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PubMed1985

Operations for cervical spondylotic myelopathy. A comparison of the results of anterior and posterior procedures.

Over the past 19 years we have operated on 269 patients with myelopathy associated with cervical spondylosis. We report our results in 191 cases which we have followed up for 1 to 12 years (average 31 months). The clinical state before and after operation was recorded using the criteria of the Japanese Orthopaedic Association. Posterior operations gave better results than anterior for the more advanced myelopathies such as transverse lesions, the Brown-Séquard syndrome and the motor syndromes, but the brachialgia and cord syndrome and the central cord syndrome were satisfactorily treated by anterior operations. Of the three anterior and three posterior techniques used, no single one showed an overall superiority. A short duration of symptoms before operation was associated with better results, but these were not influenced by the age of the patients.

Adult↗
PubMed1986

Rheumatoid arthritis of the thoracic and lumbar spine.

We report seven cases of patients with seropositive rheumatoid arthritis in whom involvement of the thoracic and lumbar vertebrae occurred. Histological corroboration is presented in four. Pathological lesions comprised various combinations of paravertebral joint erosions, erosive discitis, anteroposterior and rotatory instability, major lumbar nerve root compression, and vertebral collapse. Specific radiological features are presented, enabling a distinction to be made between pure degenerative spondylosis and rheumatoid spondylitis. We submit that subcervical rheumatoid spondylitis is commoner than is generally believed, though less common than rheumatoid involvement of the cervical spine.

Aged↗
PubMed1998

Radiculopathy after laminectomy for cervical compression myelopathy.

Postoperative radiculopathy is a complication of posterior cervical decompression associated with tethering of the nerve root. We reviewed retrospectively 287 consecutive patients with cervical compression myelopathy who had been treated by multilevel cervical laminectomy and identified 37 (12.9%) with postoperative radiculopathy. There were 27 men and ten women with a mean age of 56 years at the time of operation. The diagnosis was either cervical spondylosis (25 patients) or ossification of the posterior longitudinal ligament (12 patients). Radiculopathy was observed from four hours to six days after surgery. The most frequent pattern of paralysis was involvement of the C5 and C6 roots of the motor-dominant type. The mean time for recovery was 5.4 months (two weeks to three years). The results at follow-up showed that the rate of motor recovery was negatively related to the duration of complete recovery of postoperative radiculopathy (gamma=-0.832, p < 0.01) and that patients with spondylotic myelopathy had a significantly better rate of clinical recovery than those with ossification of the posterior longitudinal ligament (t=2.960, p < 0.01). Postoperative radiculopathy may be prevented by carrying out an anterior decompression in conjunction with spinal fusion, which will achieve stabilisation and directly remove compression of the cord at multiple levels.

Adult↗
PubMed1998

A new method of stabilising the elevated laminae in open-door laminoplasty using an anchor system.

We treated 12 patients with multilevel stenosis of the cervical canal after spondylosis or ossification of the posterior longitudinal ligament by an expansive open-door laminoplasty, stabilised by using an anchor system. The preoperative sagittal diameter of the canal was 9.8 mm(+/-2.2) which was increased to 16.1 mm(+/-2.9) after surgery. The mean expansion ratio of the canal was 64% (42 to 100). The anchoring systems did not fail during the follow-up period (mean 29.5 months), and the decompression was maintained. The use of anchor systems to stabilise the posterior elements after laminoplasty is a simple and effective technique for maintaining the increased sagittal diameter of the canal.

Aged↗
PubMed2004

Retro-pharyngeal obstruction in association with osteophytes of the cervical spine.

We describe five patients with cervical spondylosis and large anterior osteophytes causing pharyngeal compression. All had dysphagia, two had obstructive sleep apnoea and another two had dyspnoea and stridor on inspiration. One, with perforation of the pharynx, required emergency tracheostomy. Only three had pain in the neck or arm. Compression of the retroglottic space was confirmed in all patients by pharyngoscopy and in all the symptoms were relieved by excision of the osteophytes. Three also underwent intervertebral fusion. One had some persistent sleep apnoea.

Adult↗
PubMed1984

Cervical myelopathy treated by canal-expansive laminaplasty. Computed tomographic and myelographic findings.

