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PubMed2006

Bone formation-promoting effect of genistein on marrow mesenchymal cell culture.

The effect of genistein, a soybean isoflavone, on new bone formation by bone marrow cells from mature rats and humans was examined. Bone marrow cells were collected from the femoral diaphysis of 7-week-old Fisher rats, cultured in MEM containing fetal calf serum and then cultured with or without the addition of dexamethasone to the bone-forming medium. Genistein was added at concentrations of 10(-5),10(-6),10(-7) or 10(-8) M. Bone formation was examined 2 weeks after culture. After informed consent was obtained from a 55-year-old woman with lumbar spondylosis deformans, bone marrow cells were collected from her ilium for culture by the same process, and bone formation investigated. In both rats and humans, when dexamethasone was added to the bone-forming medium, genistein (10(-7) M and 10(-8) M) caused a significant increase in the levels of calcium, alkaline phosphatase, and DNA compared with cells not cultured in genistein. In conclusion, genistein was found to promote bone formation at lower concentrations across species, and thus may be useful as a bone formation-promoting factor.

Animals↗
PubMed2005

[Value of the different positioning tests in diagnosis of benign paroxysmal positional vertigo].

OBJECTIVE: To ascertain the value of different positioning tests in diagnosis of benign paroxysmal positional vertigo (BPPV). METHOD: Seventy-two patients who had determined the diagnosis of the posterior semicircular canal BPPV (PC-BPPV) in our department from Feb. 2000 to Apr. 2004 was tested with different positioning maneuvers. All cases were randomly divided into 2 groups with cross-over design. Group A with 36 subjects was tested with the Dix-Hallpike maneuver followed up by side-lying maneuver; Group B was tested in reverse order. Then, the Roll test was performed. RESULT: The results had association (P > 0.01) between the Dix-Hallpike maneuver and side-lying maneuver, and the positive rate had no significant difference (P < 0.01). The features of vertigo and nystagmus provoked by the tests were the same. One patient was found combining with BPPV of horizontal semicircular canal (HC-BPPV) by the Roll test. CONCLUSION: As the Dix-Hallpike maneuver, the side-lying test has the same diagnostic value in determine the PC-BPPV. Because it is safer and easier to perform in the condition of range-of-motion limitations such as spondylosis, it can alter the Dix-Hallpike maneuver. If the horizontal nystagmus provoked in above tests, the Roll test should be perform also to determine whether combining with HC- BPPV or not.

Adult↗
PubMed1991

Contribution of electromyography to the diagnosis, treatment and prognosis of cervical disc disease: a study of 114 patients.

The aim of this study is to verify whether EMG has the same diagnostic and prognostic capacity in cervical root syndrome as it does in lumbo-sacral syndromes. Our population includes 114 patients affected by a cervico-brachialgia with EMG denervation provoked by cervical disc disease. 26 patients were submitted to a myelography confirming the discal origin of the syndrome: there were 3 cases of disc protrusion and 23 cases of cervical spondylosis. The agreement between EMG and myelographical data was significant in 20 cases (76.9%). There were no significant differences of evolution between operated and non-operated cases. EMG failed to provide prognostic criteria as it does in lumbo-sacral syndromes: it must hence be concluded that all patients presenting cervico-brachialgia and EMG signs of denervation should in any case be admitted to the hospital for exploratory examination. In this context, the particular role of EMG is to establish the degree of the muscular impairment, the number of roots involved, the duration of the syndrome and--recently--the identification of the intervertebral space to be explored by spinal CT.

Adult↗
PubMed2006

[A case of cervical spondylotic amyotrophy resembling post-polio syndrome].

We reported a 62-year-old man with cervical spondylotic amyotrophy, in whom differentiation from post-polio syndrome was required. At the age of 3, the patient developed acute anterior poliomyelitis that caused muscular atrophy and muscle weakness in the left arm and bilateral lower limbs. At the age of 61, after approximately 58 years of symptomatic stabilization, the patient newly developed muscular atrophy and muscle weakness localized in the triceps muscle of the left arm. Since no sensory disturbance was noted, post-polio syndrome was initially suspected. However, MRI and myelo-CT demonstrated left side compression of the spinal cord at the level of the 6th cervical spine. Therefore, the patient was diagnosed as having cervical spondylotic amyotrophy, and the progression of the disease was prevented by having the patient rest. Since this patient had a history of acute anterior poliomyelitis, the number of anterior horn cells might have been decreased before he developed cervical spondylosis. Therefore, the patient might have shown clinical symptoms of cervical spondylotic amyotrophy mainly consisting of anterior horn disturbance and scarce sensory disturbance.

