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Sample records for cervical spondylotic myelopathy

  1. [Laminoplasty for cervical spondylotic myelopathy].

    Science.gov (United States)

    Fransen, P

    2014-10-01

    Cervical spondylotic myelopathy (CSM) is a common condition. Uninstrumented laminectomy may be complicated by postoperative instability, whereas anterior or posterior decompression with fusion may be associated with stiffness and adjacent segment disease. Cervical laminoplasty, initially oriented towards pediatric patients and ossification of the posterior longitudinal ligament, becomes an interesting surgical alternative to decompress and reconstruct cervical anatomy without fusion. Eighteen patients (12 men, 6 women), mean age 64.2 who presented with CSM were treated surgically using multilevel laminoplasty, and reviewed after 1 month, 6 months, 1 year and 2 years. Clinical evaluation was performed based on the Benzel-JOA and Nurick scores. The preoperative mean Benzel-JOA score was 13.55; Preoperative mean Nurick score was 1.88. Preoperative MRI was carried-out in 16/18 patients. Intramedullary hyperintensity in T2 was observed in 6 patients. The operation was performed on 2 levels (4 patients) 3 levels (11 patients) and 4 levels (3 patients). We used the open-door hinged laminoplasty technique, using metallic implants, without bone graft. At one month FU, mean JOA score was 15.44, and Nurick dropped to 1.05. At 6 months, mean JOA was 16.28 and Nurick was 0.71. At one year, the mean JOA score was 16.16, and Nurick was 0.83. At 2 years, mean JOA was 17.5, and Nurick was 0.25. One infection, one dural tear and one transient episode of C5 paresthesia were observed. We conclude that spinal cord decompression by open-door laminoplasty for CSM allows significant clinical improvement observed progressively in the two years following surgery. PMID:25239380

  2. Cervical Spondylotic Myelopathy: Factors in Choosing the Surgical Approach

    OpenAIRE

    Yalamanchili, Praveen K.; Vives, Michael J.; Chaudhary, Saad B.

    2012-01-01

    Cervical spondylotic myelopathy is a progressive disease and a common cause of acquired disability in the elderly. A variety of surgical interventions are available to halt or improve progression of the disease. Surgical options include anterior or posterior approaches with and without fusion. These include anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, cervical disc replacement, laminoplasty, laminectomy with and without fusion, and combined approaches. Rec...

  3. Cervical Spondylotic Myelopathy: Factors in Choosing the Surgical Approach

    Directory of Open Access Journals (Sweden)

    Praveen K. Yalamanchili

    2012-01-01

    Full Text Available Cervical spondylotic myelopathy is a progressive disease and a common cause of acquired disability in the elderly. A variety of surgical interventions are available to halt or improve progression of the disease. Surgical options include anterior or posterior approaches with and without fusion. These include anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, cervical disc replacement, laminoplasty, laminectomy with and without fusion, and combined approaches. Recent investigation into the ideal approach has not found a clearly superior choice, but individual patient characteristics can guide treatment.

  4. Application of magnetic resonance imaging in cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    Chuan; Zhang; Sushant; K; Das; Dong-Jun; Yang; Han-Feng; Yang

    2014-01-01

    Cervical spondylotic myelopathy(CSM) is the most common cause of spinal cord dysfunction and is caused by static or dynamic repeated compression of the spinal cord resulting from degenerative arthritis of the cervical spine and some biological injuries to the cervical spine. The T2 signal change on conventional magnetic resonance imaging(MRI) is most commonly associated with neurological deficits. Diffusion tensor imaging and MR spectroscopy show altered microstructure and biochemistry that reflect patient-specific pathogenesis and can be used to predict neurological outcome and response to intervention. Functional MRI can help to assess the neurological functional recovery after decompression surgery for CSM.

  5. Anterior cervical discectomy and fusion for noncontiguous cervical spondylotic myelopathy

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    Sun Qizhi

    2016-01-01

    Full Text Available Background: Noncontiguous cervical spondylotic myelopathy (CSM is a special degenerative disease because of the intermediate normal level or levels between supra and infraabnormal levels. Some controversy exists over the optimal procedure for two noncontiguous levels of CSM. The study was to evaluate the outcomes of the anterior cervical discectomy and fusion (ACDF with zero-profile devices for two noncontiguous levels of CSM. Materials and Methods: 17 consecutive patients with two noncontiguous levels of CSM operated between December 2009 and August 2012 were included in the study. There were 12 men and 5 women with a mean age of 60.7 years (range 45-75 years. Involved disc levels were C3/4 and C5/6 in 11 patients and C4/5 and C6/7 in six patients. Preoperative plain radiographs, computed tomography (CT with 3-D reconstruction and magnetic resonance imaging (MRI of the cervical spine were taken in all patients. All radiographs were independently evaluated by 2 spine surgeons and 1 radiologist. The outcomes were assessed by the average operative time, blood loss, Japanese Orthopedic Association (JOA score, improvement rate, neck dysfunction index (NDI, swallowing quality of life (SWAL-QOL score, the cervical lordosis and complications. Results: The mean followup was 48.59 months (range 24-56 months. The average operative time and blood loss was 105.29 min and 136.47 ml, respectively. The preoperative JOA score was 8.35, which significantly increased to 13.7 at the final followup ( P 0.05. Cerebrospinal fluid leak, dysphagia and radiological adjacent segment degeneration occurred in one patient, respectively. Conclusion: The ACDF with zero-profile devices is generally effective and safe in treating two noncontiguous levels of CSM.

  6. Laminoplasty versus laminectomy for multi-level cervical spondylotic myelopathy: a systematic review of the literature

    OpenAIRE

    Lao, Lifeng; Zhong, Guibin; Li, Xinfeng; Qian, Lie; Liu, Zude

    2013-01-01

    Background There is considerable controversy as to which posterior technique is best for the treatment of multi-level cervical spondylotic myelopathy. The aim of this study was to compare the clinical and radiographic results and complications of laminoplasty (LAMP) and laminectomy (LAMT) in the treatment of multi-level cervical spondylotic myelopathy. Methods We reviewed and analyzed papers published from January 1966 and June 2013 regarding the comparison of LAMP and LAMT for multi-level ce...

  7. Reliability of three-dimensional gait analysis in cervical spondylotic myelopathy.

    LENUS (Irish Health Repository)

    McDermott, Ailish

    2010-10-01

    Gait impairment is one of the primary symptoms of cervical spondylotic myelopathy (CSM). Detailed assessment is possible using three-dimensional gait analysis (3DGA), however the reliability of 3DGA for this population has not been established. The aim of this study was to evaluate the test-retest reliability of temporal-spatial, kinematic and kinetic parameters in a CSM population.

  8. Gait impairment in cervical spondylotic myelopathy: comparison with age- and gender-matched healthy controls.

    LENUS (Irish Health Repository)

    Malone, Ailish

    2012-12-01

    Gait impairment is a primary symptom of cervical spondylotic myelopathy (CSM); however, little is known about specific kinetic and kinematic gait parameters. The objectives of the study were: (1) to compare gait patterns of people with untreated CSM to those of age- and gender-matched healthy controls; (2) to examine the effect of gait speed on kinematic and kinetic parameters.

  9. Retrospective cost analysis of cervical laminectomy and fusion versus cervical laminoplasty in the treatment of cervical spondylotic myelopathy

    OpenAIRE

    Warren, Daniel T.; Ricart-Hoffiz, Pedro A.; Andres, Tate M.; Hoelscher, Christian M.; Protopsaltis, Themistocles S.; Goldstein, Jeffrey A; Bendo, John A.

    2013-01-01

    Background Cervical laminoplasty (CLP) and posterior cervical laminectomy and fusion (CLF) are well-established surgical procedures used in the treatment of cervical spondylotic myelopathy (CSM). In situations of clinical equipoise, an influential factor in procedural decision making could be the economic effect of the chosen procedure. The object of this study is to compare and analyze the total hospital costs and charges pertaining to patients undergoing CLP or CLF for the treatment of CSM....

  10. Multilevel cervical spondylotic myelopathy treated by anterior cervical decompression in subsection and autograft fusion

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective:To investigate a novel surgical method for multilevel cervical spondylotic myelopathy (CSM). Methods: Totally 21 patients with multilevel CSM undergoing a novel surgical procedure from April 2001 to January 2004 were analyzed retrospectively. All patients experienced anterior cervical decompression surgery in subsection, autograft fusion and internal fixation. Preoperative, immediate postoperative and follow-up image data, X-rays and semi-quantitative Japanese orthopaedics association (JOA) scores were used to evaluate the restoration of lordosis (Cobb's angle), intervertebral heights, the stability of the cervical spine and the improvement of neurological impairment. Results: Preoperative symptoms were markedly alleviated or disappeared in most of the patients. According to the JOA scores, the ratio of improvement in neurological function was 72.2%, including excellent in 9 cases (42.9%), good in 7 cases (33.3%), fair in 3 cases (14.3%) and poor in 2 cases (9.5%). Immediate postoperative X-rays showed obvious improvements in lordosis and in the intervertebral height of the cervical spine (P<0.01). There is no evidence of instrument failure during the mean follow-up period of 14.2 months (9-24 months, P>0.01). Conclusion:Anterior cervical decompression in subsection, autograft fusion and internal fixation is a rational effective method for the surgical treatment of multilevel CSM.

  11. Value of somatosensory evoked potentials in diagnosis, surgical monitoring and prognosis of cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    DING Yu; HU Yong; RUAN Di-ke; CHEN Bo

    2008-01-01

    Background The value of somatosensory evoked potentials (SEPs) in the diagnosis and prognosis of cervical spondylotic myelopathy, as well as the usefulness of monitoring intraoperative potentials in terms of safety and predictive factors were investigated.Methods Each of the 76 myelopathic patients underwent surgical intervention. According to the wave configurations of the SEPs, the cases were categorised into four groups: Type Ⅰ, Ⅱ, Ⅲ and Ⅳ. The clinical myelopathy disability was classified and the severity of neurological deficits was scored. Clinical function after surgery was evaluated. Preoperative potentials and intraoperative monitoring were categorized. The correlations between evoked potentials detection, monitoring, myelopathy disability and surgical outcome in the different groups were discussed. Results According to the configurations of the SEPs, there were 27 patients (36%) of Type Ⅰ, 30 patients (39%) of Type Ⅱ, 8 patients (11%) of Type Ⅲ, and 11 patients (14%) of Type Ⅳ. The categorised evoked potentials were shown to be significantly associated with the clinical representation of myelopathy (P 〈0.01) and the recovery rate from identifiable SEPs waves (groups A, B and C) was significantly higher than unidentifiable waves (group D, P〈0.01). A deterioration of SEPs was detected in 23 cases (30%), whereas there was no change in 40 cases (53%) and improvements in 13 cases (17%). A significant difference in recovery rates could be observed in various monitoring groups within the short-term follow-up period, while there were no obvious differences in the long-term follow-up groups. Conclusions SEP technique is a valuable and practical tool for the diagnosis, monitoring and prognosis of myelopathy. Classified evoked potentials are well correlated with cervical spondyiotic myelopathy disability, and unidentifiable SEPs waves in patients are indicative of a relatively poor outcome. In addition, intraoperative monitoring of SEPs plays an

  12. Kinematic MR imaging in surgical management of cervical disc disease, spondylosis and spondylotic myelopathy

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    Muhle, C.; Metzner, J.; Brinkmann, G.; Heller, M. [Christian-Albrechts-Universitaet, Kiel (Germany). Dept. of Diagnostic Radiology; Weinert, D.; Schoen, R.; Rautenberg, E.; Mehdorn, H.M. [Christian-Albrechts-Universitaet, Kiel (Germany). Dept. of Neurosurgery; Falliner, A. [Christian-Albrechts-Universitaet, Kiel (Germany). Dept. of Orthopedics; Resnick, D. [Veterans Affairs Medical Center, San Diego, CA (United States). Dept. of Radiology

    1999-03-01

    Purpose: To estimate the clinical value and influence of kinematic MR imaging in patients with degenerative diseases of the cervical spine. Material and methods: Eighty-one patients were examined with a 1.5 T whole body magnet using a positioning device. Cervical disc disease was classified according to clinical and radiographic findings into 4 stages: stage I=cervical disc disease (n=13); stage II=spondylosis (n=42); stage III=spondylosis with restricted motion (n=11); and stage IV-cervical spondylotic myelopathy (n=15). Findings on kinematic MR images were compared to those on flexion and extension radiographs, myelography, CT-myelography and static MR imaging. Furthermore, the influence of kinematic MR imaging on surgical management and intra-operative patient positioning was determined. Results: Additional information obtained by kinematic MR imaging changed the therapeutic management in 7 of 11 (64%) patients with stage III disease, and in 13 of 15 (87%) patients with stage IV disease. Instead of an anterior approach, a posterior surgical approach was chosen in 3 of 11 patients (27%) with stage III disease and in 6 of 15 patients (40%) with stage IV disease. Hyperextension of the neck was avoided intra-operatively in 4 patients (27%) with cervical spondylotic myelopathy, and in 1 patient with stage II (2%) and in 1 patient with stage III (9%) disease. Kinematic MR imaging provided additional information in all patients with stages III and IV disease except in 1 patient with stage III disease, when compared to flexion and extension radiographs, myelography, CT-myelography and static MR examination. Conclusion: Kinematic MR imaging adds additional information when compared to conventional imaging methods in patients with advanced stages of degenerative disease of the cervical spine. (orig.)

  13. Anterior versus posterior approach for four-level cervical spondylotic myelopathy.

    Science.gov (United States)

    Lin, Dasheng; Zhai, Wenliang; Lian, Kejian; Kang, Liangqi; Ding, Zhenqi

    2013-11-01

    The purpose of this study was to compare the results of 2 surgical strategies for 4-level cervical spondylotic myelopathy: a hybrid procedure using anterior cervical diskectomy and fusion (ACDF) combined with segmental corpectomy versus posterior laminectomy and fixation. Between 2002 and 2010, fifty-one patients with consecutive 4-level cervical spondylotic myelopathy were treated surgically, with 27 patients undergoing the hybrid procedure and 24 undergoing posterior laminectomy and fixation. Radiologic data were compared between the 2 groups, including cervical curvature and cervical range of motion (ROM) in the sagittal plane. Pre- and postoperative neurological status was evaluated using the Japanese Orthopaedic Association (JOA) scoring system and the Nurick grading system. Mean ROM at last follow-up was not significantly different between the 2 groups (P>.05). In the hybrid group, mean JOA score and Nurick grade improved from 9.6±1.4 and 2.74±0.45 respectively, preoperatively, to 13.9±1.3 and 0.86±0.38 respectively, postoperatively. In the fixation group, mean JOA score and Nurick grade improved from 9.4±1.2 and 2.81±0.42 respectively, preoperatively, to 13.1±1.5 and 1.32±0.36 respectively, postoperatively. The JOA scores and Nurick grades at last follow-up were significantly different between the 2 groups (Pcervical kyphosis, preoperative JOA score and Nurick grade were not significantly different between the 2 groups (P>.05); however, JOA scores and Nurick grades at last follow-up showed better improvement in the hybrid group than in the fixation group (Pcervical lordosis, the preoperative and last follow-up JOA score and Nurick grade were not significantly different between the 2 groups (P>.05). PMID:24200449

  14. Value of intraoperative neurophysiological monitoring to reduce neurological complications in patients undergoing anterior cervical spine procedures for cervical spondylotic myelopathy.

    Science.gov (United States)

    Thirumala, Parthasarathy D; Muralidharan, Aditya; Loke, Yoon K; Habeych, Miguel; Crammond, Donald; Balzer, Jeffrey

    2016-03-01

    The primary aim of this study was to conduct a systematic review of reports of patients with cervical spondylotic myelopathy and to assess the value of intraoperative monitoring (IOM), including somatosensory evoked potentials, transcranial motor evoked potentials and electromyography, in anterior cervical procedures. A search was conducted to collect a small database of relevant papers using key words describing disorders and procedures of interest. The database was then shortlisted using selection criteria and data was extracted to identify complications as a result of anterior cervical procedures for cervical spondylotic myelopathy and outcome analysis on a continuous scale. In the 22 studies that matched the screening criteria, only two involved the use of IOM. The average sample size was 173 patients. In procedures done without IOM a mean change in Japanese Orthopaedic Association score of 3.94 points and Nurick score by 1.20 points (both less severe post-operatively) was observed. Within our sub-group analysis, worsening myelopathy and/or quadriplegia was seen in 2.71% of patients for studies without IOM and 0.91% of patients for studies with IOM. Variations persist in the existing literature in the evaluation of complications associated with anterior cervical spinal procedures. Based on the review of published studies, sufficient evidence does not exist to make recommendations regarding the use of different IOM modalities to reduce neurological complications during anterior cervical procedures. However, future studies with objective measures of neurological deficits using a specific IOM modality may establish it as an effective and reliable indicator of injury during such surgeries. PMID:26677786

  15. Surgical Treatment of Cervical Spondylotic Myelopathy Associated Hypertension--A Retrospective Study of 309 Patients.

    Directory of Open Access Journals (Sweden)

    Ze-qun Li

    Full Text Available Hypertension is the most prevalent cardiovascular disease, and various risk factors are known to be involved in it. Cervical spondylotic myelopathy (CSM is the most common non-traumatic cause of myelopathy, which displays neurological symptoms and may induce systemic symptoms. To date, it is still unknown whether CSM is associated with hypertension, and if so, whether the decompression operations can attenuate CSM associated hypertension. Here, a total of 309 patients with CSM who received anterior or posterior decompression surgery were enrolled as subjects. Blood pressure measurements were performed before and within one week after the surgery. Among the 309 subjects, 144 (46.6% of them exhibited hypertension before surgery, a significantly higher ratio than that of the whole population. One week after surgery, blood pressure of 106 (73.6% patients turned back to normal. Blood pressure of another 37(25.7% patients decreased with different degrees, although still higher than normal. Moreover, it appears that both approaches were effective in improving blood pressure, while the posterior approach was more effective in decreasing systolic blood pressure. We speculate this type of hypertension might result from hyperactivity of sympathetic nervous system as the heart rate of these patients decreased after surgery as well. Collectively, compression of spinal cord in CSM patients might be associated with hypertension, and decompression surgery largely attenuated this type of hypertension. These findings prove CSM to be a potential associated factor of high blood pressure and may shed light on therapies of hypertension in clinics.

  16. Comparison of Two Reconstructive Techniques in the Surgical Management of Four-Level Cervical Spondylotic Myelopathy

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    FengNing Li

    2015-01-01

    Full Text Available To compare the clinical efficacy and radiological outcome of treating 4-level cervical spondylotic myelopathy (CSM with either anterior cervical discectomy and fusion (ACDF or “skip” corpectomy and fusion, 48 patients with 4-level CSM who had undergone ACDF or SCF at our hospital were analyzed retrospectively between January 2008 and June 2011. Twenty-seven patients received ACDF (Group A and 21 patients received SCF. Japanese Orthopaedic Association (JOA score, Neck Disability Index (NDI score, and Cobb’s angles of the fused segments and C2-7 segments were compared in the two groups. The minimum patient follow-up was 2 years. No significant differences between the groups were found in demographic and baseline disease characteristics, duration of surgery, or follow-up time. Our study demonstrates that there was no significant difference in the clinical efficacy of ACDF and SCF, but ACDF involves less intraoperative blood loss, better cervical spine alignment, and fewer postoperative complications than SCF.

  17. Indication for the operative methods in surgical treatment of cervical spondylotic myelopathy

    International Nuclear Information System (INIS)

    Indication for the operative methods for cervical spondylotic myelopathy was examined in 16 patients undergoing CT-myelography before and after operation. There was a highly significant correlation between the anteroposterior (A-P) diameter of the spinal cord and clinical symptoms. Patients with shorter A-P diameter of the spinal cord tended to have severer preoperative clinical symptoms. Clinical symptoms improved as the post operative A-P diameter of the spinal cord increased. Fixation with decompression of the anterior spinal cord should be indicated when constriction of 5 mm or less of the spinal cord is seen segmentally at the level of the intervertebral disc. Dilation of the spinal cavity should be indicated when the constriction of the spinal cord is 5 mm or less at all levels of the cervical spinal cord. In performing fixation with anterior decompression, 15 mm is considered to be the most suitable width for complete and safe decompression of the flattened spinal cord with a wide transverse diameter. (Namekawa, K)

  18. Long term results of anterior corpectomy and fusion for cervical spondylotic myelopathy.

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    Rui Gao

    Full Text Available BACKGROUND: Results showed good clinical outcomes of anterior corpectomy and fusion (ACCF for patients with cervical spondylotic myelopathy (CSM during a short term follow-up; however, studies assessing long term results are relatively scarce. In this study we intended to assess the long term clinical and radiographic outcomes, find out the factors that may affect the long term clinical outcome and evaluate the incidence of adjacent segment disease (ASD. METHODS: This is a retrospective study of 145 consecutive CSM patients on ACCF treatment with a minimum follow-up of 5 years. Clinical data were collected from medical and operative records. Patients were evaluated by using the Japanese Orthopedic Association (JOA scoring system preoperatively and during the follow-up. X-rays results of cervical spine were obtained from all patients. Correlations between the long term clinical outcome and various factors were also analyzed. FINDINGS: Ninety-three males and fifty-two females completed the follow-up. The mean age at operation was 51.0 years, and the mean follow-up period was 102.1 months. Both postoperative sagittal segmental alignment (SSA and the sagittal alignment of the whole cervical spine (SACS increased significantly in terms of cervical lordosis. The mean increase of JOA was 3.8 ± 1.3 postoperatively, and the overall recovery rate was 62.5%. Logistic regression analysis showed that preoperative duration of symptoms >12 months, high-intensity signal in spinal cord and preoperative JOA score ≤ 9 were important predictors of the fair recovery rate (≤ 50%. Repeated surgery due to ASD was performed in 7 (4.8% cases. CONCLUSIONS: ACCF with anterior plate fixation is a reliable and effective method for treating CSM in terms of JOA score and the recovery rate. The correction of cervical alignment and the repeated surgery rate for ASD are also considered to be satisfactory.

  19. Quantitative analysis of cyclooxygenase 2 in the posterior longitudinal ligament of cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    SONG Hong-xing; Michael Scarpatetti; Wolfgang Kreil; SHEN Hui-liang; Koppany Bodo; Birgit Ebner; Heribert Schr(o)ttner; Michael Mokry

    2011-01-01

    Background Cervical spondylotic myelopathy (CSM), in part, results from degeneration of the posterior longitudinal ligament (PLL), which mechanically compresses the spinal cord. Much research was done on the ossification of PLL, but not concerning the non-ossifying degeneration of cervical PLL. The degeneration of cervical PLL may be related to inflammation. The aim of this study was to elucidate the pathological features of the PLL and the role of cyclooxygenase 2 (COX-2) in the degeneration of the PLL in CSM.Methods A total of 23 PLL specimens were collected during surgery from patients with CSM for the histological and immunohistochemical (type Ⅱ collagen and Ki-67) study. For the control group 14 cervical PLL autopsy specimens were investigated in the same manner. mRNA expression of COX-2 was quantitatively measured by real-time reverse transcription-polymerase chain reaction (RT-PCR) from 18 PLL specimens of patients with CSM and 18 PLL specimens of autopsy cases. Immunohistochemistry was used to evaluate the cellular location of COX-2 in PLL.Results A distinct amount of fibrotic area, chondrometaplastic tissue and calcification were found in the PLL of the patient group, compared with the control group. Type Ⅱ collagen was apparent around chondrometaplastic cells. Ki-67 positive reaction was less than 5%. A COX-2 positive reaction was found in 9 of the patient specimens (39.1%) in which the COX-2 was released from vascular endothelial cells in the PLL. However, such reactions were not found in the control group. Real-time PCR showed that the mRNA expression level of COX-2 in the patient group was significantly higher than that in the control group (P <0.01).Conclusions Chondrometaplastic tissue producing type Ⅱ collagen was identified as the most predominant pathological feature in the degenerative PLL. The higher expression of COX-2 might be related to degeneration of the PLL in CSM.

  20. Reliability of surface electromyography timing parameters in gait in cervical spondylotic myelopathy.

    LENUS (Irish Health Repository)

    Malone, Ailish

    2012-02-01

    The aims of this study were to validate a computerised method to detect muscle activity from surface electromyography (SEMG) signals in gait in patients with cervical spondylotic myelopathy (CSM), and to evaluate the test-retest reliability of the activation times designated by this method. SEMG signals were recorded from rectus femoris (RF), biceps femoris (BF), tibialis anterior (TA), and medial gastrocnemius (MG), during gait in 12 participants with CSM on two separate test days. Four computerised activity detection methods, based on the Teager-Kaiser Energy Operator (TKEO), were applied to a subset of signals and compared to visual interpretation of muscle activation. The most accurate method was then applied to all signals for evaluation of test-retest reliability. A detection method based on a combined slope and amplitude threshold showed the highest agreement (87.5%) with visual interpretation. With respect to reliability, the standard error of measurement (SEM) of the timing of RF, TA and MG between test days was 5.5% stride duration or less, while the SEM of BF was 9.4%. The timing parameters of RF, TA and MG designated by this method were considered sufficiently reliable for use in clinical practice, however the reliability of BF was questionable.

  1. Application of anterior decompression and reconstruction using titanium mesh with locking plates in the management of cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    Maolin He; Zengming Xiao; Shide Li; Qianfen Chen

    2008-01-01

    Objective:To observe the clinical effect of anterior decompression and reconstruction using titanium mesh with locking plates in the treatment of cervical spondylotic myelopathy.Methods:One hundred and twenty patients with cervical spondylotic myelopathy were treated by anterior decompression and reconstruction using titanium mesh with locking plates.There were 66 men and 54 women ranges in age from 37 to 72 Years(mean age, 58.3 years).The mean Japanese orthopedic surgery association(JOA) scale was 9.6 points before operation.Patients were followed up clinically and radiographically.Results:Having stood surgery well, the operation time ranged between 60-100 min and bleeding during operation ranged between 20-200 ml.There were no case of postoperative infection, recurrent laryngeal nerve palsy, or esophageal or tracheal laceration or rupture.The average follow-up period was 14.3 months(range, 12 to 24 months) in 96 who were followed up.At the last follow-up visit the mean JOA scale had improved to 14.4 points, reflecting an improve ment of 4.8 points.The results were considered to be excellent in 87 patients, good in 25, fair in 6, and poor in 2.No hardware-related complications or adjacent segment degenerative changes were encountered during the follow-up periods.Stable bone union was observed in all cases and the average time required for fusion was 5.7 months.Conclusion:Titanium mesh filled with autologous bone graft can avoid the complications associated with harvesting bone from the iliac crest donor site.When combined with cervical anterior locking plate, it can obtain satisfatory clinical results for the treatment of cervical spondylotic myelopathy.

