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PubMed1993

[Superoxide dismutase in cerebrospinal fluid in patients with neurological diseases].

To evaluate significance of superoxide dismutase in neurological diseases, we measured cerebrospinal fluid (CSF) levels of copper-zinc superoxide dismutase (Cu/Zn SOD) and manganese superoxide dismutase (Mn SOD) using enzyme immunoassay methods in 181 neurological patients and 43 controls. The mean level of Cu/Zn SOD in CSF of controls was 54.4 +/- 28.7 ng/ml, and that of Mn SOD 8.1 +/- 2.5 ng/ml, although other methods have reported that Mn SOD is undetectable in CSF. Cu/Zn SOD or Mn SOD showed no statistical difference in age or sex of the controls. The elevation of both SOD levels was marked in acute diseases such as cerebrovascular diseases (CVD), bacterial meningitis and encephalitis, but mild in aseptic meningitis. The elevation of Cu/Zn SOD level was more prominent than that of Mn SOD in CVD, whereas vice versa in bacterial meningitis and encephalitis. In neurodegenerative diseases and cervical spondylosis, only Mn SOD level was significantly elevated. To examine the source of CSF SOD, we compared it with CSF levels of neuron-specific enolase (NSE) and S-100b protein (S-100b) in cerebral infarction and bacterial meningitis. Both SOD levels were correlated with NSE and S-100b levels in patients with cerebral infarction, but in bacterial meningitis no significant relationship was found among SOD levels, NSE and S-100b levels. This means that elevations of SODs in CSF may be due to not only damage of the nervous tissues but also the other mechanisms, as induction of SOD in the lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[A case report of acute death caused by hyperextension injury of neck].

We report an autopsy case of acute death from an upper cervical spinal cord injury caused by hyperextension of the neck. A 59-year-old drunken man who had been suffering from cervical spondylosis was slapped in the face, fell flat on his face, and remained as such for 4 hours. The victim was carried to a hospital, he had already been dead on arrival. Although he received an intensive care, he remained unconscious for 12 hours until a cardiac arrest. The findings of an autopsy were as follows: Externally, excoriation on the forehead and the left eyebrow and slight subcutaneous hemorrhage in the dorsum of the nose were observed. The intervertebral disk and the anterior longitudinal ligament between the 5th and 6th cervical vertebrae were severed, and a lot of bleeding in the region of the injuries was observed. The 6th cervical spinous process was fractured in the direction to a major axis. A part of the posterior root filaments was torned and the bleeding points could be seen on the front of the 6th cervical spinal cord. In the cross section of the 6th cervical spinal cord, the typical hemorrhagic necrosis could be recognized surrounding the central canal, whereas the similar finding was observed at the second cervical spinal cord. On the histopathological examinations, in C2, C5-C6 regions marked ischemic changes and hemorrhagic necrosis could be observed. From these post-mortem results, we diagnosed that the victim died from an upper spinal cord damage due to a stretching consequence of the hyperextentional injury.

Autopsy↗
PubMed1993

[Neurological causes for wrist pain].

The most common cause of wrist pain, due to neurological disorder is carpal tunnel syndrome. In aging patients with atrophy of the hand muscles it is to be differentiated from s.c. myelopathic hand, caused by denervation of anterior horn cells in conditions such as cervical spondylosis. The referred pain affiliated with palpable bands and trigger points in the muscles has to be also considered as origin of pain.

Carpal Tunnel Syndrome↗
PubMed1993

[Central motor conduction time in diagnosis of spinal processes].

In patients with extra- and intramedullary spinal disorders (32 cases with myelopathy due to cervical spondylosis, 11 with syringomyelia and 17 with spinal tumours) central motor conduction time (CMCT) was studied after transcranial magnetic stimulation of the cortex. Compound muscle action potentials (CMAP) were recorded from abductor digiti minimi muscle (ADM) and anterior tibial muscle (TA) bilaterally. Of 37 patients with extramedullary located cervical lesions CMCT to the ADM was abnormal in 51% (n = 19) and to the TA in 70% (n = 26). In 10 patients with intramedullary cervical lesions abnormal CMCT to the ADM as well as to the TA was observed in 30% (n = 3) each. In extramedullary disorders measurement of CMCT to the TA was more sensitive in detecting impaired central motor conduction, though not significantly. Prolonged CMCT correlated to clinical signs of upper motor neuron involvement and to spinal cord compression. In addition, the method proved useful for detection of subclinical lesions of corticospinal pathways. The different results between intra- and extramedullary affections are explained by the anatomical localisation of pyramidal tract fibers.