Cervical Vertebrae↗
PubMed2006

[Insertion of a laryngeal mask airway before removal of a nasotracheal tube in a patient after anterior spine surgery].

A 19-year-old man with cervical spondylosis (C4-C6) was scheduled for an anterior spine surgery. Anesthesia was induced with propofol and fentanyl, and nasotracheal intubation was performed without difficulty after vecuronium administration. Anesthesia was maintained with sevoflurane and nitrous oxide in oxygen supplemented with fentanyl. No complications were observed during the operation. After surgery, the patient's head and neck were stabilized by a halo-vest, and we attempted to minimize stress responses associated with tracheal extubation. While the patient was still deeply anesthetized, and the nasotracheal tube was in place, a laryngeal mask airway (LMA) was placed without difficulty. After confirming correct position of the LMA, the nasotracheal tube was removed without body movement or coughing. Removal of the LMA was safely performed after recovery of the patient's respiration and consciousness. We believe that the laryngeal mask airway is useful during emergence from anesthesia in the patient whose trachea is intubated nasally.

Adult↗
PubMed1991

Plate fixation for anterior cervical interbody fusion.

From April 1989 to April 1990, 13 patients with cervical spinal fracture/dislocation, spondylosis or metastasis were treated at the respective hospitals. There were 4 women and 9 men whose ages ranged from 25 to 70 years (mean 45 years). All of them were treated with neural decompression, bone grafting and anterior spinal interbody fusion. All iliac crest or fibular bone grafts were anchored to the vertebral bodies with plates and screws. The clinical outcomes were evaluated retrospectively. The results showed that all had improvement of neurological symptoms and signs. The radiographic evaluation revealed satisfactory alignment and sound union of the cervical spine in all 13 patients. No serious complications were found except screw loosening in two instances without impairment of clinical results. We concluded that anterior cervical plates provide effective stabilization which is essential for good results. Furthermore, from this study and a review of the literature, we advocated that it was not necessary for the tip of the screws to reach or even penetrate the posterior cortex of the vertebral body.

Adult↗
PubMed2006

SPECT-guided CT for evaluating foci of increased bone metabolism classified as indeterminate on SPECT in cancer patients.

UNLABELLED: Hybrid cameras combining SPECT and spiral CT offer the opportunity to obtain a diagnostic-quality CT image of scintigraphically suggestive lesions that directly correlates with the SPECT image. The field of view of the CT scan can be adapted on the basis of the SPECT findings ("SPECT-guided CT"). The aim of the present study was to investigate the value of SPECT-guided CT in the assessment of foci of increased bone metabolism classified as indeterminate on SPECT. METHODS: Of 272 consecutively examined patients with histologically confirmed malignancy who underwent bone scintigraphy, 112 (41%) required further workup by SPECT because a definite diagnosis could not be established using whole-body planar scintigraphy alone. In 57 of these patients, SPECT was accompanied by inline CT over the body region of interest; the remaining 55 subjects underwent only stand-alone SPECT for logistic reasons. The 57 SPECT/CT studies were retrospectively evaluated by readers who were unaware of the clinical pretest probability and the findings on the planar scans. In total, 52 lesions in 44 patients were rated as indeterminate on the SPECT images. Afterwards, the corresponding SPECT/CT images were analyzed and the findings previously rated as indeterminate were classified either as definitely benign, indeterminate, or definitely malignant. RESULTS: Of the 52 indeterminate findings on SPECT, 33 (63%) could be correlated with benign findings on CT. These findings involved mostly osteochondrosis, spondylosis, and spondylarthrosis of the spine. Fifteen lesions (29%) could be correlated with osteolysis or sclerotic metastases on CT. Even after analysis of the SPECT/CT images, 4 lesions (8%) remained indeterminate. These lesions were in the ribs and the scapula. CONCLUSION: SPECT-guided CT was able to clarify more than 90% of SPECT findings classified as indeterminate in an analysis that was masked as to clinical pretest probability and the planar scan findings. Further studies carefully addressing the cost efficiency of this new technology and its actual clinical value are encouraged by this observation.

Bone and Bones↗
PubMedDate not supplied

Central cord syndrome in a high school wrestler: a case report.

