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PubMed2001

Spinal cord injury.

OBJECT: It is known that the spinal cord can sustain traumatic injury without associated injury of the spinal column in some conditions, such as a flexible spinal column or preexisting narrowed spinal canal. The purpose of this study was to characterize the clinical features and to understand the mechanisms in cases of acute cervical cord injury in which fracture or dislocation of the cervical spine has not occurred. METHODS: Eighty-nine patients who sustained an acute cervical cord injury were treated in our hospitals between 1990 and 1998. In 42 patients (47%) no bone injuries of the cervical spine were demonstrated, and this group was retrospectively analyzed. There were 35 men and seven women, aged 19 to 81 years (mean 58.9 years). The initial neurological examination indicated complete injury in five patients, whereas incomplete injury was demonstrated in 37. In the majority of the patients (90%) the authors found degenerative changes of the cervical spine such as spondylosis (22 cases) or ossification of the posterior longitudinal ligament (16 cases). The mean sagittal diameter of the cervical spinal canal, as measured on computerized tomography scans, was significantly narrower than that obtained in the control patients. Magnetic resonance (MR) imaging revealed spinal cord compression in 93% and paravertebral soft-tissue injuries in 58% of the patients. CONCLUSIONS: Degenerative changes of the cervical spine and developmental narrowing of the spinal canal are important preexisting factors. In the acute stage MR imaging is useful to understand the level and mechanisms of spinal cord injury. The fact that a significant number of the patients were found to have spinal cord compression despite the absence of bone injuries of the spinal column indicates that future investigations into surgical treatment of this type of injury are necessary.

Adult↗
PubMed2001

[Personal experience with surgical treatment of degenerative diseases of the cervical spine using an anterior approach].

In 1995 to 1999 the authors operated on account of cervical spondylosis, using an anterior approach and methylmethacryl filling of the intervertebral space 57 patients. The mean period of hospitalization was 6.2 days (4-9 days). The clinical condition was evaluated 1, 3, 6, and 12 months after surgery. In 55 patients also X-ray pictures were evaluated. One year after surgery in a group of 14 patients with radiculipathy complete restoration of the condition occurred in 13 patients, improvement was recorded in one patient. In a group of 4 patients with myelopathy the condition did not change in two patients and in two deterioration was recorded. In a group of 39 patients with radiculo- and myelopathy improvement of the condition was recorded in 30 and the condition was unaltered in 9 patients. X-ray examination revealed bridging of the intervertebral space in 11 patients, mobility in the operated segment in 8 and a slight shift of the graft in three instances. The submitted results are comparable with those of other authors.

Adult↗
PubMed2001

[Nerve conduction velocity of repeater F-waves is identical to that of M-waves].

F-wave normally varies in latency and waveform from one response to the next. But the number of identical responses in a series of F-waves may be increased with neurogenic atrophy consistent with a decreased number of motoneurons capable of responding to antidromic stimulation. They are called "repeater F-waves". We herein demonstrate some repeater F-waves observed in three patients with moderate or slight diabetic polyneuropathy. In their motor nerve conduction studies on the peroneal nerve the maximum conduction velocity was 33 m/sec in patient 1, 36 m/sec in patient 2 and 48 m/sec in patient 3. A total of 6 delayed indirect potentials were repeatedly evoked after nerve trunk stimulation. They fulfilled the characteristics of F-wave. Their conduction velocities in the leg segment were 27, 26, 23 m/sec in patient 1, 34, 33 m/sec in patient 2 and 46 m/sec in patient 3. Repeater F-waves are occasionally observed in patients with amyotrophic lateral sclerosis, cervical spondylosis or entrapment neuropathies, in which the number of motoneuron is decreased. In diabetic polyneuropathy some repeater F-waves were also observed in patients not only with moderate to severe neuropathy but also with normal nerve conduction. F-waves are generated by an antidromic backfiring of motor neurons, and they occur preferentially in large motor neurons. Larger motor neurons inhibit smaller axons through the activation of Renshaw cells. In our 3 patients conduction velocities of the repeated F-waves were all identical to the main component of M-wave. These observations reconfirmed the hypothesis that relatively large motor neurons generating F-waves are preferentially activated also in repeater F-waves.

Aged↗
PubMed1999

[Radiculopathy after cervical laminectomy].

