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PubMed1997

Cervical spine degenerative diseases: an evaluation of clinical and imaging features in surgical decisions.

In clinically severe cervical spondylosis, imaging plays a vital role in surgical decisions. A prime factor is acquired canal stenosis with cord compression. To validate this concept, the clinical and imaging features of 20 patients with spondylotic myelopathy and 24 with radiculopathy were retrospectively reviewed. All had computed tomographic myelography (CTM) as part of their clinical work-up. The patients' clinical severity was graded as mild, moderate and severe; the age, length of illness and a history of eventual surgery or otherwise were recorded. At the level of maximum compression the following parameters were obtained from the axial CTM images: surface area and ratio of the anteroposterior to the transverse diameter of the cord; subarachnoid space and vertebral canal areas. Data were statistically analysed. A significant association exists between surgery and increasing severity of symptoms (P = 0.04), and advancing age (P = 0.01). These associations hold true for myelopathy and radiculopathy. A strong association is present between surgery and the surface area of the cord (P = 0.01), being applicable to myelopathy only. The other parameters show no association with surgical decisions. It is concluded that with myelopathy a narrow cord area at the level of maximum compression, and moderate--severe functional impairment are indicators for surgical intervention.

Case-Control Studies↗
PubMedDate not supplied

Rotary manipulation for cervical radiculopathy: observations on the importance of the direction of the thrust.

OBJECTIVE: To describe the clinical presentation of eight patients with cervical spine radiculopathy, the manipulation technique used for each patient and the outcomes of treatment. CLINICAL FEATURES: The cause of radiculopathy in four patients was disc herniation. The other four patients had a combination of spondylosis, disc herniation and sprain injury. INTERVENTION AND OUTCOME: Six of eight patients had a good outcome associated with receiving manipulation performed by contacting the cervical spine at the level of the radiculopathy, laterally flexing toward the side of radiculopathy, rotating the neck away from the side of the radiculopathy and applying a gentle high-velocity, low-amplitude thrust. Two patients had an exacerbation of arm pain and increased neurological deficit associated with manipulation performed with the neck rotated toward the side of radiculopathy. CONCLUSION: There is little compelling evidence supporting or disputing the use of manipulation for patients with cervical spine radiculopathy. In our patients, rotary manipulation was associated with a different outcome depending on the direction of neck rotation. Prospective time-series studies and randomized, blind trials are needed to identify the efficacy and effectiveness of different manipulation techniques for this condition.

Adult↗
PubMed1997

Trends and complications in cervical spine surgery: 1989-1993.

In an effort to determine trends in surgery of cervical spine disorders and the incidence of complications resulting from this treatment, a mechanism was established for the collection and analysis of multicenter data on an every-5-year basis. This data collection technique allowed the tracking of trends in the treatment for specific diagnoses and determination of complication rates for individual procedures. We present the results occurring in 4,589 patients operated on by 35 surgeons per year between 1989 and 1993. Principal diagnoses included spondylosis, herniated nucleus pulposus, trauma, rheumatoid arthritis, ankylosing spondylitis, ossification of the posterior longitudinal ligament, and tumor. Surgical procedures included anterior cervical discectomy, anterior cervical discectomy and fusion, corpectomy, laminectomies, posterior arthrodesis, laminoplasty, and cervical plating. Complications reported include: bone graft failure, cerebrospinal fluid leak, recurrent laryngeal nerve injury, root injury, quadriplegia, and death. The yearly percentages of each diagnosis have been roughly stable for each year of the study. However, the operative procedures revealed some interesting trends. There was no overall trend with regard to complications over time, and the overall complication risk was approximately 5%. The present data confirm that cervical spine disease is primarily degenerative or discogenic. However, trauma still remains a major part of the practice, accounting for upwards of 17% of reported cases. Anterior procedures were twice as common as posterior ones. The risk of operative complications remains small yet significant.

Bone Transplantation↗
PubMed1997

Primary hyperparathyroidism with cardiac abnormalities: a case report.

