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There appears to be premature onset of cervical spondylosis in the cervical spines of rugby players who are then at increased risk of hyperextension injury to the spinal cord with resultant paralysis. An illustrative case report is presented. The value of and necessity for routine radiological examination of the cervical spines of all rugby players is stressed.
Cervical spondylosis may be the most common cause of arm pain in the elderly. Although patients describe this pain as "severe," they seem able to ease it by massaging the area, which is not the case with other painful rheumatoid conditions. Elevated serum uric acid in an arthritis patient is not always a sign of gout. A definite diagnosis of gout can be made only when urate crystals are found in the joint fluid.
In two healthy and two diseased whitefish (Coregonus Wartmanni) taken from Lake Constance (FRG), ankylosis of the vertebral column was investigated both roentgenologically and histologically. Subsequent to the collapse and necrosis of the "residual" spinal cord within the intervertebral spaces, the outside edges of the vertebral bodies come into direct contact. The compression and tensile forces that occur to an increased extent as a result of the instability, lead not only to a remodelling of the vertebral bodies, but also to the formation of spondylotic osteophytes at the edges of the vertebrae and, as a result of periosteal stimulation, to the development of cellular hyaline cartilage, which fills the intervertebral spaces. Finally, as a result of perichondral ossification, a bony ankylosis develops. The humping of the spine of the fish due to the stiffening and shortening of the vertebral column, is accompanied by a restriction in the animal's freedom of movement. Muscular atrophic processes and disordered food uptake give rise to poor growth and a reduction in the weight of the diseased fish. These remodelling processes in the spine resulting from instability are specific to the periosteum and may be equated with the changes seen in man in spondylosis deformans. The possible cause of this vertebral column ankylosis is cadmium poisoning. The accumulation of this heavy metal obviously leads primarily to an irreversible toxic degeneration of the cells of the chorda dorsalis.
Monitoring of the spinal cord function by evoked spinal cord potentials (ESP) has come to be used widely with the establishment of a safe technique using an epidural electrode and the great improvement in medical electronic devices. According to other investigations ESP has been recorded through an electrode placed in the posterior epidural space, it is well known that residual ESP can be actually recorded after transection of the posterior half of the spinal cord and that ESP shows no change after a small transection of the anterior column. If ESP originating from the anterior half of the spinal cord is recorded, it is very useful for monitoring during anterior decompression surgery for myelopathy such as ossification of the posterior longitudinal ligament and cervical spondylosis. The purpose of this report is to analyse ESP originating from the anterior half of the spinal cord experimentally and further investigate the ESP monitoring clinically. Sixty cats were used in this study. ESP recording principally consisted of stimulation to the spinal cord at the level of thoracic or lumbar region and recording of ESP with a monopolar electrode placed in the cervical epidural space. Changes in the ESP after transection and compression of the spinal cord were analysed. Anterior vertebrectomy and laminectomy at C2 and C6 were performed for the purpose of placing an electrode correctly and facilitating transection or compression of the spinal cord. Recording electrodes were placed on both the anterior and posterior surfaces of the dura mater at C2. As the result of this study, it is apparent that there exists the ESP originating from the anterior half of the spinal cord. Such ESPs are more accurately recorded through an anterior placed electrode rather than through that placed posteriorly.
Previous observations on the anatomic distribution of Paget's disease of bone are substantiated by a study of an additional 639 patients and by comparison with radionucleide bone imaging. The main anatomic features are a preference for the lower rather than the upper limb girdle, a spinal distribution similar to that seen in vertebral spondylosis, and a tendency to right-sided involvement. Bone stress is a possible explanation of the skeletal distribution, and may therefore be significant in the pathogenesis of the disease.
20 high performance gymnasts between 14 and 22 years of age had an anamnestical, clinical and radiological checkup on the spine in order to assess news training-methods. Radiologically only 3 gymnasts were found to be without any pathological manifestation. 7 cases of M. Scheuermann were located. The other athletes showed degenerative findings of vertebral columns especially in the thoracic-lumbar transition. These degenerative signs, and the fact tht the gymnasts had no spondylosis, are the result of new exercises, which avoid extreme bending load in the lowest segment of the lumbar region. Anamnestical and radiological findings do not correlate. A critical medical screening is necessary before and during high performance training.