  2. Voxel-based analysis of grey and white matter degeneration in cervical spondylotic myelopathy.

    Science.gov (United States)

    Grabher, Patrick; Mohammadi, Siawoosh; Trachsler, Aaron; Friedl, Susanne; David, Gergely; Sutter, Reto; Weiskopf, Nikolaus; Thompson, Alan J; Curt, Armin; Freund, Patrick

    2016-04-20

    In this prospective study, we made an unbiased voxel-based analysis to investigate above-stenosis spinal degeneration and its relation to impairment in patients with cervical spondylotic myelopathy (CSM). Twenty patients and 18 controls were assessed with high-resolution MRI protocols above the level of stenosis. Cross-sectional areas of grey matter (GM), white matter (WM), and posterior columns (PC) were measured to determine atrophy. Diffusion indices assessed tract-specific integrity of PC and lateral corticospinal tracts (CST). Regression analysis was used to reveal relationships between MRI measures and clinical impairment. Patients showed mainly sensory impairment. Atrophy was prominent within the cervical WM (13.9%, p = 0.004), GM (7.2%, p = 0.043), and PC (16.1%, p = 0.005). Fractional anisotropy (FA) was reduced in the PC (-11.98%, p = 0.006) and lateral CST (-12.96%, p = 0.014). In addition, radial (+28.47%, p = 0.014), axial (+14.72%, p = 0.005), and mean (+16.50%, p = 0.001) diffusivities were increased in the PC. Light-touch score was associated with atrophy (R(2) = 0.3559, p = 0.020) and FA (z score 3.74, p = 0.003) in the PC, as was functional independence and FA in the lateral CST (z score 3.68, p = 0.020). This study demonstrates voxel-based degeneration far above the stenosis at a level not directly affected by the compression and provides unbiased readouts of tract-specific changes that relate to impairment.

  3. A Global Perspective on the Outcomes of Surgical Decompression in Patients With Cervical Spondylotic Myelopathy: Results From the Prospective Multicenter AOSpine International Study on 479 Patients

    NARCIS (Netherlands)

    Fehlings, M.G.; Ibrahim, A.; Tetreault, L.; Albanese, V.; Alvarado, M.; Arnold, P.; Barbagallo, G.; Bartels, R.H.; Bolger, C.; Defino, H.; Kale, S.; Massicotte, E.; Moraes, O.; Scerrati, M.; Tan, G.; Tanaka, M.; Toyone, T.; Yukawa, Y.; Zhou, Q.; Zileli, M.; Kopjar, B.

    2015-01-01

    STUDY DESIGN: Prospective, multicenter international cohort. OBJECTIVE: To evaluate outcomes of surgical decompression for cervical spondylotic myelopathy (CSM) at a global level. SUMMARY OF BACKGROUND DATA: CSM is a degenerative spine disease and the most common cause of spinal cord dysfunction wor

  4. Surgical outcomes of elderly patients with cervical spondylotic myelopathy: a meta-analysis of studies reporting on 2868 patients.

    Science.gov (United States)

    Madhavan, Karthik; Chieng, Lee Onn; Foong, Hanyao; Wang, Michael Y

    2016-06-01

    OBJECTIVE Cervical spondylotic myelopathy usually presents in the 5th decade of life or later but can also present earlier in patients with congenital spinal stenosis. As life expectancy continues to increase in the United States, the preconceived reluctance toward operating on the elderly population based on older publications must be rethought. It is a known fact that outcomes in the elderly cannot be as robust as those in the younger population. There are no publications with detailed meta-analyses to determine an acceptable level of outcome in this population. In this review, the authors compare elderly patients older than 75 years to a nonelderly population, and they discuss some of the relevant strategies to minimize complications. METHODS In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the authors performed a PubMed database search to identify English-language literature published between 1995 and 2015. Combinations of the following phrases that describe the age group ("elderly," "non-elderly," "old," "age") and the disease of interest as well as management ("surgical outcome," "surgery," "cervical spondylotic myelopathy," "cervical degenerative myelopathy") were constructed when searching for relevant articles. Two reviewers independently assessed the outcomes, and any disagreement was discussed with the first author until it was resolved. A random-effects model was applied to assess pooled data due to high heterogeneity between studies. The mean difference (MD) and odds ratio were calculated for continuous and dichromatic parameters, respectively. RESULTS Eighteen studies comprising elderly (n = 1169) and nonelderly (n = 1699) patients who received surgical treatment for cervical spondylotic myelopathy were included in this meta-analysis. Of these studies, 5 were prospective and 13 were retrospective. Intraoperatively, both groups required a similar amount of operation time (p = 0.35). The elderly

  5. BMP-4 Polymorphisms in the Susceptibility of Cervical Spondylotic Myelopathy and its Outcome after Anterior Cervical Corpectomy and Fusion

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    Dawei Wang

    2013-07-01

    Full Text Available Background: To investigate the association between single nucleotide polymorphisms (SNPs of bone morphogenic proteins-4 (BMP-4 gene and the susceptibility of cervical spondylotic myelopathy (CSM and its outcome after surgical treatment. Method: A total of 499 patients with CSM and 602 healthy volunteers were recruited. 425 CSM patients received anterior cervical corpectomy and fusion (ACF and were follow-up until 12 months. The SNPs of BMP-4 were determined. Results: For 6007C > T polymorphism, the cases had a significant lower prevalence of TT genotype than controls. With the CC genotype as reference, the TT genotype carriages significantly influence the CSM risk. The T allele carriage represented a higher risk for CSM as well. The TT of 6007C>T polymorphisms is also associated with higher chance to gain improvement from ACF surgery. The T allele carriage of 6007C>T had markedly higher chance to have a better post-operative outcome compared with C allele carriage. The genotype and allele distributions of -5826G>A polymorphism did not show positive association with risk and outcome of CSM in this study. Conclusion: BMP-4 genetic polymorphisms may be used as a molecular marker for the CSM susceptibility and its postoperative outcome in those underwent surgical treatment.

  6. Posterior atlantoaxial subluxation due to os odontoideum combined with cervical spondylotic myelopathy : a case report

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    Motosuneya, Takao; Hirabayashi, Shigeru; Yamada, Hironobu; Kobayashi, Yousuke; Sekiya, Shigeki; Sakai, Hiroya

    2007-01-01

    In patients with os odontoideum and posterior atlantoaxial subluxation are extremely rare. No reports have described posterior atlantoaxial subluxation associated with os odontoideum combined with cervical spondylotic canal stenosis, both of which require surgical treatment. We report one case of a 75-year-old female who underwent arthrodesis between the occiput and C3 using a hook-and-rod system and also a double-door laminoplasty from levels C3 to C7. The claw mechanism was applied between ...

  7. Comparison between anterior cervical discectomy with fusion and anterior cervical corpectomy with fusion for the treatment of cervical spondylotic myelopathy: a meta-analysis

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    Fei Q

    2015-11-01

    Full Text Available Qi Fei,* Jinjun Li,* Nan Su, Bingqiang Wang, Dong Li, Hai Meng, Qi Wang, Jisheng Lin, Zhao Ma, Yong Yang, Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China *These authors contributed equally to this work Background: Whether anterior cervical discectomy with fusion (ACDF or anterior cervical corpectomy with fusion (ACCF is superior in the treatment of cervical spondylotic myelopathy remains controversial. Therefore, we conducted a meta-analysis to quantitatively compare the efficacy and safety of ACDF and ACCF in the treatment of cervical spondylotic myelopathy.Methods: PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System, People’s Republic of China, and CNKI (China National Knowledge Infrastructure, People’s Republic of China were systematically searched to identify all available studies comparing efficacy and safety between patients receiving ACDF and ACCF. The weighted mean difference (WMD was pooled to compare the Japanese Orthopaedic Association scores, visual analog scale scores, hospital stay, operation time, and blood loss. The risk ratio was pooled to compare the incidence of complications and fusion rate. Pooled estimates were calculated by using a fixed-effects model or a random-effects model according to the heterogeneity among studies.Results: Eighteen studies (17 observational studies and one randomized controlled trial were included in this meta-analysis. Our results suggest that hospital stay (WMD =-1.33, 95% confidence interval [CI]: -2.29, -0.27; P=0.014, operation time (WMD =-26.9, 95% CI: -46.13, -7.67; P=0.006, blood loss (WMD =-119.36, 95% CI: -166.94, -71.77; P=0.000, and incidence of complications (risk ratio =0.51, 95% CI: 0.33, 0.80; P=0.003 in the ACDF group were significantly less than that in the ACCF group. However, other clinical outcomes, including post-Japanese Orthopaedic Association score (WMD =-0.27, 95

  8. Outcome Measures of Functionality, Social Interaction, and Pain in Patients with Cervical Spondylotic Myelopathy: A Validation Study for the Iranian Version of the Copenhagen Neck Functional Disability Scale

    OpenAIRE

    Nayeb Aghaei, Hossein; Azimi, Parisa; Shahzadi, Sohrab; Azhari, Shirzad; Mohammadi, Hassan Reza; Alizadeh, Pooyan; Montazeri, Ali

    2015-01-01

    Study Design Cross-sectional. Purpose To translate and validate the Iranian version of the Copenhagen Neck Functional Disability Scale (CNFDS). Overview of Literature Instruments measuring patient-reported outcomes should satisfy certain psychometric properties. Methods Ninety-three cases of cervical spondylotic myelopathy were entered into the study and completed the CNFDS pre and postoperatively at the 6 month follow-up. The modified Japanese Orthopedic Association Score was also completed....

  9. Comparison of Functional and Radiological Outcomes Between Two Posterior Approaches in the Treatment of Multilevel Cervical Spondylotic Myelopathy

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    Da-Jiang Ren

    2015-01-01

    Full Text Available Background: Posterior cervical decompression is an accepted treatment for multilevel cervical spondylotic myelopathy (CSM. Each posterior technique has its own advantages and disadvantages. In the present study, we compared the functional and radiological outcomes of expansive hemilaminectomy and laminoplasty with mini titanium plate in the treatment of multilevel CSM. Methods: Forty-four patients with multilevel CSM treated with posterior cervical surgery in Department of Orthopedic Surgery, Beijing Army General Hospital from March 2011 to June 2012 were enrolled in this retrospective study. Patients were divided into two groups by surgical procedure: Laminoplasty (Group L and hemilaminectomy (Group H. Perioperative parameters including age, sex, duration of symptoms, operative duration, and intraoperative blood loss were recorded and compared. Spinal canal area, calculated using AutoCAD ® software(Autodesk Inc., San Rafael, CA, USA, and neurological improvement, evaluated with Japanese Orthopedic Association score, were also compared. Results: Neurological improvement did not differ significantly between groups. Group H had a significantly shorter operative duration and significantly less blood loss. Mean expansion ratio was significantly greater in Group L (77.83 ± 6.41% than in Group H (62.72 ± 3.86% (P < 0.01. Conclusions: Both surgical approaches are safe and effective in treating multilevel CSM. Laminoplasty provides a greater degree of enlargement of the spinal canal, whereas expansive hemilaminectomy has the advantages of shorter operative duration and less intraoperative blood loss.

  10. Measuring surgical outcomes in cervical spondylotic myelopathy patients undergoing anterior cervical discectomy and fusion: assessment of minimum clinically important difference.

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    Brenda M Auffinger

    Full Text Available OBJECT: The concept of minimum clinically important difference (MCID has been used to measure the threshold by which the effect of a specific treatment can be considered clinically meaningful. MCID has previously been studied in surgical patients, however few studies have assessed its role in spinal surgery. The goal of this study was to assess the role of MCID in patients undergoing anterior cervical discectomy and fusion (ACDF for cervical spondylotic myelopathy (CSM. METHODS: Data was collected on 30 patients who underwent ACDF for CSM between 2007 and 2012. Preoperative and 1-year postoperative Neck Disability Index (NDI, Visual-Analog Scale (VAS, and Short Form-36 (SF-36 Physical (PCS and Mental (MCS Component Summary PRO scores were collected. Five distribution- and anchor-based approaches were used to calculate MCID threshold values average change, change difference, receiver operating characteristic curve (ROC, minimum detectable change (MDC and standard error of measurement (SEM. The Health Transition Item of the SF-36 (HTI was used as an external anchor. RESULTS: Patients had a significant improvement in all mean physical PRO scores postoperatively (p<0.01 NDI (29.24 to 14.82, VAS (5.06 to 1.72, and PCS (36.98 to 44.22. The five MCID approaches yielded a range of values for each PRO: 2.00-8.78 for PCS, 2.06-5.73 for MCS, 4.83-13.39 for NDI, and 0.36-3.11 for VAS. PCS was the most representative PRO measure, presenting the greatest area under the ROC curve (0.94. MDC values were not affected by the choice of anchor and their threshold of improvement was statistically greater than the chance of error from unimproved patients. CONCLUSION: SF-36 PCS was the most representative PRO measure. MDC appears to be the most appropriate MCID method. When MDC was applied together with HTI anchor, the MCID thresholds were: 13.39 for NDI, 3.11 for VAS, 5.56 for PCS and 5.73 for MCS.

  11. Influence of hinge position on the effectiveness of open-door expansive laminoplasty for cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    WAN Jun; XU Tian-tong; SHEN Qing-feng; LI Hui-nan; XIA Ying-peng

    2011-01-01

    Objective: To assess the influence of different hinge positions on clinical results of expansive open-door laminoplasty (EOLP) for cervical spondylotic myelopathy (CSM).Methods: A total of 102 CSM patients who underwent EOLP from February 2006 to February 2007 were enrolled in this randomized controlled trial. Using a random digits table,57 patients with the hinge located at the inner margin of the lateral mass were classified as wide-open group, while 45 patients with the hinge positioned at the lamina margin served as narrow-open group. All patients were observed over 24 months, and the clinical and radiological results were analyzed statistically.Results: There were no significant differences in operation duration, intraoperative bleeding volume, Japanese Orthopaedic Association (JOA) scores, cervical curvature index, range of motion and neural function recovery rate.The neural functions were satisfactorily improved after surgery in both groups, while the severity of axial symptoms was significantly lower in the narrow-open group than in the wide-open group (P=0.003). The incidence of C5 palsy in the wide-open group was higher than that in the narrowopen group (5.3% vs 0), even though the difference did not reach statistical significance (one tailed Fisher's exact test,P=0.17).Conclusions: Proper inward shift of the hinge can ensure effectiveness of surgical decompression, avoid an excessive backward shift of the spinal cord, decrease the incidence of C5 palsy and alleviate the severity of axial symptoms.

  12. Laminoplasty and laminectomy hybrid decompression for the treatment of cervical spondylotic myelopathy with hypertrophic ligamentum flavum: a retrospective study.

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    Huairong Ding

    Full Text Available OBJECTIVE: To report the outcomes of a posterior hybrid decompression protocol for the treatment of cervical spondylotic myelopathy (CSM associated with hypertrophic ligamentum flavum (HLF. BACKGROUND: Laminoplasty is widely used in patients with CSM; however, for CSM patients with HLF, traditional laminoplasty does not include resection of a pathological ligamentum flavum. METHODS: This study retrospectively reviewed 116 CSM patients with HLF who underwent hybrid decompression with a minimum of 12 months of follow-up. The procedure consisted of reconstruction of the C4 and C6 laminae using CENTERPIECE plates with spinous process autografts, and resection of the C3, C5, and C7 laminae. Surgical outcomes were assessed using Japanese Orthopedic Association (JOA score, recovery rate, cervical lordotic angle, cervical range of motion, spinal canal sagittal diameter, bone healing rates on both the hinge and open sides, dural sac expansion at the level of maximum compression, drift-back distance of the spinal cord, and postoperative neck pain assessed by visual analog scale. RESULTS: No hardware failure or restenosis was noted. Postoperative JOA score improved significantly, with a mean recovery rate of 65.3 ± 15.5%. Mean cervical lordotic angle had decreased 4.9 degrees by 1 year after surgery (P<0.05. Preservation of cervical range of motion was satisfactory postoperatively. Bone healing rates 6 months after surgery were 100% on the hinge side and 92.2% on the open side. Satisfactory decompression was demonstrated by a significantly increased sagittal canal diameter and cross-sectional area of the dural sac together with a significant drift-back distance of the spinal cord. The dural sac was also adequately expanded at the time of the final follow-up visit. CONCLUSION: Hybrid laminectomy and autograft laminoplasty decompression using Centerpiece plates may facilitate bone healing and produce a comparatively satisfactory prognosis for CSM patients

  13. Comparative study on the effect of anterior and posterior decompression in the treatment of multi-segmental cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    Liang Li; Mei-Lin Jiang; Xiao-Jun Yang

    2016-01-01

    Objective: To analyze and compare the clinical efficacy of anterior and posterior decompression in the treatment of multi-segmental cervical spondylotic myelopathy (MCSM), providing certain guidance for the clinical treatment. Methods:A total of 72 patients with MCSM who were admitted in our hospital from September, 2012 to October, 2014 were included in the study and divided into the anterior group (n=37) and the posterior group (n=35) according to different surgical methods. The patients in the anterior group were given anterior cervical discectomy fusion (ACDF) and anterior cervical corpectomy fusion (ACCF), while the patients in the posterior group were given laminoplasty (LP). The general materials, surgical materials, and postoperative functional recovery in the two groups were compared. Results:The comparison of gender, age, course, preoperative JOA score, follow-up time, and affected segment between the two groups was not statistically significant. The operation time in the anterior group was significantly longer than that in the posterior group, but the intraoperative amount of bleeding was significantly less than that in the posterior group. The postoperative spinal cord function in the two groups was significantly improved when compared with before operation;moreover, the improved degree in the anterior group was more obvious. The postoperative cervical physiological curvature in the anterior group was significantly increased, but in the posterior group was significantly reduced. The comparison of the occurrence rate of postoperative complications between the two groups was not statistically significant. Conclusions:The anterior and posterior surgeries in the treatment of MCSM can significantly improve the postoperative spinal cord function, among which the anterior surgery can effectively recover the cervical physiological curvature. It is recommended that an appropriate surgical method should be reasonably selected by comprehensively considering the

  14. [A case of very slowly progressive, high-cervical spondylotic myelopathy presenting with symmetric deep sensory deficits in the palms].

    Science.gov (United States)

    Yamashita, M; Yamamoto, T

    1995-09-01

    We report a case of very slowly progressive, high-cervical spondylotic myelopathy with symmetrical deep sensory deficits in the palms. A 76-year-old man began to feel tingling sensation in the second fingers of the bilateral hands 30 years prior to admission. The abnormal sensation spread from the first to the third fingers, and subsequently all over the palms. He noticed intermittent sharp pain in the dermatomes of C4 and 5 bilaterally from his late sixties, and later he developed clumsiness of fine finger movements. In recent years he experienced stiffness in the thighs while walking. On neurological examination, there was a mild sensory deficits in light touch over the bilateral palms, while perception of temperature and pain was normal. Vibration sense was severely and position sense mildly impaired. Discriminative sensation, including graphesthesia, stereognosis, two-point discrimination and texture recognition, was severely impaired over the bilateral palms. On the other hand, all modalities of sensation were normal in the lower limbs. Gross motor dysfunction, such as weakness of limbs, amyotrophy or gait disturbance, was not present. He did not show limb ataxia, but the dexterity of his fingers was severely impaired. Deep tendon reflexes were mildly increased except for the Achilles tendons that were hyporeactive. Plantar responses were flexor bilaterally. Nerve conduction study revealed giant F waves and H reflexes by stimulations of the median and ulnar nerves bilaterally.(ABSTRACT TRUNCATED AT 250 WORDS)

  15. Comparison of Functional and Radiological Outcomes Between Two Posterior Approaches in the Treatment of Multilevel Cervical Spondylotic Myelopathy

    Institute of Scientific and Technical Information of China (English)

    Da-Jiang Ren; Fang Li; Zhi-Cheng Zhang; Guan Kai; Jian-Lin Shan; Guang-Min Zhao; Tian-Sheng Sun

    2015-01-01

    Background:Posterior cervical decompression is an accepted treatment for multilevel cervical spondylotic myelopathy (CSM).Each posterior technique has its own advantages and disadvantages.In the present study,we compared the functional and radiological outcomes of expansive hemilaminectomy and laminoplasty with mini titanium plate in the treatment of multilevel CSM.Methods:Forty-four patients with multilevel CSM treated with posterior cervical surgery in Department of Orthopedic Surgery,Beijing Army General Hospital from March 2011 to June 2012 were enrolled in this retrospective study.Patients were divided into two groups by surgical procedure:Laminoplasty (Group L) and hemilaminectomy (Group H).Perioperative parameters including age,sex,duration of symptoms,opcrative duration,and intraoperative blood loss were recorded and compared.Spinal canal area,calculated using AutoCAD(R) software(Autodesk Inc.,San Rafael,CA,USA),and neurological improvement,evaluated with Japanese Orthopedic Association score,were also compared.Results:Neurological improvement did not differ significantly between groups.Group H had a significantly shorter operative duration and significantly less blood loss.Mean expansion ratio was significantly greater in Group L (77.83 ± 6.41%) than in Group H (62.72 ± 3.86%) (P < 0.01).Conclusions:Both surgical approaches are safe and effective in treating multilevel CSM.Laminoplasty provides a greater degree of enlargement of the spinal canal,whereas expansive hemilaminectomy has the advantages of shorter operative duration and less intraoperative blood loss.

  16. Prolonged length of stay after posterior surgery for cervical spondylotic myelopathy in patients over 65years of age.

    Science.gov (United States)

    De la Garza-Ramos, Rafael; Goodwin, C Rory; Abu-Bonsrah, Nancy; Jain, Amit; Miller, Emily K; Neuman, Brian J; Protopsaltis, Themistocles S; Passias, Peter G; Sciubba, Daniel M

    2016-09-01

    Prolonged length of stay (PLOS) has been associated with increased hospital resource utilization and worsened patient outcomes in multiple studies. In this study, we defined and identified factors associated with PLOS after posterior surgery for cervical spondylotic myelopathy in patients over the age of 65. PLOS was defined as length of stay beyond the "prolongation point" (that is, the day after which discharge rates begin to decline). Using the United States Nationwide Inpatient Sample database, 2742 patients met inclusion criteria, out of whom 16.5% experienced PLOS (stay beyond 6days). After multivariate analysis, increasing age was independently associated with PLOS (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.02-1.06). Multiple comorbid conditions were associated with PLOS, including alcohol abuse (OR 3.85, 95% CI 1.87-7.94), congestive heart failure (OR 1.72, 95% CI 1.11-2.64), obesity (OR 1.70, 95% CI 1.14-2.55), and deficiency anemia (OR 1.44, 95% CI 1.01-2.05); the strongest associated operative parameter was blood transfusion (OR 2.39, 95% CI 1.75-3.28). Major complications independently associated with PLOS were deep vein thrombosis (OR 18.32, 95% CI 6.50-51.61), myocardial infarction (OR 8.98, 95% CI 2.92-27.56), pneumonia (OR 6.67, 95% CI 3.17-14.05), acute respiratory failure (OR 6.27, 95% CI 3.43-11.45), hemorrhage/hematoma (OR 5.04, 95% CI 2.69-9.44), and implant-related complications (OR 2.49, 95% CI 1.24-4.98). Average total hospital charges for patients who experienced PLOS were $122,965 US dollars, compared to $76,870 for the control group (p<0.001). Mortality for patients who experienced PLOS was 2.7% versus 0.5% for patients who did not epxerience PLOS (p<0.001). In conclusion, patients over the age of 65 who underwent posterior surgery for cervical myelopathy and stayed over 6days in hospital were defined as having PLOS. Hospital charges and mortality rates were significantly higher for patients who experienced PLOS. Potentially

  17. Long-term results of anterior cervical corpectomy and fusion with nano-hydroxyapatite/polyamide 66 strut for cervical spondylotic myelopathy

    Science.gov (United States)

    Zhang, Yuan; Deng, Xu; Jiang, Dianming; Luo, Xiaoji; Tang, Ke; Zhao, Zenghui; Zhong, Weiyang; Lei, Tao; Quan, Zhengxue

    2016-05-01

    To assess the long-term clinical and radiographic outcomes of anterior cervical corpectomy and fusion (ACCF) with a neotype nano-hydroxyapatite/polyamide 66 (n-HA/PA66) strut in the treatment of cervical spondylotic myelopathy (CSM). Fifty patients with CSM who underwent 1- or 2-level ACCF with n-HA/PA66 struts were retrospectively investigated. With a mean follow-up of 79.6 months, the overall mean JOA score, VAS and cervical alignment were improved significantly. At last follow-up, the fusion rate was 98%, and the subsidence rate of the n-HA/PA66 strut was 8%. The “radiolucent gap” at the interface between the n-HA/PA66 strut and the vertebra was further noted to evaluate the osteoconductivity and osseointegration of the strut, and the incidence of it was 62% at the last follow-up. Three patients suffered symptomatic adjacent segment degeneration (ASD). No significant difference was detected in the outcomes between 1- and 2-level corpectomy at follow-ups. In conclusion, the satisfactory outcomes in this study indicated that the n-HA/PA66 strut was an effective graft for cervical reconstruction. Moreover, the osteoconductivity and osseointegration of the strut is still need to be optimized for future clinical application owing to the notably presence of “radiolucent gap” in present study.

  18. Different Approaches for Treating Multilevel Cervical Spondylotic Myelopathy: A Retrospective Study of 153 Cases from a Single Spinal Center.

