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At least 1,351 records · Page 75Linked to original sources
PubMed1988

Neurological deterioration after laminectomy for spondylotic cervical myeloradiculopathy: the putative role of spinal cord ischaemia.

Most cases of neurological deterioration after laminectomy for cervical radiculomyelopathy occur several weeks to months postoperatively, except when there has been direct trauma to the spinal cord or nerve roots during surgery. Four patients are described who developed episodes of neurological deterioration during the postoperative recovery period that could not be attributed to direct intraoperative trauma nor to epidural haematoma or instability of the cervical spine as a consequence of laminectomy. Following laminectomy for cervical radiculomyelopathy four patients were unchanged neurologically from their pre-operative examinations, but as they were raised into the upright position for the first time following surgery focal neurological deficits referrable to the spinal cord developed. Hypotension was present in all four cases during these episodes and three of the four patients had residual central cervical cord syndromes. These cases represent the first reported instances of spinal cord ischaemia occurring with post-operative hypotensive episodes after decompression for cervical spondylosis.

Adult↗
PubMed1994

Diagnostic imaging algorithm for cervical soft disc herniation.

MRI with surface coils is currently the preferred method for evaluating degenerative cervical spine disease. The differentiation between soft disc herniation and osteophytic spurs is not always obvious, however, on a 0.5 Tesla unit. The procedure of choice for soft disc herniation, MRI on a 0.5 T superconducting system associated with plain radiography of the cervical spine, in selecting patients for anterior cervical discectomy without interbody fusion (ACD), was evaluated. This prospective study comprised 100 patients with cervical radicular symptoms, not subsiding after conservative treatment. Plain radiographs were obtained for all patients. Patients without spinal instability, spondylosis, or major osteophytes on plain radiographs and without clinical findings of myelopathy underwent MRI (n = 59) on a 0.5 Tesla superconducting system. The other 41 patients underwent CT myelography. On MRI, herniation of a cervical soft disc was seen in 55 patients and the localisation corresponded well with the clinical symptoms. CT myelography showed a foraminal herniation in one of four selected patients with negative MRI. Fifty of 55 patients underwent ACD. All herniations were confirmed at operation, but in two patients there were important foraminal spurs not seen on MRI. It is concluded that 0.5 T MRI combined with plain radiographs offers an accurate, non-invasive test in the assessment of selected patients with cervical radiculopathy.

Adult↗
PubMed1996

Paravertebral muscles in disease of the cervical spine.

OBJECTIVES: Cervical spine disorders are common in the older population. The paravertebral muscles are essential to the support and stabilisation of the cervical spine but have been little studied. The aim was to determine whether pathological changes develop in these muscles in patients with severe cervical spine disease, which, if present, might contribute to the pathogenesis and symptomatology of their disorder. METHODS: Open biopsies of superficial and deep paravertebral muscles were obtained during the course of surgical procedures to alleviate cervical myelopathy. Most of these patients had cervical spondylosis or rheumatoid arthritis involving the cervical spine. The biopsies were compared with muscle obtained at necropsy from patients without a history of cervical spine or neuromuscular disorder. RESULTS: Muscle from both the study and control groups showed a similar range and severity of abnormalities. In several patients, grouped fibre atrophy suggested chronic partial denervation. Most biopsies showed type 1 fibre predominance and selective type 2 fibre atrophy. Ragged red fibres were a frequent finding and electron microscopy disclosed accumulations of mitochondria, a small proportion of which contained rounded, or longitudinally oriented, single osmiophilic inclusions. Fibres containing core-like areas were also frequent. These pathological features were seen with increasing severity and frequency with increasing age. CONCLUSIONS: The paravertebral cervical muscles develop pathological abnormalities with increasing age with both neurogenic and myopathic features, the pathogenesis of which is probably multifactorial. Such a muscle disorder would be expected to be accompanied by functional impairment which may contribute to the development and symptomatology of cervical spine disease with increasing age.

Aged↗
PubMed2003

Occupational risk factors for symptomatic lumbar disc herniation; a case-control study.