OBJECTIVE: To investigate radiculopathy after multilevel laminectomy in patients with cervical compression myelopathy and underlying mechanism. METHODS: We retrospectively reviewed 287 consecutive patients with cervical compression myelopathy treated by multilevel cervical laminectomy and identified 37 patients (12.9%) with postoperative radiculopathy. There were 27 men and 10 women, with an average age of 56 years at time of surgery. The diagnosis was either cervical spondylosis (25 patients) or ossification of the posterior longitudinal ligament (12 patients). RESULTS: Radiculopathy was observed from 4 hours to 6 days after surgery. The most frequent patterns of paralysis were C(5) and C(6) root involvements of the motor-dominant type. All patients showed complete recovery in 2 weeks to 3 years (average, 5.4 months). Follow up results showed that the recovery rate was negatively related to the duration of complete recovery of postoperative radiculopathy (r = -0.832, P < 0.01) and the patients with spondylotic myelopathy had a significantly better clinical recovery rate than those with ossification of the posterior longitudinal ligament (t = 2.960, P < 0.01). CONCLUSIONS: Postoperative radiculopathy is complicated with posterior cervical decompression and associated with tethering effect upon the nerve root. More logical procedures for prevention of postoperative radiculopathy are decompression through an anterior decompressive procedure in conjunction with a spinal fusion, which may achieve stabilization and directly remove all of the anterior spinal cord compression at multiple levels.

Adult↗
PubMed2000

Experimental study on mechanism of vertebral osteophyte formation.

OBJECTIVE: The purpose of this experimental stud y was to explore the mechanism of the vertebral osteophyte formation. METHODS: An experimental model of cervical spondylosis in rabbits was established by resection of the cervical supraspinous and interspino us ligaments and detachment of the posterior paravertebral muscles from cerv ical vertebrae. Because of individual difference, the natural development proced ure of the vertebral osteophyte formation could be seen with a microscope by dyn amic observation. RESULTS: The cartilage end-plate was divided into a growth car tilage layer and an articular cartilage layer. Vertebrae and discs from the 3-m onth control group rabbits showed normal structure. The changes of cartilage pla tes from the 3-month experimental group and the 8-month control group animals showed proliferation in peripheral articular cartilage. The osteophytes from the 8-month experimental group animals could be seen. The osteophyte obviously ari sed from proliferation, calcification and ossification of the peripheral articul ar cartilage. CONCLUSIONS: The vertebral osteophyte arises from proliferation of peripheral articular cartilage which undergoes cartilaginous osteophyte, and then changes into bony osteophyte through an endochondral calcification and ossification.

Journal Article↗
PubMedDate not supplied

[Microsurgical treatment of compression of the rear wall of the spinal artery in intervertebral arthrosis].

Vertebral artery stenosis caused by cervical spondylosis is generally caused by compression of the artery by osteophytes arising from an uncinate process. Compression caused by facet joint osteophytes is rarely reported. The paper shows that compression may also occur posteriorly by osteophytes from the facet complex. Careful evaluation of preoperative angiograms and computed tomographic or MRI scans is required to determine whether an anterolateral, posteriorlateral or posterior approach might be more beneficial for decompression.

Arteries↗
PubMed2002

[Multiorgan tuberculosis: central peripheral hemodynamic features].

The paper deals with the study of central and peripheral hemodynamic features in patients with multiorgan tuberculosis. The study is based on the analysis of examination findings and treatment outcomes in 42 patients with concurrent tuberculosis of the lung and vertebral column. A control group consisted of 46 patents with spinal tuberculosis. The authors provide evidence that concurrent pulmonary and spinal tuberculosis substantially makes basic central and peripheral hemodynamic parameters worse in patients with tuberculosis spondylosis, aggravates their general condition, requires cardiotropic therapy on an individual basis, substantially prolongs preoperative preparation and postoperative rehabilitation.

Adult↗
PubMed1975

[Differentiation of spondylitis ankylopoietica and spondylitis hyperostotica].