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    Xiumao Li

    Full Text Available The optimal surgical treatment for multilevel cervical spondylotic myelopathy (MCSM remains controversial. This study compared the outcomes of three surgical approaches for MSCM treatment, focusing on the efficacy and safety of a combined approach.This retrospective study included 153 consecutive MCSM patients (100 men, 53 women; mean age ± standard deviation, 55.7 ± 9.4 years undergoing operations involving ≥3 intervertebral segments. The patients were divided into three groups according to surgical approach: anterior (n = 19, posterior (n = 76, and combined (n = 58. We assessed demographic variables, perioperative parameters, and clinical outcomes ≥12 months after surgery (20.5 ± 7.6 months, including Japanese Orthopaedic Association (JOA score, improvement, recovery rate, and complications.The anterior group had the most favorable preoperative conditions, including the highest preoperative JOA score (12.95 ± 1.86, p = 0.046. In contrast, the combined group had the highest occupancy ratio (48.0% ± 11.6%, p = 0.002. All groups showed significant neurological improvement at final follow-ups, with JOA recovery rates of 59.7%, 54.6%, and 68.9% in the anterior, posterior, and combined groups, respectively (p = 0.163. After multivariable adjustments, the groups did not have significantly different clinical outcomes (postoperative JOA score, p = 0.424; improvement, p = 0.424; recovery rate, p = 0.080. Further, subgroup analyses of patients with occupancy ratios ≥50% showed similar functional outcomes following the posterior and combined approaches. Overall complication rates did not differ significantly among the three approaches (p = 0.600. Occupancy ratios did not have a significant negative influence on postoperative recovery following the posterior approach.If applied appropriately, all three approaches are effective for treating MCSM. All three approaches had equivalent neurological outcomes, even in subgroups with high occupancy

  19. Comparison of 2 Zero-Profile Implants in the Treatment of Single-Level Cervical Spondylotic Myelopathy: A Preliminary Clinical Study of Cervical Disc Arthroplasty versus Fusion

    Science.gov (United States)

    Yang, Li-Li; Liu, Zu-De; Yuan, Wen

    2016-01-01

    Objectives Cervical disc arthroplasty (CDA) with Discover prosthesis or anterior cervical discectomy and fusion (ACDF) with Zero-P cage has been widely used in the treatment of cervical spondylotic myelopathy (CSM). However, little is known about the comparison of the 2 zero-profile implants in the treatment of single-level CSM. The aim was to compare the clinical outcomes and radiographic parameters of CDA with Discover prosthesis and ACDF with Zero-P cage for the treatment of single-level CSM. Methods A total of 128 consecutive patients who underwent 1-level CDA with Discover prosthesis or ACDF with Zero-P cage for single-level CSM between September 2009 and December 2012 were included in this study. Clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) score and Neck Disability Index (NDI). For radiographic assessment, the overall sagittal alignment (OSA), functional spinal unit (FSU) angle, and range of motion (ROM) at the index and adjacent levels were measured before and after surgery. Additionally, the complications were also recorded. Results Both treatments significantly improved all clinical parameters (P 0.05). Besides, no significant differences existed in dysphagia, subsidence, or adjacent disc degeneration between the 2 groups (P > 0.05). However, significant differences occurred in prosthesis migration in CDA group. Conclusions The results of this study showed that clinical outcomes and radiographic parameters were satisfactory and comparable with the 2 techniques. However, more attention to prosthesis migration of artificial cervical disc should be paid in the postoperative early-term follow-up. PMID:27441736

  20. Cervical Spondylotic Myelopathy Secondary to Dropped Head Syndrome: Report of a Case and Review of the Literature

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    Abolfazl Rahimizadeh

    2016-01-01

    Full Text Available The dropped head syndrome (DHS is a disabling condition caused by severe weakness of the neck extensor muscles causing progressive reducible kyphosis of the cervical spine and the inability to hold the head up. Weakness can occur in isolation or in association with a generalized neuromuscular disorder. Isolated cases are owed to the late onset of noninflammatory myopathy designated as INEM, where persistent chin to chest deformity may gradually cause or aggravate preexisting degenerative changes of the cervical spine and ultimately result in myelopathy. In review of the literature, we could find only 5 cases, with no unique guidelines to address the management of these two concomitant pathologies. Herein, a 69-year-old man who had developed cervical myelopathy 2 years after being affected by isolated dropped head syndrome is presented. Chin to chest deformity and cervical myelopathy were managed through three-level anterior cervical discectomy and fusion (ACDF combined with decompressive cervical laminectomy and stabilization with C2 to C7 pedicle screw-rod construct. At 4-month follow-up, despite recovery in patient’s neurological status, flexion deformity reappeared with recurrence of dropped head due to C7 pedicle screws pull-out. However, this was successfully managed with extension of the construct to the upper thoracic levels.

  1. Rehabilitation intervention of cervical spondylotic myelopathy combined with thoracic spinal canal stenosis%脊髓型颈椎病合并胸椎管狭窄症的康复干预

    Institute of Scientific and Technical Information of China (English)

    宋若先; 刘晓平; 田勇; 周银; 张云昌

    2002-01-01

    Objective To investigate diagnosis and treatment characters of cervical spondylotic myelopathy combined with thoracic spinal stenosis, and to analysis effective pathway of spinal function recovery. Methods We took respective analysis on diagnosis, treatment and recovery results of 12 cases, whose symptoms, signs and MR were explicit. Results Follow ups times were from 9 months to 5 years and 8 months. Nerve function of 8 cases recovered completely or nearly completely; that of 2 cases improved apparently and that of 2 cases improved slightly. Conclusion Detailed disease history collection, particular body examination and MR reading are very important to early diagnosis of cervical spondylotic myelopathy combined with thoracic spinal stenosis. Early operation combined with cervical and thoracic spinal canal decompression at same time or at different stages is the single effective method to patients' function recovery.

  2. Restoration of Upper Limb Function in an Individual with Cervical Spondylotic Myelopathy using Functional Electrical Stimulation Therapy: A Case Study

    OpenAIRE

    Popovic, Milos R.; Zivanovic, Vera; Taufik A. Valiante

    2016-01-01

    Non-traumatic spinal cord pathology is responsible for 25–52% of all spinal cord lesions. Studies have revealed that spinal stenosis accounts for 16–21% of spinal cord injury (SCI) admissions. Impaired grips as well as slow unskilled hand and finger movements are the most common complaints in patients with spinal cord disorders, such as myelopathy secondary to cervical spondylosis. In the past, our team carried out couple of successful clinical trials, including two randomized control trials,...

  3. Restoration of Upper Limb Function in an Individual with Cervical Spondylotic Myelopathy using Functional Electrical Stimulation Therapy: A Case Study.

    Science.gov (United States)

    Popovic, Milos R; Zivanovic, Vera; Valiante, Taufik A

    2016-01-01

    Non-traumatic spinal cord pathology is responsible for 25-52% of all spinal cord lesions. Studies have revealed that spinal stenosis accounts for 16-21% of spinal cord injury (SCI) admissions. Impaired grips as well as slow unskilled hand and finger movements are the most common complaints in patients with spinal cord disorders, such as myelopathy secondary to cervical spondylosis. In the past, our team carried out couple of successful clinical trials, including two randomized control trials, showing that functional electrical stimulation therapy (FEST) can restore voluntary reaching and/or grasping function, in people with stroke and traumatic SCI. Motivated by this success, we decided to examine changes in the upper limb function following FEST in a patient who suffered loss of hand function due to myelopathy secondary to cervical spondylosis. The participant was a 61-year-old male who had C3-C7 posterior laminectomy and instrumented fusion for cervical myelopathy. The participant presented with progressive right hand weakness that resulted in his inability to voluntarily open and close the hand and to manipulate objects unilaterally with his right hand. The participant was enrolled in the study ~22 months following initial surgical intervention. Participant was assessed using Toronto Rehabilitation Institute's Hand Function Test (TRI-HFT), Action Research Arm Test (ARAT), Functional Independence Measure (FIM), and Spinal Cord Independence Measure (SCIM). The pre-post differences in scores on all measures clearly demonstrated improvement in voluntary hand function following 15 1-h FEST sessions. The changes observed were meaningful and have resulted in substantial improvement in performance of activities of daily living. These results provide preliminary evidence that FEST has a potential to improve upper limb function in patients with non-traumatic SCI, such as myelopathy secondary to cervical spondylosis. PMID:27375547

  4. Restoration of Upper Limb Function in an Individual with Cervical Spondylotic Myelopathy using Functional Electrical Stimulation Therapy: A Case Study

    OpenAIRE

    Popovic, Milos R.; Vera Zivanovic; Taufik A. Valiante

    2016-01-01

    Non-traumatic spinal cord pathology is responsible for 25 to 52% of all spinal cord lesions. Studies have revealed that spinal stenosis accounts for 16 to 21% of spinal cord injury (SCI) admissions. Impaired grips as well as slow unskilled hand and finger movements are the most common complaints in patients with spinal cord disorders such as myelopathy secondary to cervical spondylosis. Motivated by our prior successful clinical trials, including two randomized control trials showing that fun...

  5. 脊髓病手对早期诊断和提高颈椎病手术疗效的意义%Early diagnosis of myelopathy hand improves efficacies of surgical treatment of cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    徐广辉; 马君; 李振环; 凌仕勇; 满毅; 贾连顺

    2015-01-01

    Objective To evaluate the value of early diagnosis of myelopathy hand in improving the efficacies of surgical treatment of cervical spondylotic myelopathy.Methods Analyses were conducted for 118 cases of cervical spondylotic myelopathy at Department of Orthopedics,Changzheng Hospital and Zhabei Campus from January 2009 to November 2012.They were diagnosed with myelopathy hand and classified by finger escape sign,10-second grip and release test of fist along with electromyography of ill limb to evaluate the movement function of hands.They were divided into early diagnosis group with myelopathy hand (A,n =62) and routine diagnosis group without myelopathy hand (B,n =56).All patients with cervical spondylotic myelopathy underwent anterior corpectomy decompression and fusion.The average follow-up period was up to 4.1 years.Modified Japanese Orthopedic Association (JOA) score was used to evaluate neurological function preoperation and 48 months postoperation respectively.T-test of SPSS statistical software 13.0 was used to analyze the inter-group difference of JOA scores before and after surgery.Results There were no inter-group significant differences in age,gender or smoking ratio.The JOA scores of groups A and B were 10.1 ±2.3,14.9 ±2.0; 9.8 ±3.1,12.1 ±2.3 before surgery and 48 months postoperation and the increase of JOA scores were 4.8 ± 0.9,2.3 ± 0.6.The inter-group differences between JOA scores before and after surgery were statistically significant (P =0.00).And the inter-group differences between the increase of JOA scores at 48 months postoperation were statistically significant (P =0.00).Conclusion Neurological function improves more for patients with cervical spondylotic myelopathy diagnosed with myelopathy hand in early stage than those diagnosed conventionally without myelopathy hand.And an early diagnosis of this sign may boost the surgical efficacies for cervical spondylotic myelopathy.%目的 评价脊髓病手早期诊断提高颈椎

  6. Assessment of health-related quality of life using the SF-36 in Chinese cervical spondylotic myelopathy patients after surgery and its consistency with neurological function assessment: a cohort study

    OpenAIRE

    Zhang, Yilong; Zhou, Feifei; SUN, Yu

    2015-01-01

    Background We aimed to calculate the responsiveness and statistically prove the reliability of the Medical Outcomes Study Short Form Health Survey (SF-36) in a prospective cohort study. We investigated the profile of mid-term health-related quality of life (QOL) outcome assessments after surgery for cervical spondylotic myelopathy (CSM) and determined the consistency of the SF-36 assessments of neurological function. Methods A total of 142 consecutive patients with CSM who underwent surgery w...

  7. Indication for the operative methods in surgical treatment of cervical spondylotic myelopathy. Shape of the spinal cord in the CT-myelography

    Energy Technology Data Exchange (ETDEWEB)

    Kobayashi, Akira; Inoue, Shunichi; Watabe, Tsuneo; Nagase, Joji; Harada, Yoshitada (Chiba Univ. (Japan). School of Medicine)

    1984-04-01

    Indication for the operative methods for cervical spondylotic myelopathy was examined in 16 patients undergoing CT-myelography before and after operation. There was a highly significant correlation between the anteroposterior (A-P) diameter of the spinal cord and clinical symptoms. Patients with shorter A-P diameter of the spinal cord tended to have severer preoperative clinical symptoms. Clinical symptoms improved as the post operative A-P diameter of the spinal cord increased. Fixation with decompression of the anterior spinal cord should be indicated when constriction of 5 mm or less of the spinal cord is seen segmentally at the level of the intervertebral disc. Dilation of the spinal cavity should be indicated when the constriction of the spinal cord is 5 mm or less at all levels of the cervical spinal cord. In performing fixation with anterior decompression, 15 mm is considered to be the most suitable width for complete and safe decompression of the flattened spinal cord with a wide transverse diameter.

  8. Long-term outcomes and prognostic analysis of modified open-door laminoplasty with lateral mass screw fusion in treatment of cervical spondylotic myelopathy

    Directory of Open Access Journals (Sweden)

    Su N

    2016-08-01

    Full Text Available Nan Su, Qi Fei, Bingqiang Wang, Dong Li, Jinjun Li, Hai Meng, Yong Yang, Ai Guo Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Xicheng District, Beijing, People’s Republic of China Objectives: The purpose of the present study was to explore and analyze the long-term outcomes and factors that affect the prognosis of expansive open-door laminoplasty with lateral mass screw fusion in treatment of cervical spondylotic myelopathy (CSM. Methods: We retrospectively reviewed 49 patients with multilevel CSM who had undergone expansive open-door laminoplasty with lateral mass screws fixation and fusion in our hospital between February 2008 and February 2012. The average follow-up period was 4.6 years. The clinical data of patients, including age, sex, operation records, pre- and postoperation Japanese Orthopedic Association (JOA scores, cervical spine canal stenosis, and cervical curvature, were collected. Increased signal intensity (ISI on T2-weighted magnetic resonance imaging and ossification of the posterior longitudinal ligament were also observed. Paired t-test was used to analyze the treatment effectiveness and recovery of neuronal function. The prognostic factors were analyzed with multivariable linear regression model. Results: Forty-nine patients with CSM with a mean age of 59.44 years were enrolled in this study. The average of preoperative JOA score was 9.14±2.25, and postoperative JOA score was 15.31±1.73. There was significant difference between the pre- and postoperative JOA scores. The clinical improvement rate was 80.27%. On follow-up, five patients had complaints of neck and shoulder pain, but no evidence of C5 nerve palsy was found. Developmental cervical spine canal stenosis was present in all patients before surgery. Before surgery, ISI was observed in eight patients, while ossification of the posterior longitudinal ligament was found in 12 patients. The average of preoperative cervical

  9. Clinical results of cervical laminectomy and fusion for the treatment of cervical spondylotic myelopathy in 58 consecutive patients

    Directory of Open Access Journals (Sweden)

    Victor Chang

    2014-01-01

    Conclusion: Cervical laminectomy and fusion is a safe and efficacious procedure for the treatment of CSM. The clinical outcomes appear to be quite reproducible, and this technique is an important part of a spine surgeon′s armamentarium.

  10. Surgical Outcomes and Correlation of the Copenhagen Neck Functional Disability Scale and Modified Japanese Orthopedic Association Assessment Scales in Patients with Cervical Spondylotic Myelopathy

    Science.gov (United States)

    Azhari, Shirzad; Shazadi, Sohrab; Khayat Kashany, Hamid; Nayeb Aghaei, Hossein; Mohammadi, Hassan Reza

    2016-01-01

    Study Design Cross-sectional. Purpose Clinical outcome study comparing the Copenhagen Neck Functional Disability Scale (CNFDS) and modified Japanese orthopedic association (mJOA) assessment scales in patients with cervical spondylotic myelopathy (CSM). Overview of Literature Comparison of instruments that measure patient-reported outcomes is needed. Methods A cross-sectional analysis was conducted. Ninety five patients with CSM were entered into the study and completed the CNFDS and the mJOA preoperatively and postoperatively. Correlation between the CNFDS and the mJOA was evaluated preoperatively and at the end of follow-up. Responsiveness to change of CNFDS and mJOA was also assessed. Clinical outcomes were also measured with the recovery rate of mJOA score at end of follow-up. Results The mean age of patients was 58.2 (standard deviation, SD=8.7) years. Mean follow-up was 2.1 years (range, 1 to 4 years). The mJOA correlated strongly with the CNFDS score preoperatively and postoperatively (r=–0.81 and –0.82, respectively; p<0.001). The CNFDS and the mJOA were able to detect changes after the surgery (p<0.001). The mean mJOA recovery rate was 51.8% (SD=13.1%). Conclusions Surgery for the treatment of patients with CSM is an efficacious procedure. CNFDS and mJOA scores have a strong correlation in measuring disability among CSM patients. PMID:27340528

  11. Three - dimension Computerized Tomography in Diagnosis of Cervical Spondylotic Myelopathy%螺旋CT三维重建诊断脊髓型颈椎病

    Institute of Scientific and Technical Information of China (English)

    喻忠; 王黎明; 桂鉴超; 姚京东

    2006-01-01

    目的 探讨三维CT对脊髓型颈椎病(cervical spondylotic myelopathy,CSM)的诊断价值.方法 采用三维CT技术检查86例CSM,观察颈椎骨质增生和椎管的病理改变,测量椎管矢状径及Pavlov比率,评价椎管狭窄的程度.结果 67.4%有颈椎椎体骨质增生,61.2%有钩突关节,27.9%有小关节突有骨质增生,39.5%有颈椎生理曲度改变.三维CT对脊髓型颈椎病椎管狭窄的病因表现为椎间盘突出77例(89.5%)、椎体后部缘骨质增生62例(72.1%)、黄韧带肥厚褶皱34例(39.5%)、后纵韧带钙化14例(16.3%)、小关节突骨质增生16例(18.6%)、椎板增厚15例(17.4%)、椎体滑脱10例(11.6%).结论 三维CT能对CSM作出准确、全面的评估,具有重要临床价值.

  12. Position of increased signal intensity in the spinal cord on MR images: does it predict the outcome of cervical spondylotic myelopathy?

    Institute of Scientific and Technical Information of China (English)

    SHEN Hong-xing; LI Ling; YANG Zhi-gao; HOU Tie-sheng

    2009-01-01

    Background Increased signal intensity (ISI) in the spinal cord on T2-weighted MR images has been reported in some previous researches, however no study focused on the position of the ISI in the spinal cord and its potential value. The aim of this study was to investigate the correlation between ISI position and the outcome of surgical treatment for cervical spondylotic myelopathy (CSM) patients.Methods A retrospective study was conducted. Pre- and post-operative clinical status was evaluated by modified Japanese Orthopaedic Association (JOA) score. ISI was evaluated according to the T2-weighted sequences. The JOA score and the recovery ratios among patients with ISI in gray matter (group A), in both gray and white matter (group B), and ISI-negative group were compared.Results Totally 64 patients were enrolled in this retrospective study. Preoperative JOA score of ISI positive and negative group had significant difference, but the recovery ratios had no significant difference (the recovery ratios of the two groups in week 1, week 26, and week 104 were (21.54±14.65)%, (50.56±14.76)%, (59.23±13.08)% and (20.25±14.32)%, (54.46±23.16)% and (61.26±29.4)%, respectively; P>0.05). The recovery ratios of negative group and group A in week 104 were superior to group B (the recovery ratios of negative group, group A, and group B in week 104 were (61.26±E29.49)%, (65.35±11.36)%, and (50.33±10.20)%, respectively; P <0.05). Conclusions Patients with ISI in the gray matter alone on T2-weighted MR images did not have significantly different surgical outcomes compared with those without ISI. Patients with ISI in both gray and white matter had surgical outcomes that were worse than those without ISI.

  13. [Cervical Spondylotic Amyotrophy].

    Science.gov (United States)

    Sonoo, Masahiro

    2016-05-01

    Keegan (1965) reported a patient who presented with "dissociated motor loss," an acute paralysis of the upper extremity with minimal sensory signs and no long tract signs, and documented an anterior root lesion following autopsy. Sobue et al. (1975) reported similar cases using the term "cervical spondylotic amyotrophy (CSA)," but postulated pathology of the anterior horn. Although Keegan's "dissociated motor loss" surely referred to isolated motor paresis with no or minimal sensory signs, contrary to existing criticism, a more general term, CSA, should be preferred. CSA is divided into proximal and distal types. Distal CSA often presents with a drop finger, and thus may be misdiagnosed as posterior interosseous nerve palsy. Documentation of the involvement of ulnar muscles by clinical signs and EMG would lead to the diagnosis of distal CSA. Proximal CSA may be confused with neuralgic amyotrophy (NA), although the sparing of the serratus anterior and the stereotypic involvement of deltoid, infraspinatus, biceps brachii, and brachioradialis suggest CSA. Cervical MRI is not diagnostic in around half of CSA cases, and denervation in paraspinal EMG is a more sensitive test that can exclude NA. Amyotrophic lateral sclerosis is another important differential diagnosis for CSA. PMID:27156504

  14. Anterior cervical decompression and fusion by microscope for the treatment of cervical spondylotic myelopathy%显微镜下减压融合术治疗脊髓型颈椎病

    Institute of Scientific and Technical Information of China (English)

    宋红浦; 郭峭峰; 张晓文; 张春

    2012-01-01

    目的:探讨显微镜下颈前路减压融合术治疗脊髓型颈椎病的疗效.方法:2005年2月至2010年3月,在显微镜辅助下经颈前路减压融合术治疗脊髓型颈椎病21例,男13例,女8例;年龄32~71岁,平均51.5岁;病程6个月~3年,平均12.5个月.手术操作:在显微镜下应用高速磨钻等工具进行减压操作,脊髓充分减压后取自体髂骨植骨融合加内固定.对手术前后JOA颈椎病评分进行比较并评价其疗效.结果:21例患者均获随访,时间18~24个月,平均20个月.患者脊髓神经功能均有不同程度提高,JOA评分由术前9.26±1.72增加至术后的13.64±1.38 (t=2.452,P=0.000).根据JOA评分评定疗效:优12例,良7例,一般2例.结论:显微镜下颈前路减压融合术具有操作精细、减压充分等优点,治疗脊髓型颈椎病安全、有效.%Objective: To explore clinical effects of anterior cervical decompression and fusion by microscope in treating cervical spondylotic myelopathy. Methods:From February 2005 to March 2010,21 patients with cervical spondylotic myelopathy, 13 males and 8 females with an average age of 51.5 years (ranged, 32 to 71) ,were treated with anterior cervical decompression using high-speed bur,then bone grafting and fusion with auto iliac bone and internal fixation by microscope. According to JOA score of cervical spondylosis to evaluate clinical effects before and after operation. Results: All patients were followed up from 18 to 24 months with an average of 20 months. JOA score improved significantly from preoperative 9.26±1.72 to postoperative 13.64±1.38 (t=2.452,P=0.000). According to JOA score, 12 cases were excellent,7 good and 2 fair. Conclusion : Anterior cervical decompression and fusion by microscope is a refined, safe and effective surgical procedure for cervical spondylotic myelopathy.

  15. Operative Outcomes for Cervical Myelopathy and Radiculopathy

    Directory of Open Access Journals (Sweden)

    J. G. Galbraith

    2012-01-01

    Full Text Available Cervical spondylotic myelopathy and radiculopathy are common disorders which can lead to significant clinical morbidity. Conservative management, such as physical therapy, cervical immobilisation, or anti-inflammatory medications, is the preferred and often only required intervention. Surgical intervention is reserved for those patients who have intractable pain or progressive neurological symptoms. The goals of surgical treatment are decompression of the spinal cord and nerve roots and deformity prevention by maintaining or supplementing spinal stability and alleviating pain. Numerous surgical techniques exist to alleviate symptoms, which are achieved through anterior, posterior, or circumferential approaches. Under most circumstances, one approach will produce optimal results. It is important that the surgical plan is tailored to address each individual's unique clinical circumstance. The objective of this paper is to analyse the major surgical treatment options for cervical myelopathy and radiculopathy focusing on outcomes and complications.

  16. Risk of spinal cord injury in patients with cervical spondylotic myelopathy and ossification of posterior longitudinal ligament: a national cohort study.

    Science.gov (United States)

    Chen, Li-Fu; Tu, Tsung-Hsi; Chen, Yu-Chun; Wu, Jau-Ching; Chang, Peng-Yuan; Liu, Laura; Huang, Wen-Cheng; Lo, Su-Shun; Cheng, Henrich

    2016-06-01

    OBJECTIVE This study aimed to estimate the risk of spinal cord injury (SCI) in patients with cervical spondylotic myelopathy (CSM) with and without ossification of posterior longitudinal ligament (OPLL). Also, the study compared the incidence rates of SCI in patients who were managed surgically and conservatively. METHODS This retrospective cohort study covering 15 years analyzed the incidence of SCI in patients with CSM. All patients, identified from the National Health Insurance Research Database, were hospitalized with the diagnosis of CSM and followed up during the study period. These patients with CSM were categorized into 4 groups according to whether they had OPLL or not and whether they received surgery or not: 1) surgically managed CSM without OPLL; 2) conservatively managed CSM without OPLL; 3) surgically managed CSM with OPLL; and 4) conservatively managed CSM with OPLL. The incidence rates of subsequent SCI in each group during follow-up were then compared. Kaplan-Meier and Cox regression analyses were performed to compare the risk of SCI between the groups. RESULTS Between January 1, 1999, and December 31, 2013, there were 17,258 patients with CSM who were followed up for 89,003.78 person-years. The overall incidence of SCI in these patients with CSM was 2.022 per 1000 person-years. Patients who had CSM with OPLL and were conservatively managed had the highest incidence of SCI, at 4.11 per 1000 person-years. Patients who had CSM with OPLL and were surgically managed had a lower incidence of SCI, at 3.69 per 1000 person-years. Patients who had CSM without OPLL and were conservatively managed had an even lower incidence of SCI, at 2.41 per 1000 person-years. Patients who had CSM without OPLL and were surgically managed had the lowest incidence of SCI, at 1.31 per 1000 person-years. The Cox regression model demonstrated that SCIs are significantly more likely to happen in male patients and in those with OPLL (HR 2.00 and 2.24, p risk for approximately 50

  17. Advancement of posterior surgical treatment of multilevel cervical spondylotic myelopathy%多节段脊髓型颈椎病的后路手术治疗进展

    Institute of Scientific and Technical Information of China (English)

    仲伟涛(综述); 匡正达(审校)

    2016-01-01

    Multilevel cervical spondylotic myelopathy (MCSM) is a common disease in spine surgery. Due to its severe clinical symptoms, and influence of patient’s life quality and safety, so the disease should be treated with surgery as far as quickly once diagnosis is clear. Posterior cervical spine surgery is a commonly used surgical approach. This article reviews the advancement of its treatment and common complications.%多节段脊髓型颈椎病(multilevel cervical spondylotic myelopathy,MCSM)是脊柱外科的常见病,由于临床症状严重,影响患者的生活质量及生命安全,诊断明确时,应尽早采取手术治疗。颈椎后路手术是目前比较常用的手术方式,笔者就其治疗方式进展及常见并发症进行综述。

  18. Degenerative cervical myelopathy.

    Science.gov (United States)

    Kato, So; Fehlings, Michael

    2016-09-01

    Cervical myelopathy is the most common cause of acquired spinal cord compromise. The concept of degenerative cervical myelopathy (DCM), defined as symptomatic myelopathy associated with degenerative arthropathic changes in the spine axis, is being introduced. Given its progressive nature, treatment options have to be chosen in a timely manner. Surgical options include anterior discectomy and fusion (ACDF), anterior corpectomy and fusion (ACCF), arthroplasty (in highly select cases), posterior laminectomy with/without fusion, and laminoplasty. Indications for each should be carefully considered in individual patients. Riluzole, a sodium-glutamate antagonist, is a promising option to optimize neurologic outcomes post-surgery and is being examined in the CSM-Protect Randomized Controlled Trial. Preoperative risk assessment is mandatory for prognostication. Sagittal alignment is known to play an important role to optimize surgical outcome. Guidelines for optimal management of DCM are in process. In principle, all but the mildest cases of DCM should be offered surgery for optimal outcome. PMID:27250040

  19. Clinical efficacy of three different techniques of fusion in the treatment of cervical spondylotic myelopathy%三种前路手术治疗脊髓型颈椎病临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    陈占磊; 官众

    2013-01-01

    Objective To observe the clinical effects of cervical spondylotic myelopathy and bone graft fusion by different methods for cervical spondylotic myelopathy.Methods Seventy-one cases of cervical spondylotic myelopathy were treated by cervical anterior decompression and bone graft fusion with three surgical procedures from January 2009 to November 2011.Twenty-four cases were treated by anterior cervical discectomy and bone grafting and fusion (group A),27 cases were treated by cervical anterior decompression bone grafting and internal fixation with steel plate (group B),20 cases were treated by anterior cervical decompression,titanium plate internal fixation(group C),cervical disc prosthesis implantation.X-ray films and regular follow-up were taken after operation to observe the curative effects,the interbody height,the cervical vertebra antecttrvature and the fusion of operative segments.Results According to the results of the follow-up,the fusion rates of A,B,C group were 95.3%,95.4%,97.8%.When the follow-up was over,while there was no such difference in A,B or C group (F =2.32,P > 0.05),while there was no statistical significance in the differences among A,B or C group (F =2.23,P > 0.05).Condusions The key point of the treatment of cervical spondylotic myclopathy lies in thorough decompression and effective bone graft fusion,furthermore,different techniques of fusion affect the curative effects significantly.%目的 观察分析三种颈椎前路手术治疗脊髓型颈椎病(CSM)的临床疗效.方法 将2009年1月至2011年11月青海大学附属医院手术治疗的71例CSM患者分为A、B、C三组.A组24例采用颈椎前路减压植骨钢板内固定术;B组27例采用颈前路减压cage植入植骨术;C组20例采用颈椎间盘切除减压、人工颈椎间盘植入术.术后定期随访及拍摄X线片,观察疗效、椎间高度、颈椎前弯曲度和植骨融合情况.结果 经过随访,A组融合率为95.3%,B组为95.4%,C组为97.8

  20. The early-to-mid treatment efficacy of applying ROI interbody fusion cage in cervical spondylotic myelopathy%双嵌式颈椎融合器治疗脊髓型颈椎病早中期效果

    Institute of Scientific and Technical Information of China (English)

    李战友; 潘兵; 阮立奇; 张志敬

    2015-01-01

    Objective:To observe the clinical effect and radiological outcomes of ROI interbody fusion cage in cervical spondylotic myelopathy. Methods:21 patients were treated with lumbar disc excision and cervical vertebra fusion with ROI cage trans anterior approach. Clinical effect was evaluated by Japanese Orthopaedic Association (JOA) score for cervical function.Each patient underwent cervical anteroposterior and lateral radiographs,CT scanning before operation,at 3 days,3 months,and 6 months after operation to assess fusion effect. Intervertebral height was measured. The time of operation,in-traoperative blood loss and complication relative to opration were recorded. Results:As time goes on,the score of JOA was increased gradually after operation,and patients were all cured after 6 months. The fusion rate was 100%. No complication was found. Conclusion:Favorable early and midterm outcomes may be yielded in patients with cervical spondylotic myelopathy treated by anterior cervical discectomy and fusion with ROI interbody fusion cage.%目的:评估双嵌式颈椎融合器(ROI-C)治疗脊髓型颈椎病的临床疗效及影像学效果. 方法:2012年5月-2013年6月我科应用颈椎压力固定器对21名患者行颈椎前路减压椎间盘切除椎体融合术.应用JOA功能评分评价临床疗效,并于术前,术后3d、术后3个月、术后6个月行常规X线正侧位片检查,评估椎体间融合情况及椎间高度,并记录每例病例手术时间、出血量及手术相关并发症情况. 结果:JOA评分随时间顺序逐渐升高,6个月内所有病例椎间全部融合,椎间高度在术后3 d即显著恢复,3个月内下降,术后6个月趋于稳定.在随访期间,未发生手术相关并发症.结论:应用双嵌式颈椎融合器治疗脊髓型颈椎病可在早中期达到较好的临床疗效.