The operation known as canal-expansive laminaplasty has the following advantages over wide laminectomy: (1) osseous protection of the spinal cord is retained, (2) the invasion of the cord by scar tissue is minimized, and (3) the stability of the spine is retained. We are reporting the clinical, computed tomographic, and computed myelographic findings before and after this operation in twenty-four patients with cervical myelopathy due to cervical spondylosis, spinal stenosis, or ossification of the posterior longitudinal ligament. The clinical results were excellent in four patients, good in eighteen, and fair in two. Symmetrical expansion of the spinal canal was clearly demonstrated by computed tomograms, and the metrizamide ring on the myelograms had a normal rounded curvature.

Cervical Vertebrae↗
PubMed2004

Prevention and management of iatrogenic flatback deformity.

The most common cause of iatrogenic flatback syndrome is Harrington distraction instrumentation extending into the lower lumbar spine. Other common causes and exacerbating factors include failure to enhance regional lordosis during lumbar fusion for degenerative spondylosis, development of pseudarthrosis or postoperative loss of correction, development of kyphosis at the thoracolumbar junction, development of degeneration and decompensation cephalad or caudad to a prior fusion, and hip flexion contractures. Prevention of flatback syndrome involves preoperative assessment of sagittal balance, avoidance of distraction instrumentation and extension of long fusions into the lower lumbar spine, enhancement of physiologic lordosis during lumbar fusions, and intraoperative positioning with the hips extended. Treatment of flatback syndrome involves corrective pedicle subtraction or Smith-Petersen osteotomies with segmental instrumentation. Polysegmental osteotomies and vertebral column resection may be utilized in cases of sloping global sagittal imbalance and related severe coronal imbalance, respectively. Following surgical treatment, sagittal balance is generally improved with fair-to-good clinical outcomes, high patient satisfaction, and moderately high perioperative complication rates.

Humans↗
PubMed1989

[Surgical treatment of cervical spondylotic radiculomyelopathy with abnormal involuntary neck movements. Report of three cases].

Cervical spondylotic myelopathy usually arises in patients in their late 40s or early 50s, most frequently at the C5/6 and C6/7 levels. Recently, excellent results have been attained with microsurgery in cases of cervical spondylosis. On the other hand, treatment of cervical spondylotic myelopathy in patients with athetoid dystonic cerebral palsy entails several problems. The authors report three cases of such troublesome myelopathy. A 34-year-old male with severe athetoid movement showed cervical spondylotic myelopathy. Myelography and magnetic resonance (MR) imaging demonstrated compression of the spinal cord through the C3-C5 levels. A 47-year-old female with athetoid dystonic cerebral palsy presented myelopathy. Myelography and MR imaging showed instability and spinal cord compression at the C5/6 level. A 34-year-old male with spasmodic torticollis showed C6 radiculopathy due to cervical disc hernia at the C5/6 level. Cervical anterior decompression with interbody fusion brought temporary improvement in all the three patients. However, such problems as slippage of Halo-vest, difficulty in eating during Halo-vest fixation, relapse of neurological deficit, were experienced. Due to postoperative cervical instability, cervical laminectomy is considered to be contraindicated in such patients. Anterior decompression with bone fusion has been reported effective, but, if athetoid dystonia continues, there is a potential for myelopathic deterioration due to spondylotic changes adjacent to the fused vertebrae.

Adult↗
PubMed1991

[Clinical analysis of ossified thoracic ligaments and thoracic disc hernia].