OBJECTIVE: To alert athletic trainers to the importance of recognizing the signs and symptoms of central cord syndrome. BACKGROUND: A 15-year-old high school wrestler was found lying supine on the mat after sustaining a hyperextension injury to his neck while drilling during practice, complaining of numbness, tingling, and a burning sensation in all 4 extremities. Touching the extremities elicited an extreme burning sensation. After in-line stabilization of the cervical spine was performed, palpation of the spinous processes elicited tenderness and an increase in pain. Six weeks before the injury, the athlete had experienced forced lateral flexion of the cervical spine during a match, resulting in an episode of bilateral numbness and burning in his arms. On evaluation by the athletic trainer, symptoms were limited to the right hand, and brachial plexus neurapraxia was diagnosed. DIFFERENTIAL DIAGNOSIS: Central cord syndrome, brachial plexus injury, cervical spine injury, burning hands syndrome, Brown-Séquard syndrome, anterior cord syndrome. TREATMENT: Upon assessment, the athlete's cervical spine was immobilized until emergency medical services arrived and applied a cervical collar. Radiographs taken at the hospital revealed a congenital fusion of C6-7. Magnetic resonance imaging and computed tomography showed evidence of stenosis, a herniated disc at C3-4, and a central cord injury. He was admitted to the hospital for observation and was placed on a corticosteroid protocol. At approximately 1 week after the injury, the athlete underwent a cervical decompression and fusion at C3-4. Subsequently, he underwent extensive rehabilitation and has had some persistent neck stiffness. The athlete is no longer allowed to participate in contact sports as a result of the presence of stenosis at multiple levels. UNIQUENESS: Central cord syndrome is typically seen in an older population with cervical spondylosis and rarely occurs in young adolescents. However, this athlete sustained 2 central cord injuries, 1 mild and 1 severe, in less than 6 weeks' time. CONCLUSIONS: The original injury sustained by the wrestler was thought to be a brachial plexus injury but, in fact, was a mild central cord injury. Central cord syndrome was not suspected in the original injury because the athlete's complaint was of unilateral numbness. With the second injury, the central cord injury was more severe. Proper recognition, assessment, and handling of this situation were crucial in providing optimal care to this athlete.

Journal Article↗
PubMed2006

[Rhabdomyolysis accompanying low back pain following prolonged urological surgery in the exaggerated lithotomy position: a case report].

A 69-year-old man (163 cm, 72 kg) with hypertension and lumbar spondylosis deformans was diagnosed as having prostate cancer and subsequently underwent perineal prostatectomy under sevoflurane anesthesia combined with epidural anesthesia using mepivacaine in the exaggerated lithotomy position. Supplemental intravenous fentanyl was also given. The patient's systolic blood pressure ranged between 80 and 120 mmHg throughout the 255-minute procedure. On emergence from the anesthesia, the patient was free from pain and epidural infusion with 0.2% ropivacaine, fentanyl 2 microg x ml(-1) and droperidol 12.5 microg x ml(-1) at a rate of 5 ml x hr(-1) was started. Shortly thereafter, the patient began to complain of severe low back pain, which required intramuscular pentazocine injection as a rescue analgesic for 5 days postoperatively. On the 6th postoperative day, creatine kinase, which had apparently passed its peak, was 4,795 IU x l(-1). MRI on the 8th day demonstrated the presence of hemorrhage in the bilateral erector spinae muscles. On day 16, CT scan also confirmed partial necrotizing changes in the bilateral gluteal and erector spinae muscles. We believe that the low back pain was due to rhabdomyolysis secondary to ischemia of the lumbar and pelvic muscles resulting from lengthy compression during surgery. The recognition and early diagnosis of rhabdomyolysis following prolonged time in the exaggerated lithotomy position are the key to prevent potentially fatal sequelae.

Aged↗
PubMed2006

Effects of different cervical traction weights on neck pain and mobility.

AIMS AND OBJECTIVES: This study investigated the effects of 3 different traction weights on neck pain and range of motion/mobility. MATERIALS AND METHODS: Ninety subjects, 42 men and 48 women, with neck pain due to cervical spondylosis participated in the study. They were assigned into three groups, each of which was subjected to a different cervical traction(CT) weight namely: group A = 7.5% total body weight(TBW), group B = 10%TBW, and group C =15%TBW CT respectively. Pain intensity and neck mobility, pre-treatment and post-treatment, were assessed using visual analogue scale(VAS) and universal goniometer respectively. RESULTS: There was no significant difference(p < 0.05) pre-treatment, but existed post-treatment (p < 0.05) between the groups for neck pain and mobility. Nineteen subjects had reactions due to the CT application: 3,5 and 11 in groups A,B and C respectively. The least reactions were recorded with the use of 7.5% TBW traction and the highest with the 15% TBW traction. The 10%TBW CT recorded the most significant pain relief and neck flexibility/mobility compared with the 7.5% TBW and 15% TBW CT therapy. CONCLUSION: This study established the 10% TBW CT as the ideal weight with minimal side effects and with highest therapeutic efficacy. Therefore clinicians could adopt this weight in managing neck disorders requiring traction.