  1. 突出的颈椎间盘组织炎症反应机制研究%Study on inflammatory mechanism of herniated cervical intervertebral discs from patients with cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    彭宝淦; 王占朝; 唐家广; 侯树勋; 吴仕良

    2003-01-01

    Aim To study the inflammatory mechanism of herniatedcervical intervertebral discs from patients with cervical spondyloticmyelopathy, and the roles of the inflammation in the cervical disc degenera-tion and cervical spondylosis. Methods 35 herniated cervical discs wereobtained fron 31 patients with cervical spondylotic myeloyathy during theanterior cervical surgery. 7 normal, nondegenerated cervical discs(controlgroup) were obtained from three fresh cadavers. All discs were divided intotwo samples, one of which was used as histological examination, and theother was used to detect contents of IL-1α. IL-6 and TNF-α biochemi-cally. Results In 35 herniated cervical discs, 18(51% ) were shownabundant inflammatory cell infiltrates in margin of herniated discs; 17(49%) no inflammatory cell infiltrates; normal discs also no any inflam-matory cell infiltrates. Biochemical assay indicated IL-1 α, IL-6 and TNF-αin cervical spondylotic myelopathy was (10.4 ± 1.9), (7.7 ± 2. 1 ) and(7.5 ± 1.7) pg/g respectively and those in noninflammatory infiltrates groupwas (10.2 ± 1.6), (6.7 ± 2.6) and (7.0 ± 1.8) pg/g respectively and thosein the control group was (2.0±0.9), (1.2±1.0) and (1.3±0.8)pg/g.The contents of cytokine IL-1α, IL-6 and TNF-α were obviously higher thanthat of normal discs( P =0. 000 1, t = 11. 359 1, 7. 951 0, 9. 372 8), andthere were no differences in the contents of cytokines between discs withinflammatory cell infiltrates and discs with no inflammatory cell infiltrates(P> 0.05, t=0.6120, 2.6204, 1.7394).Conelusion Herniatedcervical disc from the cervical spondylotic myelopathy was inflammatory, andinflammation may play an important role in cervical disc degeneration and inpathogenesis of cervical spondylosis.%目的研究颈椎病发生中突出颈椎间盘组织的炎症反应机制及其在颈椎间盘退行性变和颈椎病发病中的作用.方法临床收集了31例脊髓型颈椎病患者的35个突出的颈椎间盘标本和3

  2. Treatment options and efficacy evaluation for multilevel cervical spondylotic myelopathy%多节段脊髓型颈椎病治疗方式选择与疗效评价

    Institute of Scientific and Technical Information of China (English)

    侯增涛; 赵爱琳; 郭传友; 陈伯华

    2014-01-01

    背景:手术是终止多节段脊髓型颈椎病病理进展,改善脊髓功能的重要措施,但如何选择最佳手术方式,减少并发症发生及提高临床疗效存在较大的争议。  目的:系统性回顾多节段脊髓型颈椎病患者资料,评价单纯前入路、单纯后入路及一期后前联合入路治疗对患者颈椎曲率指数及脊髓功能恢复的影响。  方法:选取2000年2月至2008年2月青岛大学附属医院和青岛市市立医院接受多节段脊髓型颈椎病手术治疗,符合纳入和排除标准的患者资料共148例,分为单纯前入路、单纯后入路及一期后前联合入路手术组,评估不同治疗方式治疗后患者功能恢复的差异。  结果与结论:单纯后入路组患者治疗前颈椎曲率指数最高(P0.05),治疗后一期后前联合入路手术组患者JOA改善率与其他2组相比较差异有显著性意义(P OBJECTIVE:To systematical y review patients’ profiles of multilevel cervical spondylotic myelopathy, and to evaluate the effects of simple anterior approach, simple posterior approach and one stage posterior anterior combined approach on cervical spinal curvature index and functional recovery in patients. METHOD148 sample profiles of patients, who received multilevel cervical spondylotic myelopathy operation in The Affiliated Hospital of Qingdao University and Qingdao Municipal Hospital from February 2000 to February 2008, and met the inclusion and exclusion criteria, were selected. They were divided into simple anterior approach group, simple posterior approach group and one stage posterior anterior combined approach group. The differences in the functional recovery were assessed after treatment using different therapeutic methods. RESULTS AND CONCLUSION:Cervical spinal curvature index was highest in the simple posterior approach group before treatment (P0.05). Significant differences in improvement rate of Japanese Orthopaedic

  3. Long Segment Cervical Corpectomy versus Discectomy Combined with Corpectomy for Multilevel Cervical Spondylotic Myelopathy%前路不同术式治疗多节段颈椎病

    Institute of Scientific and Technical Information of China (English)

    储建军; 裴少保; 王涛; 李定滨; 李键

    2014-01-01

    Objective To explore the effect of two different anterior approaches in the treatment of multilevel cervical spondylotic myelopathy . Methods The clinical data of 40 cases of multilevel cervical spondylotic myelopathy treated in our hospital from February 2008 to October 2011 were retrospectively analyzed .Of the 40 patients, 20 patients were treated with one or more cervical corpectomy combined with titanium mesh fusion and internal fixation ( Long-segment group ) and the remaining 20 cases were treated with anterior cervical discectomy and anterior cervical corpectomy combined with bone grafting and internal fixation ( Separate-segmental group ). Results The operative time in Separate-segmental and Long-segmental group was ( 118.2 ±23.4 ) and (102.3 ±20.4) min, respectively;the blood loss was (182.4 ±35.8) and (164.1 ±23.6) ml, respectively; the hospital stay was (7.1 ±3.2) and (5.2 ±2.8) d, respectively.Significant differences were found between the two groups in the improvement rate of JOA at every time point (P0.05;q=0.854,P>0.05).Cobb angle were improved after operation in both groups (F=181.80,P=0.000;F=245.36,P=0.000).Angle loss rate at the 12-month postoperative follow-up in Long-segment and Segment group was (6.5 ±0.4)%and (5.1 ±0.3)%, respectively.Two cases in Long-segment group showed bone graft fusion 6 months after operation , and the remaining patients in both groups showed bone graft fusion 4 months after operation . Conclusion Both methods could obtain good clinical results in the treatment of multilevel cervical spondylotic myelopathy .%目的:探讨长节段椎体次全切钛网植骨融合钢板内固定术和椎间盘摘除联合椎体次全切植骨融合钢板内固定术治疗多节段脊髓型颈椎病的临床疗效。方法回顾性分析我院2008年2月~2011年10月累及≥3个节段的脊髓型颈椎病40例,其中20例采用≥1个椎体次全切除植骨融合钢板内固定术(长节段组),20例采用单个椎

  4. Evaluation of anterior cervical reconstruction with titanium mesh cages versus nano-hydroxyapatite/polyamide66 cages after 1- or 2-level corpectomy for multilevel cervical spondylotic myelopathy: a retrospective study of 117 patients.

    Directory of Open Access Journals (Sweden)

    Yuan Zhang

    Full Text Available OBJECTIVE: To retrospectively compare the efficacy of the titanium mesh cage (TMC and the nano-hydroxyapatite/polyamide66 cage (n-HA/PA66 cage for 1- or 2-level anterior cervical corpectomy and fusion (ACCF to treat multilevel cervical spondylotic myelopathy (MCSM. METHODS: A total of 117 consecutive patients with MCSM who underwent 1- or 2-level ACCF using a TMC or an n-HA/PA66 cage were studied retrospectively at a mean follow-up of 45.28 ± 12.83 months. The patients were divided into four groups according to the level of corpectomy (1- or 2-level corpectomy and cage type used (TMC or n-HA/PA66 cage. Clinical and radiological parameters were used to evaluate outcomes. RESULTS: At the one-year follow-up, the fusion rate in the n-HA/PA66 group was higher, albeit non-significantly, than that in the TMC group for both 1- and 2-level ACCF, but the fusion rates of the procedures were almost equal at the final follow-up. The incidence of cage subsidence at the final follow-up was significantly higher in the TMC group than in the n-HA/PA66 group for the 1-level ACCF (24% vs. 4%, p = 0.01, and the difference was greater for the 2-level ACCF between the TMC group and the n-HA/PA66 group (38% vs. 5%, p = 0.01. Meanwhile, a much greater loss of fused height was observed in the TMC group compared with the n-HA/PA66 group for both the 1- and 2-level ACCF. All four groups demonstrated increases in C2-C7 Cobb angle and JOA scores and decreases in VAS at the final follow-up compared with preoperative values. CONCLUSION: The lower incidence of cage subsidence, better maintenance of the height of the fused segment and similar excellent bony fusion indicate that the n-HA/PA66 cage may be a superior alternative to the TMC for cervical reconstruction after cervical corpectomy, in particular for 2-level ACCF.

  5. Hybrid Surgery术式治疗颈前路多节段脊髓型颈椎病的临床分析%Clinic analysis of Hybrid Surgery to treat multi segmental anterior cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    福嘉欣; 江汉; 江毅; 肖联平; 田永刚

    2015-01-01

    Objective To investigate the effect of corpectomy decompression by subtotal vertebrectomy and fusion of adjacent segmental artificial disc replacement through anterior intervertenral spance (Hybrid Surgery) in the anteriorcervical spondylotic myelopathy treatment . Methods Hybrid Surgery were operated on 18 patients who suffered from anterior cervi⁃cal spondylotic myelopathy . Follow up of 1-50 months. Patient’s conditions were assessed according to the Japanese Associ⁃ation for Department of orthopedics assessment score (JOA score) before and after operation. Effects of Hybrid operation were assessed by the improvement of JOA score, Odom’s follow-up grade and cervical mobility . Results The JOA scores of all 18 operated patients were improved from 10.6 ± 1.7 before operation to 13.5 ± 2.4 after operation. And the difference is statistically significant (t=1.314, P 0.05). Conclusion Hybrid Surgery of anterior cervical decompression and fusion can both improve the nerve function and preserve cervical mobility.%目的:探讨颈椎前路经椎间隙或椎体次全切除减压植骨融合联合邻近节段人工间盘置换(Hybrid Surgery)在颈前路多节段脊髓型颈椎病治疗中的效果。方法应用Hybrid Surgery术式治疗颈前路多节段脊髓型颈椎病患者18例。随访1~50个月,手术前后根据日本骨科协会评估分数(JOA)进行评分。通过JOA评分的改善情况, Odom’s分级随访结果及颈椎活动度的变化评价Hybrid Surgery的效果。结果18例术后JOA评分(13.5±2.4)分高于术前(10.6±1.7)分,差异有统计学意义(t=1.314,P0.05)。结论 Hybrid Surgery术式颈前路充分减压融合,既可改善患者神经功能,又可保留一定程度上的颈椎活动度。

  6. 综合疗法治疗非脊髓型颈椎病的临床研究%Clinical research on cervical spondylosis except for cervical spondylotic myelopathy treated with comprehensive therapy

    Institute of Scientific and Technical Information of China (English)

    胡阿威; 吕建芳; 夏春明; 陈新武; 何正华; 徐明

    2011-01-01

    Objective To explore the clinical effect on cervical spontlylosis except for cervical spondylotie myelopathv treated with comprehensive therapy. Methods 210 cases of patients with cervical spondvlosis except for cervical spondylotie mytlopathy were divided into 3 groups. There, were, 70 eases in the treatment group,they were treated with comprehensive therapy composed of cervical traction,massage,microwave,medications and functional training. There wen' 70 cases in the control group, thev were treated with cervical traction,computerized mid-frequency electrotherapyand functional training. There were 70 cases in the traction group,they were only treated with cer-vical traction.After treatment for 15 days, curative effects were evaluated according to numerical rating scales,neck disability index and the standard of clinical diseases diagnosis and treatment Results All the patients were follow up for average 8 months. The curative effects of the treatment group were better than the control group (P<0.05). The curative effects of the control group were better than the traction group (P<0.05). The curative effects of the treatment group were much better than the traction group (P<0.01). Conclusion Comprehensive therapy are bettter than simple therapy for the clinical effect on cervical spondylosis.The comprehensive therapy is safe,simple and much effective for cervical spondylosis except for cervical spondylotic myelopathy.%目的 探讨综合疗法治疗非脊髓型颈椎病的临床疗效.方法 210例非脊髓型颈椎病患者分为3组,治疗组70例,行综合疗法(颈椎牵引、推拿、微波、药物、功能锻炼)治疗;对照组70例,行颈椎牵引、电脑中频治疗、功能锻炼;牵引组70例,仅给予颈椎牵引治疗;治疗15天后,采用数字疼痛评分(NRS )、颈部残障指数(NDI)及临床疾病诊断依据治愈好转标准评价临床疗效.结果 平均随访8月,三组临床疗效比较,治疗组疗效优于对照组(P<0.05),对

  7. 保留椎体后壁的椎体次全切除术治疗脊髓型颈椎病%Anterior Cervical Corpectomy and Fusion with Preserved Posterior Vertebral Wall for Cervical Spondylotic Myelopathy

    Institute of Scientific and Technical Information of China (English)

    郑军; 申才良; 董福龙; 巩陈; 汪卫兵

    2011-01-01

    Objective:To investigate the effect of anterior cervical corpectomy and fusion with preserved posterior vertebral wall for cervical spondylotic myelopathy (CSM), and to compare the results with preserved posterior vertebral wall with the classical anterior cervical corpectomy with ft,sion. Methods :Forty patients with CSM were randomized into two groups, anterior cervical eorpeetomy with fusion (n = 20) and anterior cervical eorpeetomy and fusion with preserved posterior vertebral wall (n=20). The values of operation time, surgical bleeding, the numbers and types of complications, disc height, segmental lordosis, and fusion tale were compared hetween two groups. Results: The average operation time and surgical hleeding decreased significantly in the anterior cervical corpectomy and fusion with preserved posterior vertebral wall group. Improvements in segmental lordosis and disc height were similar in both groups (P>0.05). Both fusion rates after 2 processes reached 100% at 3 months postoperatively. Conclusion: Anterior cervical corpectomy and fusion with preserved posterior vertebral wall is a feasible procedure for anterior decompression and fusion, with a shorter operation time, less surgical bleeding and smaller structural damage to the cervical vertebrae.%目的:探讨保留椎体后壁椎体次全切除术治疗脊髓型颈椎病的疗效,并与传统的椎体次全切除术比较.方法:脊髓型颈椎病患者40例随机均分为2组,分别行传统的椎体次全切除术和保留椎体后壁的椎体次全切除术.比较2组的手术时间、出血量、并发症、节段高度、节段曲度及植骨融合评分等指标变化.结果:保留椎体后壁组较椎体次全切除术组的手术时间短、出血少.2组节段高度和曲度的改善差异均无统计学意义(P>0.05).2种术式术后3个月植骨融合率均为100%.结论:保留椎体后壁的椎体次全切除术具有手术时间短、出血少、对颈椎椎体结构破坏小等优

  8. Treatment of hyperexsion injury with severe cervical spondylotic myelopathy by early posterior laminectomy and fusion.%颈椎过伸伤伴颈椎管狭窄症的早期后路手术治疗

    Institute of Scientific and Technical Information of China (English)

    谭俊铭; 王金鑫; 来津; 王朝阳; 陈德纯; 邢顺民; 申练兵; 苏加向; 廖腾; 时国华; 何翔

    2012-01-01

    Objective To retrospectively evaluate lite therapeutic effect of 18 patients with hy — percxsion injury and severe multilevel cervical spondylotic myelopathy treated by early posterior laminectomy and fusion. Methods All patients had. preoperative radiographs,computed tomography and magnetic resonance imaging,and noted 11 patients had abnormal T2—weighted MR] signal. Neurologic function and clinical assessment of myelopathy were graded preoperatively and postoperative— ly by the grading system of Nurick and Niu respectively. The mean follow—up period were 26 months (from 6 months to 5.5 years ). Results Mean Niu score improved from 6.221, range 5—7) to 4.72 (range 3—7.) postoperatively. Fifteen patients (83.3%) had improvement in Nurick grade of at least one level,and three showed no improvement. There were 6 cases had residual abnormal T2 — weighted MRI signal postoperatively. Conclusion Good clinical effectiveness are obtained from early laminectomy and fusion in hyperexsion injury with severe multilevel cervical myelopathy and obviously improvement of myelopalhy are observed, with low complication rales were.%目的 回顾分析了早期颈后路切除减压融合治疗18 例颈椎过伸伤伴颈椎管狭窄患者.方法 术前常规X 线、CT 和MRI 检查,其中11 例患者存在异常T2加权MRI 信号,手术前后分别行Nurick 和Niu 系统评估.随访6 个月~5.5 年,平均2.4 年.结果 平均Niu 评分由术前6.22(5~7)提高到术后4.72(3~7),15 例患者(83.3%)的最后随访示Nurick 评分至少提高Ⅰ级,3 例无明显改善和恶化.术后6 例患者仍存在T2加权MRI 信号异常.结论 颈椎过伸伤伴颈椎管狭窄症患者行早期后路椎板切除减压融合可取得较好的临床效果,术后疗效改善明显,并发症发生率较低.

  9. Anterior Cervical Fusion with Cervical Hollow Threaded Fixator for Cervical Spondylotic Myelopathy%脊髓型颈椎病前路减压椎间融合器临床应用

    Institute of Scientific and Technical Information of China (English)

    刘利乐; 曹盛俊; 王文军; 陈志伟

    2001-01-01

    Objectives: To evaluate the effect of anterior cervica l fusion with cervical hol low threaded fixator (CHTF,Synthys) for cervical spondylotc myelopathy as substi tute for the conventional anterior fusion. Methods: 18 patients with cervi cal spondylofie myelopathy were treated with the new method and followed up afte r surgery.Results:6 months to 1 year postoperatively, the clinical symptom s were obviously improved, the stability of cervical segmental unit was satisfact ory and the normal lordosis was obtained. There were no stenosis of the cervical canal and no displacement of the cervical body. The average time for the cervic al fusion was 4.5 months.%目的 探讨脊髓型颈椎病(CSM)前路减压,颈椎空心螺纹内固定器(CHTF)椎间融合,代替 传统的前路减压,植骨融合的方法。方法 对18例CMS采用环锯减压再潜行扩大减压,植入C HTF无磁性医用钛合金空心螺纹内固定器椎间融合,随访疗效,进行分析。结果 植入CHTF 术后随访6个月至1年,症状改善明显,稳定性好,生理曲度恢复达正常,无椎间隙高度丢 失,无CHTF滑脱、移位。术后平均4.5个月椎间隙融合。

  10. Depression contributed a dissatisfied cervical surgery outcome of the posterior decompression in cervical spondylotic myelopathy%抑郁对脊髓型颈椎病后路减压手术预后的不良影响

    Institute of Scientific and Technical Information of China (English)

    宗雅琪; 雪原; 赵莹; 林威; 丁怀荣; 何冬; 李志阳; 唐炎铭; 王一

    2015-01-01

    目的:探讨抑郁对脊髓型颈椎病后路减压手术疗效的影响。方法2006年10月至2011年10月接受后路椎板切除或椎板成形减压手术的脊髓型颈椎病患者396例纳入研究,男132例,女264例;年龄39~84岁,平均60.2岁。术前按贝克抑郁量表(Beck depression inventory,BDI)评分将患者分为抑郁组与非抑郁组,两组患者年龄、性别、吸烟情况、症状持续时间、工作情况(是否从事当前工作)的差异均无统计学意义。术后影像学评价指标包括脊髓膨胀面积、脊髓后移距离、颈椎曲率指数;临床疗效评价指标包括日本骨科协会(Japanese Orthopedic Association,JOA)评分、颈椎失能指数(neck disability index,NDI)、疼痛视觉模拟评分(visual analogue scale,VAS)及BDI。术后1.5个月对两组患者上述指标进行评价,并进行统计学分析。结果全部396例均获得随访,随访时间24~50个月,平均32个月。抑郁组与非抑郁组术后颈椎曲率指数下降分别为7.1%±2.1%和6.8%±1.5%、脊髓膨胀面积分别为(130.9±7.0)mm2和(150.8±5.2)mm2、脊髓后移距离分别为(5.7±1.2)mm和(6.2±0.8)mm,差异均无统计学意义。抑郁组与非抑郁组患者术后JOA评分分别提高(1.42±0.56)分和(6.76±3.12)分,差异有统计学意义;NDI分别下降7.31±2.18和21.11±11.36,差异有统计学意义;VAS评分分别下降(16.08±19.76)分和(23.85±20.79)分,差异有统计学意义。抑郁组与非抑郁组患者术后BDI评分均有所改善,但与术前比较差异均无统计学意义。结论术前抑郁状态对脊髓型颈椎病后路减压术后的功能恢复、伤残指数下降及疼痛缓解有不良影响。%Objective To investigate the effect of depression symptoms on surgical outcome of posterior decompression among cervical spondylotic myelopathy (CSM) patients. Methods Between October 2006 and October 2011

  11. 颈前路手术治疗脊髓型颈椎病并颈椎外伤所致急性颈髓损伤19例临床分析%Clinical analysis on 19 cases of anterior cervical surgical treatment of acute cervical spinal cord injury caused by cervical spondylotic myelopathy and cervical trauma

    Institute of Scientific and Technical Information of China (English)

    张明友; 陈德元

    2014-01-01

    目的 探讨颈前路椎体次全切并后纵韧带切除减压植骨融合术治疗脊髓型颈椎病并颈椎外伤所导致的急性颈髓损伤的疗效.方法 回顾性分析采用颈前路椎体次全切并后纵韧带切除减压植骨融合术治疗的脊髓型颈椎病并颈椎外伤所导致的急性颈髓损伤的19例患者病历资料,对患者外伤前(T1)、外伤后(T2)、术后1周内(T3)、术后10个月后(T4)四个时期的颈椎曲度及神经功能评分(JOA)变化进行分析,判断手术疗效.结果 所有患者均获得10~24个月随访,平均(15.2±6.7)个月.T1、T2、T3、T4四个时期的颈椎曲度分别为(28.621±1.850)°、(29.326±2.416)°、(38.384±2.611)°、(37.316±2.521)°.T1、T2、T3、T4四个时期的JOA脊髓型颈椎病评分分别为(12.79±1.316)、(4.00±2.082)、(9.68±3.001)、(11.68±3.334).结论 颈前路椎体次全切并后纵韧带切除减压植骨融合术可达到有效减压效果、可重建颈椎曲度,能提供脊髓型颈椎病并颈椎外伤所导致的颈髓损伤有效康复条件;术后积极康复治疗也是改善神经功能的重要方法.%Objective To explore the effect of anterior cervical corpectomy and posterior longitudinal ligament resection and decompression and fusion for the therapeutic in acute cervical spinal cord injury caused by cervical spondylotic myelopathy and cervical trauma.Methods Retrospective analysis was carried out to 19 cases of acute cervical spinal cord injury caused by cervical spondylotic myelopathy and cervical trauma who used anterior cervical corpectomy and posterior longitudinal ligament resection and decompression and fusion for the therapeutic,and analysis of patients before trauma (T)1,post-traumatic (T2),within 1 week after operation (T3),10 months after operation (T4) these four periods about the changes of cervical curvature and neural function (JOA score) were analyzed,then evaluated the operation curative effect.Results All patients were followed

  12. 人工颈椎椎间盘置换与颈前路减压融合术治疗脊髓型颈椎病的疗效分析%Comparison of artifical cervical disc replacement versus anterior discectomy and fusion for the treatment of cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    杨兴; 薛峰; 盛晓文; 彭育沁; 陈兵乾

