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PubMed1986

[Herniated cervical disk, with or without arthrosis--surgical management by simple discectomy or associated with spondylodesis?].

58 patients underwent surgery by an anterior approach for nerve root or spinal cord compression at one or more levels. The cause was a soft disc herniation, an osteophyte or the two combined. 44 underwent simple discectomy with 70.5% good or very good results. 14 also had interbody fusion by the method of Smith and Robinson, with good and very good results in 57.1%. In most cases the latter group had major cervical spondylosis and myelopathy. The bad results were due to severe neurologic lesions (myelopathy), duration of symptoms and associated illness. The anterior approach with use of the microscope provides good vision and involves few complications. Neither recurrence nor secondary posture disorders were observed.

Adult↗
PubMed1987

[Open-door decompressive cervical laminotomy. Technic and initial experiences].

The cervical laminectomy is usually applied in the treatment of cervical myelopathy caused by cervical canal stenosis and multiple spondylosis. Nevertheless, late complications are often reported, especially scar formation, the so-called laminectomy membrane, between the dura and overlying paraspinal muscles, which, compressing the cord, reduces until to abolish the favourable effects of the previous laminectomy; moreover, malalignment of the cervical spine with secondary kyphosis may follow an expansive laminectomy. In order to avoid these complications, in 1977 Hirabayashi introduced a new surgical technique, the "expansive open-door laminoplasty", which permits the enlargement of the spinal canal over multiple segments by completely incising the laminae laterally on one side and partially on the opposite: elevation with tilting of the laminae upward in the incised side, allows enlargement of the canal. The Authors describe in detail the operative procedure and report their experience in 10 patients.

Adult↗
PubMed1987

Cervical radiculopathy or myelopathy secondary to athetoid cerebral palsy.

Radiculopathy or myelopathy often occurs during adult life in patients who have athetosis. Herniation of an intervertebral disc, spondylosis, malalignment or instability of the cervical spine, or a combination of these lesions, can develop because of the athetoid hyperactivity. We reviewed the cases of ten patients who had cervical radiculopathy or myelopathy, or both, secondary to athetosis and who were surgically treated between the ages of thirty and fifty-eight years. The surgery consisted of discectomy, removal of osteophytes, and anterior interbody fusion. When several segments were involved, an extensive subtotal resection of the vertebrae and discs, followed by strut bone-grafting, was done.

Adult↗
PubMed1987

[Roentgenological study of antero-posterior diameter in developmental canal stenosis of cervical spine].

Developmental canal stenosis of the cervical spine is an important underlying condition of cervical spondylotic myelopathy. However, the criteria of the degree of narrowing is different among investigators and their rationales are unclear. To clarify this point, the antero-posterior diameter of the cervical spinal canal was measured in groups of normal subjects, patients with neck-shoulder-arm syndrome and cervical spondylosis. The measured values were analyzed statistically. The antero-posterior diameter was the widest in normal individuals and the narrowest in patients with the cervical spondylotic myelopathy. The point of differentiation of developmental canal stenosis was determined as 14 mm for males and 13 mm for females using the mean +/- 2SD of the values in normal subjects. Patients with values lower than this criteria comprised 82% of those with the cervical spondylotic myelopathy. These patients could be further classified into those that also showed clear cervical spondylotic changes and those that did not.

Adolescent↗
PubMed1987

[Septic arthritis of a posterior vertebral inter-apaphysial articulation. Apropos of a case].

A report of a case of haematogenous infection of a lumbar zygapophysial joint. In spite of radiographic and bone scan findings that localised the lesion, the diagnosis was not made until an operative exploration was made, which also effected a cure. This is an unusual site for sepsis and the clinical picture can easily lead to confusion with spondylosis which is much more common.

Arthritis, Infectious↗
PubMed1987

[Diagnosis of a cystic lesion in the spinal cord--studies on delayed CT myelography and MRI].

UNLABELLED: The collection of contrast medium within the spinal cord on delayed CT myelography generally indicates the presence of syringomyelia. We report the cases of cystic myelopathy with intramedullary contrast accumulation on delayed CT myelography. The purpose of this report is to compare MRI with delayed CT myelogram and to discuss the pathogenesis of the intramedullary contrast accumulation on delayed CT myelography. METHODS AND MATERIALS: Thirty patients with intramedullary contrast accumulation on delayed CT myelography were studied with High Resolution Computed Tomography (Siemens Somatom II) and Magnetic Resonance Imaging (MRI) (0.15T imager, Toshiba MRT 15A). MRI were routinely obtained in both axial plane and sagittal plane. Short spin-echo sequences (30 msec TE, 500 msec TR) were used. This series included 6 cases of cervical disc disease, 5 cases of Chiari malformation, 4 cases of lipomeningocele, 4 cases of adhesive arachnoiditis, 2 cases of thoracolumbar spondylosis, 2 cases of trauma, one case of spinal arachnoid cyst, one case of spinal epidural cyst, and 5 cases of idiopathic type. RESULTS: 1) In 17 out of the 30 patients (57%), the region corresponding to the region of contrast medium collection, which was visualized on delayed CT myelography, was seen as an area of the low signal intensity on MRI. In 11 cases out of 17, the syrinx cavity was confirmed at surgery. 2) In 13 cases, delayed CT myelogram showed collection of intramedullary contrast medium, but MRI failed to reveal an area of low signal intensity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

The long-term results of chymopapain. Ten-year follow-up of 268 patients after chemonucleolysis.

