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PubMed1976

[EEG after so-called whiplash injury of cervical vertebral column (cervicocephalic acceleration trauma)].

The results of electroencephalographic examinations made on four groups of patients are compared. These groups include 80 patients with cervicocephalic syndromes due to flinging injuries to the cervical vertebral column, 80 patients with postconcussive syndromes, and 39 patients whose anamneses suggested conditions resulting from the two kinds of injury referred to above. A fourth group of 40 patients with nontraumatic spondylosis deformans cervicalis is compared with the first three groups of patients. The rate (49 percent, 52 percent, and 54 percent), kind, and distribution of electroencephalographically determined abnormalities are in agreement with those obtained for the first three groups. For patients with nontraumatic cervicocephalic syndromes the rate of general alterations determined from records obtained by means of the electroencephalograph is equal to the occurrence of constitutional EEG variants, the rate being of the order of 10 percent. EEG alterations observed in the case of flinging traumata are considered to de due to acceleration injuries to the cranial contents.

Accidents, Traffic↗
PubMed1999

[Results of cervical interbody fusion with coral grafts].

OBJECTIVES: We present the long term clinical and radiological results of a retrospective series of 46 cervical interbody fusions using coral grafts performed in 38 patients. MATERIAL AND METHODS: The patients were treated for prolapsed discs (19 cases) or cervical spondylosis (19 cases) with a clinical presentation of either radiculopathy (31 cases) or myelopathy (7 cases). We have done a post-operative clinical analysis of cervicoscapulalgia and radiculo-medullary symptoms and a radiological comparison of the change of the cervical spine angulation, the loss of height and the fusion rate at the graft site. RESULTS: The early clinical postoperative outcome showed that 10 out of 20 patients with excellent radiculo-medullary results had cervicoscapulalgia and 13 out of 18 patients with partial improvement had cervicoscapulalgia. No poor results according to our classification were noted. The late clinical outcome (average follow-up of 16 months) showed that 15 patients out of 31 had radiculo-medullary degradation and 24 presented with cervicoscapulalgia. Sixteen out of 20 patients had a loss of lordosis (range 6.2 degrees; SD 1.2) and 17 a loss of height (range 11.3%; SD 1.5). After 2 years, 13 out of 20 grafts were still hyperdense compared to the adjacent bone, and 8 had a hypodense peripheral edge. CONCLUSIONS: Coral grafts of this series have not been able to keep a physiological sagittal balance of the cervical spine, which is probably one of the essential factors to prevent postoperative cervicoscapulalgia. In the same way, the loss of height of the fused segments, by narrowing of the intervertabral foramen, may explain some further radiculo-medullary deterioration.

Adult↗
PubMed1999

[Young-adult-onset hereditary subcortical vascular dementia: cerebral autosomal recessive arteriosclerosis with subcortical infarcts and leukoencephalopathy (CARASIL)].

The clinical features of a probably autosomal recessive syndrome ("CARASIL"), yet to be confined in Japan and characterized by prematurity of vascular dementia, alopecia and spondylosis deformans are reviewed through comparison with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), which has been reported in Europe and North America, and recently in Japan. These two syndromes have many common features, such as familiality, encephalopathy of Binswanger type, and absence of vascular risk factors. There exists, however, a number of differences as follows: (1) Onset of encephalopathy is 32 years of age in "CARASIL" vs. 45 in CADASIL. (2) Male to female ratio is 3.2: 1 vs. 2:1.(3) Two thirds of "CARASIL" patients show stroke and/or stepwise deterioration, while almost all CADASIL patients have stroke. (4) Associated psychiatric features are euphoria, emotional lability and loss of spontaneity vs. severe mood disorders. (5) Migraine is a cardinal feature of CADASIL and vasospasm may occur during cerebral angiography. (6) White matter lesions on MRI are diffuse and homogeneous vs. punctuated and nodular. The latter four differences may mirror the difference in the pathology of arteriopathies. "CARASIL" is clearly different from CADASIL and reflect a second genetic condition with a seemingly direct effect upon the cerebral vasculature.

Age of Onset↗
PubMed1999

[Magnetic resonance imaging in the complex radiation diagnosis of tuberculous spondylitis in adults].

