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PubMed1986

Differential diagnosis of motoneurone disease from other neurological conditions.

Analysis of 422 patients with clinical diagnoses of motoneurone disease (MND), multiple sclerosis, cervical spondylosis with myelopathy, or stroke, from two referral centres, suggested a simple four-step algorithm for diagnosing MND. The algorithm provided a 98% sensitivity (true positive diagnosis) and 86% specificity, and therefore gives a baseline for diagnostic criteria suitable for use in clinical research of MND.

Algorithms↗
PubMed1986

Low back pain: a radiographic enigma.

Ninety-nine anteroposterior and lateral lumbar radiographs taken of males ages 18-55 were independently analyzed by three chiropractors who assessed 56 variables, including determinations of disc space height, vertebral malalignments and subluxations, spondylosis, postural disturbances, relationships between pelvis and spine, and other congenital or acquired abnormalities. The distribution of low back complaints in this study included 31% with no low back pain, 44% with previous or present mild low back pain and 24% with previous or current severe, and often disabling, low back pain. Determinations were made of interobserver reliability between the three chiropractors and a medical radiologist. Of the 56 radiographic variables assessed by the chiropractors, six demonstrated a high interobserver reliability. In general, the best reliability was for variables that were actual measurements, rather than subjective observations. Sixteen additional variables demonstrated a fair interobserver reliability. Comparison of the observations between a radiologist and the chiropractors showed correlations in their assessments of disc space height at L3-4 and L4-5; otherwise, there was poor interobserver reliability. Few of the radiographic variables were found to be reliable predictors of present or prior history of low back and leg complaints. A few variables (most notably disc space narrowing) were statistically associated with back or leg complaints (P = 0.025). We conclude that spinal radiographs, whether analyzed by measurements, by a radiologist or by chiropractors, have minimal value in predicting the presence or absence of low back complaints and, in particular, have no value in epidemiological studies.

Adolescent↗
PubMed1987

[A new non-steroidal anti-inflammatory drug pirprofen (rengasil) in the treatment of rheumatoid arthritis and osteoarthrosis].

The results of a double blind clinical study of pirprofen, as compared to piroxicam and placebo in 197 patients with rheumatoid arthritis, as compared to piroxicam in 200 patients with gonarthrosis and/or coxarthrosis, and as compared to naproxen in 165 patients with lumbar spondylosis, are reviewed. In rheumatoid arthritis, pirprofen (1200 mg daily) was significantly superior to placebo, and proved in some respects more active than piroxicam where its daily dose was 20 mg. In patients with osteo-arthrosis affecting major joints and the spine, pirprofen (800 mg daily) showed the same therapeutic effects as piroxicam (20 mg) and naproxen (1000 mg). Owing to its obvious anti-inflammatory effect and good tolerance, pirprofen merits large-scale use in rheumatology.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1986

High field strength magnetic resonance of extra-axial spinal pathology.

High field strength (1.5 T) surface coil magnetic resonance imaging (MRI) of the spine was performed on 560 patients over a 9 month period of time. A total of 220 patients with extra-axial pathology including spinal stenosis, spondylosis, herniated disc, traumatic, inflammatory, vascular, developmental and tumorous lesions were included in this initial spine MRI experience. Results of these studies clearly indicate an expanded role of increasing importance for MRI performed at high field strength in the evaluation of spinal extra-axial pathology compared with the information that has been obtained from examinations performed at lower field strengths. Studies obtained at 1.5 T may obviate the need for myelography in many cases.

Adult↗
PubMed1986

CT findings in the vertebral column in the radicular lumbosacral syndrome.

An analysis of the CT findings in 150 patients with the radicular lumbosacral syndrome showed that 98 of them (65.3%) were suffering from intervertebral disc prolapse or protrusion. In 44 of these patients the finding of a prolapsed disc was combined with major spondylarthrosis while 20 others had marked spondylarthrosis or spondylosis with no apparent disc prolapse. Other findings included metastatic destruction of the vertebra (4 cases), fractured vertebra (2 cases), osteoid osteoma (1 case), and discitis (1 case). Slight or major asymmetry was found in 94 per cent, and a high incidence (38.8%) of the atypical rotatable type of intervertebral articulation was noted. The high percentage seems to confirm the hypothesis, according to which the rotatable type of intervertebral union is one of the predisposing factors for the development of the radicular lumbosacral syndrome.

Adolescent↗
PubMed1986

Magnetic resonance imaging in the diagnosis of the posterior fossa and the spinal column.