Thoracic lesions present several clinical problems, particularly in their diagnosis and treatment, compared with cervical or lumbar lesions. Since 1983, 18 cases of thoracic space lesions, excluding spinal tumors or trauma have been experienced: nine cases of ossification of yellow ligament (OYL), five of ossification of posterior longitudinal ligament (OPLL), and four of disc hernia (DH). In these 18 patients, problems of clinical manifestations, neuroradiological examination, and surgical approaches are analyzed and discussed. As clinical manifestations, there was a preponderant occurrence in males in the OYL group, while in the OPLL group all the patients were females. OYL and DH occurred at lower thoracic levels. Thirteen of the 18 patients showed combined lesions either in the cervical or in the lumbar regions, such as cervical OPLL, cervical spondylosis, lumbar DH, and lumbar canal stenosis. In the neuroradiological examinations diagnosis of the upper thoracic lesions was difficult. Computed tomography (CT) scan with intrathecal metrizamide injection seemed essential for examination of ossified thoracic lesions. However, because CT imaging of the entire spine is impractical, efficient use of this examination requires previous localization of the offending vertebral level from either the neurological findings or other neuroradiological examinations such as myelography. Magnetic resonance imaging seemed most useful for ruling out the thoracic compressing lesions. As for surgical approaches, posterior decompression was effective for OYL and the anterior approach was useful for OPLL and DH. In patients with "tandem lesions," neurological and neuroradiological findings played an important role in deciding the responsible site.

Aged↗
PubMed2003

Long-term outcome for surgically treated cervical spondylotic radiculopathy and myelopathy.

Long-term follow-up results were examined to verify the efficacy of anterior osteophytectomy for cervical spondylotic myelopathy and radiculopathy, in particular the outcome for patients with developmentally narrow cervical canals and patients with associated ossification of the posterior longitudinal ligament (OPLL). One hundred thirty-nine patients who had undergone anterior osteophytectomy with interbody fusion between 1976 and 1990 were followed up for 1 to 22.5 years (mean 11.4 years). Overall results evaluated by the neurosurgical cervical spine scale scoring and grading showed significant improvement in both improvement score (2.7 +/- 2.3) and improvement rate (52.3 +/- 45.7%). Lower extremity motor function improved in 66.1% of patients, upper extremity motor function in 82.0%, and sensory/pain function in 70.5%. Improvement ranged from one to three grades. Severely affected patients showed good recovery. Outcome for patients with narrow cervical canals (41 patients, 29.5%) did not differ significantly from that for patients with normal canals (98, 70.5%). Patients with associated OPLL (32 patients, 23.0%) had approximately the same outcomes as those with only spondylosis (107, 77.0%). Fifteen patients (10.8%) underwent reoperation because of myelopathy due to disc degeneration adjacent to the fused level (11 patients) or OPLL (4 patients). Anterior osteophytectomy with interbody fusion can achieve good outcomes in patients with cervical spondylotic myelopathy and radiculopathy, regardless of the size of the spinal canal and association with OPLL.

Adult↗
PubMed1983

NMR imaging of the spine.

The usefulness of nuclear magnetic resonance (NMR) images in the evaluation of spinal disorders below the craniocervical junction was studied. Six normal subjects and 41 patients with various spinal abnormalities were examined. NMR proved capable of demonstrating important normal and pathologic anatomic structures; it was useful in the evaluation of syringohydromyelia and cystic spinal cord tumors, and the bright signal intensity of lipoma was quite impressive. In the evaluation of herniated disk, NMR images offered a new perspective by visualizing abnormal degradation of the signal intensity of the nucleus pulposus itself. NMR images were least valuable in the evaluation of spondylosis and spinal stenosis. Although NMR imaging of the spine is still in a very early developmental stage, the absence of both ionizing radiation and risks associated with contrast material makes it especially attractive as a new diagnostic method. This limited experience with currently available equipment suggests that, with technical refinement, the efficacy of NMR of the spine will increase.

Adolescent↗
PubMed1998

Use of lumbosacral spine radiographs in a level II emergency department.