The effect of chymopapain injection was investigated in myelographically confirmed intervertebral disc herniation in 268 patients after ten years. Mean age is 39.4 years, 178 males and 90 females. Sixty-two patients had compensation or litigation and 12 had prior lumbar spine surgery. Discography was performed in 223 patients, resulting in 134 one-level injections, 124 two-level injections, and ten three-level injections. Forty percent of the patients experienced postoperative muscle spasm for several days. No complications were seen in 241 patients (92%) who were available for follow-up examination at ten years; 86% had less leg pain, 82% were employed at a capacity equal to or greater than before injection, 9% were at a less strenuous job, 1% were disabled, and 8% had retired. In 22 patients treated surgically within one year of chemonucleolysis, disc-related pathology was present in 14 cases and spondylosis or spinal stenosis was present in seven cases. One had a negative exploration and continued to be disabled. Eight patients came to surgical intervention after one year because of persisting symptoms: four patients had disc protrusion, three had laminectomy and spinal fusion, and one had a decompressive laminectomy secondary to spondylotic change. Chemonucleolysis did not prejudice the outcome of subsequent surgical treatment with good results following this intervention. One tumor, a neurofibroma, was found in this study. Chemonucleolysis with chymopapain was a safe and effective treatment of radicular complaints caused by well-documented intervertebral disc herniation.

Adult↗
PubMed1985

Cervical spondylitic myelopathy.

The myelopathy that may accompany cervical spondylosis is examined with reference to pathogenesis, clinical features, investigations, and treatment. The importance of canal size, disk degeneration, osseous changes, the cervical motion segments, and vasculature are presented. Frequent clinical patterns, radiologic and electrophysiologic investigations, and surgical treatments are discussed. An eclectic approach appears to be best.

Cervical Vertebrae↗
PubMed1985

[Another new etiology of vertebral artery insufficiency--a case of dynamic entrapment of the vertebral artery by the cervical nerve].

In the etiology of vertebral artery insufficiency, cervical spondylosis with uncal osteophyte, Power's syndrome, A-V malformation and atheromatous narrowing have been recognized. We recently experienced a patient with episodic vertigo and hyposthenia of the left side of the body on rotational movement of the neck. On surgical exploration of the atlanto-axial area of the vertebral artery where dynamic constriction of the artery could be observed by angiography, we found that the right vertebral artery was entrapped and constricted by the anterior branch of the second cervical nerve with fibrous adhesion after injury. With the release and resection of the injured nerve, the patient became free of any vertigo or hyposthenia. Although this kind of etiology involving entrapment-constriction of the vertebral artery by the cervical nerve after trauma has not been reported at all in the literature, we should always keep this in mind when dealing with patients with cervical vertigo after trauma.

Adult↗
PubMed1977

Expanding lesions of the cervical spinal canal.

Attention has recently been directed to decrease in size of the spinal canal, notably in relation to production of posterior osteophytes in spondylosis. Tumors of the cord, roots, or meninges, syringolmyelia and hydromyelia may enlarge sufficiently in size or be critically located so that expansile change of the cervical spinal canal may result.

Glioma↗
PubMed1985

[Extended spinal decompression using an anterior approach in the treatment of myelopathies caused by cervical arthrosis].

Forty-five patients suffering from severe myelopathy due to cervical spondylosis with stenosis of the spinal canal were treated by anterior decompression extending over three levels or more. In eight instances, the decompression was the only surgical procedure: in 37 instances, there was associated bone graft. No severe complications were noted. The clinical results were assessed, using the Nurick scale. The average follow-up was four years. No patient was made worse. Twelve were completely relieved, 21 were improved and 12 were unchanged. The authors conclude that this technique is worthwhile. Grafting should be done only in cases where there is post-operative instability. After a review of the literature, the authors conclude that anterior resection of the vertebral bodies is more reliable than extensive laminectomy.

Adult↗
PubMed1979

Congenital stenosis of the cervical spine: diagnosis and management.

An analysis of 11 cases of congenital stenosis of the cervical spine seen over the past three years is reported. The authors' experiences at an urban community hospital, as well as a large Veterans Administration Hospital, lead them to conclude that this disorder is a neurologically significant anomaly which is probably more common than published reports would imply. It can be clinically and radiographically distinguished from "pure" cervical spondylosis, to which it is related, and its treatment should be appropriately modified. It appears to have a predilection for young adult black males, and cervical myelopathy is the predominant clinical feature. Varying degrees of trauma, a disease endemic to the inner city, plays a major role in precipitating the neurological catastrophes associated with this potentially correctable disorder. Proper management of this entity demands a heightened awareness of its existence as well as a high standard of neurological and roentgenographic diagnosis, and operative performance. A flexible operative strategy which takes into account the specific biomechanical factors involved in this disorder as well as the patient's individual physiological and social status is imperative. Surgery offers a good opportunity for improving neurological function.