Changes in the bodies of vertebrae in ancylopoetic spondylitis (Bekhterev's disease) and in hyperostotic spondylitis (Forestier's disease) may be very similar, in particular as regards the ancylotic connection of the bodies of the vertebrae and syndesmophytes. In the differential diagnosis the following differences are important: Syndesmophytes in Bekhterev's disease are symetrical and continuous, there is ossification of the intervertebral discs, and ancylosis affects always sacroiliac, intervertebral and costovertebral joints. In hyperostotic spondylosis the sclerotic syndesmophytes bulge in a lateral direction, mainly to the right. The inveretebral discs do not ossify, the sacroilliac and other above mentioned joints are not affected.

Aged↗
PubMed1975

Spinal cord injury as a complication of elective anterior cervical fusion.

The true incidence of spinal cord injury as a complication of elective anterior discectomy and interbody fusion is not known. It would appear that the risk of encountering this complication increases if the surgical procedure includes instrumentation within the spinal canal. In 5 of the cases reported herein the cause for spinal cord injury was identifiable; in the remaining 5, the mechanism of injury is either obscure or not reported. All 10 patients reported had their surgery performed using the drill and dowel technique. The role of the posterior osteophyte in spondylosis and the rationale for routinely entering the spinal canal in order to decompress the spinal cord and nerve roots are examined. Since the majority of refractory disk problems that require surgery can be satisfactorily managed by discectomy and interbody fusion alone, routine instrumentation within the spinal canal may be an avoidable hazard in the majority of instances. The pathogenesis and prognosis of the anterior cord syndrome is reviewed, a possible etiology is suggested, and the anatomy, the autonomy and the importance of the anterior spinal artery system are noted. Its vulnerability in the treatment of degenerative disk disease and a possible mechanism for its occult impairment is mentioned.

Adult↗
PubMedDate not supplied

[Multisegmental spondylotic cervical myelopathy treated by longitudinal medial corporectomy without fusion].

INTRODUCTION: The treatment of cervical spondylosis may be medical, surgical or both. Surgical treatment is indicated mainly in patients with untreatable pain, progressive neurological deficit and proven compression of the nerve roots and spinal cord. Corporectomy with a graft and fusion is one of the most widely used techniques carried out by neurosurgeons and orthopaedic surgeons using an anterior approach. PATIENTS AND METHODS: Between January 1993 and December 2000, six patients aged between 62 and 75 years, with a median age of 68.5 years, clinically and radiologically diagnosed as having multisegmental spondylotic cervical myelopathy, had surgical operations involving corporectomies without grafts. Nurick s scale was used to classify symptoms and radiological assessment was done before and after operation using plain Xrays, three dimensional computerized tomography and magnetic resonance. In one case one corporectomy was done, in two cases two and in three cases three. RESULTS: The patients follow up varied from 3 months to seven years. In four patients symptoms improved, two became stable and in no case was there any radiological sign of vertebral instability. As far as we know after reviewing the literature, this is the first time that this technique has been published. CONCLUSIONS: Corporectomy without grafting is a new, simple, effective technique for the treatment of multisegmental spondylotic cervical myelopathy.

Aged↗
PubMed2002

Polylactic acid mesh reconstruction of the anterior iliac crest after bone harvesting reduces early postoperative pain after anterior cervical fusion surgery.

OBJECTIVE: Autologous iliac crest bone enhances the rate of spinal arthrodesis. However, graft site complications are common, with donor site pain being particularly troublesome. Reconstruction of the hip defect with an absorbable polylactic acid mesh to restore the bony cortical contour has been proposed to reduce hip pain. METHODS: Thirty-nine consecutive patients treated by a single senior surgeon (BAG) during a 14-month period were studied. All patients had cervical spondylosis treated through an anterior approach supplemented with an autologous hip graft. Patients with preexisting hip pain were excluded. Pain was rated on a scale of 1 to 10 at 1 week and 3 months after surgery via a questionnaire. Postoperative pain medication regimens were standardized. RESULTS: Thirty patients were available for follow-up, 15 with mesh implantation and 15 without. Hip pain in the mesh-treated group averaged 4.7 and 1.6 at 1 week and 3 months, respectively. Hip pain in the standard-treatment group averaged 6.9 and 2.5 at 1 week and 3 months, respectively. These differences were statistically significant (P = 0.004 at 1 wk and 0.055 at 3 mo). Hospital length of stay was shorter in the mesh-treated group (2.1 versus 3.2 d, respectively), but this difference was not statistically significant. Two patients without mesh treatment complained of the cosmetic defect resulting from absent bone, and three had temporary difficulty with hip eversion or flexion. Two patients in the mesh-treated group developed seromas, which were treated conservatively. CONCLUSION: Reconstruction of the iliac crest reduces early postoperative pain. Other potential benefits may include shorter hospitalizations and a reduced incidence of hip weakness; however, careful attention to wound closure is necessary to prevent seroma formation.