Four cases of dysphagia associated with disease of the cervical spine have been presented. One of the patients had cervical spondylosis with osteophyte formation while the other three had Forestier's disease or ankylosing hyperostosis. Symptoms of dysphagia dominated the clinical picture and led to their referral for further management. Two patients underwent surgical procedures and one died in the postoperative period. Two patients were managed conservatively, one with antibiotics, and both did reasonably well. The literature of 40 cases published in the last 54 years has been reviewed. We suggest that dysphagia due to cervical spine disease while an uncommon complication of these bony growths, is by no means rare. The dysphagia may be due to bony protuberances into the hypopharynx or into the esophagus and may be accompanied by soft tissue inflammation. Although most patients have been treated surgically, there may be a role for anti-inflammatory or antibiotic therapy in the first instance as surgery is often morbid and sometimes fatal.
Previous case reports of vertebral-basilar system infarction following chiropractic cervical manipulation have emphasized the role of predisposing factors such as cervical spondylosis, atherosclerosis, and congenital asymmetry of the posterior circulation. Ten patients without prior neurologic symptoms had vertebral-basilar system infarction promptly after chiropractic maneuvers. One patient, who was free of clinical and radiographic evidence of predisposing factors, subsequently died. Autopsy studies revealed massive nonhemorrhagic brainstem infarction due to bilateral vertebral artery thrombosis. Nine patients survived with residual neurologic deficits due to lesions in various locations of the posterior circulation. No patient received anticoagulants. Previous case reports are summarized and the kinetic anatomy of the vertebral arteries is reviewed to clarify the potential mechanisms involved in the pathogenesis of this entity. Although a causal relationship may be difficult to establish in individual cases, cervical manipulation seems to be the major identifiable factor in the pathogenesis of stroke in some patients.
A series of 24 patients presenting with features of both cervical and lumbar spondylosis and disc disease has been studied in order to evaluate the results of surgical treatment. Myelography is essential for confirmation of multifocal lesions. In all but 4 cases beneficial results were obtained after decompression of the predominantly involved region of the spinal canal. These 4 patients were improved after both lumbar and cervical laminectomy in two stages with an interval of 3-6 months. Morbidity was insignificant.
Fifteen dogs with stenosis of the lumbosacral portion of the spinal canal were treated by laminectomy, bilateral facetectomy, and foraminotomy. Concomitant disk extrusion, spondylosis, fracture, infection, neoplasia, hemivertebrae, and spinal bifida were not associated with the stenosis and attendant cauda equina compression. The predominant neurologic signs were intermittent hindlimb lameness and motor weakness; hindlimb muscle atrophy; presumed paresthesia with resultant dermatologic manifestations from self mutilation of the hindlimbs, tail, perineum, anal area, and genitalia; urinaryu or fecal incontinence, or both; and consistently elicitable pain on manipulation of the lumbosacral spine. Surgical decompression of the stenotic canal alleviated the clinical signs in all cases.
The evaluation of the mineral content of peripheral bones by measuring the photon absorption of the radius has proven to be a valuable method for routine clinical work: for diagnosis, follow-up and control of therapy. While there was a significant difference in the findings of normal persons compared with those of patients suffering from osteoporosis, renal osteodystrophy, osteogenesis imperfecta and skeletal fluorosis, there was no difference between normals and these patients suffering from Bechterew, Scheuermann, coxarthrosis, spondylosis, skoliosis and rheumatoid arthritis. Normal values for the mineral content and width or the radius at the junction of the middle and lower third--based on 8000 examinations--are mentioned.
During a 3-year period, diskospondylitis was diagnosed in 32 dogs. The condition affected primarily large dogs, with males outnumbering females by approximately 2:1. Diagnosis was made principally by evaluation of radiographs, wherein various degrees of vertebral lysis, sclerosis, and spondylosis were seen. Evaluation of titers for Brucella canis and bacterial cultures of blood, urine, and bone were used to identify the causative organism(s). Six of 24 dogs were seropositive for B canis, 21 of 26 dogs were blood culture-positive, 10 of 23 dogs were urine culture-positive, and 9 of 11 dogs were bone culture-positive. Staphylococcus aureus was the most common organism identified by cultures of blood, urine, and bone. Antibiotic therapy alone and in combination with vertebral curettage was used to treat dogs with minimal neurologic dysfunction. Dogs with severe neurologic deficits were treated with curettage, hemilaminectomy, vertebral immobilization, and antibiotics. Follow-up information was available for 29 dogs. Twenty dogs were clinically normal after treatment. Five dogs were euthanatized because of the severity of neurologic dysfunction; three of these dogs were not treated, and two deteriorated despite treatment. Three dogs died while hospitalized, and one dog died after discharge.