Adult↗
PubMed2006

[Type IX collagen diseases].

Type IX collagen is a structural protein which consists of the cartilage collagen II/IX/XI heteropolymer. Transgenic mice overexpressing a mutant alpha 1 (IX) collagen chain in cartilage develop a chondrodysplasia-like phenotype associated with early-onset osteoarthritis and spondylosis. Subsequent identifications of the human type IX collagen diseases proved the correctness of the work on mice. Now we know that type IX collagen gene mutations cause multiple epiphyseal dysplasia, an osteochondrodysplasia which frequently features early onset osteoarthritis. Polymorphic variants of the type IX collagen genes are associated with lumbar disc diseases. It is getting more important to understand the biological roles of collagen IX in the musculoskeletal system.

Animals↗
PubMed2006

[Analysis of the long-term outcome of anterior approach surgery on cervical spondylotic myelopathy].

OBJECTIVE: To investigate the long-term efficacy of anterior approach surgery on cervical spondylotic myelopathy and factors affecting prognosis. METHODS: The data in 116 patients suffered from cervical spondylosis from January 1992 to December 2000 were reviewed, including 80 male cases and 36 female cases, whose age ranged from 36 to 76 years (mean, 51 years). The preoperative course of disease was 2 months to 20 years (mean, 19 months). There were 65 cases (56.0%) with single segments involved, 44 cases (37.9%) with two segments, 7 cases (6.0%) with three segments. Ninety-eight cases were onset slowly, 18 cases with no remote cause and aggravating quickly. Three kinds of surgeries were performed: anterior cervical decompression and autoiliac bone interbody fusion, anterior cervical decompression and fusion with threaded fusion cage, anterior cervical decompression and autoiliac bone interbody fusion with anterior screw-plate system. Improvement in spinal cord function was assessed using the Japanese Orthopaedic Association (JOA) scoring system, the long-term efficacy and influential factors were also analyzed. RESULTS: The mean follow-up time was 7 years and three months (5 - 12 years). The mean preoperative JOA score was 9.34 +/- 1.81. The mean postoperative JOA score was 10.35 +/- 1.85. At the final follow-up, the JOA score was 14.09 +/- 1.90 and the recovery rate was 63.2%. Among the total patients, 27 cases were excellent, 47 cases were fine, 23 cases were good, 19 cases were poor, the fineness rate was 63.8%. The long-term efficacy of anterior approach surgery has close correlations with time of course, age of onset, preoperative spinal cord function and the number of affected segments, but has no correlations with modes of fusion and internal fixation. CONCLUSIONS: The patients will be attentively observed while having a definite diagnosis of cervical spondylotic myelopathy. The good long-term results will be obtained after early anterior cervical decompression and fusion.

Adult↗
PubMed2006

Soft tissue rheumatic lesions and HIV infection in Zambians.

OBJECTIVE: To explore the relationship between human immunodeficiency virus (HIV) infection and soft tissue rheumatic lesions in HIV-positive black Zambians. METHODS: We performed a prospective study of all patients over 18 years of age attending a rheumatic clinic in a teaching hospital. All patients underwent routine blood tests, and radiographs were performed when indicated. HIV status was determined by ELISA, and clinical staging was determined by World Health Organization criteria. Patients with isolated sacroiliac pain, enthesitis, or a soft tissue lesion were selected for analysis. For HIV-positive patients, only those in clinical stage 1 (asymptomatic or persistent generalized lymphadenopathy) were selected. RESULTS: Our study cohort comprised 120 patients (41 men, 79 women, age 23-70 yrs). Diagnosis and number (% HIV positive) were distributed as follows: sacroiliitis, 14 (100%); heel pain, 14 (100%); costochondritis, 3 (100%); polyenthesitis (> or = 4 sites), 20 (100%); carpal tunnel syndrome, 8 (63%); rotator cuff syndrome, 18 (30%); tendinitis, 8 (25%); sciatica/cervical spondylosis, 12 (16%); sacroiliac strain, 7 (0%); and de Quervain's tenosynovitis, 16 (0%). HIV seroprevalence was 54% overall, 74% in those under 45 years of age, and 17% in those over 45 years of age. Population prevalence of HIV in Lusaka is about 30% in the 30-40-year age range. Mean erythrocyte sedimentation rate (ESR) in 65 patients positive for HIV was 80 mm/h and in 55 patients negative for HIV, 18 mm/h. Within each subgroup the mean ESR was significantly higher in HIV-positive patients. CONCLUSION: A young age and a raised ESR are both good indications of HIV infection in Zambian patients with soft tissue lesions. Enthesitis is a distinct HIV-related phenomenon, either an early form or a forme fruste of HIV-related spondyloarthropathy.