    2012-01-01

    目的 比较人工颈椎椎间盘置换术与颈前路椎间盘切除减压植骨融合术(anterior cervical discectomy and fusion,ACDF)治疗脊髓型颈椎病的临床疗效.方法 回顾性分析本院收治的人工颈椎椎间盘置换术及ACDF治疗的脊髓型颈椎病病例.测量所有患者颈椎活动度(range of motion,ROM),置换节段及相邻节段的ROM,并行日本骨科学会(Japanese Orthopaedic Association,JOA)评分及Odom分级.结果 所有患者术后JOA评分和Odom功能评定均得到显著改善.置换组术后颈椎ROM、置换节段及其邻近间隙平均ROM无明显改变,差异无统计学意义(P>0.05).ACDF组患者中,术后颈椎ROM显著减小,邻近间隙ROM明显增大,差异有统计学意义(P<0.05).置换组术后邻近节段的ROM明显小于ACDF组,差异有统计学意义(P<0.01).结论人工颈椎椎间盘置换术能保持颈椎ROM,避免邻近节段退变,早、中期疗效满意,远期效果尚有待临床进一步研究.%Objective To compare the clinical outcome of artifical cervical disc replacement versus anterior cervical discectomy and fusion ( ACDF ) in the treatment of cervical spondylotic myelopathy. Methods A total of 50 cases of cervical spondylotic myelopathy treated by artifical cervical disc replacement ( n = 20 ) or ACDF ( n = 30 ) were involved. Among these cases , the range of motion ( ROM ) of the cervical vertebra, the implanted level and the adjacent segment were measured. The Japanese Orthopaedic Association ( JOA ) score and Odom' s grade were record and analyzed. Results All of these patients were followed-up, and JOA score and Odom' s grade of all patients were significantly improved. The ROM of the cervical vertebrae, the implanted levels and the adjacent segments were preserved in artifical cervical disc replacement group ( P >0. 05 ). In the ACDF group, the ROM of the cervical vertebrae decreased, but the adjacent segments of the fusion segment compensatory increased remarkably( P 0

  13. Postoperative factors affecting neurological recovery after laminoplasty for cervical spondylotic myelopathy%影响单开门椎管扩大成形术治疗颈椎病疗效的术后相关因素分析

    Institute of Scientific and Technical Information of China (English)

    杨海云; 顾锐; 朱本清; 邓树才; 贾占华; 吕工一; 刘建坤

    2009-01-01

    Objective To elucidate possible postoperative factors affecting neurological recovery af-ter cervical expansive open-door laminoplasty in treatment of patients with multilevel cervical spondyiotic myelopathy. Methods This study involved the patients with multilevel cervical spondylotic myeiopathy who underwent expansive open-door laminoplasty between May 2001 and December 2006. They were classified into two groups according to the degree of neurological recovery: an excellent recovery group (group A), the recovery rotes greater than 75%, and a poor recovery group (group B), the recovery rates lower than 25%. Comparisons of various preoperative clinical and imaging parameters such as patient's age, gender, duration between symptom onset and surgery, follow-up time, preoperative JOA score, preoperative range of motion (ROM), preoperative cervical curvature index(CCI), preoperative Pavlov ratio, segments of myelopathy and so on, revealed that the mean age and mean preoperative JOA scores were significantly different. The cases with the age older than 60 years and preoperative JOA scores less than 6 were excluded. Therefore, group A re-mained 24 cases (group A1) and group B 18 cases (group B1). The same analyses were repeated between group A1 and group B1. There was no significant difference between two groups among the above mentioned parameters. Postoperative ROM and its reduction rate, postoperative CCI and its reduction rate, Pavlov ratio and its increasing rate were analyzed by t test, and the relationship between these six parameters and im-proving rate of JOA scores were also analyzed. Results Except postoperative ROM, other five indexes were statistical differences between A1 and B1 groups. Except postoperative ROM in group A1 and postoperative ROM and its reduction rate in group B1, other indexes had statistical correlation with improving rate of post-operative JOA scores. Conclusion Modulating postoperative ROM, maintaining cervical lordosis and achieving

  14. 不同入路方式治疗多节段脊髓型颈椎病的研究分析%Different approaches in treatment of multi-segmental cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    曾昭池; 郭中凯; 朱志勇; 汪海军; 朱凡

    2013-01-01

    [ Objective]To compare the effects of anterior and posterior cervical decompression and fusion for the treatment of multi - segmental cervical spondylotic myelopathy. [Method] A retrospective study was made on 126 patients with anterior (group A) .posterior (group B) approach operations for the treatment of cervical disease from September 2008 to September 2011. Preoperative and postoperative JOA scoring system was used to compare the recovery rate. MRI measurement of dural sac sagittal diameter was calculated for the expansion and recovery rate. [Result]Preoperative and postoperative JOA scores showed no statistically significant difference between 2 groups (P > 0.05). Improve rate in group A was better than that in group B, with significant difference ( P < 0.05 ). Expansion recovery rate in group A was better than that in group B, with significant difference (P<0.05). [Conclusion]Both anterior and posterior approach are effective operations to multilevel CSM,however,the therapeutic effects of anterior approach is better than posterior approach.%[目的]比较前、后路不同入路方式对多节段脊髓型颈椎病的治疗效果.[方法]回顾性分析本院2008年9月~2011年9月分别对126例患者采用前路、后路的手术方法治疗颈椎病,术前和术后按照JOA评分系统进行评分并计算恢复率,MRI测量硬脊膜囊矢状径并计算膨胀回复率.[结果]两组患者术前、术后JOA评分比较,差异无显著统计学意义(P>0.05),改善率比较则A组优于B组,差异具有统计学意义(P<0.05).两组患者术前、术后硬脊膜囊矢状径比较,差异无显著统计学意义(P>0.05),膨胀回复率比较则A组优于B组,差异具有统计学意义(P<0.05).[结论]前、后路减压手术均是治疗多节段脊髓型颈椎病的有效方法,前路减压效果更佳.

  15. Laminoplasty for Cervical Myelopathy

    OpenAIRE

    Ito, Manabu; Nagahama, Ken

    2012-01-01

    This article reviews cervical laminoplasty. The origin of cervical laminoplasty dates back to cervical laminectomy performed in Japan ~50 years ago. To overcome poor surgical outcomes of cervical laminectomy, many Japanese orthopedic spine surgeons devoted their lives to developing better posterior decompression procedures for the cervical spine. Thanks to the development of a high-speed surgical burr, posterior decompression procedures for the cervical spine showed vast improvement from the ...

  16. Hybrid手术治疗脊髓型颈椎病的临床疗效分析%Clinical efficacy analysis of hybrid spinal fusion surgery in the treatment of cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    马迅; 梅军; 冯皓宇; 张丽; 关晓明

    2013-01-01

    Objective To investigate the clinical efficacy,operative essentials and indications of hybrid spinal fusion surgery for cervical spondylotic myelopathy.Methods From August 2008 to December 2011,thirty-eight patients with cervical spondylotic myelopathy underwent hybrid spinal fusion surgery in our hospital.There were 27 males and 11 females,aged from 33 to 70 years (average,51 years).A total of 86 segments were treated (fusion 48 vs.non-fusion 38).Twenty-eight patients underwent a two-level surgery,and ten patients received a three-level surgery.The Japanese Orthopaedic Association (JOA) score and Visual analogue scale (VAS) were used to evaluate pre-and post-operative neurological function and pain,respectively.The pre-and post-operative range of motion of the cervical spine was measured according to Xrays.Moreover,the surgical complications were recorded and analyzed.Results Thirty-seven patients were followed up for 15 to 55 months (average,29.1 months).The improvement of neurological function was obtained in 36 patients.The JOA score was improved from preoperative 10.5±1.57 to 14.3±1.97 at final follow-up,with an improvement rate of 58.46%,and the results were excellent in 16 cases,fair in 20 cases and poor in 1 case.The VAS was improved from preoperative 7.3±1.04 to 3.2±1.41 at final follow-up.The Cobb angle changed from preoperative 25°±3.21°to 20°±2.56°at final follow-up.After operation,the neurological function was not restored in 1 case; hoarseness and bucking occurred in 2 cases; sore throat occurred in 22 cases; anterior displacement of prosthesis (PCM) occurred in 3 cases.Other patients had no complications,such as displacement,loosening and heterotopic ossification.Conclusion In hybrid spinal fusion surgery,the lesions segments are decompressed fully,the severely degenerative segments are fused,and the motion of the non-fusion segments is reserved.As a result,not only the stability of the cervical spine is achieved,but also an obvious

  17. Observation of the effect of multilevel anterior discectomy and fusion for aged patients with cervical spondylotic myelopathy%前路经椎间隙减压植骨融合术治疗老年人多节段脊髓型颈椎病的疗效观察

    Institute of Scientific and Technical Information of China (English)

    王军; 刘玉芹; 朱洪新; 师大雷; 仇立萍; 李翠萍; 杨磊

    2011-01-01

    目的 探讨颈前路经椎间隙减压植骨融合术治疗老年人多节段脊髓型颈椎病的疗效.方法 对25例老年脊髓型颈椎病患者行颈前路椎间隙减压、椎间植骨融合器(cage)植骨、钛板螺钉内固定术治疗,术后随访3~10个月,观察JOA评分改善率、Odoms临床疗效、植骨融合情况以及并发症发生情况.结果 末次随访时Odoms临床疗效评定,优8例,良14例,中3例,优良率为88%.JOA评分由术前的7.8分提高到末次随访时的12.8分,JOA评分平均改善率为54%.末次随访时cage及内固定位置良好,植骨融合率为100%.结论 颈前路经椎间隙减压植骨融合内固定术治疗老年人多节段脊髓型颈椎病临床疗效良好,值得推广.%Objective To explore the efficacy of multilevel anterior cervical discectomy and fusion for aged patients with cervical spondylotic myelopathy. Methods 25 aged patients with cervical spondylotic myelopathy were treated by multilevel anterior cervical discectomy and fusion. Japanese Orthopedic Association (JOA) scores were evaluated,clinical results were graded from excellent to poor using Odoms criteria,and the sagittal alignment of fusion segements were measured using Cobb method. Bone fusion and complications was evaluated. Results The final follow up score according to Odoms criteria was excellent in 8 patients ,good in 14 patients,and fair in 3 patients ,with excellent and good rate of 88%. The JOA score at final follow up(7.8) was significantly higher than preoperative(12. 8),with average improvement rate of 54%. At final follow up,bone fusion rate was 100%. Conclusion Multilevel anterior discectomy and fusion for aged patients with cervical spondylotic myelopathy was effective.

  18. The relationship between the imaging features and prognosis in the patients with cervical spinal stenosis and cervical spondylotic myelopathy%先天性颈椎管狭窄与脊髓型颈椎病影像学表现以及预后的关系

    Institute of Scientific and Technical Information of China (English)

    丁文元; 曹来震; 申勇; 张为; 王林峰; 张英泽

    2011-01-01

    目的 探讨脊髓型颈椎病(cervical spondylotic myelopathy,CSM)患者先天性颈椎管狭窄(cervical spinal stenosis,CSS)与颈椎MRI改变及预后的关系.方法 回顾性分析自2006年11月至2009年11月,采用前路、后路或前后路联合手术治疗的286例CSM患者的病例资料,根据患者是否存在CSS将患者分为两组,在MRI T2加权像上评价脊髓高信号的等级以及脊髓受压程度.记录患者日本骨科学会评分标准(Japanese Orthopaedic Associatio,JOA)评分、病程和体征,包括感觉减退或者消失、Hoffman征、Babinski征、腱反射.结果 在CSM患者中CSS的发生率为33.6%,先天性CSS组的年龄、JOA评分、病程均大于无CSS组,术后临床改善率小于无CSS组.两组之间性别的差异无统计学意义(x2=0.006,P=1.00),两组之间的颈椎MRI T2加权像脊髓高信号发生率的差异有统计学意义(x2=-62.396,P<0.001),CSS组脊髓高信号的发生率为70.8%,无CSS组脊髓高信号的发生率为22.6%.先天性CSS组脊髓受压程度相对于无CSS组严重,且先天性CSS组患者体征的数目相对较多.应用多元线性回归分析法得出术后改善率与CSS、病程、临床体征的数目和年龄有关(R2=0.565).结论 先天性CSS患者出现CSM时往往脊髓受压程度较重、MRI T2加权像脊髓内高信号出现的概率大,病程长且预后较差.%Objective To investigate the relationship between the cervical MR images and pathological changes, prognosis in patients with cervical spinal stenosis and cervical spondylotic myelopathy. Methods From Nov. 2006 to Nov. 2009, 286 patients with cervical spondylotic myelopathy were included through retrospective analysis. All patients were divided into two groups according to whether there was cervical stenosis, the grade of increased signal intensity (ISI) in spinal cord and the degree of spinal cord compression was evaluate in T2-weighted MR images of midian sagittal slices. JOA scale, duration of disease

  19. Multilevel decompressive laminectomy and transpedicular instrumented fusion for cervical spondylotic radiculopathy and myelopathy: A minimum follow-up of 3 years

    OpenAIRE

    Kadir Kotil; Emine Ozyuvaci

    2011-01-01

    Objective: Cervical laminectomies with transpedicular insertion technique is known to be a biomechanically stronger method in cervical pathologies. However, its frequency of use is low in the routine practice, as the pedicle is thin and risk of neurovascular damage is high. In this study, we emphasize the results of cervical laminectomies with transpedicular fixation using fluoroscopy in degenerative cervical spine disorder. Materials and Methods: Postoperative malposition of the transpedicul...

  20. Multilevel decompressive laminectomy and transpedicular instrumented fusion for cervical spondylotic radiculopathy and myelopathy: A minimum follow-up of 3 years

    Directory of Open Access Journals (Sweden)

    Kadir Kotil

    2011-01-01

    Full Text Available Objective: Cervical laminectomies with transpedicular insertion technique is known to be a biomechanically stronger method in cervical pathologies. However, its frequency of use is low in the routine practice, as the pedicle is thin and risk of neurovascular damage is high. In this study, we emphasize the results of cervical laminectomies with transpedicular fixation using fluoroscopy in degenerative cervical spine disorder. Materials and Methods: Postoperative malposition of the transpedicular screws of the 70 pedicles of the 10 patients we operated due to degenerative stenosis in the cervical region, were investigated. Fixation was performed between C3 and C7, and we used resected lamina bone chips for fusion. Clinical indicators included age, gender, neurologic status, surgical indication, and number of levels stabilized. Dominant vertebral artery of all the patients was evaluated with Doppler ultrasonography. Preoperative and postoperative Nurick grade of each patient was documented. Results: No patients experienced neurovascular injury as a result of pedicle screw placement. Two patients had screw malposition, which did not require reoperation due to minor breaking. Most patients had 32-mm screws placed. Postoperative computed tomography scanning showed no compromise of the foramen transversarium. A total of 70 pedicle screws were placed. Good bony fusion was observed in all patients. At follow-up, 9/10 (90% patients had improved in their Nurick grades. The cases were followed-up for an average of 35.7 months (30-37 months. Conclusions: Use of the cervical pedicular fixation (CPF provides a very strong three-column stabilization but also carries vascular injury without nerve damage. Laminectomies technique may reduce the risk of malposition due to visualization of the spinal canal. CPF can be performed in a one-stage posterior procedure. This technique yielded good fusion rate without complications and can be considered as a good

  1. 融合与非融合固定治疗脊髓型颈椎病:谁更易于椎体的活动度及稳定性?%Fusion and non-fusion fixation for cervical spondylotic myelopathy:which is more appropriate for maintaining range-of-motion and stability of vertebrae?

    Institute of Scientific and Technical Information of China (English)

    申超; 王文军; 晏怡果

    2014-01-01

    BACKGROUND:In recent years, many scholars adopted a joint non-fusion and fusion spinal fixation for multisegmental cervical spondylotic myelopathy, and achieved good clinical results. However, long-term clinical efficacy and possible related complications also require long-term fol ow-up of more in-depth study. OBJECTIVE:To review the research and application progress of anterior fusion and non-fusion fixation surgical operation for cervical myelopathy. METHODS:Computer-based search was conducted in China Journal Ful-text Database and PubMed database by the first author for articles related to anterior fusion and non-fusion fixation surgical operation for cervical myelopathy published between January 2004 and January 2014. The key words were“implant material;cervical spondylotic myelopathy;anterior;surgery;fusion;non-fusion;progress;hybrid;summary”in Chinese and“implant material;cervical spondylotic myelopathy;anterior;surgery/operation;fusion;non-fusion;research progress;hybrid;summary”in English. Final y, 35 articles were included for review. RESULTS AND CONCLUSION:Fusion and non-fusion fixation methods for cervical spondylotic myelopathy had their own advantages. From the view point of indications, the non-fusion fixation was relatively limited. Currently, the fusion fixation was stil the main method in treatment of cervical myelopathy. Non-fusion method as an emerging fixation method also achieved good short-period results, but it needs a long fol ow-up study. Hybrid fixation integrates the advantages of both methods, and can reduce the pressure. Simultaneously, Hybrid fixation also can reduce fusion segments, and retain the range-of-motion of the cervical spine as much as possible. Hybrid fixation becomes a hot topic in recent studies. However, most current researches on Hybrid fixation are retrospective study, lack of control. The overal fol ow-up time is short. Thus, Hybrid fixation needs to be researched more deeply.%背景:近年来,许多国

  2. Anterior fusion technique for multilevel cervical spondylotic myelopathy: a retrospective analysis of surgical outcome of patients with different number of levels fused.

    Directory of Open Access Journals (Sweden)

    Shunzhi Yu

    Full Text Available OBJECTIVE: The anterior approach for multilevel CSM has been developed and obtained favorable outcomes. However, the operation difficulty, invasiveness and operative risks increase when multi-level involved. This study was to assess surgical parameters, complications, clinical and radiological outcomes in the treatment of 2-, 3- and 4-level CSM. METHODS: A total of 248 patients with 2-, 3- or 4-level CSM who underwent anterior decompression and fusion procedures between October 2005 and June 2011 were divided into three groups, the 2-level group (106 patients, the 3-level group (98 patients and the 4-level group (44 patients. The clinical and Radiographic outcomes including Japanese Orthopedic Association (JOA score, Neck Disability Index (NDI score, Odom's Scale, hospital stay, blood loss, operation time, fusion rate, cervical lordosis, cervical range of motion (ROM, and complications were compared. RESULTS: At a minimum of 2-year follow-up, no statistical differences in JOA score, NDI score, Odom's Scale, hospital stay, fusion rate and cervical lordosis were found among the 3 groups. However, the mean postoperative NDI score of the 4-level group was significantly higher than that in the other two groups (P<0.05, and in terms of postoperative total ROM, the 3-level group was superior to the 4-level group and inferior to 2-level group (P<0.05. The decrease rate of ROM in the 3-level group was significantly higher than that in the 2-level group, and lower than that in the 4-level group (P<0.05. CONCLUSIONS: As the number of involved levels increased, surgical results become worse in terms of operative time, blood loss, NDI score, cervical ROM and complication rates postoperatively. An appropriate surgical procedure for multilevel CSM should be chosen according to comprehensive clinical evaluation before operation, thus reducing fusion and decompression levels if possible.

  3. Commentary on article: Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: A meta-analysis of clinical and radiological outcomes by Chang-Hyun Lee et al

    OpenAIRE

    Nancy E Epstein

    2015-01-01

    Background: This is a commentary on the article laminoplasty versus laminectomy and fusion (LF) for multilevel cervical myelopathy: A meta-analysis of clinical and radiological outcomes by Chang-Hyun Lee et al. Here, the authors utilized seven studies to compare the efficacy of cervical expansive laminoplasty (EL) versus laminectomy and fusion (LF) to address three or more level multilevel cervical spondylotic myelopathy (CSM). Both procedures led to similar degrees of neurological recovery a...

  4. 便携步态分析量化评价脊髓型颈椎病患者的步态特征%Evaluation of gait characteristics of cervical spondylotic myelopathy patients by a portable gait analyzer

    Institute of Scientific and Technical Information of China (English)

    刘艳成; 夏群; 胡永成; 张继东; 白剑强; 吉宁; 张宽

    2014-01-01

    owing gait analysis in the ward. OBJECTIVE:To quantitatively analyze gait characteristics of patients with cervical spondylotic myelopathy (CSM) by a portable gait analyzer. METHODS:From March 2013 to November 2013, 15 CSM patients and 30 healthy subjects were enrol ed in the study. The involved patients were accompanied by gait abnormalities. A portable gait analyzer was used for gait analysis. Subjects walked on a 30-meter corridor back and forth for 120 meters. Total y 12 gait parameters were involved in this study, including seven common parameters (single limb support, double limb support, gait cycle, speed, cadence, step length and stride length) and five new parameters (pul ing acceleration, swing power, ground impact, foot fal , and pre-swing angle). Three patients underwent cervical decompression surgery. The gait characteristics were re-evaluated one week later, carrying neck support. RESULTS AND CONCLUSION:The double limb support and gait cycle duration of CSM group were significantly longer than control group (P0.05). after cervical decompression surgery, the mean remission rate of Japanese Orthopedics Association scores was 32.5%and lower limb acceleration was improved obviously in the graph one week after surgery. Varying degree of correlation was seen between Japanese Orthopedics Association scores and the detected 12 gait parameters in CSM patients. The portable gait analyzer can effective measure the pathological gait deviation in CSM patients with abnormal gaits, and assists to evaluate the lower limb functions.

  5. Cervical myelopathy in rheumatoid arthritis.

    Science.gov (United States)

    Meijers, K A; Cats, A; Kremer, H P; Luyendijk, W; Onvlee, G J; Thomeer, R T

    1984-01-01

    Results obtained in 43 Rheumatoid arthritis (RA) patients with cervical myelopathy are described; all patients showed several alarm signs together with neurological disturbances. Thirty-four cases were operable; nine patients were not operated upon for various reasons (refusal, and general condition). In the surgically treated patients, the changes were localized in the C1-C2 area (n = 20), in the area below C2 (n = 5), or in both (n = 9). The patients were put on skull traction pre- and post-operatively and nursed on a circo-electric bed. Pre-operatively, the duration of traction varied from a few days to weeks (mean 3 weeks). Post-operatively, the patients were given continuous skull traction for 2 1/2-3 months. This procedure yielded neurological improvement and a stable graft in all but two patients. On follow-up, recurrence of neurological complaints was seen in nine patients, in four due to a new slip at a lower level. Three of these cases were reoperated with good results. Twenty-three patients have died: four 'early' (one pre-operatively and three within 6 weeks post-operatively) and 19 'late'. The mean duration of follow-up was 4.5 years. In those who died 'late', the cause of death was due to the effects of an unstable graft in two cases and in the others the causes were not related to changes in the cervical spine. In the 10 patients who are still alive the mean duration of follow-up is 5 years. The nine patients who were not operated upon all died within a year, 4 of them due to consequences of cord compression. If cervical spondylodesis is feasible in an RA patient with myelopathy, the procedure is advocated. PMID:6529877

  6. Long-term influence of three cervical posterior operative methods for multilevel cervical spondylotic myelopathy:a retrospective study of cervical curvature and clinical outcomes%颈椎后路三种手术方式对改善多节段颈椎病生理曲度及疗效的远期观察

    Institute of Scientific and Technical Information of China (English)

    苗洁; 申勇; 王林峰; 李冠军; 葛志强; 仝超; 步振英

    2012-01-01

    [Objective] This study was to analyze ihe cervical curvature changes, JOA score recovery rate, VAS score recovery rate (cervical and shoulder axial pain) of the patients with multilevel cervical spondylotic myelopathy (CSM) combined ossification of posterior longitudinal ligament (OPLL) which were performed by three different cervical posterior suigical procedures through a retrospective control study, and to explore the long - term influence of three cervical posterior operative procedures to cervical curvature, neurologic function and axial symptoms. [Methods] According to the surgical procedures, 78 patients were divided into three groups: Group A (expansive open - door laminoplasty) comprised 29 patients, Group B (laminec-tomy) comprised 23 patients, Group C (laminectomy and lateral mass screw fixation) comprised 26 patients. Tlie preoperative and postoperative cervical cuvature, JOA score, axial symptoms, ect were recorded [Results] The improvement rale of JOA score; there were significant difference between postoperative symptoms and preoperative symptoms of three groups (P<0.05) .In the final follow - up, neurological recovery rate was highest in group C. The improvement rate of cervical curvature: it was best in group C, secondary in group A, poor in group B. Complications: there were significant differences for VAS score of cervical and shoulder axial pain among group A, group B and groupC (P<0. 05) , with an highest incidence in group B, secondary in group A, lowest in group C. [ Conclusion] Three cervical posterior surgical procedures for multilevel CSM combined OPLL all can achieve satisfactory results. Laminectomy and lateral mass screw fixation (group C) can effectively improve neurological function, recover and maintain cervical curvature and reduce the incidence of axial symptoms and C, nerve root palsy.%[目的]本研究通过回顾性分析行颈椎后路手术的多节段脊髓型颈椎病合并后纵韧带骨

  7. 显微镜辅助下颈前路精细化减压治疗多节段脊髓型颈椎病的研究%Elaborative decompression under microscope through anterior cervical approach for treatment of multilevel cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    邵进; 杨铁毅; 刘树义; 张岩; 吴亮; 黄国华; 宋超; 范鑫斌

    2015-01-01

    目的:探讨显微镜辅助下颈前路精细化椎间隙减压内固定治疗多节段脊髓型颈椎病的临床效果。方法2011年1月~2014年1月,第二军医大学附属上海市浦东新区公利医院骨科52例多节段脊髓型颈椎病患者给予了显微镜辅助下精细化减压治疗。摄颈椎正侧位X线片,测量颈椎曲度,运用日本矫形外科学会(JOA)评分标准进行神经功能评价。结果所有52例患者均获得随访,术前、术后3 d、术后6个月和术后12个月颈椎生理曲分别为(14.92±2.81)º、(19.85±3.37)º、(19.57±2.69)º、(19.49±3.05)º,日本矫形外科学会(JOA)评分分别为(9.82±3.32)、(13.72±3.23)、(13.63±3.17)、(13.56±3.24)分,术后3 d、6个月和术后12个月颈椎生理曲度较术前均明显恢复、JOA评分较术前均明显提高(P<0.01);末次随访示植骨融合。除1例患者术后10 d发生血肿致呼吸困难,即刻清除血肿后恢复正常外,未发生切口感染、钛板断裂、螺钉松动以及融合器下沉或移位等并发症。结论显微镜辅助下颈前路手术,具备视野清晰、配合默契、彻底精细减压、术后即刻功能恢复等优势,显著提高颈椎前路手术优良率。%Objective To investigate the clinical efficacy of elaborative decompression under microscope through anterior cervical approach for treatment of multilevel cervical spondylotic myelopathy. Methods From January 2011 to January 2014, a total of 52 patients of multilevel cervical spondylotic myelopathy was carried out elaborative decompression under microscope through anterior cervical approach. The cervical curvature was measured by anterior-posterior and lateral X-ray of the cervical vertebrae, and the neurological function was evaluated using JOA score. Results All the 52 patients were followed up. The cervical curvature of preoperation, 3 days, 6 months and 12 months was (14.92±2.81)o, (19.85±3.37)o, (19.57±2.69)o, (19.49±3.05)orespectively. The JOA

  8. Application of n-HA/PA66 in anterior cervical subtotal corpectomy and fusion for treatment of cervical spondylotic myelopathy%纳米羟基磷灰石/聚酰胺在脊髓型颈椎病椎体次全切减压融合术中的应用

    Institute of Scientific and Technical Information of China (English)