Magnetic resonance imaging (MRI) is more advantageous for evaluation of the posterior fossa and spinal column because it can delineate the brain stem and the spinal cord in multidimensional planes without intrathecal contrast and ionizing radiation. In 18 cases with posterior fossa tumors, MRI was definitely superior to computed tomography (CT) in 11 cases (61%) and was equally diagnostic in 5 cases (28%). In investigations in 58 cases of spinal disorders examined by MRI, MRI was useful in diagnosing intramedullary cord tumors, syringomyelias, herniated discs, and infections, but CT was still more diagnostic in spondylosis, ossification of the posterior longitudinal ligament, and canal stenosis.

Brain Neoplasms↗
PubMed1988

The use of somatosensory evoked potentials in the evaluation of the central nervous system.

SEPs may be recorded over the spine and scalp to stimulation of any accessible mixed or sensory nerve in the extremities. SEP abnormalities are useful in detecting lesions in central somatosensory pathways. They do not establish a specific diagnosis, but they may suggest or support a diagnosis made on clinical grounds. They have been used particularly to detect subclinical lesions in multiple sclerosis, but their role in following the course of this disorder is unclear. SEPs have been used as a prognostic guide in patients with hemispheric stroke and in patients who are comatose following head injury or severe cerebral anoxia; in such instances, however, the SEP often adds little to what can be determined by clinical examination. Their role in the evaluation of patients with brain death is controversial. Preserved SEPs or their early return after a spinal injury suggests an incomplete lesion, and therefore a better prognosis than otherwise. SEPs have been used to minimize or prevent intraoperative neurologic complications by monitoring spinal cord function, but their role in this regard awaits adequate validation. In patients with cervical spondylosis, SEPs elicited by stimulation of a nerve in the lower extremities may be helpful in indicating which patients are liable to develop a significant cord deficit, so that surgical treatment can be considered at an early stage. SEP abnormalities have been described in a number of other neurologic contexts, but the findings may be of more academic than clinical relevance in that they help to define the extent of neuropathologic involvement without altering the management of individual patients.

Diagnosis, Differential↗
PubMed1986

[Histopathological studies of the osteophytes and ossification of the posterior longitudinal ligament (OPLL) in the cervical spine].

To obtain information on ossification around the vertebral body of the cervical spine, we carried out histopathological investigation on 30 autopsy cases. The results were as follows; Intervertebral discs were untouched, anterior osteophytes developed along the anterior longitudinal ligament and they corresponded to anterior spur in spondylosis deformans. Posterior osteophytes around the posterior edges of vertebral body resulted in intervertebral insufficiency, and corresponded to hypertrophic spur in osteochondrosis. Histopathological findings of hyperostotic anterior osteophytes were similar to anterior osteophytes, but in the former there were advanced osteophyte formations. In OPLL of the segmental type, intervertebral discs were degenerated, and ossified mass did not involve the posterior longitudinal ligament of the parts of discs. With regard to morphological appearance and the tendency of increasing ossification, OPLL of the continuous type was similar to hyperostotic anterior osteophytes, without involvement of intervertebral disc. OPLL of the distinctly continuous type was differentiated from that of the segmental type.

Adult↗
PubMed1986

[A case of ossified yellow ligaments (ossified ligamenta flava) of the thoraco-lumbar region and magnetic resonance imaging].

A Case of ossified yellow ligaments in thoraco-lumbar region is reported. A 47-year-old-male complained low back pain with suddenness in August, 1984. One month later, he noticed dyesthesia on his right lower extremity and gait disturbance. These symptoms progressed slowly. In June, 1985, he admitted to The Jikei University Hospital. On neurological examinations, he was noticed an intermittent claudication, spastic paraparesis and stocking type sensory loss in his lower extremities. Plain lumbar X-ray films showed ossified yellow ligaments (OYL) in the posterior half of the spinal canal from the level of 10th thoracic to second lumbar vertebrae. Magnetic resonance imaging disclosed marked indentations of the spinal cord at the same level. The wide laminectomy was carried out and OYL were removed totally in gentle manner. Postoperative course was uneventful. His sensory disorders improved remarkably and he gained good muscle strength in his lower extremities, but a considerable spasticity remained still. OYL is closely related to the developmental canal stenosis, the spondylosis and the other degenerative disorders such as ossification of posterior longitudinal ligaments. This allows more complicated neurological signs and symptoms in the case of OYL. When OYL is suggested, it is recommended to performed whole spinal radiological survey. The surgical consideration should be done. From this point of view, MRI would be a most useful weapon.

Adult↗
PubMed1988

[Radiological diagnosis of chronic spinal cord compressive lesion at thoraco-lumbar junction].

