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PubMed1999

Vertebral synovial osteochondromatosis with compressive myelopathy.

STUDY DESIGN: A case report of vertebral synovial osteochondromatosis with compressive myelopathy. OBJECTIVES: To describe the clinical, radiologic, and histopathologic features of vertebral facet synovial osteochondromatosis with compressive myelopathy. SUMMARY OF BACKGROUND DATA: There has been only one previously reported case of synovial osteochondromatosis affecting the vertebral facet joint and no previous report of associated compressive myelopathy. METHODS: The case history, radiology, surgical findings, and histopathology are reviewed. RESULTS: Vertebral facet synovial osteochondromatosis is a potential and readily manageable cause of spinal cord compression. CONCLUSIONS: Synovial osteochondromatosis of the vertebral facet joint should be considered as a cause of compressive myelopathy.

Chondromatosis, Synovial↗
PubMed1997

A new method for estimating spinal cord function. Refractory period of conductive spinal cord evoked potentials.

STUDY DESIGN: This study was designed to examine the possibility of a new spinal cord monitoring method using measurement of the refractory period to monitor spinal cord function. OBJECTIVES: To determine whether measuring the refractory period and the recovery rate of conductive spinal cord evoked potential is a useful method for estimating spinal cord function. BACKGROUND: Measuring the refractory period and constructing the recovery curve have been used to investigate peripheral nerve function. Spinal cord evoked potential elicited by the single stimulus usually is used to evaluate spinal cord function, and it has been said that 50% attenuation of the amplitude is the critical alarm level. METHODS: In anesthetized cats, amplitude, area, and latency were measured on a personal computer from subtracted data collected with a paired-stimulation technique. The authors constructed recovery curves of ascending and descending conductive spinal cord evoked potentials and measured the refractory period during spinal cord compression. RESULTS: When the amplitude of the ascending spinal cord evoked potential began to decrease during spinal cord compression, the amplitude of the response elicited by the second stimulus with interstimulus intervals of 0.8 msec and 1.0 msec decreased more significantly. When the amplitude of the ascending spinal cord evoked potential decreased to 50% of the precompression amplitude, the mean value of the absolute refractory periods of the ascending and descending spinal cord evoked potentials became prolonged from 0.40 +/- 0.007 msec to 0.53 +/- 0.014 msec, and the mean values of their amplitude and area recovery rates decreased from 75% +/- 1% to 35% +/- 2% (interstimulus interval, 0.8 msec) and from 81% +/- 1% to 46% +/- 2% (insterstimulus interval, 1.0 msec). CONCLUSIONS: The change of the responses elicited by the paired stimuli is more sensitive than those elicited by the single stimulus in the spinal cord evoked potentials. The absolute refractory periods and the recovery rate during 50% attenuation of the precompression amplitude is the critical alarm level in spinal cord monitoring.

Animals↗
PubMed1996

Intervertebral disk disease in dogs with signs of back pain alone: 25 cases (1986-1993).

OBJECTIVE: To evaluate the population characteristics, historical, clinical, and diagnostic findings; and treatment outcome of dogs with thoracolumbar intervertebral disk disease (IVDD) whose only clinical signs were those of back pain. DESIGN: Retrospective case series. ANIMALS: Dogs with IVDD and clinical signs of back pain only, without neurologic deficits, in which survey radiography of the vertebral column and diagnostic myelographic studies were performed. PROCEDURE: Review of the medical record, evaluation of survey radiographs of the vertebral column, evaluation of myelograms and estimation of apparent extent of spinal cord compression, and follow-up information provided by telephone contact with owners. RESULTS: Spinal cord compression was detected on myelography in 20 of 25 (80%) dogs. Treatment included decompressive surgery in 18 of 25 (72%) dogs and all dogs underwent intervertebral disk fenestration. The condition was improved in 24 of 25 (96%) dogs after surgery. CLINICAL IMPLICATIONS: Dogs with thoracolumbar IVDD that have clinical signs of back pain alone, without neurologic deficits, may have substantial compression of the spinal cord.

Animals↗
PubMed2001

Ossification of the posterior longitudinal ligament and ligamentum flavum: imaging features.

Ossifications of the posterior longitudinal ligament and ligamentum flavum are both special subcategories of degenerative diseases responsible for compression of the spinal cord. Ossification of the ligaments is well demonstrated by plain radiography and computed tomography. Magnetic resonance imaging noninvasively provides useful information about the degree and extent of spinal cord compression as well as the character of the ossification. T2-weighted sequences are most effective to evaluate both spinal cord compression due to the ossification and abnormal signal intensity of the spinal cord.