    杨朝垒; 王利民; 谭洪宇; 王卫东; 廖文胜; 鲍恒; 刘屹林

    2011-01-01

    Objective To discuss the application effect of nano-hydroxyapatite and polyamide composite (n-HA/PA66) in anterior cervical subtotal corpectomy and fusion with plate for the treatment of cervical spondylotic myelopathy. Methods Thirty patients with cervical spondylotic myelopathy were treated with anterior cervical subtotal corpectomy, in which n-HA/PA66 was grafted and platted for the decompression and fusion. The clinical results and graft fusion were evaluated after the operation. Results All patients were operated successfully and followed up for 9 to 17 months with an average of 12.6 months. The neurological symptoms and signs of patients were greatly improved. There was no allergic and toxic reactions induced by n-HA/PA66 implantation. Imaging studies showed that cervical alignments and intervertebral height were well maintained, and graft fusions were achieved in all cases 6 to 8 months after operation. However, there were heterotopic ossifications of different degrees in the posterior edge of n-HA/PA66 artificial vertebral body. Conclusions n-HA/PA66 artificial vertebral body has good fusion rate, and could effectively maintain the biological alignment and cervical intervertebrai height. The long-term effects depend on further follow-up.%目的 探讨纳米羟基磷灰石/聚酰胺(n-HA/PA66)在脊髓型颈椎病椎体次全切减压融合术中的应用效果.方法 对30例脊髓型颈椎病患者均行颈椎前路椎体次全切n-HA/PA66植入钛板内固定术,对其疗效及融合情况进行评价.结果 30例患者均成功完成手术并获得随访,随访时间9~17个月,平均12.6个月.所有患者神经症状均明显改善,植入物未引起过敏及毒性反应,颈椎生理曲度、椎间高度有良好的恢复和维持,术后6~8个月时获得植骨融合,n-HA/PA66人工椎体后缘存在不同程度的异位骨化.结论 n-HA/PA66人工椎体作为颈椎前路手术植骨材料融合率高,可以有效保持颈椎生理曲度及椎

  9. A clinical, electromyographic, and mgnetic resonance imaging study of cervical spondylotic myelopathy: analysis of 96 cases%脊髓型颈椎病临床、电生理和影像学改变的研究

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    张洁; 刘明生; 崔丽英; 李本红; 杜华

    2009-01-01

    Objective To investigate the clinical, electromyographic, and magnetic resonance imaging (MRI) manifestations of the patients with cervical spondylotic myelopathy (CSM) and the correlation among them. Method 96 CSM patients, 56 males and 40 females, aged 53 2/32 - 72 ), underwent electromyography (EMG) of the deltoid muscle (C5), biceps muscle of arm (C6), common extensor muscle of fingers (C7), and short abductor muscle of thumb and abductor muscle of little finger (CB -T), and MRI of the cervical vertebrae before surgical treatment. The clinical symptoms were graded according to the Japanese Orthopaedic Association (JOA) scoring system. The correlation among the JOA score, MIR classification, and EMG manifestation was analyzed. Results EMG showed that 61 of the 96 patients (64%) with root injury at C5, 6, 7, and 8. Those positive in EMG showed higher severity in MRI (Z=2.863, P=0.004). The JOA score was not correlated with the degree of spinal cord compression demonstrated by MRI and the EMG results. Conclusion The root injury rate is high in the CSM patients. The patients positive in EMG have severe MRI results. No clear correlation is between the severity of clinical symptom and MRI of cervical vertebrae and root injury demonstrated by EMG. Hence, treatment should be considered by integration of EMG, MRI and JOA scores.%目的 研究脊髓型颈椎病患者临床、肌电图(EMG)和颈椎磁共振成像(MRI)表现的特点.探讨三者之间的相关性.方法 对96例诊断为脊髓型颈椎病并行手术治疗的患者术前进行功能评估,临床症状分级参照日本整形外科协会(JOA)评分标准.患者均行颈椎MRI及肌电图检查,根据MRI上硬膜囊受压程度及髓内信号有无将其分级(0~3级).对96例患者临床症状分级,MRI分级,肌电图神经源性损害(根性)表现间的相关性进行统计分析.结果 96例患者MRI 0级16例,1级14例,2级34例,3级32例.临床症状分级严重1例,重度6例,中度38例,轻度51

  10. The clinical application of unilateral open-door cervical expansive laminoplasty plus centerpiece titanium plate fixation for multilevel cervical spondylotic myelopathy%单开门椎管扩大成形Centerpiece钛板固定术治疗多节段脊髓型颈椎病的临床应用

    Institute of Scientific and Technical Information of China (English)

    曾云; 熊敏; 余化龙; 何宁; 王志勇; 刘志刚; 韩珩; 陈森; 郭乐运

    2012-01-01

    Objective To evaluate the efficacy of unilateral open -door cervical expansive laminoplasty plus centerpiece titanium plate fixation for multilevel cervical spondylotic myelopathy. Methods 39 patients with multilevel cervical spondylotic myelopathy were randomly divided into "centerpiece titanium plate" group and "tradition" group. Before and after operation, the JOA score were performed. The improving rate of nerve function,the rate of spinal canal expansion and the rates of complication were compared after operation. Results Before operation,both of the two groups were the same in age and JOA score (P>0.05). Two groups of operative time were respec-tively( 109±25) min and (lll±23) min,there were no significant differences between them(P>0.05). The rate of spinal canal expansion of "centerpiece titanium plate" group (61 %±21%)was obviously higher than"tradition"group(40%±17%)(P0.05),but"centerpiece titanium plate" group had a significant increase at 12 months after operation (P<0.05). CT scan at 3-6 months after operation displayed that door spindle already reach osseous fusion. There were no occurrence of "re-close of door" in two groups. Conclusion The rate9 of complication of "centerpiece titanium plate" group were lower than "tradition" group (P<0.05). Conclusion Unilateral open-door cervical expansive laminoplasty plus centerpiece titanium plate fixation is a new operation which is safe,simple,effective with few complication.%目的 评价单开门颈椎管扩大成形Centerpiece钛板固定术治疗多节段脊髓型颈椎病的临床应用价值.方法 39例多节段脊髓型颈椎病患者随机分为Centerpiece钛板组(18例)及传统组(21例),治疗前后行JOA评分,比较治疗后神经功能改善率、椎管扩大率、并发症发生率.结果 前两组年龄、JOA评分均无显著性差异;两组手术时间分别为(109±25) min和(111±23) min,无显著性差异( P>0.05);Centerpiece钛板组椎管扩大率(61%±21

  11. Anterior surgical treatment of 4-level cervical spondylotic myelopathy%前路手术治疗4节段脊髓型颈椎病的疗效分析

    Institute of Scientific and Technical Information of China (English)

    侯铁胜; 严宁; 虞舜志; 蔡晓冰; 张海龙; 顾广飞; 赵杉; 贺石生

    2015-01-01

    Objective To investigate the clinical results, neurological scores, radiographic changes and complications for patients with 4-level cervical spondylotic myelopathy (4-level CSM) who underwent anterior decompression and fusion surgery.Methods All the medical records of anterior cervical surgery in our hospital between September 2006 and March 2014 were collected.Among them, thirty-two consecutive patients with 4-level CSM underwent the anterior decompression and fusion procedures were retrospectively investigated.Neurological function was measured at different times using Japanese Orthopedic Association (JOA) scores.The visual analogue score (VAS) was recorded for neck-shoulder pain evaluation.X-rays were conducted before and after surgery for cervical lordosis and fusion rate.Complications such as iliac pain, dysphonia, C5 palsy, cerebral fluid leakage, axial neck pain and temporary dysphagia were recorded and analyzed as well.Results All the operations were performed uneventfully.The mean operative time was 136± 18min and mean blood loss was 67±16ml.The overall follow-up period of the patients ranged from 1-8 years (average 3.6± 1.7years).The VAS score significantly decreased from 7.3± 1.2 preoperatively to 3.6±0.8 at 12 months postoperatively.The JOA score was 9.2± 1.6 preoperatively, and 9.6±2.2, 12.5±3.3, 13.2±3.2, 13.7±3.4 at 1 week, 3 months, 6 months and 12 months postoperatively.Autologous iliac bone grafts were used in 4 patients, whose fusion rate was 100% at 6 months postoperatively.Titanium meshes were used in 28 patients, whose fusion rate was 85.7% at 6 months postoperatively and 100% at 12 months postoperatively.No hardware-related complications such as screw pull-out or plate bending occurred during the short-or long-term follow-up.Complications included iliac pain (3 cases), dysphonia (1 case), C5 palsy (1 case), cerebral fluid leakage (2 cases), axial neck pain (5 cases) and temporary dysphagia (1 case).Conclusion Anterior

  12. Anterior approach versus posterior approach for multilevel cervical spondylotic myelopathy:a meta-analysis%颈前路与后路内固定系统置入治疗多节段脊髓型颈椎病的Meta分析

    Institute of Scientific and Technical Information of China (English)

    谢冲; 金格勒; 李忠伟; 王鹏; 赵学飞; 汪坤; 耿冲; 陈波

    2014-01-01

    背景:目前以植入物置入稳定脊柱的方法治疗多节段脊髓型颈椎病的主要置入路径为前路入路和后路入路,如何选择存在争议。  目的:对于前路与后路入路治疗多节段脊髓型颈椎病的疗效及安全性进行比较。  方法:检索 MEDLINE、EMBASE、PubMed 数据库、万方以及中国知网等数据库中有关前路与后路入路方式治疗多节段脊髓型颈椎病的相关研究和文献,对颈椎前路组和颈椎后路组患者置入治疗时间、治疗中出血量、治疗前JOA评分、治疗后JOA评分、并发症发生率、邻近节段退变发生率、颈椎活动度以及再手术率等指标进行比较。  结果与结论:12篇研究符合纳入标准,累计病例790例,其中前路组359例,后路组431例。Meta分析表明前路组与后路组治疗前JOA评分、治疗时间、治疗中出血量比较差异无显著性意义(P >0.05)。与后路组相比,前路组治疗后JOA评分高(P OBJECTIVE:To compare the therapeutic effect and safety of anterior and posterior approaches for the treatment of multilevel cervical spondylotic myelopathy. METHODS:Databases such as MEDLINE, EMBASE, PubMed, Wanfang data and China National Knowledge Infrastructure were searched about related research and literature on anterior and posterior approaches for the treatment of multilevel cervical spondylotic myelopathy. Operative time, amount of blood loss, preoperative Japanese Orthopedic Association score, postoperative Japanese Orthopedic Association score, complication rate, degeneration rate of adjacent segments, cervical range of motion and reoperation rate were compared between anterior and posterior groups. RESULTS AND CONCLUSION:12 studies were accorded with the inclusion criteria, total y containing 790 cases (359 cases in the anterior group, and 431 cases in the posterior group). Meta-analysis showed that no significant difference in preoperative Japanese Orthopedic

  13. Posterior atlantoaxial ′facetal′ instability associated with cervical spondylotic disease

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    Atul Goel

    2015-01-01

    Full Text Available Aim: The association of single or multiple level cervical spondylotic disease with atlantoaxial instability is assessed. The implications of identifying and treating atlantoaxial instability in such an association are highlighted. Materials and Methods: The analysis is based on an experience with 11 patients treated during the period June 2013-June 2014. All patients had single or multilevel cervical spondylotic disease. The spinal canal compromise and evidence of cord compression was evident on imaging in the cervical subaxial spine and was related to disc bulges and osteophytic bars. There was no or relatively insignificant compression of the cervicomedullary cord by the odontoid process. There was no evidence of odontoid process-related instability on dynamic imaging. Apart from presence of features of cervical spondylosis, investigations and surgical exploration and direct manual handling of the facets revealed evidence of Type B (posterior atlantoaxial′facetal′ instability in all patients. Our 5-point clinical grading system and Japanese Orthopaedic Association (JOA scores were used to monitor the patients both before and after surgery and at follow-up. Surgery involved both at lantoaxial and subaxial cervical fixation. During the average period of follow-up of 9 months (5-17 months, all patients showed remarkable and gratifying neurological recovery. Conclusion: We conclude that atlantoaxial facetal instability can be ′frequently′ associated with cervical spondylosis and needs surgical stabilization. Our surgical outcome analysis suggests that missing or ignoring the presence of atlantoaxial facetal instability can be an important cause of suboptimal result or failure of surgery for cervical spondylotic myelopathy.

  14. Anterior and Posterior Approaches in One Stage Operation for Treatment of Cervical Spondylotic Myelopathy with Cervical Spine Threaded Fusion Cage%应用颈椎螺旋融合器前后路一次性手术 治疗脊髓型颈椎病

    Institute of Scientific and Technical Information of China (English)

    袁峰; 龚维成; 郭开今; 周冰; 葛保健

    2001-01-01

    Objective: To discuss the procedure and the clinical significance of one stage operation accomplished through posterior and anterior routes with threaded fusion cage (TFC) for the treatment of cervical spondylotic myelopathy (CSM) of severe multi-segmental cervical disc herniation, intervertebral instability and spinal canal stenosis. Methods: The posterior approach was carried out with laminoplasty or laminectomy firstly on 7 patients, then the anterior intervertebral decompression was executed and the TFC was planted. Assessment after surgery was based on the recovery rate using the scoring system of the Japanese Orthopaedic Association. Results: The average follow-up were 12 months. After operation 7 patients′ skin sensation showed improvement and limb muscle strength elevated. The overall mean improvement was 76.2%. Conclusion: The procedure is decompressed completely and carried safely. The instability of the cervical spine is resolved.%目的:对合并发育性颈椎管狭窄的严重的多节段颈椎间盘突出及不稳的脊髓型颈椎病患者应用颈椎螺旋融合器前后路一次性手术治疗,并进行分析。方法:对7例合并发育性颈椎管狭窄的多节段颈椎间盘突出及不稳的脊髓型颈椎病患者先行后路颈椎单开门椎板成形术或颈椎板切除减压术,然后前路行颈椎间盘、骨赘切除减压颈椎螺旋融合器植入术,术后采用日本整形外科学会标准17分法进行测评。结果:平均随访时间12个月,7例患者术后均有不同程度皮肤感觉改善和四肢肌力提高,其中2例大小便障碍者括约肌功能恢复,脊髓功能的平均改善率为76.2%。结论:本手术方法减压彻底,具有安全性,颈椎螺旋融合器的应用解决了颈椎间稳定性问题。

  15. Magnetic resonance imaging of cervical myelopathy

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    Chosa, Hirofumi; Yamano, Kouichirou; Ihara, Fumitoshi; Ueda, Yoshiaki; Maekawa, Masayuki; Tokuhisa, Ginichirou; Kuwano, Tadashi; Kamo, Yoshi; Nomura, Shigeharu (Kyushu Rosai Hospital, Fukuoka (Japan))

    1990-03-01

    Forty-three patients operated for cervical myelopathy were examined with a 1.5 T magnetic resonance imaging. Cord compression was demonstrated directly on the sagittal image in cases of cervical disc herniation, cervical spondylosis and O.P. L.L. Herniated disc material was seen positive on axial image. But factors of cord compression in cases of cervical spondylosis and O.P. L.L. were not clearly confirmed, so additional examinations such as myelogram, tomogram and CT was needed. (author).

  16. Activ C cervical disc replacement for myelopathy

    Directory of Open Access Journals (Sweden)

    L McGonagle

    2011-01-01

    Full Text Available Background: Cervical disc replacement is becoming an increasingly popular treatment option for cervical myelopathy. It retains motion at the affected segment, unlike anterior cervical discectomy and fusion. The aim of this study is to assess the outcomes of a series of patients who underwent Activ C disc replacement for cervical myelopathy. Materials and Methods: A series of patients at the above Trust with clinical and radiological evidence of cervical myelopathy who were suitable for cervical disc replacement from 2007 to 2009 were included. Implants were inserted by one of two consultant surgeons {IMS, MO′M}. Patients were assessed preoperatively and at six, 12 and 24 months, postoperatively, with a visual analogue score (VAS for neck and arm pain severity and frequency, the Neck Disability Index questionnaire (NDI and the Centre for Epidemiologic Studies Depression questionnaire (CES-D. Results: Ten patients underwent surgery between May 2007 and July 2009, 6 women, and 4 men. Average age was 54 years (40-64. Disc levels replaced were: four at C4-5; eight at C5-6; seven at C6-7. Three patients had one disc replaced, five patients had two discs replaced, and two patients had three discs replaced. The VAS for neck pain improved from 5.9 pre-operatively to 1.4-24 months postoperatively and the VAS arm pain improved from 5.4 to 2.6. The NDI improved from 51% preoperatively to 26.8% at 24 months postoperatively. The CES-D showed a slight increase from 19.5 preoperatively to 21.7 at 24 months, postoperatively. Conclusion: Cervical decompression and disc replacement improves pain and function in patients with cervical myelopathy. This benefit is maintained at 24 months post op, with no cases requiring revision.

  17. Effects of “Yiqi Huayu Bushen Recipe” on Col Ⅰ and Col Ⅱ mRNA Expressions of Degenerative Intervertebral Disc Cells in Patients with Cervical Spondylotic Myelopathy%益气化瘀补肾方对脊髓型颈椎病患者退变椎间盘细胞Col Ⅰ与ColⅡmRNA表达的影响

    Institute of Scientific and Technical Information of China (English)

    李具宝; 许鹏; 施杞; 王拥军; 周泉; 赵永见; 赵红云; 李宁; 莫文; 张霆; 侯炜; 梁倩倩

    2011-01-01

    Objective: To investigate the effects of "Yiqi Huayu Bushen Recipe" containing serum on Col I and Col D mRNA expressions of the degenerative intervertebraJ disc cells in patients with cervical spondylotic myelopathy. Methods: The degenerative intervertebral disc tissues were obtained from the patients with cervical spondylotic myelopathy through surgery, and the primary cells were cultured by tissue mass method; the male SD rats of SPF level were chosen lo prepare (he drug serum. The degenerative intervertebral disc cells of the first generation were vaccinated in 96-well microliter plates, divided into six groups, and cultured by low (5% ), medium (10% ) and high {20% } concentration serum containing "Yjqi Huayu Bushen Recipe" and corresponding concentration serum containing normal saline, respectively. The Col I and Col II mRNA expressions were detected by real-time quantitative PCR method. Results: The different concentration serum containing " Yiqi Huayu Bushen Recipe" could obviously promote proliferation of the intervertebral disc cells. Compared with the corresponding concentration serum containing normal saline groups, the Col B mRNA expression was increased, and the Col [ mRNA expression was decreased in different concentration serum containing "Yiqi Huayu Bushen Recipe" groups, especially the medium concentration group was more obvious ( P < 0.01). Conclusion: " Yiqi Huayu Bushen Recipe" may regulate collagen expression in degenerative intervertebral disc cells to prevent and treat cervical epondylotic myelopathy.%目的:观察益气化瘀补肾方含药血清对脊髓型颈椎病患者退变椎间盘细胞Col Ⅰ、ColⅡmRNA表达的影响.方法:选择脊髓型颈椎病患者经手术摘除的椎间盘组织,采用组织块法培养原代细胞;以SPF级雄性SD大鼠制备药物血清.将传代第1代的退变椎间盘细胞接种于96孔酶标板中,分为6组,分别予低(5%)、中(10%)、高(20%)浓度的益气化瘀补肾方古药血清及相

  18. Effect of anterior cervical spine surgery on inflammatory cytokines for cervical spondylotic myelopathy%颈椎前路手术对脊髓型颈椎病患者椎间盘组织中炎性细胞因子的影响

    Institute of Scientific and Technical Information of China (English)

    李翔; 戴志唐; 常新; 戴璐

    2011-01-01

    目的 探讨颈椎前路手术对脊髓型颈椎病(CSM)患者椎间盘组织中炎性细胞因子的影响.方法 35例脊髓型颈椎病患者(CSM组)和30例颈椎外伤患者(对照组)均行颈椎前路手术治疗,观察治疗效果.采用固相分离放射免疫分析法(SPRIA)测定两组颈椎间盘组织中白细胞介素(IL)-6、IL-8、肿瘤坏死因子(TNF)-α水平.结果病程≤6个月组优良率为81.8%,病程>6个月组优良率为38.5%,两组优良率比较差异有统计学意义(P<0.05);CSM患者术前JOA评分为(9.73±2.12)分,术后JOA评分为(14.21±2.52)分,术后JOA评分显著高于术前(P<0.05);CSM组颈椎间盘中IL-6、IL-8、TNF-α水平均显著高于对照组(P<0.05).结论 颈椎前路手术是治疗CSM的一种较有效手术方法;IL-6、IL-8、TNF-α在颈椎间盘退变和CSM发病中起重要作用.%Objective To explore the effect of anterior cervical spine surgery on inflammatory cytokines for cervical spondylotic myelopathy (CSM).Methods Thirty cases of CSM ( CSM group) and 30 cases of cervical trauma (control group) were given the anterior cervical spine surgery.The CID IL-6,IL8 and tumor necrosis factor (TNF)-α levels were detected by solid phase radioimmunoassay.The patients of CSM were followed up for the clinical efficacy and courses of disease were analyzed.Results The excellent rate in course of disease ≤ 6 months group and the course of disease > 6 months group was 81.8% and 38.5% respectively (P < 0.05 ).The preoperative and postoperative JOA scores in patients with CSM were (9.73 ±2.12) and (14.21 ±2.52) respectively (P<0.05).The CID IL-6,IL-8 and TNF-α levels in CSM group were significantly higher than in control group (P < O.05 ).Conclusion The anterior cervical spine surgery is an effective surgical treatment for CSM.The IL-6,IL-8 and TNF-α may play important roles in cervical disc degeneration and CSM.

  19. 颈椎后路单、双开门椎管成形术治疗多节段脊髓型颈椎病的临床比较%Multilevel cervical spondylotic myelopathy with single、double door laminoplasty: a clinical comparison

    Institute of Scientific and Technical Information of China (English)

    王玺; 李钦亮; 刘艺; 储朝明; 代凤雷; 张向征

    2012-01-01

    目的 分析比较颈椎后路单、双开门椎管成形术治疗多节段脊髓型颈椎病的临床效果.方法 回顾2003-09-2009-06收治的50例多节段脊髓型颈椎病患者,其中28例行颈椎后路单开门椎管成形术,作为A组;22例行颈椎后路双开门椎管成形术,作为B组.对两组患者术前及术后2年的JOA评分改善率、轴性症状严重程度、颈椎活动度进行评估比较.结果 JOA评分改善率A组(52.0±21.4)%,B组为(52.7±19.8)%.两组差异无统计学意义(P=0.970>0.05).A组术后有明显轴性症状患者的比例为42.9%,B组为36.4%,组间比较差异无统计学意义(P=0.642>0.05).颈椎活动度A组平均丢失3.9°,B组平均丢失3.6°,两组差异无统计学意义(P=0.492>0.05).结论 颈椎后路双开门椎管成形术比单开门椎管成形术的轴性症状发生率及颈椎活动丢失率更低.但两者间的差异无统计学意义.术者可以根据不同的适应证及术者自身的熟练程度来采用不同开门方法.%Objective Clinical effect of multilevel cervical spondylotic myelopathy with cervical posterior single or double door laminoplasty were analyzed and compared. Methods From September 2003 to June 2009,28 patients with cervical spondylotic myelopathy (CSM)undergone single door laminoplasty (Croup A), 22 patients with CSM undergone double door laminoplasty (Group B). Postoperative improvement rate of Japanese Orthopedics Association (JOA)scores,the degree of axial symptom and ranges of neck motion were recorded and compared. Result The average JOA improvement rate were(52.0±21.4)% for group A and(52.7± 19.8)% for group B,There was no significant difference in JOA improvement rate. In group A,42.9% of patients had evident axial symptoms compared with 36.4% in group B( P=0.642>0.05). Significant difference was not found in loss of ranges of neck motion between group A and group B (3.9°vs 3.6°,P=0.492>0.05). Conclusions Double door laminoplasty than single

  20. 两种颈前路减压重建术治疗多节段脊髓型颈椎病的疗效比较%Two procedures of anterior cervical decompression and reconstruction in the treatment of multilevel cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    李会明; 夏刚; 田融

    2016-01-01

    目的 探讨两种颈椎前路减压重建术治疗多节段脊髓型颈椎病的临床疗效.方法 我院2009至2013年采用颈椎前路单节段间盘切除、椎间融合器植骨融合钛板内固定术(A组)及颈椎前路椎体次全切除、钛网椎间植骨钛板内固定术(B组)治疗的多节段脊髓型颈椎病患者210例,根据手术方式分为两组,进行疗效分析.结果 术后7d、术后3个月、术后6个月、术后18个月各时间点,A组患者神经功能改善[日本骨科协会(JOA)评分]分别为(12.94±3.82)、(13.95±3.19)、(4.12±3.95)、(14.06±3.85)分和B组(12.73±3.53)、(13.39±3.95)、(14.09±3.53)、(14.11±2.98)分,两组JOA评分均较术前明显改善,两组比较JOA评分的差异无统计学意义(P>0.05);两组患者术后椎间隙高度比较差异无统计学意义(P>0.05),A组颈椎生理曲度深度(弧弦距)分别为(9.11±2.34)、(9.36±1.88)、(9.89±2.46)、(9.61±1.62) mm和B组(7.57±0.78)、(7.76±0.91)、(7.21±0.33)、(7.36±0.79) mm,A组均大于B组,A组植骨融合率为96.3%,B组为89.0%,A组高于B组.结论 两组术后神经功能恢复较好,两组术后均能保持椎间隙高度;但椎间融合器植骨融合率较钛网椎间植骨融合率高,而且椎间融合器组与钛网组比较能较好的维持颈椎生理曲度.%Objective To investigate the clinical curative effect of two procedures of anterior cervical decompression and reconstruction in the treatment of multilevel cervical spondylotic myelopathy.Methods In our hospital from 2009 to 2013 the anterior cervical single segmental discectomy,interbody bone graft fusion and titanium plate internal fixation (group A),and anterior cervical subtotal resection,titanium mesh cage bone and titanium plate internal fixation (group B) were used in 210 patients with multilevel cervical spondylotic cervical spondylosis.The efficacy was evaluated.Results On the 7th day,3rd month,6th month,and 18th month after the surgery,the scores of

  1. [Langerhans cell histiocytosis causing cervical myelopathy].

    Science.gov (United States)

    Doléagbénou, A K; Mukengeshay Ntalaja, J; Derraz, S; El Ouahabi, A; El Khamlichi, A

    2012-08-01

    Langerhans cell histiocytosis (LCH), a disorder of the phagocytic system, is a rare condition. Moreover, spinal involvement causing myelopathy is even rare and unusual. Here, we report a case of atypical LCH causing myelopathy, which was subsequently treated by corporectomy and fusion. An 8-year-old boy presented with 3 weeks of severe neck pain and limited neck movement accompanying upper and lower limbs motor weakness. CT scans revealed destruction of C5 body and magnetic resonance imaging showed a tumoral process at C5 with cord compression. Interbody fusion using anterior cervical plate packed by autologus iliac bone was performed. Pathological examination confirmed the diagnosis of LCH. After the surgery, the boy recovered from radiating pain and motor weakness of limbs. Despite the rarity of the LCH in the cervical spine, it is necessary to maintain our awareness of this condition. When neurologic deficits are present, operative treatment should be considered. PMID:22552159

  2. Operative techniques for cervical radiculopathy and myelopathy.

    LENUS (Irish Health Repository)

    Moran, C

    2012-02-01

    The surgical treatment of cervical spondylosis and resulting cervical radiculopathy or myelopathy has evolved over the past century. Surgical options for dorsal decompression of the cervical spine includes the traditional laminectomy and laminoplasty, first described in Asia in the 1970\\'s. More recently the dorsal approch has been explored in terms of minimally invasive options including foraminotomies for nerve root descompression. Ventral decompression and fusion techniques are also described in the article, including traditional anterior cervical discectomy and fusion, strut grafting and cervical disc arthroplasty. Overall, the outcome from surgery is determined by choosing the correct surgery for the correct patient and pathology and this is what we hope to explain in this brief review.