The paper analyzes X-ray study and MR imaging of 36 adult patients with tuberculosis spondylosis having an active process developed in maturity (n = 20) and sequelae of childhood spondylitis (n = 16). X-ray study is shown to retain its basic value in the diagnosis of spondylitis. MRI is the optimum technique for early diagnosis of inflammatory changes in the spine and soft tissues, the method of choice in neurological disorders.

Adult↗
PubMed1979

[Ossification of the posterior longitudinal spinal ligament--comparative studies with computerized tomography (author's transl)].

Ossification of the posterior longitudinal spinal ligament (OPLL) was characterized by calcified longitudinal band along the posterior margin of vertebrae, but it has not been possible to know how the cord is compressed within the narrowed spinal canal. Our neuroradiological studies based on CT-view of the 15 cases of OPLL suffering from various degree of myelopathy revealed: 1) Computed tomography precisely delineated shape of OPLL, which was quite polymorphic, like mushroom, irregular cubic and round. OPLL ranged more than two vertebrae was not uniform, but exhibited different configuration at each level. 2) OPLL at lower cervical and higher thoracic regions was difficult to diagnose by conventional lateral roentgenograms, but CT-scan demonstrated clearly whole extent of OPLL. 3) obliteration ratio of the affected spinal canal was calculated on CT-scan. Cases showing severe myelopathy, such as quadriparesis and neurogenic bladder, presented spinal canal stenosis of more than 30%. Spondylosis were concomittant roentgenographic findings on 13 cases of OPLL (87%). However, spondylotic changes responsible to the myelopathy were seen on only three cases. In these case, the obliteration ratio by ossificated ligament was lower than 26%. On conclusion, computed tomographic views of OPLL gave us more detailed information about the stenotic spinal canal and found to be essential examination when considering operative intervention.

Aged↗
PubMed1999

Posterior lumbar interbody fusion and cages.

The author of the paper presents an overview of posterior lumbar interbody fusion (PLIF), including a historical note, a global surgical strategy as well as specific indications for this procedure (discogenic low back pain, spondylosis, spondylolisthesis, recurrent disc herniation, failed chemonucleolysis, spinal stenosis). A short description of surgical technique can also be found in the paper. The author also emphasises the possible complications linked with this procedure and the need for experienced surgeons in order to decrease the number of postoperative complications. Finally the paper contains a short description of the most commonly used implants during surgical corrections of lumbar biomechanics.

Adult↗
PubMed1999

Anterior cervical stabilization with the synthes cervical spine locking plate system.

BACKGROUND: The Synthes cervical spine locking plate (CSLP) was originally designed by Mörscher and colleagues, who refined it to prevent the migration and loosening of a locking screw by using a cross-split screw head that could be locked into the plate. This eliminated the requirement of the posterior cortex purchase and thereby decreased the risk of spinal cord injury. The purpose of this report is to review our experience using the cervical spine locking plate system and to evaluate its ability to stabilize the cervical spine. METHODS: Twenty patients with cervical trauma, cervical spondylosis of failed anterior interbody fusion underwent anterior cervical fusion with the Synthes CSLP system between August, 1993, and April, 1996. All patients were evaluated preoperatively and postoperatively by plain radiography and magnetic resonance imaging (MRI). RESULTS: All 20 patients achieved solid bone fusion and 19 of them had neurologic improvement, by a mean follow-up period of 36 months. No patients suffered from neurologic injury as a result of the locking device. No patient demonstrated radiologic evidence of implant failure. The postoperative MRI examination disclosed minimal implant artifacts and adequate spinal cord decompression. CONCLUSIONS: The Synthes CSLP system for anterior stabilization provides efficacy, safety and ease of use. It also caused less distortion and minimal artifacts on postoperative MRI.

Adult↗
PubMed2000

[Spinal diseases and professional longevity of flying personnel].

Analyzed were histories of medically discharged (n = 727), physically qualified (n = 807), pilots and navigators, and flying personnel (n = 372) who had been repeatedly tested in one and the same hospital at the age of 34-36 yrs and 38-41 yrs. Spondylosis deformans is diagnosed more frequently in medically discharged than qualified flyers but, according to the covariation analysis, this is explained by elder age of the discharged persons. Physically fit persons with SD diagnosed at the age of 30-40 are prone to be grounded earlier than healthy persons. Compared with persons having other diagnoses, flying career (FC) will have longer if SD was stated at the age of 30, same if SD was stated at the age of 35, and shorter if SD was diagnosed at the age of 40. These differences remain statistically significant after covariation correction for specialty, age of entering military school and number of chronic diseases.