Early whole body bone scintigraphy was performed on 25 patients with prostatic cancer (15 cases with bone metastases and 10 cases without bone metastasis) to obtain anterior and posterior whole body images five minutes after administration of 99mTc-HMDP. The results were compared with the findings of routine bone scintigraphy after three hours, and the usefulness of the above method for the diagnosis of bone metastasis from prostatic cancer was evaluated. In cases in which increased activity was found in the upper and lower lumbar vertebrae by routine bone scintigraphy but no abnormality was seen by early whole body bone scintigraphy, senile degenerative bone changes such as spondylosis deformans were observed by bone radiography. In cases with multiple bone metastases, abnormal multiple accumulations were found by both early whole body bone scintigraphy and routine bone scintigraphy. In addition, in cases showing super bone scan, high accumulation in the skeletal system had already been detected by early whole body bone scintigraphy. When the courses before and after treatment in nine cases of multiple bone metastases were passaged from the results of early whole body bone scintigraphy and from changes in tumor markers (prostatic specific antigen, gamma-semino protein and prostatic acid phosphatase), increased activity and the appearance of new hot spots as well as an increase in tumor markers were detected by early whole body scintigraphy in three of the four advanced cases, whereas decreased accumulations and a decrease in and normalization of tumor markers were observed in five improved cases.
We examined the efficacy of systemic local anesthetics on various types of neuropathic pain in 89 patients. Lidocaine 1.5 mg.kg-1 was infused intravenously for one minute. Pain score (PS) by visual analogue scale (VAS, 0-10) was measured 1, 5, 15 and 35 min after the infusion. The efficacy of intravenous lidocaine was evaluated by PS which was lowest after infusion. PS decreased to less than 50 percent of pre-infusion value in more than 75 percent of cases of cancer pain, postherpetic neuralgia, trigeminal neuralgia, low back pain with signs of root pain or spinal canal stenosis, peripheral nerve injury and thalamic pain, in 50-75 percent of cases of herpetic neuralgia, and in less than 50 percent of cases of cervical spondylosis, spinal cord injury, reflex sympathetic dystrophy, causalgia and psychogenic pain. This study suggests that systemic local anesthetics is effective in neuropathy due to cancer pain, postherpetic neuralgia, trigeminal neuralgia, low back pain with signs of root pain or spinal canal stenosis, peripheral nerve injury and thalamic pain.
A group of 674 (266 males and 410 females) elderly living in a rural community of Nangai Village, Akita Prefecture, were subjects of bone mineral measurements in the lumbar spine and three areas of proximal femur (femoral neck; FN, trochanter; TR and Ward's triangle; WD). Measurement was by dual energy x-ray absorptiometry (DXA) set in a mobile van during mass health examination. The purpose of this study was to verify the appropriateness and imitations in the bone mineral measurements by DXA in elderly who have other aging related abnormal calcifications such as osteophytosis in the lumbar spine and calcification of the abdominal aorta, all of which may have an influence on the 'true' value of bone mineral density (BMD) particularly in the lumbar region. The results were as follows: 1) Subjects who were not capable of being measured by DXA tended to be older and reported experiencing pain and who scored low in TMIG index of competence compared to measurable subjects. 2) BMD of 2nd-4th lumbar spine with antero-posterior projection (AP) did not show simple age-declines that are seen in younger generations. In contrast, BMDs of proximal femur show linear aging declines. 3) Analysis of the association between BMDs and osteophytosis by spondylosis deformans in the lumbar spine and calcification of the abdominal aorta in front of the lumbar spine showed that AP-BMD had a strong correlation with the grade of both spinal osteophytosis and aortic calcification. On the other hand, BMDs of proximal femur showed no significant associations with these abnormal calcifications. 4) In this context, in order to evaluate the 'true' BMD in the elderly, BMDs in the proximal femur are a more appropriate indicator than AP-BMD which may be easily contaminated by other aging-related calcification in and around the lumbar region.
