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This article reviews common chronic diseases of the spinal cord such as spinal multiple sclerosis, cervical spondylosis, and motor system diseases, including amyotrophic lateral sclerosis. Secondary epidural and meningeal tumors and syringomyelia are also discussed.
Between the years 1976 und 1989 147 patients were operated on cervical disc herniation at the Neurosurgical Clinic of Innsbruck. 122 of these cases underwent a posterior approach according to Frykholm, 25 patients were treated by an anterior approach according to Cloward and Smith and Robinson, respectively. All patients received a descending myelography followed by a CAT-Scan of the questionable cervical segments the latter was available. In patients with disc herniation and only mild degenerative changes of the cervical spine a dorsal foraminotomy was chosen whereas the cases with nerve root compressions primarily due to spondylosis the ventral approach was preferred. Patients revealed a convincing benefit of motoric deficits after foraminotomy whereas disturbances of sensibility showed minor improvement either by ventral or posterior approach.
An old bull, it is said by those who know, can have his troubles. Included among these are vertebral osteosclerosis and ankylosing spondylosis--this stiffening up limite, rather than accentuates, the value and reproduction potential of a stud bull past prime. But associated with these abnormalities--and not seen in age-matched cows of comparable breeds--are fascinating endocrine neoplasms that might suggest a pattern that could be productive as a model of human hereditary endocrine abnormalities. Adjacent to the thyroid gland in other vertebrates are ultimobranchial bodies, that are incorporated into the lateral thyroid lobes in primates as the parafollicular "C-cells" of the thyroid. These are the cells in man that give rise to medullary thyroid cancer and are associated with calcitonin secretion, useful as a tumor marker. In aging bulls of whatever breed, nearly half exhibit abnormality of these ultimobranchial bodies: 20% show hyperplasia, and 30% have frank neoplasia. These ultimobranchial tumors appear in bulls passing 6 1/2 years in age, and are absent in young bulls and all cows of any age. Calcitonin can be demonstrated in the ultimobranchial tumors from bulls, and secretion is stimulated by calcium infusion, though serum calcium remains normal. The ultimobranchial tumors themselves can range from hyperplasia through adenoma to metastasizing carcinoma--in fact, representing one of the commoner cattle cancers. Parathyroid glands taken from bulls with these ultimobranchial tumors initially show evidence of inhibited secretory activity and morphologic atrophy, but later go on to develop hyperplasia and, eventually, autonomy.(ABSTRACT TRUNCATED AT 250 WORDS)
Intervertebral disk space widths were measured on lateral radiographs of 73 anesthetized dogs. Weight was found to have a significant (P less than 0.01) effect on disk space width. Using weight-adjusted disk space width measurements for all subsequent studies, older (7- to 16-year-old) dogs and males had consistently, but not significantly, wider, disk spaces than did alternative groups. Cervical and lumbar intervertebral disk spaces tended to be wider than those in the caudal thoracic region. The widest cervical intervertebral disk spaces were C4-5 and C5-6 and the narrowest was C2-3. In the lumbar region, L2-3 was the widest disk space and L4-5 was the narrowest. Dachshunds generally had greater mean intervertebral disk space width than did other breeds of dogs. Cervical (n = 6 dogs) and thoracolumbar (n = 6 dogs) disk fenestration resulted in narrow intervertebral disk spaces, regardless of breed. When a ventral approach was used in thoracolumbar fenestration, the mean intervertebral disk space was narrower than that resulting from use of a dorsolateral approach. Spondylosis was found radiographically 1 to 4 years after intervertebral disk fenestration in 3 of 6 dogs that had cervical fenestrations and in 5 of 6 dogs that underwent thoracolumbar fenestration.
Ossification of the ligamentum longitudinale posterius is a rare disease found in particular in Japan and southeastern Asia. In the literature it is described as the so-called Japanese disease or OPLL syndrome. The disease takes a slow, frequently asymptomatic, course but may cause severe stenosis of the spinal canal with neurological disorders, OPLL occurs frequently concurrently with ankylosing spondylitis, hypertrophic spondylosis, diffuse idiopathic hyperostosis of the skeleton. Own observation: a 68-year-old man with a long history of cervicalgia, subsequently paraesthesias of the upper extremities, without a spastic atactic symptomatology of the lower extremities. An X-ray extremities, of the skeleton was made, tomograms and CT of the cervical spine. In the Cl-6 area major ossifications of the posterior longitudinal ligament were found which caused stenosis of the spinal canal of an extent of up to two thirds.