Adult↗
PubMed2000

[Anterior and antero-lateral surgery for degenerative cervical spine diseases. Role of graft and osteosynthesis. Analysis of practices of the French-speaking european neurosurgeons].

The neurological complications of cervical spondylosis depend on the direct or indirect effects of the mechanical compression of the spinal cord and roots. Nobody questions the interest of a surgical decompression, when the medical treatment is ineffective, but there is no consensus on the choice of the surgical approach and on the necessity of performing a graft with or without osteosynthesis after an anterior decompression. On the initiative of the French Speaking Neurosurgical Society (SNLF), we have analyzed the practices of its European members in 1998 and report here the results of this study which collects 3 645 surgical procedures for degenerative pathology of the lower cervical spine responsible for radiculopathy or myelopathy. An anterolateral approach was used in 85.3 % of all cases, among which 87.9 % of extensive discectomy (Smith Robinson or Cloward technique) and 12.1 % of median somatotomy. In case of discectomy, no grafting was performed in 34.7 % of cases, grafting without fixation in 25.7 %, grafting with plating in 14.9 %, interbody cages in 21.9 %, other techniques in 2.8 %. In case of somatotomy, no grafting was performed in 17.8 % of cases, grafting without fixation in 15.5 %, and grafting with plating in all other cases. When a graft was performed, an autograft was used in 59.5 % of cases, hydroxyapatite in 24.4 %, and many other bone substitutes in rare cases every time. For the fixation, monocortical screwing was used in 75 % of all cases, and bicortical in 25 %. The reasons for these practices are equivocal and not based on scientific attitude. The reasons given are : to avoid discal plucking, to prevent or treat kyphosis and postoperative spinal instability, to prevent cervical postoperative pain, to help eliminate osteophytes and hypertrophy of the ligamentum flavum.

Belgium↗
PubMed2000

[A case of juvenile bow hunter's stroke].

Bow hunter's stroke results from vertebrobasilar insufficiency caused by mechanical occlusion or stenosis of the vertebral artery at the C 1-2 level on head rotation. Commonly it is seen in elder people with cervical spondylosis. Here we reports a case of bow hunter's stroke in a 25-year-old male who complained of visual disturbance and syncope on rotation of the head 90 degrees or more to the left. This problem was frequently seen on driving a car. A cervical x-ray and MRI of the head revealed no abnormal findings such as atlantoaxial dislocation. Angiograms demonstrated obstruction of the right vertebral artery at the C 1-2 level on left rotation of the head. The hemodynamics on the circle of Willis were evaluated and surgical treatment was planned. The posterior fusion involving C 1-2 has long been used to limit atlantoaxial rotational movements. However, it has the serious disadvantage because the range of head motion is severely reduced. Recently decompression of the atlantoaxial portion of the affected vertebral artery has been used, but recurrence of occlusion with head rotation can be seen postoperatively. Since the patient could predict the onset of attack, we managed him conservatively, and no traffic accident reported during this period of observation. Due to several surgical disadvantages, we propose that whenever possible, patients with bow hunter's stroke should be managed conservatively especially in young patients.

Adult↗
PubMedDate not supplied

Review of myelograms in evaluation of spinal lesions prior to advent of computed tomography (CT) scan in Ghana.

We retrospectively reviewed myelographic appearances of 2005 patients in ten years prior to advent of computed tomography (CT) scan in three major hospitals in Ghana. 877 (43.75%) were normal and 1128 (56.25%) were pathological. The lesions detected were spondylosis 321 (28.22%), disc herniation 272 (24.37%) trauma 172 (15.25%), Pott's disease 133 (11.79%), spinal tumours 101 (8.96%); Arachnoiditis 74 (6.56%) and spinal stenosis 46 (4.07%). Myelography still remains the examination of choice in the investigation of spinal lesions in the sub-region.

Adolescent↗
PubMed1999

Clinical study on manipulative treatment of derangement of the atlantoaxial joint.