Primary hyperparathyroidism, characterized by hypersecretion of parathyroid hormone (PTH) leading to hypercalcemia and relative hypophosphatemia, is quite common in the elderly. Most patients with primary hyperparathyroidism have only mild hypercalcemia and are symptomless. But others experience various other organ diseases. Primary hyperparathyroidism is also associated with cardiovascular abnormalities, including QT interval shortening, heart block, cardiac arrhythmias, hypertension, myocardial hypertrophy, myocardial calcification and, though rarely, with valvular heart disease. We described a case of primary hyperparathyroidism associated with cardiac abnormalities. An 82-year-old male presented with the complaints of chest discomfort, fatigue, general weakness, nausea and vomiting over a period of months and was admitted in July 1996. Physical examination with heart auscultation showed a pansystolic murmur over the right sternal border and apex region, and a blowing diastolic murmur over the left sternal border. Biochemistry profiles revealed elevations of serum calcium (14.3 mg/dl) and chloride/phosphate ratio (> 33). Endocrinological studies showed elevations of serum PTH-C (4.8 ng/ml) and PTH-intact (705 pg/ml) concentrations. Kidney ultrasonography revealed a left renal stone. A spine X-ray revealed spondylosis and a compression fracture of the lumbar-spine with osteoporotic change. Thyroid ultrasonography and Thallium (Tl201)-technetium (Tc99m) subtraction scan showed parathyroid adenoma in the low pole of the right thyroid bed. Parathyroid aspiration cytology revealed few and discrete cells. Echocardiogram revealed moderate to severe aortic valvular calcification as well as stenosis with moderate aortic regurgitation, mitral regurgitation and myocardial calcification. The patient received parathyroidectomy one month later. During his postoperative days, he suffered from muscle twitching with positive Trousseau's sign and Chvostek's sign. The patient received calcium carbonate and vitamin D for hypocalcemia, diltiazem and capoten for his heart problems. A repeated echocardiogram two months after surgery showed no improvement of valvular calcification.

Aged↗
PubMed1976

Cervical spinal cord injury without evidence of fracture or dislocation. An assessment of the radiological features.

An analysis of plain X-ray films, tomography and myelography in 30 patients with proven cervical spinal cord injury, whose X-ray films were negative, has been performed. Features considered were the sagittal diameter of the spinal canal, associated cervical spondylosis, soft tissue changes, mobility studies and the value in cases of cervical injury of two recently described radiological signs. The only consistent feature in the majority of patients was a large posterior osteophytic spur in the lower cervical spine. No other radiological feature was found to be of particular value in diagnosis.

Adipose Tissue↗
PubMed1998

Clinical results of anterior cervical discectomy without interbody fusion.

A retrospective review of 42 patients who had undergone anterior cervical discectomy without bone fusion using an operating microscope was performed to analyze the results in patients who had a diagnosis of soft disc herniation or spondylosis between 1988 and 1994. There were 29 males and 13 females (age range, 30 to 77 years). Discectomy of single level was performed in 28 cases and at two levels in 14 cases. A soft disc lesion was found in 15 patients and a hard disc in 27 patients. A good result was achieved in 93% of patients with soft disc and 59% of those with hard disc lesion. Twenty-six patients underwent radiological evaluation after the surgical intervention. Collapse of disc space was observed in 43% of these and vertebral fusion in 28% of these. In analysis of the influencing factors, it can be seen the pattern of the onset of symptoms significantly influences the surgical result. A comparison of our results at follow-up with published series in which the anterior cervical discectomy without bone fusion was used, shows no significant differences. Therefore, we recommend the anterior discectomy without fusion as the treatment of choice for soft disc lesion.

Adult↗
PubMed1998

[A case of bow hunter's stroke caused by bilateral vertebral artery occlusive change on head rotation to the right].

We report a case of bow hunter's stroke caused by simultaneous bilateral vertebral artery occlusive changes at the right C3-4 and the left C1-2 level on head rotation to the right side. The pathogenesis and surgical treatment for this particular case are discussed. A 61-year-old male with cervical spondylosis repeatedly experienced vertebrobasilar insufficiency when he rotated his head over 60 degree from the mid-position to the right side. Bilateral vertebral angiography demonstrated severe compression of the right vertebral artery by a lateral osteophyte and instability at the C3-4 level accompanied with the mechanical stenosis of the left vertebral artery at the C1-2 level only at the time of turning his head to the right. As the surgical treatment we performed osteophytectomy of the right uncovertebral joint at the C3-4 level in addition to anterior decompression with fusion using hydroxyapatite spacer and titanium plate at that level. Postoperatively, the patient had no ischemic episodes and there was angiographical resolution of the rotational stenosis at the C3-4 level. For the clinical manifestation of bow hunter's stroke on head rotation, it is indispensable that simultaneous severe occlusive changes present on bilateral vertebral arteries. In case of a vertebral occlusive change caused by lateral osteophyte at the unstable vertebral joint, anterior decompression and fusion with osteophytectomy may be a wiser approach than arterial decompression or posterior fusion at the C1-2 level to another vertebral artery occlusive lesion.