Radiological findings in five cases with chronic spinal cord compressive lesion at thoraco-lumbar junction were reported. Three cases had spondylosis and two cases had ossification of yellow ligament (OYL). The levels of the lesions were T12/L1 in three cases and T11/12 in two cases. Two out of three spondylotic patients had also OYL at the same level. The five cases consisted of three men and two women. The ages ranged from 42 to 60 years old with a mean age of 53 years old. Neurologically, every patient showed flaccid paresis and sensory disturbance of the legs. Two cases had sensory disturbance of stocking type. The intervals from the onset of the symptoms to the final diagnosis were 6 months, 7 years, 8 years, 11 years and 12 years. Myelography showed anterior spinal cord compression by bony spur in spondylotic patients, and posterior compression by OYL in other cases. Myelography in flexion posture disclosed the cord compression by bony spur more clearly in two out of three spondylotic patients. Delayed CT-myelography showed intramedullary filling of contrast material in two cases, which indicated degenerative change or microcavitation due to long term compression of the spinal cord. MRI was taken in three spondylotic patients and could directly show compression of the spinal cord. Difficulty in detecting abnormality at thoraco-lumbar junction on plain roentgenogram, and similarity of the symptoms to peripheral nerve disease often lead to a delay in diagnosis. The significance of dynamic myelography and delayed CT-myelography when dealing with such a lesion was discussed here.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Health status of journalists and organization of work in a national daily newspaper].

A multidisciplinary investigation was performed on 173 reporters (53 men and 20 women) of a newspaper. The microclimate and illumination conditions of the main seat, in which the use of VDT was beginning, were satisfactory, although not all the instruments were correctly adjusted. A very low percentage of reporters working in the main center was suffering from arterial hypertension indicating the presence of the "healthy worker effect". The values of plasma cortisol and arterial blood pressure of 10 reporters of the main seat, except two cases, changed normally during the evening hours. It is to point out that among the reporters there was significant correlation between spondylosis and astigmatism. The psychological investigation evidenced that the reporters were aggressive, eager of success and with constant attention. The EMG biofeedback demonstrated in the reporters with a more prolonged period of employment nervous tension and difficulty in relaxing. Particularly, in the reporters of the main center, the Stait-Trait Anxiety Inventory was more altered than in those of the peripheral seats.

Adult↗
PubMed1985

CT in low back pain syndrome.

CT has become the imaging modality of choice for diagnosing the specific cause of low back pain syndrome. This article describes and illustrates those abnormalities commonly associated with low back pain: disk herniation, spinal stenoses, facet joint abnormalities, spondylosis, inflammatory conditions of the lumbar spine, and sacroiliitis.

Adolescent↗
PubMed1988

[Segment changes in the cervical spine following cervical spondylodeses of unstable injuries].

Radiologic and functional assessments were performed in 60 patients who underwent cervical fusion for traumatic instability. Follow up range was one to eight years (average 3.9 years). 235 motion segments (C2/3 to C7/th1) were analyzed. Follow up radiologic examination included a.p., flexion-extension and oblique cervical spine films. Each motion segment was analyzed for range of mobility according the method of Penning. Total range of spinal motion was recorded, radiologic disc appearance and spondylophyte formation were also classified. The most striking findings included 15 "nose-like" and eleven "bridging" spondylophytes noted anteriorly on the lateral views. Segmental function was diminished an average of 67.8% in "noses" and 46.6% in "bridges". Since the disc height remained radiologically normal, and osteophytes were located exclusively anterior, adjacent to the fusions, these changes were interpreted as secondary to excessive dissection along the anterior longitudinal ligament or the improper placement of the plates. In seven cases rapid development of degenerative change was attributed to previously undetected traumatic insult to a normal motion segment. This resulted in significant loss of function in all cases. In 134 non-adjacent motion segments no spondylophyte formation or disc degeneration secondary to operation or trauma was found. Of 235 motion segments, ten adjacent and five non-adjacent segments in nine patients were found to show increased degenerative changes. In this population the average patient age was 51 years (significantly higher than the group average of 38.7 years). The function of these segments was only 45.2% of normal. With historical controls the incidence of increased degenerative changes of the non-fused segments is at no greater risk for early degenerative phenomena than the population at large. 1. Cervical fusion for traumatic instabilities carries a higher risk for the adjacent motion segments, but lower than the risk in patients with deforming spondylosis. Careful operative technique can offer a distinct decrease in postoperative spondylophyte formation. 2. Non fused motion segments in this study were affected by degenerative disease at a rate approximately equal to the general population. 3. This investigation revealed no hypermobility in any non-fused motion segment. 4. Even radiologically normal segments could reveal a diminished range of motion.

Adult↗
PubMed1988

[Complications of Forestier disease affecting the cervical vertebrae as seen from a neurosurgical point of view].