Adult↗
PubMed1991

Transoral decompression and posterior stabilisation in Morquio's disease.

A 3.5 year old boy with Morquio's disease was referred with a persisting left hemiparesis four months after a fall and was found to have craniocervical junction compression due to atlantoaxial subluxation and significant anterior soft tissue compression. Transient unconsciousness at the time of the fall was probably due to medullary concussion as a result of hyperextension, not a head injury. Spinal cord compression due to atlantoaxial subluxation at the craniovertebral junction is a major cause of disability and death in these patients. Once cervical myelopathy appears, early posterior occipitocervical fusion has been advocated in order to arrest the progression of neurological disability and this is successful in most cases. This conventional approach was considered unsafe because of the significant anterior compression. A combined anterior transoral decompression with posterior fusion to deal with this particularly difficult problem is described.

Child, Preschool↗
PubMed1981

[Experimental study of cervical spondylotic myelopathy--spinal cord blood flow in cervical canal stenosis (author's transl)].

There exists the view that ischemia in the spinal cord accounts for the paralysis caused by cervical spondylotic myelopathy (CSM), but little work has been done to study the change of spinal cord blood flow (SCBF) in CSM. To clarify this situation, the experimental model designed by Tanaka (1978) was used as a model of CSM (Fig. 1). Among 27 cats in which the spinal canal was narrowed between C4 and C6, 13 cats developed delayed paralysis 33 weeks after operation in an average. Spinal cord blood flow was measured by the reference sample method using isotopelabeled microspheres of 15 +/- 3 mu in diameter. The mean SCBF values for each spinal segments in normal animals ranged from 23.0 g/min . 100 g in T11 to 40.2 g/min . 100 g in C8, resulting in that blood flow in the cervical and lumbar enlargements was constantly higher than that in the other regions of the cord (Fig. 3). The mean blood flow values for the gray matter, ventral white matter, lateral white matter, and dorsal white matter in cervical region were 99.1, 5.0, 5.9, and 11.4 g/min . 100 g respectively, without significant difference between each spinal segments (Fig. 4). In an animal with acute spinal cord compression, the SCBF decreased significantly 15 minutes after spinal cord compression was induced (Figs. 5, 6). On the other hand, in two delayed paralysis animals SCBF in the narrowed segments was within normal limits (Figs. 5, 6). These results suggest that paralysis as seen in CSM may develop without ischemia of the spinal cord.

Animals↗
PubMed2000

The long-term effects of pre-treatment with activated protein C in a rat model of compression-induced spinal cord injury.

OBJECTIVES: Recently, we demonstrated that activated protein C (APC) can lessen the severity of spinal cord injury (SCI) in rats during the acute and subacute phases. The purpose of the present study is to determine the long-term effects of pre-treatment with APC following SCI in rats. METHODS: The motor function of rats was assessed using the inclined-plane test during 8 weeks after SCI, and the grid runway test 7 weeks after the trauma. Somatosensory evoked potentials (SEPs), brainstem-derived motor evoked potentials (B-MEPs) and corticomotor evoked potentials (CMEPs) were used to quantify axonal function 8 weeks after SCI. Morphometric analysis of the spinal cord lesion was carried out to determine lesion size. Twelve male Sprague-Dawley rats were randomly allocated to either APC (25 IU/kg) or saline group and then subjected to 20 g compression injury of the spinal cord for 20 min at T12. The sham group (n=6) received laminectomy alone. RESULTS: APC significantly reduced the motor disturbances and electrophysiological impairments induced by SCI. APC-treated animals also showed a trend towards a reduction in lesion size. However, this change, was not significant. CONCLUSION: Pre-treatment with APC attenuates the harmful effects of SCI not only during the acute and subacute phases but also in the chronic stage.

Animals↗
PubMed1983

Evaluation of cervical spine surgery by postoperative myelography.

After spontaneous remission of nerve root compression, a myelographic defect may persist. Similarly, myelopathy may remain nonprogressive for long periods despite appreciable myelographic deformity. Although operation may arrest or improve the symptoms of cervical disc lesions and spondylosis, the ultimate confirmation that entrapped neural elements have been relieved permanently can only be provided by postoperative myelography. Preoperative and postoperative myelography documents the significant improvement that can be achieved by using posterolateral and posterior approaches to the cervical spine in patients with nerve root or spinal cord compression. The results in this group of patients were achieved with none of the disadvantages or complications of cervical spine fusion or of the interbody removal of cervical disc tissue, also leading to cervical fusion.

Cervical Vertebrae↗
PubMedDate not supplied

Treatable extramedullary cord compression. Meningioma as a cause of the Brown-Séquard syndrome.