Cerebrovascular Disorders↗
PubMed1998

[Cervical epidural hematoma caused by cervical twisting after epidural anesthesia: a case report].

A case of cervical epidural hematoma caused by cervical twisting after epidural anesthesia was reported. A 41-year-old man who had had anterior fusion of C5 - 7 using a plate due to cervical spondylosis fifteen months before admission, had undergone epidural anesthesia through the C7/T1 interspace without difficulty for shoulder pain in a pain clinic. Two hours after injection, he complained of severe pain in his neck and both shoulders just after cervical twisting as was his custom. Within minutes he noted paresis of his left extremities. Neurological examination on admission revealed left side dominant tetraparesis and loss of pain and temperature sensations below the level of T4 on his right side. Laboratory data analysis and coagulation tests were normal. CT scans and MRI demonstrated an epidural hematoma with a small amount of air extending from C3 to the upper margin of C7. Four hours after the onset, a laminoplasty was performed from C3 to C7 with total removal of the hematoma. No bleeding site or any vascular abnormality was found to account for the hematoma formation. He was discharged with good recovery after operation. Most of the reported epidural hematomas associated with epidural anesthesia were related to coagulopathy, anticoagulant therapy or difficult puncture. On review of the literature, this is the first case of spinal epidural hematoma cause by cervical twisting after spinal anesthesia and which was without impaired coagulation or difficult spinal puncture. Cervical epidural hematoma should be considered as a possible complication in patients with pain or neurological deficits after some cervical manipulations.

Adult↗
PubMed1998

Dual-head pinhole bone scintigraphy.

UNLABELLED: This article describes dual-head pinhole bone scintigraphy (DHPBS), which makes use of two opposing pinhole-collimated detectors to obtain one pair of magnified images of bone and joint at one time. The aims are to reduce scan time and solve the problem of the blind zone that is created in the background in single-head pinhole bone scintigraphy. METHODS: DHPBS was used for normal hip and knee joints and one case each of lumbar spondylosis, vertebral compression fracture and pyoankle. The gamma camera used was a digital dual-head SPECT camera (Sopha Camera DST; Sopha Medical Vision International, Buc Cedex, France) connected to an XT data processor and a printer. Each of two opposing detectors was collimated with either a 3- or 5-mm pinhole collimator. The scan was performed 2-3 hr postinjection of 12-25 mCi 99mTc-oxidronate. Some 1500-2000 Kilocounts were accumulated at 15-40 min per pair. Anterior and posterior views were taken for the spine and hip and medial and lateral views for the knee and ankle. DHPBS images were correlated to radiographs. RESULTS: DHPBS produced a pair of high-resolution bone and joint images at one time, reducing scan time by nearly half for each image. The paired DHPBS images clearly visualized both foreground and background objects, which effectively eliminated the blind zone. CONCLUSION: DHPBS can significantly improve efficiency and diagnostic acumen.

Aged↗
PubMed1998

[Analysis of fusion waves created with temporal pacing].

Fifty-five beats of fusion waves were recorded continuously with an audio digital tape and the tape was re-played for analysis. A 45-year-old male (56 kg, 175 cm) with cervical spondylosis was scheduled to undergo laminoplasty of the cervical vertebral (C2-C6). A temporal ventricular (VVI mode) pacing lead was inserted from the right cubital vein to the right ventricular apex for preventing bradycardia while manipulating the medulla. The height of the R wave decreased gradually and the depth of S wave increased in the earlier period of fusion beats and it was reversed later. The narrow QRS width indicated that the electrode was placed near the cardiac conducting system. The gradually increasing intervals between P waves activated the pacing, and the P wave intervals recovered inhibiting the pacing. During the recovery phase, some beats were still activated by pacing instead of depressing the rate below the original rate. These beats suggest the importance of considering the atrial-ventricular conducting time. Arterial pressure fluctuated only slightly during the 'fusion beats, suggesting that despite the abnormality in the cardiac conduction system due to pacing, contraction of the ventricular muscles was only slightly affected in this case.

Anesthesia, General↗
PubMedDate not supplied

[Occipital nerve neuralgia as postoperative complication. Views on etiology and treatment].