Magnetic stimulation of the nervous system is a new technique introduced in 1985 by Barker, Jalinous and Freeston. Using short pulses of a time-varying magnetic field it allows a noninvasive stimulation of the motor cortex and deeply placed peripheral nerves. The authors presented basic principles and applications of this method. Stimulation procedures were described and the problem of safety and possible side-effects was discussed. Advantages and disadvantages of the method were presented in comparison to electrical stimulation. Preliminary results of the clinical studies conducted chiefly in patients with multiple sclerosis and cervical spondylosis were reviewed.
Two patients developed Lhermitte's sign after cervical spine fractures. The patients were otherwise without evidence of spinal cord dysfunction. Both patients were studied with magnetic resonance scans of the cervical spine. The magnetic resonance scans were normal. The possible etiology of Lhermitte's sign in these patients is discussed. The differential diagnosis including cervical spondylosis, combined systems degeneration, multiple sclerosis, neoplasm, and radiation myelopathy is reviewed. These patients should be carefully evaluated clinically, and flexion/extension lateral cervical spine films as well as a complete blood count and peripheral smear should be obtained. Magnetic resonance scanning may have an important role in evaluating these patients. Magnetic resonance is exquisitely sensitive in detecting demyelination; therefore, we speculate that subarachnoid scarring may be responsible for this symptom. Gadolinium-enhanced magnetic resonance scanning may confirm the presence of such scarring in the future.
Dogs with hyperadrenocorticism had a higher incidence of intervertebral joint disease, i.e., disc protrusion or spondylosis. In comparing cases of hyperadrenocorticism with age- and breed-matched controls with hypothyroidism, the incidence was significantly greater than expected. This was not seen, however, in beagle dogs in which the incidence was already high and attributed to chondrodystrophoid tendencies in this breed. To investigate the pathogenesis of this association and its possible relationship to steroid-induced osteopenia, adult dogs were given a placebo, prednisone, or prednisone plus calcium for six months. Torque testing of intervertebral joints revealed a consistent trend of lower force to failure in both prednisone-treated groups, but the difference was not statistically significant. In these dogs with mild to moderate hyperadrenocorticism, compression tests of intact vertebral bodies were not significantly different, but blocks of trabecular bone cut from the vertebral bodies failed at significantly lower compressive forces in both prednisone-treated groups compared with controls. Histomorphometric evaluation of lumbar vertebral trabecular bone revealed that the percentage of bone volume was not significantly decreased in the prednisone-treated groups. Nor was there any difference in the thickness or porosity of vertebral end-plates, which might contribute to weakening of intervertebral ligamentous insertions.
Morphological alterations of the craniocervical junction as basilar impressions, a ponticulus posterior, an atlas assimilation, an intervertebral narrowing and spondylosis deformans, were found radiologically in patients with sudden hearing loss. There were no radiological differences to a healthy population. No relationship could be established between static morphological changes of the craniocervical junction of the upper cervical spine and the sudden hearing loss. However, there was a statistically significant reduction of the mobility in the upper cervical spine in patients suffering from sudden hearing loss. Very high standard deviations in the atlanto-occipital and the atlanto-odontoid joints are interpreted as hyper- as well as hypomobile joints. These results indicate a possible correlation between sudden hearing loss and a functional pathology of the craniocervical junction.
The painful arm often presents a diagnostic challenge. The cause is often obvious, especially with regional pain syndromes including the carpal tunnel and the tennis elbows. However, pain reference syndromes can be confusing and it is advisable to first examine the cervical spine because it is a common and often overlooked cause of arm pain or paraesthesia. It is common for arm pain to cause sleep disturbances and in such cases it is worth considering cervical causes, carpal tunnel syndrome and the thoracic outlet syndromes. The working rule is: patients with thoracic outlet syndrome cannot fall asleep; a carpal tunnel lesion wakes the patient in the middle of the night; and cervical spondylosis wakes the patient with pain and stiffness that persists well into the day.
