 patients requiring cervical disc surgery was performed to determine the frequency of coexistent lumbar disc or spine abnormalities. The duration of follow-up ranged from 5 to 25 years, averaging 14 years. Sixty percent were women and 40% were men, their ages ranging from 25-73 years. Antecedent motor vehicle injury had occurred in 49 cases and work injury to the spine in 23. Sixty-four percent had no history of prior back injury. It was found that over 31% had undergone lumbar disc surgery, and a high number of patients demonstrated abnormal lumbar radiographs or myelograms, including 78 with bulging discs, 100 with major root defects, 78 with minor root defects, 8 with spinal stenosis, and 7 with spondylolisthesis. Myelograms were normal in 22 cases. The sites of lumbar abnormalities included L4-5 (110), L5-S1 (90), and multilevel (8). There was a higher incidence of lumbar disc abnormalities associated with multilevel cervical spondylosis. There also was a relationship between residual symptoms and myelographic abnormalities. Two studies in the authors' institution suggest an autoimmune basis for the frequent coexistence of cervical and lumbar disc disease, namely the demonstration of antigenic properties in the nucleus pulposus and high serum immunoglobulins.

Adult↗
PubMed1990

The neurologic workup in patients with cervical spine disorders.

Care must be exercised in interpreting the clinical and radiologic findings when assessing patients with cervical spondylosis and involvement of neural structures for surgery. If the clinical picture cannot logically be explained by the radiologic findings, further investigation is indicated to exclude a coexistent disorder. Investigations may include electrophysiologic tests, transcranial magnetic stimulation, cerebrospinal fluid (CSF) analysis, and magnetic resonance imaging (MRI). Only then can the indication for surgical intervention be properly determined.

Aged↗
PubMed1990

Anterior cervical plate fixation with the titanium hollow screw plate system. A preliminary report.

Morscher, of Switzerland, has developed an anterior cervical spine plate system (THSP) that does not require screw purchase of the posterior cortex. This design eliminates potential neurologic complications usually associated with the anterior plate system, but maintains the mechanical advantages of internal fixation. The authors reviewed 13 consecutive patients in whom the THSP system was applied. Indications for the use of this device included acute trauma in three patients, trauma of more than 6 weeks' duration in five patients, and spondylosis in five patients. Fifteen plates and 58 screws were placed, with no screws purchasing the posterior cortex. Postoperative immobilization varied from no immobilization to four-poster brace. With a mean follow-up of 13 months, all 13 patients went on to fusion. One patient had screws placed in the disc rather than in bone and went on to malunion. In all other patients, radiographs did not demonstrate screw migration, screw-bone lucency, graft dislodgement, or malunion. No patient suffered neurologic injury as a result of this device. The THSP system facilitates reliable fusion with minimal complications. Its use should be considered in multilevel anterior spine defects, posttraumatic cervical kyphosis, and cervical fractures with posterior disruption requiring anterior fusion.

Adult↗
PubMed1991

Neurologic complications of surgery for cervical compression myelopathy.

Neurologic complications resulting from surgery for 384 cases of cervical myelopathy (cervical soft disc herniation, spondylosis, ossification of the posterior longitudinal ligament) were reviewed. Surgical procedures performed included 134 anterior interbody fusions (Cloward or Robinson-Smith technique), 70 subtotal corpectomies with strut bone graft, 85 laminectomies, and 95 laminoplasties. Twenty-one patients (5.5%) sustained neurologic deterioration related to surgery. The deterioration was classified into two types on the basis of the neurologic signs observed: deterioration of spinal cord function or of nerve root function. Manifestations of the former varied from weakness of the hand to tetraparesis. Paralysis of the deltoid and biceps brachii muscles was an exclusive feature of deterioration in the nerve root group. Causes of this paralysis included malalignment of the spine related to graft complications, and a tethering effect on the nerve root following major shifting of the spinal cord after decompression. The causes of deterioration of the cord function included spinal cord injury during surgery, malalignment of the spine associated with graft complication, and epidural hematoma.

Cervical Vertebrae↗
PubMed1991

Diagnosis and operative treatment of intraforaminal and extraforaminal nerve root compression.

The clinical, radiologic, and operative findings, and clinical results in 26 cases of foraminal nerve root involvement, each treated by variable operative procedures for an existing pathologic condition, were studied. These 26 cases consisted of 8 intraforaminal or extraforaminal lumbar disc herniations and 18 foraminal nerve root entrapments. The cases with an extreme lateral lumbar disc herniation underwent lateral fenestration or osteoplastic hemilaminectomy without concomitant spinal fusion, and showed excellent operative results. A sufficient selective decompression was achieved with a good clinical result in the cases of lumbar spondylosis without preoperative spinal instability, by lateral fenestration or osteoplastic hemilaminectomy. This result suggests that the selective decompression procedure is recommended for cases with reliable preoperative diagnoses. When an intraspinal lesion makes it difficult to diagnose coexisting foraminal nerve root involvement, decompression of the nerve root canal, approaching from medial to lateral, is recommended. The fusion operation should be performed in cases undergoing even a unilateral total facetectomy, regardless of the patient's old age. A correct preoperative diagnosis is crucial in order to obtain satisfactory operative results.

Adult↗
PubMed1992

The use of freeze-dried fibular allograft in anterior cervical fusion.

Eighty-three segmental fusions were performed on 42 patients who underwent anterior cervical discectomy and fusion with freeze-dried fibular allograft for cervical spondylosis. Fusions were carried out over one to four levels. The mean follow-up period was 22.1 months (range, 9-47 months). The patients had both clinical and radiographic follow-up. Eighty-eight percent of the patients were found to have excellent or good clinical results. Radiographic follow-up revealed that 92% of the grafts obtained complete or partial union by 6 months after surgery. Forty patients were shown to be radiographically stable on lateral flexion and extension films by 8 weeks after surgery. The use of freeze-dried fibular allograft is a safe and efficacious procedure.

Bone Transplantation↗
PubMed1992

Preoperative and postoperative magnetic resonance image evaluations of the spinal cord in cervical myelopathy.

To evaluate the morphologic changes of the spinal cord in patients with cervical myelopathy due to cervical spondylosis and ossification of the posterior longitudinal ligament, the authors measured the thickness and signal intensity of the cervical cord with magnetic resonance imaging in healthy adults and patients with cervical myelopathy, and compared these findings. In patients with cervical myelopathy, the preoperative and postoperative magnetic resonance imaging findings were compared with the severity of myelopathy and postoperative results. In healthy adults, the anteroposterior diameter of the cervical cord was 7.8 mm at the C3 level and decreased at lower levels. In the patients with cervical myelopathy, the preoperative spinal anteroposterior diameter was significantly reduced at various levels corresponding to the stenosis site within the vertebral canal. In the group with ossification of the posterior longitudinal ligament, the minimal anteroposterior diameter of the cervical cord tended to decrease with increasing severity of myelopathy. However no relationship was observed between the two parameters in the cervical spondylotic myelopathy group. In the group with ossification of the posterior longitudinal ligament, surgical results were good when the postoperative anteroposterior diameter was increased, whereas in the cervical spondylotic myelopathy group there was no relationship between the two parameters. In the patients with myelopathy, a high intensity area was observed in about 40% of all patients before operation and about 30% after operation. However, the presence or absence of a high intensity area did not correlate with the severity of myelopathy or with surgical results in the group with ossification of the posterior longitudinal ligament and the cervical spondylotic myelopathy groups.

Cervical Vertebrae↗