OBJECTIVE: We studied indications for lumbosacral spine radiographs in an emergency department setting. SUBJECTS AND METHODS: Clinicians completed a lumbosacral spine request form before obtaining lumbosacral radiographs on 482 patients who were examined in a level II emergency department. The clinicians detailed the indications for the examination, their suspected clinical diagnoses, and the expected effect of the lumbosacral spine study on management. In addition, the duration of the patients' symptoms was recorded as well as their age and sex. These data were compared with the actual radiographic findings as interpreted by board-certified musculoskeletal radiologists. RESULTS: Major indications for lumbosacral radiographs were lower back pain (92%) and trauma (36%). Patient expectation and medicolegal concerns, related either to insurance documentation or to physician litigation, were cited in 42% of cases. A neurologic deficit was present in 88% of patients, and a history of neoplasm was elicited in 4%. Strain (56%) and fracture (20%) were the most commonly suspected clinical diagnoses. Radiographs showed either normal findings or spondylosis in 86% of cases. Fractures, of which 10 were definitely acute, were identified in 55 patients. No fracture required decompression. Neoplastic involvement was found in seven patients, all of whom had histories of osseous metastases. Neurologic deficit, present in 37 patients, did not correlate with abnormalities seen on lumbosacral radiographs. CONCLUSION: As with studies of lumbosacral spine radiographs obtained in outpatient settings, our data from a level II emergency department support the use of lumbosacral spine radiographs for patients with a history of trauma, even if relatively minor, in elderly patients and in patients with lower back pain who have a history of neoplasm. Lumbosacral radiographs obtained for an isolated complaint of lower back pain generally provide no clinically useful information. Similarly, lumbosacral radiographs obtained for patients with isolated neurologic abnormalities are unrevealing. Such patients are better examined (although not necessarily at the time of emergency department evaluation) with techniques such as MR imaging that show soft-tissue lesions.

Aged↗
PubMedDate not supplied

[Comorbidity of migraine and somatic diseases].

INTRODUCTION: A 5-year prospective follow-up study was performed at the Institute of Mental Health in Belgrade, and it included adult patients diagnosed with migraine. MATERIAL AND METHODS: A protocol for prospective follow-up of comorbiditiy of migraine and somatic diseases was designed, whereas data were analyzed using standard statistical methods. RESULTS: The study comprised 381 patients, mean age 35.8 (range 19-60) years, 60 (15.8%) males and 321 (84.2%) females. The mean duration of migraine history before the first visit to the doctor was 7.7 (0-36) years. There was no concomitant disease in 50.5% of examinees. The most common concomitant diseases in the study population were: spondylosis (15.9%), head injury (12.9%), gynecological disorders (11.6% of female subgroup), hypotension (8.8%), hypertension (8.5%), allergy and asthma (5.8%), various cardiovascular diseases (4%) and epilepsy (3%). The incidence of the majority of diseases is in accordance with known epidemiological data for general population (except for head injury and epilepsy). In the subgroup of patients with comorbidity, almost 70% of patients reported more than one migraine attack per month, compared to 35% of patients without concomitant diseases, and about 60% of them had a higher intensity of headache in comparison with 35% of those without comorbidity. CONCLUSION: Present results indicate an increased severity of migraine attacks in patients with comorbidity. Therefore, it is necessary to assess how good management of comorbid diseases can alleviate the course and intensity of migraine headaches.

Adult↗
PubMed2001

Development of new surgical treatments in spinal surgery: expansive open-door laminoplasty and percutaneous nucleotomy.

The outstanding achievements of two renowned spine surgeons, who are alumni of the Department of Orthopaedic Surgery, Keio University, are described. Anterior decompression followed by fusion and laminectomy had been the standard techniques for cervical myelopathy due to disc herniation, spondylosis and ossification of the posterior longitudinal ligament. However, both techniques were not without certain comorbidities. Dr. Kiyoshi Hirabayashi devised an epoch-making expansive open-door laminoplasty, in which both sufficient posterior decompression and preservation of cervical stability are achieved simultaneously with reduced risk of such complications. Dr. Sadahisa Hijikata is the pioneer of a totally new concept treatment, percutaneous nucleotomy, for lumbar disc herniation, one of the most prevailing diseases that cause low back pain and sciatica. He devised this technique to avoid prolonged conservative treatment with associated suffering of the patients and to minimize the chance of morbidity that is occasionally associated with an open surgery. This technique, together with chemonucleolysis, has led to the establishment of intradical or intermediate treatments which lie between conservative and surgical treatments. Both techniques have not only brought the relief of pain and suffering in numerous patients, but have also opened the door to the development of many new modified procedures and technologies. Most importantly, these two techniques still remain as the most viable choice among various similar modifications. The rationale, indictions, technique as well as the present status and future perspective for these two innovative yet fundamental techniques are introduced and discussed.

Cervical Vertebrae↗
PubMed1987

Cervical disc prolapse in the elderly: an easily overlooked, reversible cause of spinal cord compression.