Cervical Vertebrae↗
PubMed2002

[Goethe's skull and skeleton].

In 1970 there was a conservation of Goethe's skeleton, housed in the Fürstengruft in Weimar. This procedure was kept secret until 1999. The restoration of the sarcophagus and the conservation of the skeleton have been documented together with many photos in the so-called "Sonderakte Mazeration Goethe" (special file mazeration Goethe). In this special file there are also photos of Goethe's skull and skeleton which will be published here for the first time and analysed under anthropological and palaeopathological aspects. A short description of the skull will be given. The dentition of Goethe at the time of his death and the question of progenia in Goethe's family are discussed in detail. Data on Goethe's stature obtained from the skeleton qualify statements of Goethe's contemporaries. Among the few documented pathological changes the ankylosis of eight thoracal vertebrae (T 5-12) and five right ribs are of special interest, caused by the loss of the intervertebral discs, spondylosis deformans and Morbus Forestier. A connection between this ankylosis and the known stiff posture and stiff gait of Goethe is obviously and possibly dates back to Goethe's fortieth years of age.

Famous Persons↗
PubMedDate not supplied

Lumbar stenosis. An electromyographic evaluation.

Analysis of bilateral EMG and operative findings reveal that there is a definite correlation between bilateral positive EMG in particular and multiradicular EMG's and the findings of stenosis or spondylosis of the lumbar canal. Electromyography is helpful in identifying the atypical patient or the patient with unilateral symptoms who actually has bilateral pathology. The importance of a bilateral electromyographic examination is emphasized and the rarity of bilateral or multiradicular findings in simple herniated nucleus pulposus.

Constriction, Pathologic↗
PubMed2003

[The medial medullary infarction (Dejerine syndrome) following chiropractic neck manipulation].

A-38-year-old man suddenly developed nausea, vomiting and vertigo during chiropractic neck manipulation. This was followed by right hemiplegia, right deep sensory disturbance and left hypoglossal nerve palsy, consistent with the medial medullary infarction (Dejerine syndrome). The MRI revealed infarction at left medial part of the medulla. The vertebral angiogram and MRA showed marked narrowing of the left vertebral artery. X-rays of the cervical spine showed no spondylosis, dislocation nor osteolysis of the odontoid process. The serological studies, including lupus anticoagulant, protein C, and protein S gave normal results. Although vascular accidents involving the brain stem after chiropractic neck manipulation have been reported since Pratt-Thomas and Berger, previous reports are still rare. In them lateral medullary infarction (Wallenberg syndrome) is probably the most common case. On the other hand, medial medullary syndrome (Dejerine syndrome) is absolutely rare. To our knowledge, the only one report has been made by Watanabe and his colleagues before our present case. The mechanism was suggested that rotation and tilting of the neck stretches and compresses the vertebral artery at the cervical joint causing injury to the vessel, with an intimal tearing, dissection, and pseudoaneurysm formation. Consequently, the present case may be caused by injury to the left vertebral artery with an intimal tearing during neck manipulation sufficient to cause disection and subsequent infarction of the brain stem.

Adult↗
PubMed2002

[Cervical spondylotic myelopathy: motor and somatosensory evoked potentials, clinical and radiological correlation].

Somatosensory and motor evoked potentials (EPs) have been recorded in 38 patients with cervical spondylosis, documented by MRI. All were symptomatic, 23 presented with myelopathy. Somatosensory evoked potentials were abnormal in 66p.cent as well as motor evoked potentials. The N13 potential, generated by the posterior dorsal horn of the cervical spinal cord, was abnormal in 63p.cent of patients and was the only disorder detected in 12p.cent. Together, somatosensory and motor evoked potentials were abnormal in 82p.cent of patients. There was no correlation between EPs findings and radiological data. Similary, MRI and clinical data were agreeing in only 50p.cent of patients. When a spondylotic myelopathy is suspected, SEPs proved more sensitive to detect somatosensory dysfunctionning than clinical testing and radiological data were discordant with clinical status in 50p.cent of cases. In order to obtain a high sensitivity, both somatosensory and motor evoked potentials should be recorded on all limbs with a special attention to segmental cervical and cervico-medullary responses. EPs data help to identify patients with cervical cord dysfunction and thus contribute to the therapeutic decision for surgery.