Adult↗
PubMed1992

Imaging of degenerative processes of the spine.

Because MR imaging provides accurate, clear, and noninvasive imaging for diseases of the spine and spinal cord, it has become the primary imaging modality in patients with spinal pathology. Degenerative processes of the spine are frequent, including disk degeneration and herniations, spondylosis, spinal canal stenoses, calcifications, and ossifications of the spinal ligaments. Several papers have been published recently on MR imaging in degenerative processes of the spine.

Humans↗
PubMed1991

[Neurosurgery in old age. I: Significance of the problem--herniated disk, spinal canal stenosis--craniocerebral injuries--chronic subdural hematoma--resorptive hydrocephalus].

The relative percentage of patients over 60 years who underwent operations in our clinic has greatly increased from 18% in 1874 to 27% in 1989. Postoperatively, difficulties may also result from additional medical problems, which may be cardiovascular, pulmonary, metabolic (especially diabetes mellitus), increased thromboembolism in origin as well as from the reduced tendency to neurological recovery in elderly patients. On the other hand, advances in diagnostics and surgical treatment often make it possible to help even these patients effectively today. The clinical pictures which are especially frequent in our hospital are specified below. Disc herniations: Soft nucleus-pulposus herniations occur in every age group. In elderly patients, the osseous constriction of the lumbar canal (especially by spondylarthrosis) often leads to spinal claudication. Functional myelography with myelograms taken in the sitting and the standing position is important for preoperative appraisal. On the basis of the clinical/neuroradiological findings, it may be decided whether a selective or an extended decompression is necessary. Larger-scale decompressions are mostly possible in this age group without postoperative instability, with good results in more than 80% of the cases. In our clinic, anterior microsurgical decompression without graft is the most frequently used procedure in cervical disc herniations/spondylosis, a method which is well tolerated by spinal cord and nerve roots: 75% simple anterior discectomies/spondylectomies compared to only 25% classical Cloward operations with bone grafts. We use intervertebral bone grafts only in severe spondylosis and/or instabilities, if necessary in combination with metal plates (e.g. in the context of cervical myelopathy). Craniocerebral injuries: Epidural hematomas and CSF fistulae, but also circumscribed space-occupying contusions have a relatively favorable prognosis in every age group. The older the patient, the more serious is the acute subdural hematoma, which is often associated with extensive contusions, although surprisingly good recoveries are occasionally possible postoperatively even here. Detailed scrutiny of all prognostically relevant factors is important. In borderline situations we give the patient a chance in order to take later action, depending on the course. Chronic subdural hematomas are especially frequent and readily dealt with surgically in patients over 60 years. The simple borehole drainage to the outside is often sufficient. In extensive excreting membranes, which are especially frequent in elderly patients, we prefer today a subdural-peritoneal drainage for six to eight weeks to the very much more burdensome craniotomy: The relatively simple operation allows an early mobilization and almost always a prompt healing. Hydrocephalus male resorptivus is also very much more frequent in this age group.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1991

Operative treatment of cervicobrachialgia and vertigo due to uncovertebral joint arthritis.

In the field of cervical spondylosis, cervicobrachialgia caused by uncovertebral joint arthritis has been well defined and classified, as it is seen quite commonly in clinical practice. Non-operative treatment relieves the symptoms in most cases. Operative treatment is used when the neurovascular structures are involved and the patient does not respond to conservative treatment. The authors present the surgical technique they employed on 38 patients with neck and arm pain due to uncovertebral joint arthritis, and they report the long-term results.

Adult↗
PubMed1991

Low back pain.

The main causes of low back pain are intervertebral disc and facet joint dysfunction and spondylosis. It is important to differentiate between the pain of inflammation (worse at rest, relieved by activity) and that of mechanical dysfunction (worse on activity, relieved by rest). The key to diagnosis is understanding the daily patterns of back pain.

Back Pain↗
PubMed1991

[Spinal stenosis in hypochondroplasia and achondroplasia].

The conditions of generalized skeletal dysplasia, hypochondroplasia and achondroplasia, are reviewed. Both of these diseases may be complicated by spinal stenosis. The spinal complications are illustrated by a case history in which the basic disease was hypochondroplasia with secondary cervical spondylosis, narrow foramen magnum and clinical spastic paraplegia.

Achondroplasia↗