New Modified Wisconsin Card Sorting Test (WCST) was administered to ninety-five individuals to assess the effects of age on frontal lobe functions. The correlations between ages and scores were evaluated in the following five subgroups which were classified into whole subjects (TOL, n = 95), normals and patients who were neurologically diagnosed as only having cervical spondylosis (NOR, n = 20), individuals whose age-corrected total intelligence quotients (TIQ) by the Wechsler Adult Intelligence Scale were higher than or equal to 100 (HIQ, n = 30), individuals whose TIQ were less than 100 (LIQ, n = 27), and individuals whose Mini-Mental State Examination scores were full (MMS, n = 28). Scores of the WCST including Categories Achieved, Total Errors, Difficulty of Maintaining Set and Perseveration were significantly correlated to ages in four groups such as TOL, NOR, HIQ, and MMS. The correlation of WCST's scores of the four groups indicated almost the same tendency. Some subcategories of the WCST, indicating perservation which were characteristic signs of the frontal lobe dysfunction correlated with ages in these four groups. The groups indicating NOR, HIQ, and MMS were thought to be regarded as being normal controls. And, the scores of Mini-Mental State Examination were not correlated with ages. So, the WCST scores of the MMS group were no thought to be effected by the age-related decline of intelligence. The results might suggest that the age-related decline of the frontal lobe function precedes that of intelligence.
While insomnia is a familiar management problem for most doctors, disorders of hypersomnolence are much less familiar. The evolution of sleep monitoring at a major South African teaching hospital is described and the classification of sleep disorders reviewed. Analysis of the first 5 years' experience revealed that 27 of 46 patients had sleep apnoea (all obstructive, but 13 with a central component), while 3 had narcolepsy. Contributing causes of sleep apnoea included obesity (25 patients), tonsillar enlargement (3), acromegaly (3), rheumatoid cervical spondylosis (1), Hunter's syndrome (1) and haemangioma of the throat (1). Death from sleep apnoea occurred in 3 cases. Treatment of specific causes was effective in abolishing sleep apnoea, although attempts at weight loss were effective in a minority only. Nasal continuous positive airway pressure was effective in achieving symptomatic relief. Sleep monitoring was found to be valuable, provided all-night study facilities are available, and provided that patients who simply snore are excluded by prior clinical evaluation.
Cervical angina, resembling true angina pectoris, but resulting from cervical spondylosis and nerve root compression, is also known as pseudoangina. This report describes 164 patients treated over a 22-year period. Patients included 103 men and 61 women, with ages ranging from 45 to 68 years and averaging 54 years of age. The duration of symptoms prior to definitive diagnosis averaged ten months and ranged from ten to 18 months. Most patients had consulted at least two cardiologists prior to diagnosis. The results of stress testing were abnormal in ten patients, but none underwent angiography. Symptoms common to all patients, in varying severity, included neck pain and stiffness, occipital headache, arm pain with sensory symptoms. Neurologic deficit was found in only three instances. The majority of patients responded satisfactorily to a standard nonsurgical regimen, employed for at least three months, involving the use of a hard collar, intermittent traction, isometric exercise, and a combination of anti-inflammatory and muscle relaxant medications. In cases where disability persisted, myelography was usually employed and when confirming nerve root compression, anterior disc excision and spine fusion were performed. Such treatment was required in only 38 cases and resulted in complete relief of complaints in all but five instances in which fusion failure required re-operation with ultimate success. Fusion usually was completed in three months, during which time the patient was required to wear a hard collar.