Aged↗
PubMed2003

Validity of self-assessment outcome questionnaires: patient-physician discrepancy in outcome interpretation.

Patient outcome following total hip arthroplasty (THA) was evaluated using a previously described patient assessment outcome index questionnaires. The questionnaire was distributed to 263 patients who underwent cementless THA. One hundred and three patients responded to the self-administered questionnaire and had updated clinical evaluation. We obtained a modified Harris Hip Score (HHS) based on patient assessments of their own pain and function and compared it with the clinical HHS obtained at the patients' last office visit. The mean follow up period was 4 years. Statistical analysis was performed between the two scores. The correlation between the scores from the self-administered questionnaire and the patients' last office visit revealed a fairly low correlation coefficient (r = 0.467, p < 0.001). Relative lack of correlation between the HHS's obtained from these two sources was especially noted for patients with a pain score of 30 points or less. These 26 patients were subsequently interviewed in detail about their pain to further explain these differences. The etiology of the perceived "hip pain" was found to be secondary to trochanteric bursitis in 13 patients, lumbar spondylosis in 7 patients, arthrosis of the contralateral hip in 5 patients, and from other causes in 8 patients. Pain that was hip related (anterior thigh or groin) was present in only 5 out of the 26 patients with a pain score of 30 or less. Another source of discrepancy between the total scores of the HHS was found to be on behalf of the physician in evaluating the presence of a limp. We also found that patients' expectations had changed from their preoperative expectations. Although outcome measures developed and administered by clinicians are subject to bias from several sources, results of this study suggest that self administered patient outcome measures also have their limitations. The validity of self-administered patient outcome questionnaires can be severely impacted by the patients' understanding of the questions asked, as even the most seemingly simple questions are subject to misinterpretation.

Activities of Daily Living↗
PubMed1975

[Influence of overweight on the load-capacity of the supporting and locomotion system in women].

119 50-year-old women were examined with regard to connections between apparatus of locomotion and overweight. Middle-aged women with overweight compared with women with normal weight more frequently complain of podalgias and of by Schober's signs objectifyable sacrodynias. Compared with women with normal weight in them a more frequent hyperlordosis can be established. The percentage of the degenerative spondylopathies of 61% and of the densitometrically established osteoporosis of 25.4% in the total material corresponds with literary data. There are no differences between women with normal weight and overweight. In contrast to persons with normal weight persons with overweight have only somewhat more frequently the combination of hyperlordosis with degenerative processes of the lumbar vertebral column. The biconcavity index established at the lumbar vertebral bodies is in the lower region in persons with overweight as well as in persons with normal weight. Osteoporotic lumbar vertebral bodies show a decreased frequently of spondylosis. There is no correlation between the radiological parameters established at the lumbar vertebral column and the objectified by Schober's signs decrease of the function of the lumbar vertebral column. A decreased height of the plantar arch and a correlating with this bredth of the step plane of the foot in adipose persons compared with normal persons we regarded as an expression of the increased load of the foot, also in such cases where a connection with the more frequent foot-complaints could not be ascertained. Perhaps it corresponds with that fact that only the developing flat-foot causes complaints. In general a positive correlation is to be found between the frequency of sacrodynias and podalgias.

Age Factors↗
PubMed1992

[Musculo-skeletal system diseases in dentists--an analysis of consultation cases referred to the outpatient department of occupational diseases].

During 1984-1991, 188 dentists referred for consultation to the Outpatient Department of Occupational Diseases, Institute of Occupational Medicine in connection with suspected occupational disease of musculo-skeletal system were examined. In total, 122 (64.9%) cases of the occupational diseases were diagnosed, among which chronic inflammation of humeral bone epicondyles (61.5%) and periarticular shoulder inflammation (25.4%) dominated. Claims associated with spondylosis and discopathies were decided to be rejected, as those changes are frequent in the general population and according to the legal regulations currently in force, are not included among occupational diseases resulting from the occupational work.

Adult↗