The expression of tenascin in yellow ligaments of 67 males and 26 females was investigated by immunohistochemistry. Positive tenascin staining was observed in matrices around fibroblasts of entheses, particularly in transitional regions between the cartilage and ligament in yellow ligaments, in 38 (57%) of 67 males and in 13 (50%) of 26 females examined. The incidence of positive tenascin staining was 62.5, 60.0 and 50.0% of yellow ligaments obtained from cervical, thoracic and lumbar spines, respectively. There were no significant differences in sex or regions examined. The incidence of positive tenascin staining in yellow ligaments of patients between the ages of 10-29 years, 30-49 years, 50-69 years, 70-80 years was 29, 55, 69 and 40%, respectively. The incidence of positive tenascin staining in yellow ligaments obtained from patients with ossification in posterior longitudinal ligaments and yellow ligaments and from patients with other diseases such as lumbar disc hernition, cervical spondylosis or spinal tumors was 80.0 and 47.9%, respectively. These results show that the appearance of tenascin in ligaments varies with aging and is frequent in spinal diseases with ossification.
STUDY DESIGN: This study retrospectively reviewed the clinical and radiographic results of a series of patients who underwent osteophyte resection during anterior discectomy and fusion. OBJECTIVE: To determine whether resection of the posterior uncinate process at the time of anterior cervical discectomy is safe and effective. SUMMARY OF BACKGROUND DATA: Previous studies have described techniques of osteophyte resection, but safety and outcome have not been supported by a clinical series of patients. METHODS: Forty-three consecutive patients with radiculopathy due to spondylosis or lateral herniated nucleus pulposus had 68 foraminotomies done at the time of anterior cervical disc foraminotomy for radiculopathy. All patients were followed-up until radiographic union. All patients were examined, and Odom's criteria were used to assess postoperative pain and function in the neck, arm, and iliac donor site. RESULTS: The results were consistent with previous reports of anterior cervical disc foraminotomy for radiculopathy. Excellent and good results occurred in 77% and 14% of the patients, respectively. Three patients had no relief and no patient had worsening of radiculopathy. The fusion rate was 93%. Thirty-one patients (72%) reported being very satisfied. Three patients required a re-operation--one for bone graft dislodgment and two for pseudoarthrosis. No vascular injuries occurred. CONCLUSIONS: Resection of the posterior portion of the uncinate process to remove osteophytes that narrow the neural foraman or to allow direct visualization of laterally herniated disc material can be done safely. When combined with an autogenous interbody bone graft, good results can be expected.
STUDY DESIGN: The present study focused on the radiographic and clinical parameters that suggest lower cervical lesions directly or indirectly related to lower cervical myelopathy in rheumatoid arthritis. OBJECTIVES: The results provided the risk factor for predicting compressive myelopathy due to lower cervical spine lesions in patients with rheumatoid arthritis. SUMMARY OF BACKGROUND DATA: The clinical pathology and radiographic risk factor for upper cervical myelopathy in rheumatoid arthritis has been well documented, but the compressive factors for lower cervical myelopathy due to subaxial lesions remain unclear. METHODS: Radiographic analysis on the lateral radiographs (neutral, flexion, and extension) of the cervical spine and neurologic evaluation were carried out in 100 patients with rheumatoid arthritis. Fifty-eight of these patients were followed-up for 5 to 10 years (mean, 5.4 years) radiographically and clinically. A comparative study on the incidence of radiographic abnormalities also was performed in 100 patients with rheumatoid arthritis and in age- and sex-matched patients with cervical spondylosis. CONCLUSIONS: Among the radiographic parameters of the lesions related to lower cervical myelopathy, marked destruction of spinous processes, axial shortening, and narrow spinal canal may be important factors that suggest myelopathy. Time-related deterioration of lower cervical myelopathy can be predicted by progressions of anterior slip, axial shortening, spinous process erosion, apophysial joint erosion, and intervertebral disc collapse. Younger patient age, longer duration of disease, higher dose of corticosteroid administration, and higher stage or class of rheumatoid arthritis also are thought to be significant general factors for myelopathy.