The derangement of the atlantoaxial joint is one of main cervical sources of dizziness and headache, which were based on the observation on the anatomy of the upper cervical vertebrae, analysis of X-ray film of the atlantoaxial joint, and the manipulative treatment in 35 patients with cervical spondylosis. The clinical diagnosis of derangement consists of: dizziness, headache, prominence and tenderness on one side of the affected vertebra, deviation of the dens for 1 mm-4 mm on the open-mouth X-ray film, abnormal movement of the atlantoaxial joint on head-rotated open-mouth X-ray film. An accurate and delicate adjustment is the most effective treatment.

Adult↗
PubMed2000

A comparative study of subsyde-CR versus meloxicam in rheumatic disorders.

A prospective, randomised comparative clinical study was conducted in adult patients of either sex presenting with articular and non-articular rheumatic conditions commonly encountered in clinical practice Rheumatoid arthritis, osteo-arthritis, cervical spondylosis, and lumbago/sciatica were the most frequent conditions encountered in both the groups, followed by others like tenosynovitis, frozen shoulder, prolapsed disc, fibrositis, myositis, sprains, strains and so on. The drugs that were employed for therapy were diclofenac in a controlled release formulation employing the DRCM technology (subsyde-CR) and meloxicam in a standard formulation marketed in our country. Both drugs were well tolerated and found to be effective in reducing the signs and symptoms of the disease entities throughout the study period, but subsyde-CR was observed to produce a somewhat greater reduction in signs and symptoms scores that meloxicam, a difference that could be possibly attributed to the greater efficacy of subsyde-CR in non-articular rheumatic conditions. On the basis of the available literature on diclofenac and meloxicam as well as the DRCM technology in formulating subsyde-CR, it is reasonable to conclude that a controlled release formulation of diclofenac based on the DRCM technology offers a safe and effective alternative to other non-steroidal anti-inflammatory drugs such as meloxicam.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2000

The accuracy of the emergency physician at diagnosing CVA/TIA in the acute care setting

OBJECTIVE: To determine the accuracy of the ED physician at diagnosing CVA/TIA in the acute setting. METHODS: We reviewed 246 patients admitted for acute CVA/TIA during 1997. We reviewed admitting and discharge diagnoses, CT, MRI, and MRA results. We also reviewed the medical histories of the patients. Patients with tumors and ICH diagnosed on the initial CT scan were excluded. RESULTS: A total of 241 patients were included for analysis. Of the patients admitted for CVA, 67% were discharged with the same diagnosis. Of the patients admitted for TIA, 82% were discharged with the same diagnosis. 10% of TIAs diagnosed at admission received the diagnoses at discharge. 22% of CVAs at admission were diagnosed as TIAs. 11% of CVA/TIAs at admission were given other diagnoses at discharge. Some of these diagnoses included hemiplegic migraines, Bell's palsy, lumbosacral spondylosis, giant cell arteritis, basilar artery aneurysm, and viral meningitis. In considering thrombolysis for CVA, one may then overtreat approximately 30% of patients and miss approximately 10% of patients who could be candidates for treatment. The NNT for CVA and thrombolysis is approximately 10. If 30% overtreatment rate is accurate, then the NNH is approximately 333 assuming an ICH rate of 1%. For 1,000 patients treated, 100 may benefit (improved function) and 3 would die who did not have the disease. CONCLUSIONS: The accuracy rate of the diagnosis of CVA at initial presentation is 67%. This is due to many initial neurologic changes being TIAs and some other diagnoses which can mask as CVA. Choosing thrombolysis for CVA treatment will involve treatment of many patients who do not have disease.

Journal Article↗
PubMed2000

Cervical spinal cord injury without radiological abnormality in adults.

Spinal cord injury occurring without concomitant radiologically demonstrable trauma to the skeletal elements of the spinal canal rim, or compromise of the spinal canal rim without fracture, is a rare event. Though documented in children, the injury is not very well reported in adults. We present seventeen adult patients with spinal cord injury without accompanying fracture of the spinal canal rim, or vertebral dislocation, seen over seven years. None had preexisting spinal canal stenosis or cervical spondylosis. Following trauma, these patients had weakness of all four limbs. They were evaluated by MRI (CT scan in one patient), which showed hypo / isointense lesion in the cord on T1 weighted images, and hyperintensity on T2 weighted images, suggesting cord contusion or oedema. MRI was normal in two patients. With conservative management, fifteen patients showed neurological improvement, one remained quadriplegic and one died. With increasing use of MRI in the evaluation of traumatic myelopathy, such injuries will be diagnosed more often. The mechanism of injury is probably acute stretching of the cord as in flexion and torsional strain. Management is essentially conservative and prognosis is better than that seen in patients with fracture or dislocation of cervical spine.

