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PubMed1982

[An unusual form of osteoarthropathy in psoriatric erythroderma].

Follow-up study is reported of an unusual osteoarthropathy showing considerable changes in the vertebral column and connected with a psoriatric erythrodermia. X-ray findings are growing metaplastic ossifications in the capsular ligaments, which are extremely prominent in the regions of shoulder joints and hip joints. In the vertebral column cervical and lumbal regions are especially attacked and in fibro-ostitis huge metaplastic ossifications of the ligaments develop, which radiologically are very similar to the picture of an ankylopoietic spondylosis. After long-term therapy with high doses of cortisone the patient developed diabetes mellitus and Cushing-syndrome. The arising complications soon caused her death.

Dermatitis, Exfoliative↗
PubMed1983

The pathophysiology of degenerative disease of the lumbar spine.

Degeneration starts in one joint and eventually involves all three joints of the three-joint-complex (one disc and two posterior joints) at an intervertebral level. Later, mechanical changes occur that affect the levels above and below and cause similar changes there. The result is multilevel lumbar spondylosis and stenosis. The spectrum of degenerative changes in a three-joint-complex progresses through three stages, which help to predict the outcome of different types of treatment.

Humans↗
PubMed1978

[Morphology of the incisura scapulae in relation to the frozen shoulder (author's transl)].

A flat incisura scapulae was registered on radiological examination of four cases of frozen shoulder. A modified X-ray technique was used to investigated 250 patients with spondylosis cervicalis in a morphological study of the incisura scapulae. Three types were found: Type I with a deep, sharp incisura, type 2 with a widened, balloon-sharped incisura and type 3 with a flat, barely-distinguishable incisura. The significance of the X-ray appearance is discussed.

Adult↗
PubMedDate not supplied

Patterns of spinal cord atrophy by metrizamide CT.

Forty patients with cervical myelopathy underwent high-resolution computed tomography (CT) with intrathecal administration of metrizamide for evaluation of cervical spinal cord atrophy. Thirty of them showed evidence of either focal atrophic distortion or generalized accentuation of the anatomic surface features of the spinal cord. Patients with a Chiari malformation or syringomyelia were excluded. The characteristic features in cervical spondylosis and canal deformity include flattening of the ventral surface of the cord, central infolding, beaking of the lateral funiculi, and wasting of the dorsal surface of the cord. Patients with motor neuron disease showed a combination of anterolateral and posterolateral atrophy reflecting underlying degeneration of the anterior horn cells and/or corticospinal tracts, respectively. Those with monomelic motor neuron disease had a striking ipsilateral hemiatrophy of the spinal cord. Among those presenting with spastic paraparesis, seven with clinically definite multiple sclerosis showed diffuse atrophy or focal degeneration due to a localized plaque of demyelination. Two cases of cord neoplasm showed atrophy secondary to ascending or descending degeneration of the long tracts.

Atrophy↗
PubMedDate not supplied

Metrizamide myelography and postmyelographic computed tomography: comparative adequacy in the cervical spine.

Metrizamide myelography and postmyelographic computed tomography (CT) were evaluated for relative efficacy when correlated with operative findings in a series of 30 patients. Fifty-seven levels were operated on in the 30 patients with 27 patients diagnosed as having diffuse cervical stenosis, hyperostotic spondylosis, or herniated nucleus pulposus. Metrizamide myelography and CT metrizamide myelography were equally useful in providing preoperative diagnostic information at 44 of 57 levels. Both radiographic techniques agreed with the degree of canal and neural forman stenosis found operatively at more than 80% of levels. This study indicates that either metrizamide myelography or CT myelography alone is sufficient, and that both should be performed only if one fails to answer the clinical question or if syringomyelia or cord tumors are suspected.

Adult↗
PubMed1984

[Fundamental and clinical studies on CT gas myelography of the cervical spine].