Occipital neuralgia might have a various etiology but the most common cause is hypertrophic fibrosis of subcutaneous tissue following trauma to the occipital region, surrounding the occipital nerve. The other important cause of neuralgia is spondylosis of the upper part of the cervical spine (C1-C2). Rare causes are-diabetes, gout and neoplasm. In the presented material we point out the possibility of the occipital neuralgia after surgery in the treatment of the tumours of ponto-cerebellar region and trigeminal neuralgia. We observed the symptoms in two groups of patients and used pharmacological treatment, local blockade and cutting (neuronectomy) of the occipital nerves trunk when the conservative treatment was unsuccessful. We also present the present concepts of occipital neuralgia treatment. In case of severe symptoms, unsuccessful conservative therapy and poor results of the neuronectomy the most indicated therapy is selective posterior rhizotomy.

Cerebellar Neoplasms↗
PubMed1998

Diagnostic value of cervical somatosensory evoked potentials recorded from the intervertebral discs after median and ulnar nerve stimulation in cervical spondylotic myelopathy.

We have studied the cervical somatosensory evoked potentials (CSEPs) recorded referentially from serial intervertebral discs after stimulation of the median nerve or the ulnar nerve at the wrist in cervical spondylosis. In seven unilateral radiculopathies, the CSEPs evoked by stimulation on the asymptomatic side normally consisted of the P1-N1 and the P2-N2 components, which represented the potentials arising from the white matter and the gray matter, respectively. Of 21 myelopathies, the CSEPs revealed the white matter involvement with conduction block identified by abrupt P1-N1 amplitude reduction in 7, the gray matter involvement identified by P2-N2 amplitude reduction in 3, or a combination of both in 11. The CSEPs were useful not only for determining the level responsible for myelopathy but also for localizing the lesion in the transverse plane of the spinal cord.

Adult↗
PubMed1976

[Experience with radio isotope myelography from neurosurgical aspects (author's transl)].

Experience with Radio Isotope Myelography is reported here. 169Yb-DTPA as a tracer was intrathecally injected at lumbar region in twenty three patients with various spinal cord lesions. The first scanning is perfomed after comfirming by gamma-camera that the tracer reaches to the lesion, the second and the third scannings are done according to the ascending rate of the tracer. (I) Normal scintimyelogram (A) In normal case, the shape of the Radio Isotope Myelogram well corresponds the shape of anatomical subarachnoid space. (B) In normal adult cases, the tracer comes up to the cisterna magna in 20-25 minutes after the lumbar injection. Therefore, the scintimyelographic diagnosis should be made not only by the shape but also by the ascending rapidity of the tracer. (II) Abnormal scintimyelogram Abnormal scintimyelograms could be summarized as following three categories. (A) "Delay": It means delay of the ascending of the tracer. Besides, "Transient delay" found in a case of Arnord-Chiari's malformation was proposed. (B) "Partial block": It meas a defect at the level of the lesion. This "Partial block" were observed in cases of spinal cord angioma, cervical spondylosis and spinal cord tumor etc. (C) "Complete block": It means the stagnation of the tracer below the lesion. To sum up, Rario Isotope Myelography, especially in partial block, can more easily and more sensitively represent the maximum extent of the spinal cord lesion than other myelographic study or angiographic one. On the other hand, we can not qualitatively diagnose about the lesions by its indistinct border.

Adolescent↗
PubMed1998

[Spinal root compression and results of treatment of discogenic cauda equina syndrome].

Several experimental and clinical studies suggest an important role of the quality and quantity of the material compressing the lumbosacral spinal cord radices in the development of cauda equina syndrome. These facts inspired the author to find out if the repair of neurological functions depends also on these factors. Clinical investigations of 81 persons (30 women and 51 men) were performed at minimum time of two years after the operation of the cauda equina discogenic syndrome. Mathematical analysis of the acquired data (chi-quadrate) revealed that so-called soft compression of neural structures (intervertebral disc hernia, sequester liber) negatively influenced the restoration of lower extremities motor functions (p = 0.01), sexual functions in men (p = 0.05) and radicular pain persistence (p = 0.01). On the other hand, the so-called hard compression (spondylosis deformans and protrusion of intervertebral disc) negatively influenced the restoration of sensitive innervation (p = 0.01) and voluntary control of urinary bladder emptying (p = 0.01). (Tab. 7, Ref. 24.)

Cauda Equina↗