Adult↗
PubMedDate not supplied

Cervical radiculopathy following botulinum toxin therapy for cervical dystonia.

The development of transient right-sided lower cervical root impairment is reported in a 49-year-old woman affected by cervical dystonia, who had previously received botulinum toxin injections into the left sternocleidomastoid and the right trapezius. The possibility of a causal relationship was discussed with consideration of: 1) the absence of intercurrent illness or trauma; 2) the positive correlation between sensory-motor disturbances and the botulinum toxin-induced remission of cervical dystonia; 3) the reversibility of cervical radiculopathy (there was no recurrence in the two years following the interruption of the treatment). Magnetic resonance imaging investigation disclosed an abnormal cervical spine geometry together with moderate spondylosis. We feel that mechanical postural changes following the successful botulinum toxin treatment for cervical dystonia might have played some role in the development of cervical radiculopathy. Thus, skeletal abnormalities should be checked when attempting to correct muscle overactivity by botulinum toxin.

Botulinum Toxins↗
PubMed1993

[Lumbar spinal stenosis. An overview 50 years following initial description].

About 50 years after the first descriptions of lumbar stenosis and its most frequent symptom, neurogenic intermittent claudication, this update gives an overview of present-day concepts of the disease and of new experience in this area. Stenosis of the central and lateral lumbar spine is chiefly held to be one of the results of segmental degenerative instability throughout the several stages of spondylosis. The degenerative process of the spine has its starting point in regressive changes of the disc. This leads to instability of the motion segment, which explains the pathophysiological dynamics of the stenosis and its symptoms, including intermittent neurogenic claudication. Segmental instability is the crucial lesion causing all the changes in the degenerative process, which are not to be considered as separate entities but as part of the dynamics of the same disease. The spine's congenital anatomic individual patterns, which confirm the population thinking of the evolutionary biology (since they are different from one motion segment to the other) help to determine the outline of single cases. The disparity between radiological and clinical patterns is pointed out: severe stenosis may be asymptomatic or cause just modest monoradicular trouble as well as serious multiradicular deficit. The reason for the discrepancy is unknown. One must be careful to avoid surgery on a silent, purely radiological stenosis. Experience of more than 15 years confirms the uselessness of performing a complete laminectomy to achieve sufficient decompression. The author's method of selective decompression is described briefly. The English term "undercutting decompression" runs the risk of being misunderstood, since it is also used for rather destroying procedures. Finally, we point out that surgery for spinal stenosis must resolve both root compression and degenerative instability in the majority of cases. In most cases of lumbar stenosis, if decompression alone is performed, only the consequence, and not the cause of the disease, segmental degenerative instability, is treated. Osteophyte formation is an attempt by nature to stabilize the motion segments by stiffening its components. Spinal fusion tries to achieve the same effect. For most cases of spinal stenosis, we suggest our own technique, which combines safe and preserving ("selective") decompression according to Benini [1,7] with the translaminar screw fixation of Magerl [7]. In cases of degenerative spondylolisthesis, however, transpeduncular fusion is mandatory.

Aged↗
PubMed1993

Cervical myelopathy presenting as a genu recurvatum gait disorder.

A 49-year-old man presenting with a genu recurvatum gait disorder was found to have a cervical myelopathy, probably on the basis of cervical spondylosis and a cervical disc herniation compromising a congenitally narrow cervical spinal canal. Satisfactory resolution of abnormal hyperextension of the knee was achieved through the use of an ankle-foot orthosis. A genu recurvatum gait disorder as the presenting sign of cervical myelopathy does not appear to have been reported previously.

Cervical Vertebrae↗
PubMed1993

P3 event related cerebral evoked potential in chronic pain patients.

P3 component of event related cerebral evoked potentials has been applied as an index of information processing in a wide variety of normal and cognition impaired subjects. The present study was undertaken to examine possible changes in central nervous system processing and subjective appraisal, indexed by cerebral evoked potentials (N200 & P300), in 20 pain free controls and 20 subjects suffering from chronic pain (cervical spondylosis and low backache, sciatica). Standard auditory 'Odd ball' paradigm involving simple discrimination task of concentrating on infrequent (target) stimulus and ignoring the frequent stimulus (non-target) was employed. Evoked response trial of discriminating 32 target stimuli out of 160 total presented (20% target and 80% non target, randomly) were replicated and analysed by computer. There was significant increase in P3 latency in patients suffering from pain as compared to age and sex matched controls, suggesting change in cognitive functions.