We applied CT gas myelography at the cervical spinal region and investigated the clinical value of CT gas myelography as a supplementary diagnostic method for the spinal cord and vertebral diseases. Fundamental studies of the conditions of window width and window height and the permitted limit of the angle of incidence were made with phantoms of human neck to establish proper conditions of these factors. In clinical studies, 23 adult persons, who had no abnormality in the cervical spine and in the cervical spinal cord were observed to have normal CT gas myelograms of the cervical region, whereas 37, of clinical cases including 18 of cervical spondylosis, 10 of OPLL, 2 of cervical discopathy, 3 of fracture and dislocation of the cervical spine, 2 of cervical vertebral tumor and 2 of CYL, were found to show clear pathologic findings in the cross sections of the vertebral foramen, subarachnoidal space and spinal cord on the CT gas myelograms. The representative cases of these diseases were presented. The gas myelograms were morphologically classified and investigated in relation to the clinical findings. From the result of these investigations, CT gas myelography appears to be highly useful as a supplementary diagnostic method for diseases of the cervical spine and the cervical spinal cord. Furthermore, we compared the effect of this method with that of CT myelography using metrizamide, a recently developed water-soluble contrast medium.

Adult↗
PubMed1984

The neck-tongue syndrome: occurrence with cervical arthritis as well as normals.

The syndrome of unilateral occipital pain with simultaneous ipsilateral tongue dysesthesia on sharp turning of the neck, recently reported in 4 otherwise normal young adults, is now described in 3 additional instances; one without disease and one each having degenerative spondylosis and ankylosing spondylitis. The originally proposed anatomical explanation for the syndrome, interconnections between the lingual and hypoglossal nerves and the C2, C3 nerve roots, is consistent with this syndrome complex arising from arthritis affecting the C1-C2-C3 articulation.

Adult↗
PubMedDate not supplied

[Computerized tomography in the diagnosis of a herniated cervical disk ].

A total number of 117 cervical herniated disks was observed in 103 patients. Among these, 30 underwent surgical treatment. A comparison is made between CT findings and myelographic and surgical data. Purpose of the investigation is to define the reliability of CT in the diagnosis of cervical herniated disk. The morphology, level and tomographic localization into the vertebral canal are described. Moreover the possible association with spondylosis and "narrow canal" is stressed. The diagnosis was correct in all operated cases (100%). The topographic description too was correct in all cases. In 3 patients the level-diagnosis was mistaken. CT shows a higher degree of sensibility and specificity than myelography in the diagnosis of herniated disk in the cervical spine.

Adolescent↗
PubMedDate not supplied

[Neurogenic intermittent claudication].

In the period 1971-1981 operations were carried out in 1114 cases of discopathy or lumbar spondylosis. Three patients in this group had pains of the type of intermittent claudication as the main symptoms. In all these cases narrowing of the vertebral canal was found in the lumbar part caused in two cases by degenerative changes and herniation of the intervertebral discs, and in a third case it was due to an extensive connective tissue scar at the site of previously done laminectomy. The nerve roots of the cauda were relieved from pressure surgically and in all cases pains disappeared. The authors discuss factors contributing to the development of neurogenic intermittent claudication.

Adult↗
PubMed1984

Neurosurgical management of spinal conditions--an overview.

During 1977-80 the annual number of surgical procedures on the spinal canal and discs has remained in the vicinity of 1800-1900 and fusions have ranged from 682 to 810. Neurosurgical participation in spinal surgery amounted to 18-20% of all spinal procedures. Disc lesion, canal stenosis, spondylosis, congenital and developmental malformations constituted 70% of the total spinal work carried out in a major neurosurgical unit in New South Wales. The above conditions form an 'overlapping' field of surgery, the orthopaedic surgeons treating an estimated 80% of these patients. Surgical management by neurosurgeons and orthopaedic surgeons of the same clinical category of spinal patient is different. An estimated one-third of orthopaedic patients are submitted to lumbar fusion. Neurosurgeons avoid fusion in the lumbar region. The need for integrated and sound neurosurgical and orthopaedic methods of management in the overlapping fields of spinal surgery has become imperative. To the neurosurgeon, the outcome of spinal surgery in terms of relevance to the extent of chronic spinal disability in the community has probably become more important than the outcome of craniocerebral surgery in the community. More attention should be given to standards of work in spinal surgery in matters of training, research and quality assurance. A research project by members of the Department of Neurosurgery, The Prince Henry and Prince of Wales Hospitals is outlined.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

HLA antigens in vertebral ankylosing hyperostosis (Forestier's disease).