The Brown-Séquard syndrome is infrequently reported. Though widely considered indicative of intramedullary spinal cord disease, in the absence of penetrating spinal cord trauma, the syndrome is frequently an early stage of extramedullary spinal cord compression, as an extensive analysis of diverse literatures reveals. We describe two cases resulting from compression of the spinal cord by a meningioma. While previous reviews emphasize that radicular or vertebral pain is a prominent feature of spinal cord compression by intradural tumors, our patients had no pain referable to tumor. Awareness that painless extramedullary spinal cord compression can produce the Brown-Séquard syndrome, early myelography, and surgical intervention are necessary to prevent progressive deficit. Even when encountered in a patient who has previously well-documented demyelinating disease, the syndrome should not be written off as a relatively untreatable intramedullary process.

Aged↗
PubMed1986

Painless compressive cervical myelopathy with false localizing sensory findings.

Five patients who presented with clearly defined thoracic sensory levels were found by myelography and follow-up computed tomography (CT) to have cervical spinal cord compression. None of these patients had pain or an immediate preceding history of trauma. There is currently no satisfactory explanation for the large discrepancy between the sensory level and the level of cord compression in such patients. It is crucial that the clinician recognize the possibility of a cervical cord lesion in patients with such a presentation so that appropriate radiographic studies can be performed. Failure to appreciate this syndrome could result in failure to diagnose a treatable lesion.

Adult↗
PubMed2004

Does chronic cervical myelopathy affect respiratory function?

OBJECT: Although respiratory function is often impaired by acute cervical spinal cord injury, changes in respiratory function in patients with chronic cervical myelopathy (CCM) are not well documented. The purpose of this study was to evaluate the respiratory function of patients with CCM. METHODS: Spirometric parameters were measured in 94 patients with CCM before they underwent expansive laminoplasty. These measurements were compared with those obtained in age- and sex-matched control group patients without myelopathy. The study patients were also subdivided into two groups: those with spinal compressive lesions above or below the C3-4 disc level were compared in terms of respiratory function. The vital capacity values measured in patients with CCM were significantly lower than those in the control group. In patients in whom spinal cord compression was present above C3-4, vital capacity values were lower than in patients in whom the compression level was below C3-4. The resting respiratory rate per minute was elevated in the CCM group. Peak expiratory flow rate was significantly decreased, and expiratory velocities at 50 and 25% of vital capacity were significantly increased in the CCM group. CONCLUSIONS: The results indicated that expiratory flow may be impaired or incomplete in patients with CCM. An underlying subclinical respiratory dysfunction appears to be associated with CCM.

Adult↗
PubMed1992

Primary spinal epidural non-Hodgkin's lymphoma: report of eight patients and review of the literature.

Eight patients treated for histologically confirmed primary spinal epidural non-Hodgkin's lymphoma diagnosed between January 1979 and August 1989 (6.6% of all cases of intraspinal lymphoma) were studied. There were six men and two women. The median age was 70 years (range, 43-80 yr). Patients sought treatment for a prodrome of back pain (median duration, 3 mo) followed by an acute neurological deterioration (median duration, 6 d). The most common findings were a discrete sensory level in 5 patients, hyperreflexia in 5 patients, and paraparesis or paraplegia in 5 patients. Radiographically, there was an absence of bony destruction by these tumors. All patients underwent a decompressive laminectomy, subtotal tumor resection, and spinal irradiation (median dose, 3800 cGy). Two patients had low-grade lymphomas (one B cell and one T cell), and 6 patients had intermediate-grade lesions (six B cell). Two patients with B-cell lymphomas (one low-grade and one intermediate-grade) developed metastatic disease 15 and 17 months after the initial diagnosis; no evidence of lymphoma developed in the other 6 patients. The median survival was 22 months (range, 2-71 mo). Lymphoma was the cause of death in only 1 of the 4 patients who died, and the 4 younger patients are alive and well. Primary spinal epidural non-Hodgkin's lymphoma should be a diagnostic consideration in the older patient who seeks treatment for spinal cord compression manifested by a prodrome of back pain, followed by a rapid neurological deterioration, normal plain spine radiographs, and neuroimaging consistent with an extradural compressive lesion. Surgery for this diagnosis followed by spinal irradiation should result in significant neurological improvement.

Adult↗
PubMed1983

Spinal hemangiomas.