BACKGROUND: Previous studies mostly did not separate between symptomatic disc herniation combined with osteochondrosis/spondylosis of the lumbar spine and symptomatic disc herniation in radiographically normal intervertebral spaces. This may at least in part explain the differences in the observed risk patterns. AIMS: To investigate the possible aetiological relevance of physical and psychosocial workload to lumbar disc herniation with and without concomitant osteochondrosis/spondylosis. METHODS: A total of 267 cases with acute lumbar disc herniation (in two practices and four clinics) and 197 control subjects were studied. Data were gathered in a structured personal interview and analysed using logistic regression to control for age, region, nationality, and diseases affecting the lumbar spine. Cases without knowledge about osteochondrosis/spondylosis (n=42) were excluded from analysis. Risk factors were examined separately for those cases with (n=131) and without (n=94) radiographically diagnosed concomitant osteochondrosis or spondylosis. RESULTS: There was a statistically significant positive association between extreme forward bending and lumbar disc herniation with, as well as without concomitant osteochondrosis/spondylosis. There was a statistically significant relation between cumulative exposure to weight lifting or carrying and lumbar disc herniation with, but not without, concomitant osteochondrosis/spondylosis. Cases with disc herniation reported time pressure at work as well as psychic strain through contact with clients more frequently than control subjects. CONCLUSIONS: Further larger studies are needed to verify the concept of distinct aetiologies of lumbar disc herniation in relatively younger persons with otherwise normal discs and of disc herniation in relatively older persons with structurally damaged discs.

Adult↗
PubMed1975

Radiological diagnosis of mass lesions within and adjacent to the foramen magnum.

Masses within or adjacent to the foramen magnum may present difficult clinical problems. They may sometimes be misdiagnosed as degenerative disease of the central nervous system, cervical spondylosis, or even cervical disk disease. In most cases, roentgenographyis necessary for proper diagnosis. The anatomy of the region of the foramen magnum is reviewed and 13 cases representing various diseases are presented. Alterations in the regional arterial and venous anatomy are emphasized.

Adult↗
PubMed1976

Cervicovertebral phlebography: pathological results.

Cervical phlebography via the femoral vein approach was done in patients with spinal tumors, cervical radiculopathies, and myelopathies. Tumors originating from or extending into the spinal canal readily compress and obstruct the epidural venous plexus. Because of the lateral position of the epidural veins, the foraminal veins are deformed when cervical roots are compressed in the intervertebral foramina by spondylosis of the uncinate processes or lateral disk herniation. In congenitally narrow canals without significant spondylotic bars, the epidural veins were not opacified. Nonfilling of veins was also seen when the canal was narrowed by multiple spondylotic bars. With a few or even a single spondylotic bar, the epidural veins opacified but this was interrupted at the affected levels. When a significant spondylotic bar was associated with a narrow canal higher up, filling of the epidural veins at the level of the bar was completely arrested.

Cervical Vertebrae↗
PubMed1977

Orthopantomography of the cervical spine.

The authors describe the application of orthopantomography to study of the intervertebral foramina of the cervical spine in patients with cervical spondylosis. Other structures such as the lateral mass of the cervical spine can be studied by altering the speed of the rotating film holder, which in two changes the width of the arch of the focal layer.

Cervical Vertebrae↗
PubMed1979

Hypoplasia of the lumbar vertebral body simulating spondylolisthesis.

Fifty cases of spondylosis and spondylolisthesis were reviewed. In 9 of the 20 cases interpreted as Grade I spondylolisthesis at L5-S1, the sagittal diameter of L5 was shortened, creating a false impression of vertebral slippage. Such cases are felt to represent spondylolysis with hypoplasia of the vertebral body rather than true spondylolisthesis.

Diagnosis, Differential↗
PubMed1994

Musculoskeletal causes of spinal axis compromise: beyond the usual suspects.

The majority of cases of spinal canal compromise are caused by common pathologic conditions, including degenerative spondylosis, infection, trauma, and metastatic disease. However, there are other causes of spinal canal compromise that, though unusual, may be seen in everyday practice. Congenital abnormalities of the spine that may produce spinal canal compromise include the os odontoideum, hemivertebra, diastematomyelia, and achondroplasia. Arthritides and enthesopathies such as rheumatoid arthritis, ankylosing spondylitis, synovial cysts of the facet joint, calcium pyrophosphate dihydrate deposition or hydroxyapatite deposition, and ossification of the posterior longitudinal ligament or ligamentum flavum may lead to narrowing of the spinal canal. Primary spinal tumors and tumorlike lesions such as hemangioma, aneurysmal bone cysts, osteochondroma, and osteoblastoma may also cause spinal canal stenosis. Finally, Paget disease of bone may compromise the spinal cord. Radiologists should be aware of these unusual musculoskeletal causes of spinal canal compromise and their radiologic and clinical features.

Humans↗
PubMedDate not supplied

Evaluation of lower back pain with bone scintigraphy and SPECT.