In the presence of Spondylosis hyperostotica an isolated spondylophytary ventral ossification leads to the stiffening of the vertebral column with a considerable loss of elasticity. Patients with a rarely occurring participation of the cervical vertebral column are particularly endangered by traumata. Even a trivial trauma may lead to the fracture or a spinal canal diameter in the lower normal range lead to neurological symptoms. The degree of the instability and the neurological symptoms determine the therapeutical approach. The strategy of the treatment is discussed on the basis of the example of six patients from two neurosurgical clinics.

Aged↗
PubMed1988

Anterior spine fusion with Zielke instrumentation for idiopathic scoliosis in adolescents.

Anterior Zielke instrumentation of adolescent idiopathic scoliosis curvatures can provide excellent correction of thoracolumbar and lumbar curvatures, with substantial correction of rotational deformity. This correction allows fewer number of vertebrae to be fused, thereby leaving more normal lumbar motion segments distal to the fusion and decreasing the likelihood of lumbar spondylosis in later life. Anterior spinal surgery introduces a new set of intraoperative challenges that may be unfamiliar to the traditional posterior spine deformity surgeon. A slightly less cosmetically acceptable thoracotomy incision scar and the fact that a postoperative orthosis is required are disadvantages that are outweighed by the fewer number of motion segments that need to be involved in the fusion mass, as well as the superior correction.

Adolescent↗
PubMed1988

[Correlation between abnormal SSEP and clinicoradiological findings in cervical lesions].

The purpose of this paper is to evaluate the short latency somatosensory evoked potentials (SSEP) in the diagnosis of cervical lesions. Recordings were obtained from 59 patients with cervical lesions which included 24 cases of cervical spondylosis, 4 cases of disc herniation, 14 cases of OPLL, 4 cases of intramedullary tumor, 7 cases of extramedullary tumor and 6 cases of syringomyelia. SSEP changes in these cases were classified into three major types as follows: type I; normal SSEP, type II; prolongation of interpeak latency, and type III; absence of the component of SSEP. Types II and III were subdivided into two subgroups, respectively, as follows: type IIa; prolongation of interpeak latency between P9 and P11, type IIb; prolongation of P11-P13, type IIIa; no responses after P11 and type IIIb; no responses after P13. Type I was detected in 25 cases (42%), type II in 16 cases (27%), and type III in 18 cases (31%). These SSEP findings were compared with clinicoradiological findings. In type I, the locations of the lesions confirmed by the radiological findings were variable, and there was no definite tendency in the localizations. 80% of type I showed only numbness of extremities or disturbance of the superficial sensations. The cervical lesion was located just under the C5 vertebral level in type IIa and IIIa, while the lesion was extended above the C4 vertebral level in type IIb and IIIb. These results were explained by the generation sites of P11 and P13 (P11 originated from the lower dorsal column, and P13 from nearby the dorsal column nucleus).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1987

[Follow-up CT myelography of severe cervical spinal cord injury].

There are many reports describing gross anatomical and microscopical findings of severely injured cervical cords in autopsy of the acute and chronic state, but no morphological findings of a severe cervical spinal cord injury in a chronic state by follow-up CT myelography have been found in the literature so far. The sagittal and transverse diameters of the cervical spinal cord and subarachnoid space of 9 out of 14 severe cervical spinal cord injury patients were measured with CT myelography within 7.5 years after the trauma and their size compared with a control group which was made up of 29 patients with slight radiculopathy due to cervical spondylosis and whiplash injuries. Injured cord levels were C4 4 cases, C5 4 cases and C6 1 case. Remarkable spinal cord atrophy was recognized in the sagittal diameter from C1 to C7 and in the transverse diameter below C4 and narrowing of the cervical subarachnoid space in the sagittal diameter from C2 to C5. The significance level was set at 1-5%. From these findings, we have concluded that atrophy appeared not only in the injured segment but also the whole cervical cord after the trauma. There was less cord atrophy in a good functional prognosis than in a poor prognosis.

Adolescent↗
PubMed1987

Patient monitoring in the conservative management of cervical radiculopathy.

With increasing frequency, concern is being raised by nonmanipulating health professionals over the use of manual procedures in the cervical spine. With respect to treatment of radicular syndromes secondary to discogenic spondylosis, the potential for occasional iatrogenic complications must be an "a priori" consideration. Illustrated with the data from case presentation, conservative therapeutic management utilizing electrodiagnostic monitoring in questionable cases is discussed. Anecdotal improvement in median nerve F-wave function following conservative treatment including spinal manipulation is presented.

Cervical Vertebrae↗