Adult↗
PubMedDate not supplied

Klippel-Feil syndrome: CT and MR of acquired and congenital abnormalities of cervical spine and cord.

We reviewed MR and CT myelographic studies in patients with the Klippel-Feil syndrome (KFS) to determine the patterns of associated congenital and acquired abnormalities of the spine and spinal cord and to correlate these radiologic findings with the manner of clinical presentation. Twenty-four consecutive patients with radiologically definite KFS were evaluated by a cross-sectional imaging technique (CT or MR) over a 6 year period. Radiologic images were blindly interpreted by a panel of three experienced neuroradiologists and then correlated with clinical history. Cervical spondylosis or disk herniations were the most common radiologic abnormalities encountered, seen in 10 (42%) of the 24 patients. While some clustering of these secondary degenerative changes occurred at levels immediately adjacent to the fused vertebrae, in most patients spondylotic changes were seen widely distributed throughout the lower cervical region. Coexisting congenital defects of the spinal cord or brain were encountered in seven patients, six of whom were female, consisting of cervical cord dysraphism or diastematomyelia (n = 5) and Chiari I malformations (n = 2). In only eight patients (33%) had the diagnosis of KFS been suspected clinically prior to imaging by the presence of short neck, limited cervical mobility, or low occipital hairline. In the remaining 16 patients, mostly adolescents or adults being evaluated for cervical sensory or motor syndromes, the diagnosis of KFS was made radiologically at the time of the imaging referral.

Adolescent↗
PubMed1993

Neurosurgical management of the acquired immunodeficiency syndrome. An update.

A retrospective review of a 24-month experience on the neurosurgical service at a large metropolitan hospital identified 33 patients with the acquired immunodeficiency syndrome (AIDS) who underwent diagnostic or therapeutic procedures. Intracranial mass lesions unresponsive to empiric medical therapy for presumed Toxoplasma gondii encephalitis underwent diagnostic biopsy in 22 patients: primary lymphoma was identified in 10 (45%) of these patients, and biopsy led to a treatable diagnosis in 16 of the 22. Patients with lymphoma were significantly more likely to have a single mass lesion than those with other diagnoses. The remaining 11 patients had a wide variety of neurologic disorders, including multiple strokes and transverse myelitis, aspergillous fungal infection of the base of the skull, primary lymphoma of the spinal cord, cat-scratch fever of the spine causing painful radiculopathy, hydrocephalus associated with cryptococcal meningitis, and progressive inflammatory peripheral neuropathy. Two patients had lymphoma within the subarachnoid space. Three patients with well-controlled AIDS underwent elective neurosurgical therapy for intractable radiculopathies due to herniated lumbar discs in 2 and cervical spondylosis in 1. Current treatment strategies in AIDS appear to have limited the need for brain biopsy, but the spectrum of neurologic disorders has broadened, requiring continued participation by neurologists and neurosurgeons. With improved long-term survival, the elective treatment of non-AIDS-related neurologic disorders in selected patients may be appropriate.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Magnetic resonance imaging evaluation of the spine with metal implants. General safety and superior imaging with titanium.

We studied the cases of 15 patients who underwent postoperative magnetic resonance imaging evaluation after being treated with metal spinal implants. Spine stabilization was required in traumatic injuries for eight patients, cancer destruction in four patients, late cervical subluxation in one patient, spondylosis in one patient, and spondylolisthesis in one patient. A variety of stainless steel and titanium spinal implants were used. The images were evaluated for spinal and implant positioning and artifact production. Both stainless steel and titanium implants were imaged safely and there was no evidence of implant migration of local tissue-heating effect. The titanium spinal implants allowed postoperative spine imaging without the significant image distortion characteristic of the stainless steel implants. The stainless steel implants created significant artifact that impaired the usefulness of the magnetic resonance imaging evaluation.

Adult↗
PubMed1993

Long-term follow-up study of anterior surgery for cervical spondylotic myelopathy with special reference to the magnetic resonance imaging findings in 52 cases.