Bone scintigraphy and single photon emission computed tomography (SPECT) may be performed for evaluation of lower back pain, especially when a bone abnormality is suspected. Various patterns of tracer activity based on precise identification of the anatomic location of increased uptake may be observed and used to evaluate bones and joints. Lesions centered about the disk space and vertebral body include spondylodiskitis, metastatic disease, vertebral body fracture, and degenerative disease (disk disease, spondylosis deformans). In diskitis, tracer uptake has a vertical orientation. Metastatic involvement should be suspected in solitary lesions evaluated with SPECT when the area of increased uptake extends from the vertebral body into the pedicle. Fractures are seen on planar and SPECT images as a linear, horizontally oriented area of increased uptake centered in the vertebral body. In degenerative disease, increased uptake is centered about the disk space and may be seen in and project beyond the surface of the vertebral body. Lesions of the posterior arch (comprising the pedicle, lamina, and facet joints) include spondylolysis, pedicle lesions, osteoarthritis of the facet joints, and fracture of the transverse process. Scintigraphy may help differentiate long-standing asymptomatic spondylolysis from ongoing disease. In osteoarthritis of the facet joints, SPECT may be used to select patients to be treated with therapeutic injections. Increased uptake in the transverse process most often indicates a fracture, although tumors may also occur in this location. These findings at planar bone scintigraphy and SPECT allow differentiation of common pathologic conditions and can lead to a specific diagnosis.

Humans↗
PubMed1981

Spinal vacuum phenomena: anatomical study and review.

"Vacuum" phenomena relate to the accumulation of gas, principally nitrogen, in crevices within the intervertebral disk or vertebra. Their appearance does not uniformly indicate "degenerative" disk disease (primary intervertebral osteochondrosis), as gaseous collections may accompany other processes (vertebral osteomyelitis, Schmorl node formation, spondylosis deformans, vertebral collapse with osteonecrosis) affecting the disk and adjacent vertebral bodies. The location and appearance of the "vacuum" phenomena are helpful indicators as to the precise nature of the spinal disorder.

Humans↗
PubMed1984

Cervical radiculopathy: computed tomography and myelography compared.

The accuracy of CT in the determination of cervical disk herniation has not been measured as it has in the determination of lumbar disk disease. Cervical myelograms and CT scans of patients with cervical radiculopathy secondary to disk herniation or spondylosis, which was verified by clinical examination, surgery, and in most cases EMG, were evaluated blindly and independently, results were analyzed statistically, and receiver operating characteristic (ROC) curves were calculated. CT without or with the use of intrathecal metrizamide was more accurate than myelography in the identification of lesions that caused cervical radiculopathy. In some patients, CT obviates the need for cervical myelography. With improvement in CT techniques and more experience in interpreting the images, CT will be increasingly important in the evaluation of cervical radiculopathy.

Cervical Vertebrae↗
PubMed1985

Degenerative diseases of the vertebral column.

Several distinct degenerative processes affect the articulations of the vertebral column; each is associated with characteristic radiographic and pathologic abnormalities, and many are accompanied by significant clinical manifestations. A discussion of these processes is best accomplished according to the type of joint that is involved. With regard to cartilaginous articulations, of which the intervertebral disk is most important, intervertebral (osteo)chondrosis, spondylosis deformans, and, in the cervical spine, uncovertebral arthrosis are the major degenerative disorders. Osteoarthritis (osteoarthrosis) affects any of the synovium-lined joints of the vertebral column, including the apophyseal, costovertebral, transitional lumbosacral, median atlantoaxial, and sacroiliac articulations. Fibrous articulations, ligaments, or entheses (sites of tendon or ligament attachment to bone) are involved in diffuse idiopathic skeletal hyperostosis, ossification of the posterior spinal ligaments, and Baastrup disease. Of the many complications of these degenerative processes, alignment abnormalities (including segmental instability, degenerative spondylolisthesis, senile kyphosis, and degenerative scoliosis), intervertebral disk displacement, calcification or ossification, and spinal stenosis are the most important.

Humans↗
PubMed1987

Focal fat deposition in axial bone marrow: MR characteristics.