We undertook an audit of 200 general medical inpatients in a teaching hospital to investigate how often the locomotor system is omitted from routine medical clerking, and the impact this may have on patient care. The 104 men and 96 women (mean age 66; range 16-91 years) were interviewed and examined in the non-critical phase of admission; 42.5% had locomotor symptoms and 53.5% locomotor signs. Common problems were small or large joint osteoarthritis (39%), soft tissue lesions (9%), cervical and lumbar spondylosis (5.5%) and fibromyalgia (5%); 12% had more than one locomotor diagnosis. However, locomotor symptoms and signs (positive or negative) were recorded in their hospital notes in only 14.5% and 5.5% respectively. This compared poorly with recorded examination of other systems and regions (eg cardiovascular 100%; respiratory 99.5%; abdomen 99%; nervous system 77%; skin 13%; female breasts 13%); 92% of rheumatic lesions had been missed and treatment of symptomatic patients was omitted or considered inadequate in 94%. It is apparent that, despite a high frequency of locomotor disorders, locomotor system screening is often omitted from routine medical clerking. Many missed conditions are both significant and eminently treatable. Such discrepancy compared with screening of other systems requires consideration during planning of undergraduate training.
A newly developed instrument based on dual energy X-ray absorptiometry (DEXA), Hologic QDR-1000, was evaluated fundamentally and clinically. Image quality was quite satisfactory though radiation exposure was minimal, 780.2 nC/kg (3.024 mR) for lumbar measurement. Reproducibility of the repeated measurement of a phantom was fairly good; 0.343 CV% in a same day and 0.520 CV% in a long period. Accuracy determined by measurement of potassium phosphate solution was also satisfactory. Bone mineral densities measured by this instrument were fairly correlated with those measured by single energy quantitative CT; coefficient was 0.740 for 17 patients. Mix-DP plates of more than 10 cm thick overestimated the bone mineral densities of a phantom. Bone mineral densities of Japanese normal volunteers were in the normal range (mean +/- 2SD) of the Americans though mostly lower than the mean. In patients with spondylosis deformans or prominent aortic calcification, bone mineral densities might be overestimated. Lateral view was obtainable though its reproducibility was not good. Positioning especially for measuring femoral neck was quite critical for reproducible measurement. In conclusion, this new instrument is quite accurate and satisfactory for clinical application to measuring bone mineral densities.
A consecutive series of 47 patients with cervical radiculopathy secondary to spondylosis were treated with complete discectomy, root decompression accomplished by microscopic foraminotomy on the affected side(s), and iliac graft fusion at the involved interspace(s). Forty of the 47 patients were contacted with an average follow-up of 15 months. Eighty-three percent of the patients were judged as having good results. Fusion of the involved interspace(s) occurred in 87% of cases, although this did not appear to correlate with the clinical results.
Urodynamic test has a main role in: 1) making a precise diagnosis in presence of urinary symptoms not clearly interpretable by other means; 2) assessing the characteristics of neurogenic bladder for a correct treatment; 3) detecting an underlying, previously not diagnosed neurologic disease in patients with voiding abnormalities. This report concerns 10 patients with urinary symptoms in whom the urodynamic tests allowed to suspect a neurogenic problem. Seven pts. showed an areflexic bladder with positive betanechol supersensitive test, 3 pts. had detrusor hyperreflexia, while in 2 cases there was a low compliant bladder. All the patients with detrusor hyperreflexia had also detrusor sphincter dyssynergia, while 5 out of 7 pts. with detrusor areflexia showed a denervated perineal floor. The final neurologic diagnoses were 4 protruded discs, 2 multiple scleroses, 1 cerebral tumor, 2 spinal tumors, 1 cervical spondylosis.
The locomotor system, especially its functional important areas, joints and spinal column, undergo degenerative changes of various range during the age and owing to endo- and exogenous factors. Osteoarthrosis affects peripheral joints, spondylosis and spondylo-arthrosis affect axial skeletal joints. The problem of osteoarthrosis becomes actual both owing to the increasing incidence of this illness and in the connection with the prolongation of human life. The problem of osteo-arthrosis is significant all over the world. That's why the attention is devoted to this illness from the point of view of etiology, pathogenetic mechanisms and pathologic morphology. A special attention is devoted to joint's medium. We deal with clinical signs, diagnostic possibilities and therapeutic principles. We emphasize the necessity of complex treatment and we report its single parts. In this connection we emphasize psychological and sociological aspects of the access to the patient with this serious chronic illness. Last but not least we deal with osteoarthrosis as the economic and social problems.