A series of 151 patients with cervical spondylotic myelopathy (CSM) were surgically treated through an anterior approach in the period from 1960 to 1987. Particular attention was given to the results of the 52 patients who were operated on more than 12 years ago. Satisfactory short-term results were obtained in all but the few who had incomplete decompression. In these patients, function deteriorated within five years. A disturbing incidence of progression of myelopathy was noted ten years after surgery. Magnetic resonance imaging identified many of the causes (e.g., newly developed intervertebral disk herniation and progression of spondylosis associated with spinal malalignment in both cephalad and caudal directions). Other adverse changes were hypertrophy of the yellow ligament and ossification of the posterior longitudinal ligament. The new and improved techniques consist of decompression to a width of 16 mm or more with intraoperative ultrasonography in addition to extirpation of the posterior longitudinal ligament. This new measure may reduce the incidence of late neurologic deterioration.

Adult↗
PubMed1995

Complications of transpedicular reduction and stabilization of the thoracolumbar spine.

Between July 1990 and January 1994, 160 patients underwent transpedicular reduction and stabilization using an AO internal fixator. In this series, most of the patients (101 cases) had degenerative spondylolisthesis. The follow-up period ranged from 12 to 36 months. One hundred and thirty one patients (82%) had a good or excellent postoperative outcome. Sixteen (10%) had fair outcomes and 13 (8%) had poor outcomes. There were 26 complications (16%) secondary to this treatment. Improper screw placement was found in five patients, wound infection in four patients and dural tear with cerebrospinal fluid leakage in two patients. Two patients were suspected of having an iatrogenic root injury during the insertion of the pedicle screws. One patient with advanced spondylosis developed a postoperative neurologic deficit (foot drop). In the follow-up period, there was loss of correction of the alignment in five patients, screw breakages in three patients, screw pull-out in two patients and loosening of the clamps in another two patients. As most of the complications were preventable or treatable, pedicle fixation system is still highly recommended for the treatment of spondylolisthesis or spinal instability.

Female↗
PubMed1995

[Surgical treatment of cervical disk displacement. Anterior or posterior approach?].

PURPOSE OF THE STUDY: This study is a retrospective analysis of the treatment of cervical soft disc herniation comparing anterior and posterior approach. MATERIAL AND METHODS: Twenty eight patients presenting with cervico-brachial radiculopathy secondary to acute soft posterolateral disc herniation were reviewed. Cases with myelopathy or radiculopathy secondary to chronic spondylosis were excluded. Involved level was C5-C6 or C6-C7 in most cases. There were 14 females and 14 males. Age at operation averaged 44 years. Fourteen patients underwent an anterior approach with discectomy and fusion using autologous iliac bone graft. Average age was 46 years in this group with an average follow-up of 30 months. Average duration of surgery was 2 hours. Average hospital stay was 6 days. Fourteen patients underwent a posterior approach with partial lateral laminotomy extending medially for several millimeters over the facet joint. Extruded disc material was removed in 10 cases. No curettage was performed. Average age at surgery was 41 years with an average follow-up of 36 months in this group. Average duration of surgery was 70 minutes. Average hospital stay was 6 days. RESULTS: Patients were evaluated 3 months post-operatively and at their maximum follow-up. At 3 months follow-up, no patient complained of radicular pain; occasional cervical pain was present in 5 cases following posterior surgery but was not observed at late follow-up. Return to work was possible on an average of 3 months in both series. Results were graded as excellent, good, fair and poor. At late follow-up, in patients with a posterior approach, there were 8 excellent results, 5 good results with neck fatigue at work, and 1 fair result requiring analgesics. In patients with an anterior approach, there were 7 excellent results, 6 good results, and 1 fair result. Two patients complained of pain at the iliac donor site. DISCUSSION: These results suggest that the anterior approach gives better short term results, but no significant difference is observed between anterior and posterior approaches a few years after surgery. Although the anterior approach is more appropriate than the posterior one for the treatment of central disc herniation, the posterior approach may be considered as an alternative to anterior discectomy and fusion for antero-lateral soft disc herniation.

Adult↗
PubMed1995

Frequency of cervical spine involvement in rheumatoid arthritis.

The cervical spine x-rays of a random number of patients with confirmed rheumatoid arthritis were taken. The presence of atlanto-axial subluxation, atlanto-axial impaction, subaxial subluxation and any other associated abnormalities was noted. The spinal canal diameter was also measured which was not significantly altered in rheumatoid arthritis cases. Cervical spine disorders were seen to occur in 16 cases (69.6%) out of 23 patients. Spondylosis was the most frequent disorder ie, in 10 cases (62.5%) out of 16. Obliteration of the normal lordotic curve and disc lesions occurred in 3 cases (18.7%) each out of 16. The mean spinal canal diameter was 16.30 +/- 2 mm with a range of 13-23 mm. Female patients (73.3%) had an increased cervical spine disorder than males (62.5%). Seropositive rheumatoid arthritis cases (87.5%) were mostly involved in occurrence of disorder than those of seronegative arthritis cases (46%).