Adolescent↗
PubMed1979

[Calcification of the ligament. ant. of the spina (disease of Forestier) (author's transl)].

On the basis of the examination on a rich old-age patient material it may be established that. 1. Radiomorphologically the Forestier's disease essentially differs from the banal spondylosis. 2. Age is of particular importance in its genesis -- it is primarily a disease of old age men. 3. It is localized for the most part on the dorsal vertebral part. 4. As compared to the multiple radiomorphological signs clinical symptoms are, in general, neglectable. 5. Additional search for the relationship with diabetic metabolic disturbances in gerontological patients seems advisable.

Age Factors↗
PubMed1979

Breast pain: a symptom of cervical radiculopathy.

Eighteen women, all of whom had extensive but noninformative breast evaluations, including 10 mammograms and 4 biopies, were successfully treated by cervical traction for chronic breast pain. Each patient had distinct clinical or electromyographic evidence of cervical root compromise. Fifteen had roentgenographic evidence of cervical spondylosis, primarily at levels C6 and C7. Cervical angina, as a symptom constellation produced by cervical radiculopathy and mimicking coronary ischemic disease, is a well-defined entity. Less well recognized is persistent breast pain as a primary presenting symptom of cervical root compromise. In both instances, the early identification of the cervical radicular origin of the pain, with its quite different prognosis and associated therapeutic implications, can promptly help to allay the patient's physical and psychologic discomfort. The pathologic mechanism of pain production and the anatomic pattern of referral are described.

Adult↗
PubMed1979

When to suspect spinal cord lesions in the elderly.

Motor or sensory disturbance in the lower extremities--sometimes with gait disturbance--is the most common symptom of spinal cord disease. History and examination may localize the lesion, but spine x-rays and myelography usually are necessary to determine its cause. The most common causes of cord compression in the elderly are spondylosis and neoplasm. Compressive lesions are usually treated by surgery. Once compression has been excluded and diagnosis established, treatment should be directed toward the underlying disorder.

Aged↗
PubMed1979

Pathological changes in the lumbar spine of pigs: gross findings.

The lumbar vertebral columns from 60 sows and 30 slaughter weight pigs were examined grossly for pathological changes. Asymmetry of lumbar articular facets and minor periarticular osteophytes were seen in the slaughter weight group. Degeneration of intervertebral discs or vertebral osteophytes were not present. In contrast, 38% of 60 sows had vertebral osteophytes and 40% had degeneration of intervertebral discs. Extensive ankylosing spondylosis was present in two sows. Other vertebral lesions observed in sows include asymmetry and arthrosis of articular facets, fissures and areas of cavitation in the annulus fibrosus and vertebral end plate, and vertebral osteomyelitis and/or vertebral fracture. Extravertebral skeletal lesions, some of which could be related to a clinical history of lameness or posterior paralysis, include sacroiliac arthrosis, pelvic deformity, polyarthritis, femoral osteomyelitis, sacroiliac dislocation and epiphyseolysis involving the femoral head or tuber ischii.

Animals↗
PubMed1977

Cervical facet fusion for control of instability following laminectomy.

Cervical laminectomy may compromise the stability of the spine. Posterolateral facet fusion can be used to stabilize the spine after laminectomy and prevent progressive deformity. The procedure includes passing wires through drill holes in the articular processes and binding two longitudinal struts of bone to the posterior columns of the articular processes. Sixty-three p atients with cervical laminectomy and facet fusion were reviewed, and fifty-two of them were followed for one to seventeen years. The reasons for fusion were to control overt spinal instability and deformity or to eliminate motion which may contribute to spondylosis. Solid fusion occurred in fifty of fifty-two patients at a mean of 6.5 months and provided continuing stability without progressive deformity. Although facet fusion is a complex procedure, it provides secure stabilization, does not interfere with decompression, and permits early mobilization of the patient.

Adolescent↗
PubMed1982

[Writing of expertises on whiplash injuries of the cervical spine (author's transl)].

Reflections on the definition of the term "whiplash injury" are followed by comments on the mechanism of accidents. The author emphasizes the importance of the biphasic course of the trauma, involving a mass contraction, triggered by reflex action, of the initially suddenly overstretched muscle groups with their synergist. Reference is made to the ideas developed by Kummer, who considers the neck as an arcuate tendon construction with tractional tension on the dorsal as well as on the ventral side. In the analysis of the injury pattern of the cervical spine, the special forms of intervertebral disc injury are dealt with, the relationship to degenerative lesions prior to the accident and to secondary lesions (spondylosis deformans and osteochondrosis) are discussed in detail, and the consequences for writing medical expertises are mentioned.

Accidents, Traffic↗