  3. Clinical study of a cervical anterior hybrid technique for multilevel cervical spondylotic myelopathy%颈椎前路融合与人工椎间盘置换术联合治疗多节段脊髓型颈椎病

    Institute of Scientific and Technical Information of China (English)

    朱云荣; 蒋玉权; 胡洪涛; 刘继春; 许国华; 何海龙; 叶晓健

    2011-01-01

    Objective:To explore the early clinical effects of cervical anterior hybrid technique using anterior corpectomy and fusion (ACF) combined with cervical artificial disc replacement (C-ADR) for multilevel spondylotic myelopathy.Method: Hybrid technique was applied in 24 cases of multilevel cervical spondylotic myelopathy (group A), and 28 patients were treated by the traditional anterior noncontiguous decompression and fusion (group B) between Oct 2008 and Jun 2009. Clinical results were evaluated by JOA score preoper-atively and postoperatively at 3d,3 months, 12 months,and 24 months.The operative time and blood loss were recorded.The range of movement (ROM) in replaced segment and C2-7 of all cases were evaluated by radiograph (X-rays of bending,extending).CT or MRI scan was applied postoperatively to find out the pressure of the spine and heterotopic ossification in the replaced segment.Result: There was no serious complication.Improvement in all cases occurred obviously, and JOA score increased (P0.05).The mean C2-7 ROM of both groups did not recover to the preoperative value,but group A showed faster and better C2-7 ROM recovery. Replaced segment achieved stability and restored partial of ROM.There was no prosthesis subsidence or ex-cursion.No hetertopic ossification was found in the replaced level,and the movement had no significant difference (P>0.05) between preoperative and postoperative at two years post-operation.But the deteriorated adjacent level of 2 cases were found in group B.Conclusion:In term of surgical time,blood loss and restoring stabilityand partial motion of the C2-7 ROM,the anterior hybrid technique is superior compared with the traditional anterior noncontiguous decompression and fusion.At the same time,less compensatory motion occurs at the adjacent segments,and less ASD will result.%目的:探讨颈椎前路减压后行融合与人工椎间盘置换联合手术治疗多节段脊髓型颈椎病的临床疗效.方法:2008年10月~2009年6

  4. Criteria for preferring anterior approach in surgical treatment of cervical spondylotic myeloradiculopathy

    Directory of Open Access Journals (Sweden)

    Yurdal Gezercan

    2014-08-01

    Full Text Available Cervical spondylosis is a progressive, chronic and insidious degenerative disease, which origins from the cervical intervertebral disc and then diffuses to surrounding bony and soft tissues. If the spine and nerve roots are involved due to degenerative changes, this is called as cervical spondylotic myeloradiculopathy (CSMR and it is the most frequent cause of myelopathy over age of 50. Cases with progressive character and functional neurological deficits and cases with a prolonged course refractory to conservative therapy shall be treated surgically. The aim of the surgical treatment is to relieve the pressure on the spinal cord and nerve roots, to preserve the proper anatomical alignment of the cervical vertebrae or to reestablish correct anatomical positioning if it is distorted and lastly to increase the life quality by relieving patients neurological signs and complaints. While achieving these goals, complications shall be avoided as much as possible. These goals can be accomplished by anterior or posterior surgical approaches to the cervical vertebrae. The style of the surgical approach can only be decided by a detailed evaluation of the patient's clinical and radiological features. The utmost aim of the surgical procedure, which is to achieve sufficient neurological decompression and to preserve/establish proper cervical vertebral alignment, can be provided best by anterior approaches. In our current study, the criteria to prefer anterior approach in surgical treatment of CSMR will be reviewed. [Cukurova Med J 2014; 39(4.000: 669-678

  5. 颈后路三种手术方法对颈椎曲度及轴性症状的长期影响%Long-term clinical significance of three posterior operative ways on curvature index and axial symptom for multilevel cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    张为; 李鹏飞; 申勇; 丁文元; 杨大龙; 孙亚膨; 郭金库

    2011-01-01

    [目的] 探讨颈椎后路三种手术方法对术后颈椎曲度及轴性症状(axial symptom.AS)产生的长期影响及临床意义.[方法]自2004年5月~2008年1月,回顾性分析98例多阶段脊髓型颈椎病(cervical spondyiotic myelopathy,CMS)患者.A组30例多节段脊髓型颈椎病患者行颈后路全椎板减压手术.其中,男22例,女8例;年龄42~75岁,平均57.1岁.B组36例多节段脊髓型颈椎病患者行颈后路单开门椎管成形手术.其中,男25例,女 11例;年龄47~68岁,平均56.6岁.C组32例多节段脊髓型颈椎病患者行颈后路椎板减压侧块螺钉内固定术.其中,男23例,女9例;年龄40~72岁,平均54.4岁.所有患者术前及术后均行颈椎X线检查,对三组患者手术前后的JOA评分、颈椎曲度指数的丢失程度(curvature index,CI)及轴性症状的严重程度进行比较评估.[结果]随访时间24~48个月,平均34个月.JOA评分恢复率,A组患者为(60.1±17.2)%,B组患者为(59.6±21.3)%,C组患者为(62.3±15.8)%,三组差异无统计学意义.A组患者术后颈椎曲度丢失指数为(3.5±2.5)%,B组患者为(3.2±2.6)%,C组为(2.2±1.3)%,三组患者手术前后颈椎曲度的变化差异有统计学意义.A组术后有明显轴性症状患者的比例为43.3%,B组为30.6%,C组为15.6%,三组比较差异有统计学意义(P<0.05).[结论] 颈后路椎板减压术应用侧块螺钉内固定与病人术后恢复程度无明显关联.侧块螺钉内固定能有效防止术后颈椎曲度丢失,并且较少术后轴性症状的发生.%[Objective] To explore the long- term clinical significance of three posterior operative procedures on JOA scores, curvature index and axial symptoms for multilevel cervical spondylotic myelopathy. [ Methods] From May 2004 to January 2008, 98 patients with multilevel cervical spondylotic myelopathy treated in our hospital were reviewed in this study. Of them, 30 patients underwent traditional laminectomy in group A, which consisted of 22 male and

  6. Spondylotic myelopathy mimicking myelitis: diagnostic clues by magnetic resonance imaging.

    Science.gov (United States)

    Rua, Adriana; Blanco, Yolanda; Sepúlveda, María; Sola-Valls, Núria; Martínez-Hernández, Eugenia; Llufriu, Sara; Berenguer, Joan; Graus, Francesc; Saiz, Albert

    2015-12-01

    Introduccion. La mielopatia espondilotica es la causa mas frecuente de mielopatia no traumatica. Sus caracteristicas radiologicas en ocasiones son indistinguibles de las de una mielopatia inflamatoria, y pueden ocasionar retrasos diagnosticos o llevar a un diagnostico y tratamiento incorrectos. La descripcion reciente de un patron caracteristico de realce de gadolinio puede ayudar a diferenciar la mielopatia espondilotica de la causa inflamatoria. Casos clinicos. Caso 1: varon de 38 años que consulto por historia de dos años de evolucion de parestesias en las extremidades superiores, a las que se añadieron un año mas tarde calambres en las extremidades derechas y acorchamiento en los dermatomas C5 y C6 en relacion con los movimientos del cuello. Caso 2: varon de 44 años que consulto por historia de un año de evolucion de alteracion progresiva de la marcha con trastorno sensitivo en las manos y disfuncion vesical reciente. En ambos casos, la resonancia magnetica medular mostro en las secciones sagitales una hiperseñal cervical fusiforme en T2, asociada a una banda transversa de realce de gadolinio en forma de barra (pancakelike) justo por debajo de la zona de maxima estenosis, y un realce circunferencial o hemimedular en los cortes axiales. Conclusiones. Las caracteristicas radiologicas de la mielopatia espondilotica pueden parecerse a las de origen inflamatorio. El reconocimiento de un realce transverso en barra inmediatamente por debajo del lugar de maxima compresion como signo radiologico tipico de la mielopatia espondilotica es importante para reducir el riesgo de errores diagnosticos, y de utilidad para el manejo de estos pacientes.

  7. Unilateral ossified ligamentum flavum in the high cervical spine causing myelopathy

    Directory of Open Access Journals (Sweden)

    Singhal Udit

    2009-01-01

    Full Text Available High cervical ossified ligamentum flavum (OLF is rare and may cause progressive quadriparesis and respiratory failure . Our two patients had unilateral OLF between C1 and C4 levels. MR showed a unilateral, triangular bony excrescence with low signal and a central, intermediate or high signal on all pulse sequences due to bone marrow within. There was Type I thecal compression (partial deficit of contrast media ring. The first patient had a linear and nodular OLF with calcification within tectorial membrane, C2-3 fusion and unilateral C2-facetal hypertrophy; and the second patient, a lateral, linear OLF with loss of lordosis and C3-6 spondylotic changes. A decompressive laminectomy using "posterior floating and enbloc resection" brought significant relief in myelopathy. Histopathology showed mature bony trabeculae, bone marrow and ligament tissue. The coexisting mobile cervical vertebral segment above and congenitally fused or spondylotic rigid segment below the level of LF may have led to abnormal strain patterns within resulting in its unilateral ossification. In dealing with cervical OLF, carefully preserving facets during laminectomy or laminoplasty helps in maintaining normal cervical spinal curvature.

  8. 多节段脊髓型颈椎病在不同MRI T_2信号强度下三种手术方法疗效的回顾性研究%Comparison of three surgical approaches for multilevel cervical spondylotic myelopathy by classification of quantifying MRI T_2 signal intensity ratio

    Institute of Scientific and Technical Information of China (English)

    王林峰; 申勇; 张英泽; 丁文元; 徐佳欣; 杨大龙; 曹俊明

    2010-01-01

    目的 探讨多节段脊髓型颈椎病量化MRI T_2信号强度等级后,不同手术方法选择的临 床应用价值.方法 2000年12月至2007年11月,共116例多节段脊髓型颈椎病患者,分别接受不同术式治疗.男86例,女30例;年龄31-78岁,平均58.73岁.术前所有患者均行高分辨率1.5 T MR成像并量化脊髓信号强度比值.将患者按比值大小平均分为三组,重点分析各信号等级组内患者及全体患者在三种手术治疗方法下的JOA评分改善率.结果 所有患者获得至少12个月随访,最长随访5年.中位随访14.5个月.术前JOA评分为(8.68±2.26)分,术后1年为(12.16±3.07)分,改善率为55.13%±15.27%.经秩和检验,在低信号强度比值组,改善率于三组间差异无统计学意义.在中信号强度比值组,改善率于三组间差异有统计学意义;进一步两两比较显示,前路手术组(71%)与后路手术组(47%)、后路手术组与前后路手术组(64%)改善率差异有统计学意义.在高信号强度比值组,改善率于三组间差异有统计学意义;进一步两两比较显示,前路手术组(20%)与后路手术组(36%)、前路手术组与前后路手术组(28%)改善率差异有统计学意义.结论 手术是治疗多节段颈椎病的有效方法,区分颈脊髓MRI T_2信号强度等级后,不同术式的疗效显示出相应差异.%Objective To assess the clinical value of three approaches for multilevel cervical spondylotic myelopathy according to classification of quantifying MRI T_2 signal intensity ratio.Methods From December 2000 to November 2007,116 patients treated with anterior,posterior,or posterior-anterior combined surgery for multilevel cervieal myelopathy were enrolled retrospectively in this study.There were 86 males and 30 females,with the mean age of 58.73 years.Each patient underwent 1.5 T MRI examination before surgery.All patients were divided into three groups by signal intensity ratio.The improvement rate of JOA score were

  9. Degenerative Cervical Myelopathy: A Spectrum of Related Disorders Affecting the Aging Spine.

    Science.gov (United States)

    Tetreault, Lindsay; Goldstein, Christina L; Arnold, Paul; Harrop, James; Hilibrand, Alan; Nouri, Aria; Fehlings, Michael G

    2015-10-01

    Cervical spinal cord dysfunction can result from either traumatic or nontraumatic causes, including tumors, infections, and degenerative changes. In this article, we review the range of degenerative spinal disorders resulting in progressive cervical spinal cord compression and propose the adoption of a new term, degenerative cervical myelopathy (DCM). DCM comprises both osteoarthritic changes to the spine, including spondylosis, disk herniation, and facet arthropathy (collectively referred to as cervical spondylotic myelopathy), and ligamentous aberrations such as ossification of the posterior longitudinal ligament and hypertrophy of the ligamentum flavum. This review summarizes current knowledge of the pathophysiology of DCM and describes the cascade of events that occur after compression of the spinal cord, including ischemia, destruction of the blood-spinal cord barrier, demyelination, and neuronal apoptosis. Important features of the diagnosis of DCM are discussed in detail, and relevant clinical and imaging findings are highlighted. Furthermore, this review outlines valuable assessment tools for evaluating functional status and quality of life in these patients and summarizes the advantages and disadvantages of each. Other topics of this review include epidemiology, the prevalence of degenerative changes in the asymptomatic population, the natural history and rates of progression, risk factors of diagnosis (clinical, imaging and genetic), and management strategies. PMID:26378358

  10. Various approaches for multilevel cervical spondylotic myelopathy:a meta-analysis on clinical effectiveness and safety%不同入路治疗多节段脊髓型颈椎病:疗效与安全性的Meta分析

    Institute of Scientific and Technical Information of China (English)

    王国旗; 徐韬; 盛伟斌; 邓强; 陈柯屹; 宋扬; 张恩丰

    2014-01-01

    背景:大量研究已证实前路手术和后路手术治疗多节段脊髓型颈椎病均有较好疗效,但两种治疗方法孰优孰劣,目前尚无定论。  目的:系统评价前路与后路手术治疗多节段脊髓型颈椎病的疗效及安全性。  方法:计算机检索Cochrane图书馆(2013年第3期)、PubMed(1966年至2013年3月)、OVID(1950年至2013年3月)、EMbase(1966年至2013年3月)、中国生物医学文献数据库(1978年至2013年3月)、万方数据库(1998年至2013年3月)、中国期刊全文数据库(1999年至2013年3月),手工检索《中华外科杂志》等5种相关杂志,收集前路与后路手术比较治疗多节段脊髓型颈椎病的随机或非随机对照实验,由两名评价者按纳入与排除标准选择文献、提取资料和质量评价后,采用RevMan5.2软件进行Meta分析。  结果与结论:最终纳入11个对照实验,共814例患者。Meta分析结果显示:与后路手术相比,前路手术治疗后JOA评分高(P OBJECTIVE:To systematical y assess the clinical effectiveness and safety of anterior approach versus posterior approach for multilevel cervical spondylotic myelopathy. METHODS:The databases such as The Cochrane Library (Issue 3, 2013), PubMed (from 1966 to March 2013), OVID (from 1950 to March 2013), EMbase (from 1966 to March 2013), Chinese Biomedical Literature Database (from 1978 to March 2013), WanFang Database (from 1998 to March 2013), China National Knowledge Infrastructure (from 1999 to March 2013) were electronical y searched and five relevant journals were searched by hand to col ect the randomized control ed trials or non-randomized control ed trials about the clinical effectiveness and safety of anterior approach versus posterior approach for multilevel cervical spondylotic myelopathy. Two reviewers independently screened the literature according to the inclusive and exclusive criteria, extracted the data, and assessed the methodological

  11. Treatment of multilevel cervical spondylotic myelopathy by conjugation of anterior vertebral subtotal resection and intervertebral space decompression and bone graft fusion%前路椎体次全切除结合椎间隙减压植骨融合术治疗多节段脊髓型颈椎病

    Institute of Scientific and Technical Information of China (English)

    刘斐文; 张彤; 孙川江; 谢涛江; 王永亮; 张雪锋

    2016-01-01

    Objectives To evaluate clinical effect of multilevel cervical spondylotic myelopathy( CSM) treated by an-terior vertebral subtotal resection conjugated with intervertebral space decompression and bone graft fusion. Methods Forty-six cases of CSM whose three segments were received anterior approach treatment. Among them, 24 cases re-ceived vertebral subtotal resection conjugated with single cell gap decompression and bone graft fusion as Group A, and the other 22 cases were given subtotal resection decompression of two vertebral bodies and decompression and bone graft fusion as Group B. Operation time and bleeding, bone graft fusion rate, nerve function amelioration and cervical vertebra physiological curvature restoration were observed and compared. Results All patients were followed up for 15~36 months. Operation time in Group A was (105 ± 20) min, while that in Group B was (180 ± 30) min, bleeding during operation were (120 ± 35) ml in group A and (210 ± 25) ml in group B, the difference of the data between two groups were statistically significant ( P0. 05). Postopera-tion cervical vertebra physiological curvature of both groups were obviously ameliorated, without statistical significance (P>0. 05). Conclusions Multilevel CSM treatment by anterior vertebral subtotal resection conjugated with interver-tebral space decompression and bone graft fusion can gain satisfactory effect, with advantages such as relatively simp-ler operations, less bleeding, shorter operation time, higher bone graft fusion rates, and so on. It is a safe, effective operation method which can also reduce complications.%目的:评价前路椎体次全切除结合椎间隙减压植骨融合术治疗多节段脊髓型颈椎病( CSM )的临床疗效。方法采用前路手术治疗累及3个节段的CSM患者46例。其中24例行椎体次全切除+单间隙减压植骨融合术( A组);22例行2个椎体次全切除减压植骨融合术( B组)。观察比较两组手术时间、术中

  12. Imageological image and technical advantages of three-dimensional spiral computed tomography in the preoperative evaluation and surgical plan in cervical spondylotic myelopathy%三维CT影像学图像及技术优势对脊髓型颈椎病术前评估及辅助制定手术计划的价值

    Institute of Scientific and Technical Information of China (English)

    侯明夫; 徐杰; 王钢锐; 蒋纯志

    2007-01-01

    BACKGROUND: The appearances of spiral computer tomograph (CT) and three-dimensional image processing are of very importance for fully evaluating preoperative pathological changes,which represent various cervical spondylotic myelopathy (CSM) in clinic, and choosing proper clinical therapeutic occasion and methods.OBJECTIVE: To analyze the effects of imageological image and technical advantages of three-dimensional spiral CT on the preoperative evaluation and surgical plan of CSM.DESIGN: Retrospective analysis, controlled observation.SETTING: Nanjing First Hospital Affiliated to Nanjing Medical University. PARTICIPANTS: Altogether 268 patients with CSM admitted to Nanjing First Hospital from January 2002 to January 2005 were involved in this experiment. The involved patients were randomly assigned into preoperative evaluation group (n =146) and control group (n =122). The baseline materials of two groups were comparable.METHODS:Preoperative evaluation group: ① CT scan and three-dimensional reconstruction: Helical scanning was conducted at transverse plane with TOSHIBA-HiSpeed/I screw machine. After scanning, reconstruction was performed finally, three-dimensional reconstruction was conducted on computer workstation (RadworkS. 1 ). Correlative data were measured and analyzed with image analysis software (ADW3.1). ② Design of three-dimensional CT-assisted operation plan: Cervical vertebral osseous anatomic landmark and the anatomic relationship of its adjacent structure were revealed stereoscopically. Individual orthopaedic location marker could be provided. Preoperative routine CT examination was performed in the control group with conventional operation method.MAIN OUTCOME MEASURES: ① The hyperostosis of vertebral body, hamular process joint and small articular process were observed. ②The degree and type of intervertebral disc protrusion were observed. ③The changes of hyperostosis before and behind the vertebral canal. Spinal decompression was observed by

  13. Myelopathic signs and functional outcome following cervical decompression surgery: a proposed myelopathy scale.

    Science.gov (United States)

    El-Zuway, Salem; Farrokhyar, Forough; Kachur, Edward

    2016-06-01

    OBJECTIVE Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in adults. In spite of this, the impact of the changes in myelopathic signs following cervical decompression surgery and their relationship to functional outcome measures remains unclear. The main goals of our study were to prospectively assess changes in myelopathic signs with a functional outcome scale (the modified Japanese Orthopaedic Association [mJOA] scale) following cervical decompression surgery and to objectively test a proposed new myelopathy scale (MS). METHODS Between 2008 and 2011, 36 patients with CSM were observed following cervical decompression surgery. Patient data including mJOA and MS scores were prospectively collected and analyzed preoperatively and at 1 year after surgery. RESULTS In this cohort, reflex, Babinski, and proprioception signs showed statistically significant improvement following surgery at 1 year (p = < 0.001, p = 0.008, and p = 0.015, respectively). A lesser degree of improvement was observed with the Hoffman sign (p = 0.091). No statistically significant improvement in clonus occurred (p = 0.368). There was a significant improvement in mJOA (p ≤ 0.001) and MS (p ≤ 0.001) scores at 1 year compared with the preoperative scores. The results showed an inverse correlation between MS and mJOA scores both pre- and postoperatively (Spearman's correlation coefficient = -0.202 preoperatively and -0.361 postoperatively). CONCLUSIONS Improvement in myelopathic signs was noted following cervical decompression surgery in patients with CSM. The newly devised MS scale demonstrated these findings, and the new MS scale correlates with improvement in mJOA scores in this patient cohort. PMID:26849710

  14. Comparison analysis of anterior and posterior pathways surgery for patients with multilevel cervical spondylotic myelopathy%单纯前入路与后入路治疗多节段脊髓型颈椎病的疗效对比研究

    Institute of Scientific and Technical Information of China (English)

    陈定中

    2015-01-01

    目的:比较单纯前入路与后入路治疗多节段脊髓型颈椎病( MCSM)的疗效及对患者生活质量的影响。方法收集2008年6月至2012年6月收治的140例 MCSM 患者作为研究对象。随机分为前路组70例和后路组70例。前路组给予单纯前入路手术治疗,后路组给予后入路手术治疗。比较两组患者手术状况、日本骨科协会评估(JOA)评分、视觉模拟评分(VAS),颈椎功能障碍指数(NDI)以及生活质量。结果两组患者术中出血量与症状消失时间差异无统计学意义( P >0.05),前路组手术时间显著短于后路组,其治疗后 JOA 评分显著高于后路组,差异具有统计学意义( P 均0.05),后路组 NDI 显著低于前路组,差异具有统计学意义( P <0.05)。两组患者治疗后生活质量均显著提高,后路组在活力、情绪角色与心理卫生方面的评分均显著高于前路组,差异均具有统计学意义( P <0.05)。结论单纯前路手术与后路手术治疗 MCSM 各有优势,临床上需要结合病人的实际情况做出选择以达到较好的临床获益。%Objective To compare the efficacy of anterior and posterior pathways surgery for patients with multilevel cervical spondylotic myelopathy(MCSM)and provide clinical basis for clinical therapy. Methods From June 2008 to June 2012,140 MCSM cases were collected and divided into 2 groups randomly. 70 cases were in anterior pathways group(APG)and 70 cases in posterior pathways group(PPG). The APG was treated with anterior pathways surgery and the PPG was treated with posterior pathways surgery. The surgery status,JOA score,VAS score, NDI and life quality of the 2 groups were observed and compared. Results The length of the surgery of the APG was significantly shorter than that of the PPG( P < 0. 05). The JOA score of the APG was significantly higher than that of the PPG after treatments( P < 0. 05). The VAS score of the 2 groups

  15. 脊髓型颈椎病减压术后疗效及并发症分析%The analysis of effects and complications of cervical spondylotic myelopathy(CSM)treated with de compression by two different approaches

    Institute of Scientific and Technical Information of China (English)

    巩腾; 王沛

    2008-01-01

    目的 通过脊髓型颈椎病采用不同术式治疗后脊髓功能改善及患者预后状况的观察,探讨术后并发症及"弓弦效应"产生机制.方法 回顾性分析2001年1月至2002年10月收治的经前路减压并获随访的56例和后路减压后获得随访的62例患者,随访时间均在24个月以上,于术前、术后3个月(早期)及24个月以上(中期)行脊髓功能JOA评分、体感诱发电位和颈椎主动活动度检查,对比两组减压术后早、中期疗效.结果 获得随访的118例患者,前路手术56例中优14例(25%).良29例(51.79%),可10例(17.86%),差3例(5.36%);后路手术62例中优23例(37.10%),良31例(50%),可7例(11.29%),差1例(1.61%).前、后路减压术后不同时间JOA评分改善率与SEP波幅、潜伏期变动率差异有统计学意义;两种减压术后颈椎各向主动活动度差异有统计学意义.发生术后并发症的前路组7例和后路组13例,经保守治疗后逐渐缓解.结论 (1)仅以"C5神经根麻痹"概念解释上述术后不适症状较牵强,应系术中脊髓内组织受损所致;(2)后路椎板减压因直接扩大椎管容积及产生"弓弦效应",较前路手术同期脊髓功能恢复效果更显著;(3)后路术后颈椎主动活动度较一般人群有轻微减小,前路组主动活动度又较后路组有一定程度地下降.%Objective To analyze functional improvement of spinal cord and the prognosis of two surgical approaches for the stenosis of cervical spinal canal;to investigate the mechanisms concerning post-terior decompression,fusion with ilium graft and internal fixation and 158 cases who underwent dorsal laminectomy from January 2001 to October 2002 were follow-up for at least 24 months and examined with the evaluation systems of Japanese Orthopaedic Association Score,somatosensary evoked essential and initiative range of motion to compare preoperative,short-term and long-term efficacy.Results According to selected standard of improvement rate

  16. 多节段脊髓型颈椎病经颈后路不同术式治疗后C5神经根麻痹的观察对比%Comparative observation of C5 nerve root palsy after posterior surgical treatment of multilevel cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    贺建军; 梁盾; 陆兴