Adolescent↗
PubMed1996

[Traumatic spinal complications of cervical arthrosis].

OBJECTIVES: Cervical spondylotic myelopathy is usually a chronic and progressive disease. In a few cases, however, dramatic tetraplegia sometimes occurs after even minor injury. METHODS: We report seven patients (6 males, 1 female, aged from 41 to 63), who suffered from acute myelopathy after an injury. RESULTS: In 5 cases, the injury revealed the cervical spondylotic myelopathy. A hyperextension of the cervical spine was found in 5 cases. The injury was severe in only one case, but there was no bony abnormalities, except arthrosis. The most common cause was a fall. In contrast, severe tetraplegia was found in 4 cases. Spontaneous, but incomplete, recuperation occurred in 4 patients. In all 7 cases, CT scan and MRI showed congenital cervical stenosis associated with cervical spondylosis. The level of disco-osteophytic changes was mainly in C4, C5, C6. On T2-weighted spin-echo image, an increased signal intensity was present in the cord of 3 patients, but was not correlated with the severity of the symptoms, nor with improvement. Surgical treatment was performed in 6 cases: 3 laminectomies, 3 anterior or antero-lateral approaches. Improvement after operative decompression was observed in all but one case, even when the motor or sensory deficit persists for more than one year. Motricity of the inferior limbs improved better than the other deficits, perhaps because of the location of non-reversible lesions in the spinal gray matter. CONCLUSION: The acute medullary syndrome of cervical spondylotic myelopathy is serious and can cause major handicaps. This complication justifies a preventive surgical attitude when medullar signs are moderate, and cervical imagery shows a spondylotic compression of the cord with congenital stenosis.

Accidents, Home↗
PubMed1996

[Acute paraparesis associated with dorsal diastematomyelia in an adult].

Diastematomelia presenting in adult life has long been considered a rare occurrence. With the development of modern imagining techniques, cases of adult are being discovered with increasing frequency, but their exact number remains unclear. It occurs most often in the lumbar region, is rarely located above the level of T3 and it present clinical features such as deformity of the food, peculiar posture, or gait disturbance. The symptoms and signs of diastematomelia usually are recognized in children. We are reporting the case of an adult patient who had a forme frustre of Sjögren's syndrome and thoracic diastematomelia presenting as a acute myelopathy. Although in most of patients, the pathogenesis of the neurological deficits could be attributed to lesions such as spondylosis, herniation of a disc, traction injury or the tethering effect derived from an osseous septum or a fibrous band, in our patients was absent. We suggested as contributory cause to damage of the spinal cord a vascular ischemic mechanism during flexion and extension of the spine, and we postulated the role that anti-Ro (SS-A) antibodies play in the immunopathogenesis (mediating or potentiating) vascular injury by altering vascular endothelial function or proliferation.

Aged↗
PubMed1996

[Needle electromyography in the thoracic paraspinal muscles of motor neuron disease].

Usefulness of needle electromyography (EMG) in the thoracic paraspinal muscles was investigated in 22 patients with amyotrophic lateral sclerosis (ALS). All patients revealed denervation changes in the thoracic paraspinal muscles, though the EMG findings were insufficient to fulfill the WFN criteria of lower motor neuron sign. We could not diagnose three patients as having ALS at their first visits by conventional EMG. One patient had restricted neurogenic change within one limb and two patients had cervical spondylosis causing difficulty to diagnose anterior horn cell involvement at the cervical level. In these patients, however, we believed to having ALS because of the neurogenic findings of EMG in the thoracic paraspinal muscles. Afterwards, they became clinically definite ALS. On relation to respiratory function, patients with acute denervation potentials (fibrillation potentials) in upper thoracic paraspinal muscles innervated by Th1 approximately Th4 had respiratory dysfunction (% VC is less than 80). Two patients had the acute denervation potentials in the upper thoracic paraspinal muscles before the decrease in % VC. We conclude that needle EMG testing in thoracic paraspinal muscle is useful to diagnose ALS in early stage and to predict respiratory failure in ALS patients.

Adult↗