It is important to distinguish cord compression due to cervical disc prolapse, which has a very favourable prognosis following surgery, from that due to cervical spondylosis. In the elderly the occurrence of cervical disc prolapse as a cause of spinal compression may be under-recognised because symptoms are too readily attributed to long standing degenerative changes on plain cervical X-rays. The difficulty of making an accurate diagnosis is complicated further in the elderly by the prevalence of other diseases which may mask the symptoms of cord compression. We report our experience with 19 patients over 60 who underwent anterior cervical discectomy for myelopathy due to intervertebral disc prolapse. There was generally a short history of walking difficulty, but the presence of 'numb clumsy hands', perhaps due to selective posterior column impairment, was often a more disabling complaint. Neck pain and disturbances of micturition were unusual. The prognosis after disc excision can be excellent. In this series all the severely disabled patients returned to an independent existence. Overall 16/19 patients made an excellent or good recovery.

Aged↗
PubMed1995

A cohort study with regard to the risk of haematological malignancies in patients treated with x-rays for benign lesions in the locomotor system. I. Epidemiological analyses.

Roentgen treatment for painful benign conditions in the locomotor system as arthrosis and spondylosis was in Sweden very common up to the beginning of the 1960s. The mode of treatment differed from the British ankylosing spondylitis series as smaller parts of the red bone marrow were exposed and smaller doses were applied. A cohort of 20,024 such patients treated 1950-1964 at two hospitals in northern Sweden was analysed with regard to the risk of haematological malignancies. Average factors for conversion of prescribed skin doses to mean absorbed red bone marrow doses were estimated on random samples of the different treatment sites and then applied on the cohort in its whole. The standard incidence ratio (SIR) for leukaemia was 1.18 (95% CI: 0.98-1.42) and the standard mortality ratio (SMR) 1.25 (0.99-1.45). In the highest dose group (mean absorbed red bone marrow dose > 0.5 Gy) the corresponding values were 1.40 (1.00-1.92) and 1.50 (1.08-2.04). In the mortality analysis also a slightly increased myeloma risk was noted with SMR = 1.20 (0.99-1.56). Extension of the cohort and nested case-control studies are under progress.

Adult↗
PubMed1989

Pathoanatomical changes in the thoracolumbar junctional region of the spine.

The thoracolumbar junctional region (T10-L1) of the spine is a transitional zone, where more than half of the thoracic and lumbar fractures occur. In this presentation the origin of the pathoanatomical changes in the thoracolumbar junctional region of the spine is discussed in view of the previous studies. These studies refer to a torsional force contributing to the formation of the degenerative changes, especially in the facet joints. Degenerative changes anteriorly and posteriorly do not concur in the thoracolumbar junctional region. Only a weak concurrence is found between disc degeneration and spondylosis, which refer to differences in their pathomechanisms. A strong concurrence between the degenerative changes at different levels, especially anteriorly, reflects factors causing overall degeneration in the thoracolumbar junctional region.

Humans↗
PubMed1996

Cervical spinal epidural haematoma: the double jeopardy.

Spontaneous spinal epidural haematoma is an unusual but well recognized cause of compressive myelopathy or cauda equina syndrome. Radicular pain is one of the earliest symptoms and a hallmark of spontaneous spinal epidural haematoma, as in the case of cervical spondylosis and disc prolapse. Should an epidural haematoma be located in the cervical spine, the resultant cervical radicular pain may sometimes be erroneously attributed to a cardiac cause, especially in the setting of pre-existing cardiac disease. The error in diagnosis can lead to another pitfall, the addition of heparin. If the etiology of the pain is a cervical epidural haematoma this can have grave consequences. Moreover, patients with cardiac ischemia who are treated with anticoagulants may rarely develop a cervical epidural haematoma. The resulting radicular pain can overlap with cardiac pain and escape recognition. Symptoms of neck and upper extremity pain with bilateral signs of myelopathy with a sensory level should lead to a suspicion of acute cervical cord compression. The addition of heparin can only compound the disastrous consequence of a rapidly expanding spinal epidural haematoma. The following cases illustrate this diagnostic and therapeutic conundrum.

Aged↗