Adolescent↗
PubMed2000

Laminoplasty: an evaluation of 24 cases.

Cervical expansive laminoplasty has been advocated as an alternative procedure to laminectomy for the decompression of the cervical spine. It provides favourable cord decompression and stabilisation of the cervical spine and is a simpler and safer alternative to anterior fusion and laminectomy for myelopathy and myeloradiculopathy, due to multisegmental cervical spondylosis and ossified posterior longitudinal ligament. We report our experience in 24 patients with this procedure, 12 of whom had myelopathy and another 12 had myeloradiculopathy. The earliest symptom to improve was radicular pain or paraesthesia (75%). A reduction in spasticity was seen in 21 of the 24 patients (87.5%). Eleven patients had improvement in their motor power during a follow up period ranging from 1 month to 14 months. One patient deteriorated following the procedure and developed Brown Sequard features due to under riding of the lamina on the hinged side, another had severe post operative paraesthesias, while one patient had a CT scan evidence of 'closing of the door', without being symptomatic for it. The technique of the procedure is discussed and the pertinent literature reviewed.

Adult↗
PubMed2000

[Cervical myelopathy: diagnostic problems].

Non traumatic cervical myelopathy is a common disease. Spondylosis with or without discopathy is a major cause aside meningioma or myelitis. Most cases can get some benefit from neurosurgery. But in current practice the diagnosis encounters difficulties because of insidious course and non specific initial symptoms, so that we can think the disease remains a long time unknown. The review of 18 patients allows me to recall the criteria of diagnosis and to confirm the importance of neurological examination: thanks to it we can better focus on complementary exams (MRI, lumbar puncture, electrophysiology) and if necessary go round behind a deceptive radiologic "evidence".

Adult↗
PubMed2000

Anthropological and palaeopathological analysis of the human remains from three "Tombs of the Nobles" of the necropolis of Thebes-west, upper Egypt.

During several recent excavation campaigns at the necropolis of Sheikh-Abd-el-Gurna, Thebes-West, Upper Egypt, we investigated the human remains of three "Tombs of the Nobles" totalling at least 273 individuals. The investigation covered the human material (skeletons and mummy residues) from the tombs TT-84, TT-85 and TT-95. These tombs had been built in the New Kingdom (approx. 1500-1000 B.C.) and used until the Late period (up to 330 BC). All samples were analyzed macroscopically, isolated findings were further investigated by endoscopic and radiological techniques. The at least 273 individuals covered an age range from newborns to senile individuals with a main age of death between 20 and 40 years of age. The rate of infants and subadults was at 20.2% of all individuals and there was a slight male predominance comprising 54.5% of the adults. In this population a fairly high rate of pathological lesions was seen. Thus, dental conditions generally were poor with a high degree of dental abrasion, an also high rate of carious dental lesions (affecting between 13.8% and 27.7% of the yaws) and consequently a significant number of dental abscesses (mean 15.9%). Residues of trauma were observed in a considerable number of individuals ranging between 12.3% and 22.6% depending on the burial place (mean 15.8%). Inflammatory bone reactions (except the dental abscesses) were present to variable extent, in some locations ranging up to 6.8% of the cases (mean 5.1%). In addition, we noted several cases showing cribra orbitalia (mean 29.2%) and porotic hyperostosis (15.4% of cases), mild to severe osteopenia (7.5%) and in several cases subperiosteal new bone formation suggestive of chronic vitamin D-deficiency ("scurvy") (9.5%). The data support the notion of a significant impairment of living conditions in a high number of individuals. The rates of osteoarthrotic joint alterations were considerably variable depending on the burial places (between 1.9% and 18.5%) providing insight into the physical activities of subpopulations in different locations of the burial places. Similarly, the rate of spondylosis showed also variable extent ranging between 12% and 66.1% of vertebral bodies. In general, our analysis provides evidences that the living conditions in the ancient Egyptian population of one of the main necropoles of Thebes analyzed in this study were quite poor. This is somewhat in contrast to the usually assumed high standard of living of the socially higher population of the capital of ancient Egypt.

Adolescent↗