Vertebral ankylosing hyperostosis (VAH) represents a chronic spinal disorder that is often difficult to differentiate both from the inflammatory involvement of the spine like ankylosing spondylitis (Bechterew--AS) and from several forms of spondylosis or paravertebral ossifications of psoriatic spondylitis. Shapiro (1, 2) observed a significantly higher frequency of HLA antigen B27 in 47 patients with VAH; but this observation could not be confirmed by other authors. In our group of 46 patients with VAH, most of them males, there were no X ray signs of sacroiliitis. Compared with 1210 healthy blood donors, no significant difference was observed in the distribution of 31 HLA antigens of A, B, C locus.

Adult↗
PubMed1983

[Proposal for the definition of "foramen magnum syndrome"--foramen magnum tumor and abnormalities].

The clinical appearance of foramen magnum tumor is protean and, even at the stage when serious neurological deficits are present, the lesions are often misdiagnosed as another disease, especially cervical spondylosis and multiple sclerosis, and patients may undergo improper concervative or even surgical treatments. The best guarantee against misdiagnosis, we believed, was to establish a definition of "Foramen Magnum Syndrome" to facilitate the recollection of its peculiar clinical findings. "Foramen Magnum Syndrome" is composed of: 1. Cape distribution of sensory loss; 2. Atrophy of the intrinsic muscles of the hands; 3. Neck or suboccipital pain; 4. Dysesthesia of the hands (numbness, tingling, and cold sensation); 5. Eleventh cranial nerve palsy; 6. Stereoanesthesia. (Remember the mnemonic CANDES or DESCAN) Among these, cape distribution of sensory loss, eleventh cranial nerve palsy and cold dysesthesia (not numbness or tingling sensation) are of great importance for topological diagnosis. We also pointed out the similarities between the clinical picture of syringomyelia and that of the advanced stage of foramen magnum tumor. The syringomyelic syndrome, often seen in Arnold-Chiari malformation and basilar impression, has been attributed to the concurrent syrinx of cervical cord. But the clinical analysis of foramen magnum tumors showed that this is not always true and that compressive lesions at the foramen magnum alone can cause syringomyelic syndrome.

Accessory Nerve↗
PubMed1983

Cervical myelopathy. Technique and results of spinal cord decompression by lateral laminectomy.

The Authors describe the technique of lateral laminectomy devised by Gui in 1965 for the treatment of cervical myelopathy secondary to cervical spondylosis. Spinal cord decompression is obtained by a lateral laminectomy with the maximum saving of bone, ligaments and muscles of the cervical spine. CAT scan demonstrated very well the effective decompression of the spinal cord achieved with this technique. The results of 87 cases treated in this way between 1968 and 1980 are reported. The average follow-up was 2.5 years. There was an improvement in the neurological symptoms in 82% of the cases.

Adult↗
PubMed1984

Knee arthropathy in ochronosis: diagnosis by arthroscopy with ultrastructural features.

Knee arthroscopy in a patient with undiagnosed chronic monoarticular arthritis revealed dark pigmentation of the snyovium; synovial biopsy revealed histologic and ultrastructural features characteristic of ochronosis. Synovial fluid (SF) was non-inflammatory, without pigmented shards of cartilage; calcium pyrophosphate dihydrate crystals were absent in both the SF and biopsy specimen. Homogentisic acid was detectable in the urine by thin layer chromatography, and asymptomatic spondylosis with intervertebral disc calcification was found. The negative family history, lack of mucocutaneous pigmentation and failure of the urine to spontaneously darken obscured the diagnosis, which was easily made by arthroscopy.

Arthritis↗
PubMed1984

[Evaluation of cord functions in patients with cervical radiculomyelopathy using cortical and spinal somatosensory evoked potentials].