One hundred fifty-eight magnetic resonance (MR) imaging studies of the spine were reviewed to assess the frequency and distribution of focal deposits with signal behavior typical of fat in the axial bone marrow. In addition, three fresh cadaveric spines were evaluated with MR imaging and subsequently sectioned for anatomic and histologic correlation. Macroscopic evaluation of the sectioned cadaveric specimens revealed well-defined, yellow areas within the bone marrow that correlated precisely with localized zones of signal intensity characteristic of fat on MR images. Histologic evaluation of these regions demonstrated typical focal fatty replacement of hematopoietic bone marrow. Their appearance was related to age and the presence of pathologic changes such as spondylitis, kyphoscoliosis, and spondylosis. Based upon these observations, focal fatty replacement of hematopoietic bone marrow appears to be a common phenomenon that should not be confused with localized disease processes.

Adipose Tissue↗
PubMed1988

Syrinx-like artifacts on MR images of the spinal cord.

Magnetic resonance (MR) imaging of the spinal cord frequently demonstrates, especially on sagittal sections, a central stripe that mimics a true syrinx. This syrinx-like manifestation of a truncation artifact occurs in objects having a width of only a few pixels and was demonstrated by calculations verified with phantom MR images. Healthy volunteers and two patients with a syrinx and cervical spondylosis, respectively, underwent MR imaging. By increasing the number of phase-encoding steps, decreasing the field of view, and switching phase- and frequency-encoding axes, the syrinx-like artifact can be eliminated.

Cervical Vertebrae↗
PubMed1999

Acute cervical spine injuries: prospective MR imaging assessment at a level 1 trauma center.

PURPOSE: To determine the weighted average sensitivity of magnetic resonance (MR) imaging in the prospective detection of acute neck injury and to compare these findings with those of a comprehensive conventional radiographic assessment. MATERIALS AND METHODS: Conventional radiography and MR imaging were performed in 199 patients presenting to a level 1 trauma center with suspected cervical spine injury. Weighted sensitivities and specificities were calculated, and a weighted average across eight vertebral levels from C1 to T1 was formed. Fourteen parameters indicative of acute injury were tabulated. RESULTS: Fifty-eight patients had 172 acute cervical injuries. MR imaging depicted 136 (79%) acute abnormalities and conventional radiography depicted 39 (23%). For assessment of acute fractures, MR images (weighted average sensitivity, 43%; CI: 21%, 66%) were comparable to conventional radiographs (weighted average sensitivity, 48%; CI: 30%, 65%). MR imaging was superior to conventional radiography in the evaluation of pre- or paravertebral hemorrhage or edema, anterior or posterior longitudinal ligament injury, traumatic disk herniation, cord edema, and cord compression. Cord injuries were associated with cervical spine spondylosis (P < .05), acute fracture (P < .001), and canal stenosis (P < .001). CONCLUSION: MR imaging is more accurate than radiography in the detection of a wide spectrum of neck injuries, and further study is warranted of its potential effect on medical decision making, clinical outcome, and cost-effectiveness.

Acute Disease↗
PubMed2001

Schmorl nodes of the thoracic and lumbar spine: radiographic-pathologic study of prevalence, characterization, and correlation with degenerative changes of 1,650 spinal levels in 100 cadavers.

PURPOSE: To investigate the frequency and characteristics of Schmorl nodes in an elderly population and to correlate these findings with degenerative spinal changes. MATERIALS AND METHODS: Cadaveric thoracic and lumbar spines were removed at autopsy (mean age at death, 68.2 years; range, 43-93 years). Parasagittal sections of approximately 5-mm thickness were obtained and radiographed. At each of 3,300 endplates from T1 to L5, the presence of Schmorl nodes was noted. Vertebral endplate contour was analyzed, and abnormalities of the discovertebral junction were noted. The height of each interspace was measured, and the presence or absence of vacuum phenomena and spondylosis was recorded. RESULTS: Schmorl nodes were found in 58 specimens and were multiple in 41. Of 3,300 vertebral endplates, 225 revealed Schmorl nodes: 88 cranial and 137 caudal. More than 182 were between T7 and L2. Schmorl nodes correlated with disk space loss (P <.001) but not with evidence of advanced disk degeneration: marked disk space loss (P =.53), vacuum phenomena (P =.82), or discogenic sclerosis or erosion (P =.35). Schmorl nodes were associated with claw (P <.001) but not traction (P =.72) osteophytes. Straight (P <.001) and fractured (P <.001) vertebral endplates were associated with Schmorl nodes. CONCLUSION: Schmorl nodes are common in the spines in an elderly population, with a frequency similar to that in a younger population. Schmorl nodes are associated with moderate but not advanced degenerative changes. Geometric observations regarding the vertebral endplates support the concept that Schmorl nodes are caused by an abnormality of the discovertebral junction.

Adult↗