Three new cases of spinal cord compression due to vertebral hemangioma are reported. The clinical presentation, with spinal pain, radicular radiation, and paraparesis, is similar to that of primary lymphoma, metastatic tumor, and disc disease. If the characteristic plain film changes of vertical trabeculations and striations are present, the preoperative diagnosis is facilitated, but in the majority of cases these are not seen. In some instances, vertebral body or pedicle erosion is present. A myelographic epidural block will be seen on further study. Spinal arteriography can prove helpful. Surgical decompression results in marked neurological improvement if intervention takes place before the onset of complete paralysis. The authors recommend that the diagnosis of vertebral hemangioma be considered in the differential diagnosis of epidural spinal cord compression whenever considered in the differential diagnosis of epidural spinal cord compression whenever a primary malignant neoplasm cannot be identified.

Aged↗
PubMed2006

Prevention of urinary tract infections in palliative radiation for vertebral metastasis and spinal compression: a pilot study in 71 patients.

PURPOSE: To assess the impact of bladder instillations of hyaluronic acid (HA) on the prevalence of urinary tract infection (UTI) in patients receiving emergency radiotherapy for metastatic spinal cord compression. METHODS AND MATERIALS: Patients were recruited consecutively at one center and assigned to usual care (UC) (n = 34, mean age 62.2 years) or UC with once-weekly HA instillation (UC + HA) (Cystistat: 40 mg in 50 mL phosphate-buffered saline) (n = 37; mean age, 63.1 years). All patients had an indwelling catheter and received radiotherapy. UTI status was assessed at baseline and during hospitalization. RESULTS: At baseline, patient groups were comparable, except for the prevalence of UTI at baseline, which was 11.8% and 0% in the UC and UC + HA patients, respectively (p = 0.0477). During hospitalization, 76.5% (vs. 11.8% at baseline, p < 0.0001) of the UC patients had a UTI compared with 13.5% (vs. 0% at baseline, p = 0.0541) of the UC + HA patients (p < 0.0001). Both groups were hospitalized for similar periods (19.8 days [UC] vs. 18.5 days, p = 0.4769) and received equivalent radiotherapy sessions (4.6 [UC] vs. 5.8 sessions, p = 0.2368). CONCLUSIONS: Patients receiving UC + HA had a 5.7-fold decrease in UTI prevalence over the hospitalization period compared to UC patients, suggesting that bladder instillations of HA effectively prevent UTI in patients with indwelling catheters receiving radiotherapy for nerve compression.

Adjuvants, Immunologic↗
PubMedDate not supplied

Effect of compression of spinal cord on brain rhythms.

Electroencephalographic changes were studied in anaesthetised rats, subjecting them to the mechanical compression of spinal cord. The EEG waves that were studied-Alpha, Theta, and Delta. The changes in these waves and shift from one pattern to another after the compression of the spinal cord at the Lumbar level. These waves were subjected Fourier analysis. The results show remarkable changes in wave patterns and a shift in the dominating wave pattern. With 50% compression the EEG showed a slight increase in the amplitude in all three wave forms-- with Delta wave pattern being more dominant. At 100% compression there is a marked decrease in the Delta amplitude compared to normal. We tried to observe the changes in activity of the brain--the effects of spinal lesion and its relationship with tonic activity changes in EEG.

Alpha Rhythm↗
PubMed2002

Missed cervical spine fracture-dislocations: the importance of clinical and radiographic assessment.

OBJECTIVE: To review the case of a patient who suffered a cervical spine fracture-dislocation missed at a hospital emergency department. CLINICAL FEATURES: A 77-year-old man involved in a motor vehicle accident was transported to a local emergency hospital where cervical spine x-ray films taken were reported as demonstrating no evidence of acute injury. The patient visited a chiropractic clinic 6 days later, where x-ray films were again obtained, finding that the patient sustained fractures of C5 and C6, as well as a bilateral facet dislocation at C5/C6. Computed tomography confirmed the fractures, and magnetic resonance imaging findings demonstrated cervical spinal cord compression and posterior spinal cord displacement. INTERVENTION AND OUTCOME: The patient was referred for preoperative medical evaluation. He underwent C5-6 closed reduction and anterior/posterior fusion surgery and was released without complication. Patient follow-up indicated full recovery with minimal neurologic symptoms. CONCLUSION: Cervical spine fracture-dislocations are often missed during standard radiographic examinations in emergency department settings. Chiropractors are encouraged to perform a comprehensive evaluation of patients presenting with cervical trauma even if they have had prior x-ray films reported as normal. Standard x-ray films taken at emergency department facilities are not entirely reliable for detecting or revealing cervical spine fracture-dislocations. This case stresses the importance of careful clinical assessment and imaging procedures on patients who have encountered cervical spine trauma.

Aged↗