UNLABELLED: It is desirable for neurosurgeons to be able to evaluate cord functions. To assess electrophysiologically functional status of spinal cord, cortical and spinal somatosensory evoked potentials (SEP) were studied in 33 patients with cervical radiculomyelopathy; 11 cases of cervical spondylosis, 11 cases of OPLL, 3 cases of narrow canal, 2 cases of narrow canal with OPLL, 3 cases of intradural extramedullary tumor, 2 cases of intramedullary tumor and one case of traumatic cervical cord injury. Before the operation cortical SEP was recorded from post-Rolandic area by the median nerve stimulation. Spinal SEP was recorded from the dorsal surface of the cord after partial and complete laminectomy, or before and after tumor removal. RESULTS: Cortical SEP showed abnormalities in 45% of the cases, whose abnormalities were disappearance of the early components such as P1N1 wave, P1 to P2 complex or P1 to P3 complex and delay of the peak latency. Spinal SEP showed abnormalities in 42% of the cases, and the abnormal patterns were divided into 3 groups as follows: Type 1: Slightly abnormal, P1 and N1 waves are well recorded, whereas the P2 wave is absent or markedly suppressed in the amplitude. Type 2: Moderately abnormal, the P2 wave is flat and in addition the N1 wave is diminished in the amplitude. Type 3: Severely abnormal, only the P1 wave is recorded and the N1 to P2 complex is absent. Type 1 was obtained from 3 patients, type 2 from 9 patients, and type 3 from 2 patients. Cortical and spinal SEP were closely related to deep sensations, and cortical SEP was relatively correlated with superficial sensations. There were no differences of spinal SEP in most of the cases between partial and complete laminectomy. In intradural extramedullary tumor, however, good spinal SEP was recorded in collapsed cord after the tumor removal. Clinical symptoms were improved postoperatively in 80% of patients with both normal cortical and spinal SEP. It is concluded that cortical and spinal SEP are useful for prognostic value in patients with cervical radiculomyelopathy.

Cerebral Cortex↗
PubMed1984

[Radiotherapy in degenerative-dystrophic and inflammatory diseases of the osteoarticular system].

Analysis of a 3-6-year follow-up of 565 patients with deforming arthrosis, spondylosis, osteochondrosis, spondylarthrosis and calcareous bursitis indicates the efficacy of the proposed standardized complex of topometric and roentgenotherapeutic methods. Medical and social rehabilitation was achieved in most of the patients. The quantitative assessment of the therapeutic results makes it possible to interpret them objectively and unambiguously.

Adult↗
PubMed1978

Cauda equina compression from lumbosacral malarticulation and malformation in the dog.

Compression of the cauda equina from subluxation, stenosis, or spondylosis of the lumbosacral articulation was found in 20 dogs, 13 of which were German Shepherd Dogs or crossbred German Shepherd Dogs. Pain, posterior paresis, and urinary or fecal incontinence were the most frequent problems associated with the compression. Dorsal laminectomy was performed on 13 cases, with good to excellent results on 10 of these.

Animals↗
PubMed1983

[Vertigo--their typical clinical pictures from neurosurgical standpoints].

Although vertigo is commonly encountered in many clinical disciplines, meticulous analysis of the onset and nature of the vertigo is essential not to overlook the vertigo of brainstem or cerebral origin without any other neurological signs and symptoms. Three central vestibular projection pathways and their possible functional roles in relation to vertigo were briefly discussed. To illustrate the characteristic clinical features of vertigo of various origins, 16 typical cases were presented and discussed. Their etiology include Ménière's disease, vertigo of neurovascular compression, sudden deafness, acoustic neurinoma, Rumsay-Hunt's syndrome, BPPN (benign paroxysmal positioning nystagmus), vestibular neuronitis, brainstem infarct, MPPN (malignant persistent positional nystagmus) with brainstem midline hemorrhage, cerebellar hemorrhage followed by orthostatic hypotension, vertiginous epilepsy, TIA from MCA stenosis, intracerebral hemorrhage from a mycotic aneurysm, falx meningioma, subclavian steal phenomenon, and cervical spondylosis. It is wrong and quite dangerous to believe that vertigo of CNS origin should be associated with some definite neurological signs and symptoms and to diagnose the vertigo to be of peripheral origin merely based on normal findings of CT scan and angiography. Recently advanced detailed neurootological investigations are quite helpful in differentiating vertigo of various origins, but may totally overlook the vertigo of serious CNS pathology. For "solo vertigo," the key point is first differentiate BPPN and vertibular neuronitis from others after which careful neurosurgical and neurootological evaluation should be pursued regardless of presence or absence of concomitant neurological findings.

Adult↗