    2014-01-01

    Objective To compare the incidence of C5 nerve root palsy after laminoplasty and laminectomy with internal fixation for treating multilevel cervical spondylotic myelopathy (MCSM).Methods From January 2008 to August 2012,98 patients with MCSM were treated with laminoplasty (47 patients,group A) or laminectomy (51 patients,group B) with internal fixation.All the patients were followed up for 13-56(26.5 ± 7.9) months.In both groups,Cobb's method was applied to measure cervical lordotic angle,and Ishihara's method was conducted to measure cervical curvature index (CCI) before and after operation.The incidence of C5 nerveroot palsy was recorded and compared.Results The incidence of C5 nerve root palsy in group A was 2.1% (1/47),while 21.6 % (11/51) in group B (x2 =5.430,P < 0.05).The JOA scores in group A and group B before and after operation and improvement rate of JOA scores had no significant difference (P> 0.05).The cervical lordotic angle and CCI in group A and group B before and after operation had no significant difference (P > 0.05).The improvement rate of CCI between two groups had no significant difference (P > 0.05).All of 11 patients with C5 nerve root palsy were group B 1,and other 40 patients were group B2.The improvement rate of CCI in group B1 was significantly higher than that in group B2 [(38.7 ± 18.3)% vs.(22.1 ± 12.1)%](t =1.772,P< 0.05).Conclusions Compared with laminoplasty,laminectomy with internal fixation has a higher incidence of C5 nerve root palsy.The C5 nerve root palsy may be associated with postoperative increase of cervical lordosis angle.Moreover,tethering of the C5 root may he one of its important pathomechanisms.%目的 分析颈后路单开门椎管成形术与椎板切除内固定术治疗多节段脊髓型颈椎病术后C5神经根麻痹的发生率及其原因.方法 2008年1月至2012年8月因多节段脊髓型颈椎病分别接受椎管成形术的患者47例(A组)、接受椎

  17. Myelopathy.

    Science.gov (United States)

    Oyinkan Marquis, B; Capone, Patrick M

    2016-01-01

    Myelopathy is an inclusive term, referring to pathology leading to a neurologic deficit related to the spinal cord. The clinical diagnosis of myelopathy requires a detailed history and physical examination to define the clinical syndrome. Neuroimaging is indicated in most instances of new-onset myelopathy. It is indicated also when the worsening of a myelopathy is unexplained. Advances in neuroimaging have proved to play a vital role in diagnosis. Appropriate diagnosis and treatment are dependent upon an adequate imaging evaluation to establish the presence of mechanical stability, extrinsic spinal cord compression, or an intramedullary lesion. The most frequent etiology of myelopathy is related to degenerative disease of the spine from osteophyte or extruded disc material causing compression of the spinal cord in the cervical or thoracic spine. The next common etiologies are spinal cord compression due to extradural masses caused by metastatic disease to bone or blunt trauma. In these cases, emergency imaging should be performed to assess the nature of the lesion causing the myelopathy and plan the most appropriate treatment. Also urgent imaging should be performed when an abscess in the spinal canal is suspected. Less urgent is imaging of primary neoplasms of the meninges, roots, or spinal cord, as well as noninfectious inflammatory processes, such as multiple sclerosis, and neurodegenerative, vascular, nutritional, or idiopathic disorders leading to myelopathy. Although a survey of the entire spinal cord can be performed with imaging, it is more appropriate to define from the clinical findings what levels of the spine and spinal cord should be imaged. This approach helps limit the likelihood of false-positive imaging findings that may encourage needless attempts to fix what is not broken. Similarly, the most appropriate imaging study and protocol should be selected in order to provide a timely and accurate diagnosis. To do so requires detailed knowledge

  18. Evaluation of characteristics and surgical outcomes in cervical spondylotic amyotrophy

    Directory of Open Access Journals (Sweden)

    Hong-Li Wang

    2014-01-01

    Full Text Available Background: Cervical spondylotic amyotrophy (CSA is a rare clinical syndrome resulting from cervical spondylosis. Surgical treatment includes anterior cervical decompression and fusion (ACDF, and laminoplasty with or without foraminotomy. Some studies indicate that ACDF is an effective method for treating CSA because anterior decompression with or without medial foraminotomy can completely eliminate anterior and/or anterolateral lesions. We retrospectively evaluated outcome of surgical outcome by anterior cervical decompression and fusion (ACDF. Materials and Methods: 28 CSA patients, among whom 12 had proximal type CSA and 16 had distal type CSA, treated by ACDF, were evaluated clinicoradiologically. The improvement in atrophic muscle power was assessed by manual muscle testing (MMT and the recovery rate of the patients was determined on the basis of the Japanese Orthopedic Association (JOA scores. Patient satisfaction was also examined. Results: The percentage of patients, who gained 1 or more grades of muscle power improvement, as determined by MMT, was 91.7% for those with proximal type CSA and 37.5% for those with distal type CSA (P < 0.01. The JOA score-based recovery rates of patients with proximal type and distal type CSA were 60.8% and 41.8%, respectively (P < 0.05. Patient satisfaction was 8.2 for those with proximal type CSA and 6.9 for those with distal type CSA (P < 0.01. A correlation was observed among the levels of improvement in muscle power, JOA score based recovery rate, patient satisfaction and course of disease (P < 0.05. Conclusion: ACDF can effectively improve the clinical function of patients with CSA and result in good patient satisfaction despite the surgical outcomes for distal type CSA being inferior to those for proximal type CSA. Course of disease is the fundamental factor that affects the surgical outcomes for CSA. We recommend that patients with CSA undergo surgical intervention as early as possible.

  19. 三种颈前路减压术式治疗多节段脊髓型颈椎病的并发症比较%Comparative analysis of complications of different anterior decompression procedures for treating multilevel cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    祁敏; 王新伟; 刘洋; 梁磊; 陈华江; 杨立利; 袁文

    2012-01-01

    目的:分析比较不同颈前路减压术式治疗多节段脊髓型颈椎病术后并发症的差异.方法:回顾性分析2006年1月~2011年8月手术治疗的327例三节段脊髓型颈椎病患者的临床资料,根据手术方式不同分为三组:前路椎间盘切除减压融合术(anterior cervical discectomy with fusion,ACDF) (A组)、前路椎体切除减压融合术(anterior cervical corpectomy with fusion,ACCF)(B组)和ACDF+ACCF“混合式”减压术(C组),其中A组男性69例,女性55例,平均年龄53.48±8.50岁;B组男性51例,女性43例,平均年龄54.36±7.82岁;C组男性61例,女性48例,平均年龄53.68±7.80岁,组间比较无统计学差异.对三种不同手术方式并发症情况进行比较.结果:平均随访时间3.5年(1.5~5年).共有69例在手术后出现多种并发症,包括植骨未融合11例,其中C组3例(2.75%),B组8例(8.51%),B组植骨不愈合发生率显著高于A组和C组(P<0.05);声音嘶哑12例,其中A组5例(4.03%),B组3例(3.19%),C组4例(3.67%);吞咽困难26例,其中A组11例(8.87%),B组7例(7.45%),C组8例(7.34%);C5神经根麻痹12例,其中A组2例(1.61%),B组5例(5.32%),C组5例(4.59%);脑脊液漏5例,其中A组3例,C组2例;切口感染3例,其中B组2例,C组1例.A组患者并发症发生率为16.94%,B组为26.60%,C组为21.10%,B组患者术后并发症的发生率显著高于其余两组(P<0.05).结论:多节段脊髓型颈椎病患者手术治疗中,ACDF的并发症发生率最低,ACCF术式应慎用,其并发症的发生率较高.%Objectives: Comparative analysis of complications of different anterior decompression procedures for treating multilevel cervical spondylotic myelopathy(CSM). Methods: This study retrospectively reviewed the postoperative complications in 327 patients with three-level CSM in whom the anterior cervical surgery was performed between January 2006 and August 2011. According to the decompression procedure, patients were divided into

  20. Cervical Myelopathy Caused by Intracranial Dural Arteriovenous Fistula

    Science.gov (United States)

    Kim, Won Young; Kim, Jin Bum; Nam, Taek Kyun; Kim, Young Baeg

    2016-01-01

    Intracranial dural arteriovenous fistula (dAVF) usually results in various problems in the brain. But it can be presented as a myelopathy, which may make early diagnosis and management to be difficult. We recently experienced a case of cervical myelopathy caused by intracranial dAVF. A 60-year-old man presented with a 3-year history of gait disturbance due to a progressive weakness of both legs. Neurological examination revealed spastic paraparesis (grade IV) and Babinski sign on both sides. Magnetic resonance imaging showed serpentine vascular signal voids at C2-T1 on T2-weighted image with increased signal intensity and swelling of spinal cord at C1-C4. We performed a brain computed tomography angiography and found intracranial dAVF with multiple arteriovenous shunts. Venous drainages were noted at tentorial veins and cervical perimedullary veins. After Onyx embolization, the patient showed gradual improvement in motor power and gait disturbance. The venous drainage pattern is a well-known prognostic factor of dAVF. In our case, the intracranial dAVF drained to spinal perimedullary vein, which seemed to result in the ischemic myelopathy. Although it is rare condition, it sometimes can cause serious complications. Therefore, we should keep in mind the possibility of intracranial dAVF when a patient presents myelopathy. PMID:27437016

  1. Cervical Myelopathy Caused by Intracranial Dural Arteriovenous Fistula.

    Science.gov (United States)

    Kim, Won Young; Kim, Jin Bum; Nam, Taek Kyun; Kim, Young Baeg; Park, Seung Won

    2016-06-01

    Intracranial dural arteriovenous fistula (dAVF) usually results in various problems in the brain. But it can be presented as a myelopathy, which may make early diagnosis and management to be difficult. We recently experienced a case of cervical myelopathy caused by intracranial dAVF. A 60-year-old man presented with a 3-year history of gait disturbance due to a progressive weakness of both legs. Neurological examination revealed spastic paraparesis (grade IV) and Babinski sign on both sides. Magnetic resonance imaging showed serpentine vascular signal voids at C2-T1 on T2-weighted image with increased signal intensity and swelling of spinal cord at C1-C4. We performed a brain computed tomography angiography and found intracranial dAVF with multiple arteriovenous shunts. Venous drainages were noted at tentorial veins and cervical perimedullary veins. After Onyx embolization, the patient showed gradual improvement in motor power and gait disturbance. The venous drainage pattern is a well-known prognostic factor of dAVF. In our case, the intracranial dAVF drained to spinal perimedullary vein, which seemed to result in the ischemic myelopathy. Although it is rare condition, it sometimes can cause serious complications. Therefore, we should keep in mind the possibility of intracranial dAVF when a patient presents myelopathy. PMID:27437016

  2. Langerhans cell histiocytosis causing cervical myelopathy in a child.

    Science.gov (United States)

    Jang, Kun Soo; Jung, Youn Young; Kim, Seok Won

    2010-06-01

    Langerhans cell histiocytosis (LCH), a disorder of the phagocytic system, is a rare condition. Moreover, spinal involvement causing myelopathy is even rare and unusual. Here, we report a case of atypical LCH causing myelopathy, which was subsequently treated by corpectemy and fusion. A 5-year-old boy presented with 3 weeks of severe neck pain and limited neck movement accompanying right arm motor weakness. CT scans revealed destruction of C7 body and magnetic resonance imaging showed a tumoral process at C7 with cord compression. Interbody fusion using cervical mesh packed by autologus iliac bone was performed. Pathological examination confirmed the diagnosis of LCH. After the surgery, the boy recovered from radiating pain and motor weakness of right arm. Despite the rarity of the LCH in the cervical spine, it is necessary to maintain our awareness of this condition. When neurologic deficits are present, operative treatment should be considered. PMID:20617093

  3. Electroneurography and electromyography for assessing the difference in euroelectrophysiological characteristics between patients with amyotrophic lateral sclerosis and those with cervical spondylotic myelopathy%神经电图与肌电图评估肌萎缩侧索硬化症与脊髓型颈椎病患者的神经电生理差异

    Institute of Scientific and Technical Information of China (English)

    王春芝; 丁卫江; 徐丽君

    2005-01-01

    BACKGROUND: The early symptoms of amyotrophic lateral sclerosis (ASL) are usually located at a certain part of the body, and are similar to the clinical manifestations of cervical spondylotic myelopathy (CSM). However, their treatment and prognosis differ greatly. Therefore, multiple-part electromyography and electroneurography possess an important value of reference, particularly electromyography of thoracic paraspinal muscles can be used as an objective parameter for differentiation between ASL and CSM.OBJECTIVE: To investigate the electrophysiological changes in ASL and CSM.DESIGN: A retrospective clinical analysis.SETTING: Neurological Department of Second Hospital Affiliated to Jiangxi Medical College.PARTICIPANTS: Totally 30 inpatients and outpatients with ASL and 30 patients with CSM were selected from the Neurological Department of the Second Hospital Affiliated to Jiangxi Medical College between December 2001 and November 2004.METHODS: Totally 30 inpatients and outpatients with ASL as well as 30 inpatients and outpatients with CSM were subjected to routine electromyographic and electroneurographic examination. Routine electromyography examining three limb muscles + sternocleidomastoid + thoracic paraspinal muscles intended to observe the spontaneous potential at resting stage, time limit and wave-amplitude of motor unit potential, and recruit-ment phase during energetic contraction. Electroneurography was used to detect motsr conduction velocity and sensory conduction velocity,as well as the terminal latency and wave-amplitude of motor evoked potential.limb muscles, sternocleidomastoid and thoracic paraspinal muscles in paASL and SCM.RESULTS: Data of all the 60 patients entered the final statistical analysis.in patients with ALS and CSM, and were more severe in the former. The abnormality rate of spontaneous potential of thoracic paraspinal muscles reached 93.3% (28/30) as compared to 3.3% (1/30) in patients with CSM (P < 0.001). The average time limit

  4. Development of a self-administered questionnaire to screen patients for cervical myelopathy

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    Sekiguchi Yasufumi

    2010-11-01

    Full Text Available Abstract Background In primary care, it is often difficult to diagnose cervical myelopathy. However, a delay in treatment could cause irreversible aftereffects. With a brief and effective self-administered questionnaire for cervical myelopathy, cervical myelopathy may be screened more easily and oversight may be avoided. As there is presently no screening tool for cervical myelopathy, the aim of this study was to develop a self-administered questionnaire for the screening of cervical myelopathy. Methods A case-control study was performed with the following two groups at our university hospital from February 2006 to September 2008. Sixty-two patients (48 men, 14 women with cervical myelopathy who underwent operative treatment were included in the myelopathy group. In the control group, 49 patients (20 men, 29 women with symptoms that could be distinguished from those of cervical myelopathy, such as numbness, pain in the upper extremities, and manual clumsiness, were included. The underlying conditions were diagnosed as carpal tunnel syndrome, cubital tunnel syndrome, thoracic outlet syndrome, tarsal tunnel syndrome, diabetes mellitus neuropathy, cervical radiculopathy, and neuralgic amyotrophy. Twenty items for a questionnaire in this study were chosen from the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire, which is a new self-administered questionnaire, as an outcome measure for patients with cervical myelopathy. Data were analyzed by univariate analysis using the chi-square test and by multiple logistic regression analysis. According to the resulting odds ratio, β-coefficients, and p value, items were chosen and assigned a score. Results Eight items were chosen by univariate and multiple logistic regression analyses and assigned a score. The Hosmer-Lemeshow statistic showed p = 0.805. The area under the receiver operation characteristic curve was 0.86. The developed questionnaire had a sensitivity of 93.5% and a

  5. Use of MRI in the diagnosis of cervical myelopathy

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    Nagase, Joji; Itahashi, Takashi; Yuyama, Takuo; Lee, Motohiro; Watanabe, Tsuneo; Inoue, Schun-ichi; Arimizu, Noboru; Uematsu, Sadao; Morita, Fuminori.

    1987-12-01

    Magnetic resonance imaging (MRI) was performed in 18 cases of cervical myelopathy. They were ''disc herniation'' 8 cases, ''canal stenosis'' 5 cases, and ''ossification of posterior longitudinal ligament (OPLL)'' 5 cases. The midsagittal section was obtained in each cases. The pulse sequence was Spin Echo (SE) technique with both T/sub 1/-weighted SE (Tr = 400, Te = 40) and T/sub 2/-weighted SE (Tr = 2000, Te = 80). Cervical-cord compression by herniated disc, yellow ligament, OPLL, or osteophyte was shown very clealy on the T/sub 1/-weighted image. Cord compression was increased by cervical extension and decreased by flexion. MRI was very useful in detecting the involved levels and in selecting the operative procedures. T/sub 2/-weighted image was taken in 9 cases. High signal intensity area was noted at the cord which was compressed in 7 cases. The true mechanism of this phenomenon is unknown yet, but this might be a clue to solve the pathogenesis of myelopathy. MRI was performed in 9 cases in order to evaluate post-operative cord decompression. Cord decompression was confirmed in 8 cases except for one case. MRI was also useful for postoperative evaluation.

  6. Comparison of anterior cervical discectomy and fusion and anterior cervical corpectomy and fusion for the treatment of multi-segmental cervical spondylotic myelopathy%前路椎间盘切除减压融合与椎体次全切除减压融合治疗多节段颈椎病疗效比较

    Institute of Scientific and Technical Information of China (English)

    吴畏; 朱天亮

    2014-01-01

    目的:比较前路椎间盘减压融合( ACDF)与前路椎体次全切除减压融合( ACCF)治疗多节段颈椎病的效果。方法将138例多节段脊髓型颈椎病患者按照治疗方式的不同分为观察组(行ACDF治疗)和对照组(行ACCF治疗),比较两组手术时间、术中出血量、术后住院时间、术前与术后6个月颈椎总活动度、颈椎曲度、颈椎节段性高度及JOA评分。结果手术时间:观察组(128.3±32.4)min,对照组(163.2±43.6)min;术中出血量:观察组(161.4±122.5)ml,对照组(319.2±308.7)ml;以上指标观察组均少于对照组(P0.05)。术后颈椎曲度:观察组23.5°±7.4°,对照组16.1°±7.2°;椎间节段性高度:观察组5.6°±0.4°,对照组4.7°±0.8°;以上指标两组比较差异有统计学意义(P0. 05 ) . Postoperative cervical curvature: the observation group was 23. 5° ± 7. 4°, the control group was 16. 1° ± 7. 2°;intervertebral segmental height:observation group was 5. 6° ± 0. 4°, the control group was 4. 7° ± 0. 8°; between these indicators there were statistically significant differences between groups ( P <0. 05 ) . Conclusions Compared with ACCF, ACDF has shorter operative time, less blood loss, cervical physiological curvature and height of intervertebral segment recovered well, but there is no statistically significant differences on postoperative hospital stay time, postoperative JOA score and cervical total activity.

  7. Comparação do Índice de Torg obtido por meio de radiografia e ressonância magnética nos pacientes com mielopatia cervical espondilótica Comparación del Índice de Torg, obtenido por medio de radiografía y resonancia, en los pacientes con mielopatía espondilótica cervical Comparison of the Torg Index obtained by radiography and magnetic resonance in patients with spondylotic cervical myelopathy

    Directory of Open Access Journals (Sweden)

    Alexandre de Oliveira Zam

    2012-01-01

    68,7 ± 5 Kg y altura de 1,68 ± 0,6 m. No hubo diferencias significativas entre el Índice de Torg calculado por la radiografía y el de la resonancia magnética, siendo menores los índices observados en la RM (radiografía: 0,73 ± 0,17 vs RM: 0,48 ± 0,14, p OBJECTIVE: Cervical spondylotic myelopathy (SCM is a dysfunction related to spinal cord degeneration typical of aging. In the imaging studies can achieve a measure of the Torg index to estimate cervical stenosis. We aim therefore to measure the Torg index in X-rays and Magnetic Resonance (MR, to investigate possible discrepancies between the methods of measurement. METHODS: The Torg Index was measured on radiographs and MR of the cervical spine, obtained by determining the relationship between the posterior surface of the vertebral body and the nearest point to the corresponding laminar line, divided by the sagittal diameter of vertebral body. RESULTS: A total 29 patients has participated, 10 women and 19 men, with mean age of 48.1 ± 11 years, weight 68.7 ± 5kg and height 1.68 ± 0.6m. There were significant differences between the Torg Index calculated by radiography and MR, and lower rates observed on MR (radiography: 0.73 ± 0.17 vs. RM: 0.48 ± 0.14, p <0.05. However, both measurements reflect the same result: absolute cervical stenosis (Torg index < 0.8. CONCLUSIONS: Our results confirm reports by other authors who believe that the Torg Index measured by radiography, as recommended, minimizes the actual cervical canal stenosis. Our study suggests that MRI allows better estimate of the degree of stenosis, although our results regarding the degree of cervical stenosis were statistically similar.

  8. Anterior Cervical Spinal Surgery for Multilevel Cervical Myelopathy.

    OpenAIRE

    Jung-Ju Huang; Lih-Huei Chen; Chi-Chien Niu; Tsai-Sheng Fu; Po-Liang Lai; Wen-Jer Chen

    2004-01-01

    Background: In multilevel spinal cord compression caused by cervical spondylosis, surgeonsface the choice of performing a posterior route as a laminectomy orlaminoplasty, or an anterior route as multiple adjacent interbody decompressionsor corpectomies. The anterior cervical operation is not considered bysome clinicians because of concerns about complications and the complexityof multilevel anterior cervical surgery.Methods: In this retrospective study, 14 patients with multilevel cervical sp...

  9. Cervical myelopathy due to single level disc herniation presenting as intramedullary mass lesion: What to do first?

    Science.gov (United States)

    Ekşi, Murat Şakir; Özcan Ekşi, Emel Ece; Yılmaz, Baran; Toktaş, Zafer Orkun; Konya, Deniz

    2015-01-01

    Cervical myelopathy (CM) is mostly a degenerative process ending in myelopathic and/or radiculopathic syndromes. On T2-weighted magnetic resonance imaging (MRI), CM appears as a hyperintense area near the spondylotic spine. This high intensity signal depends on the impact of outer forces and their duration. It also determines the prognosis of the surgical candidate. A 40-year-old male patient admitted to our clinic with right upper extremity weakness and hypoesthesia that had started 2 months earlier. On neurological examination there was 2/5 motor weakness of right biceps brachii, and hypoesthesia over right C6 dermatome. Right upper extremity deep tendon reflexes were hypoactive, but lower ones were hyperactive. After clinical and radiological work-up, preliminary diagnosis was directed to a spinal intramedullary tumor. Total resection of the herniated cervical disc fragment and the mass lesion was managed. Pathology of the mass lesion was compatible with subacute infarct tissue and inflammatory response. Final diagnosis was CM under effect of cervical disc herniation. Contrast-enhanced spinal cord myelopathic lesions are very rare and resemble much more tumors and inflammatory processes. However, the principal treatment approach totally differs depending on pathology. When there are both a disc herniation and a high clinical suspicion; biopsy should be delayed. The most probable solution will be surgery for the disc disease with thorough preoperative scanning of vascular malformations; clinical and radiological close follow-up after surgery. Biopsy or surgical resection can be performed if patient deteriorates despite the primary surgery. PMID:25972718

  10. Surface electromyography activity in the upper limbs of patients following surgery for compressive cervical myelopathy

    Directory of Open Access Journals (Sweden)

    Ananth P Abraham

    2015-01-01

    Conclusion: Surface EMG is an objective tool to detect improvement in spasticity following decompressive surgery for compressive cervical myelopathy even in those patients who showed no improvement on the MMAS.

  11. Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: a meta-analysis of clinical and radiological outcomes.

    Science.gov (United States)

    Lee, Chang-Hyun; Lee, Jaebong; Kang, James D; Hyun, Seung-Jae; Kim, Ki-Jeong; Jahng, Tae-Ahn; Kim, Hyun-Jib

    2015-06-01

    OBJECT Posterior cervical surgery, expansive laminoplasty (EL) or laminectomy followed by fusion (LF), is usually performed in patients with multilevel (≥ 3) cervical spondylotic myelopathy (CSM). However, the superiority of either of these techniques is still open to debate. The aim of this study was to compare clinical outcomes and postoperative kyphosis in patients undergoing EL versus LF by performing a meta-analysis. METHODS Included in the meta-analysis were all studies of EL versus LF in adults with multilevel CSM in MEDLINE (PubMed), EMBASE, and the Cochrane library. A random-effects model was applied to pool data using the mean difference (MD) for continuous outcomes, such as the Japanese Orthopaedic Association (JOA) grade, the cervical curvature index (CCI), and the visual analog scale (VAS) score for neck pain. RESULTS Seven studies comprising 302 and 290 patients treated with EL and LF, respectively, were included in the final analyses. Both treatment groups showed slight cervical lordosis and moderate neck pain in the baseline state. Both groups were similarly improved in JOA grade (MD 0.09, 95% CI -0.37 to 0.54, p = 0.07) and neck pain VAS score (MD -0.33, 95% CI -1.50 to 0.84, p = 0.58). Both groups evenly lost cervical lordosis. In the LF group lordosis seemed to be preserved in long-term follow-up studies, although the difference between the 2 treatment groups was not statistically significant. CONCLUSIONS Both EL and LF lead to clinical improvement and loss of lordosis evenly. There is no evidence to support EL over LF in the treatment of multilevel CSM. Any superiority between EL and LF remains in question, although the LF group shows favorable long-term results. PMID:25815808

  12. Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: a meta-analysis of clinical and radiological outcomes.

    Science.gov (United States)

    Lee, Chang-Hyun; Lee, Jaebong; Kang, James D; Hyun, Seung-Jae; Kim, Ki-Jeong; Jahng, Tae-Ahn; Kim, Hyun-Jib

    2015-06-01

    OBJECT Posterior cervical surgery, expansive laminoplasty (EL) or laminectomy followed by fusion (LF), is usually performed in patients with multilevel (≥ 3) cervical spondylotic myelopathy (CSM). However, the superiority of either of these techniques is still open to debate. The aim of this study was to compare clinical outcomes and postoperative kyphosis in patients undergoing EL versus LF by performing a meta-analysis. METHODS Included in the meta-analysis were all studies of EL versus LF in adults with multilevel CSM in MEDLINE (PubMed), EMBASE, and the Cochrane library. A random-effects model was applied to pool data using the mean difference (MD) for continuous outcomes, such as the Japanese Orthopaedic Association (JOA) grade, the cervical curvature index (CCI), and the visual analog scale (VAS) score for neck pain. RESULTS Seven studies comprising 302 and 290 patients treated with EL and LF, respectively, were included in the final analyses. Both treatment groups showed slight cervical lordosis and moderate neck pain in the baseline state. Both groups were similarly improved in JOA grade (MD 0.09, 95% CI -0.37 to 0.54, p = 0.07) and neck pain VAS score (MD -0.33, 95% CI -1.50 to 0.84, p = 0.58). Both groups evenly lost cervical lordosis. In the LF group lordosis seemed to be preserved in long-term follow-up studies, although the difference between the 2 treatment groups was not statistically significant. CONCLUSIONS Both EL and LF lead to clinical improvement and loss of lordosis evenly. There is no evidence to support EL over LF in the treatment of multilevel CSM. Any superiority between EL and LF remains in question, although the LF group shows favorable long-term results.

  13. Commentary on article: Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: A meta-analysis of clinical and radiological outcomes by Chang-Hyun Lee et al

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2015-01-01

    Full Text Available Background: This is a commentary on the article laminoplasty versus laminectomy and fusion (LF for multilevel cervical myelopathy: A meta-analysis of clinical and radiological outcomes by Chang-Hyun Lee et al. Here, the authors utilized seven studies to compare the efficacy of cervical expansive laminoplasty (EL versus laminectomy and fusion (LF to address three or more level multilevel cervical spondylotic myelopathy (CSM. Both procedures led to similar degrees of neurological recovery and short-term loss of lordosis, but found that LF led to more favorable long-term results. Methods: For patients with three or more level CSM, laminectomy followed by an instrumented fusion (LF has major advantages; open bilateral decompression of the nerve roots, while minimizing the risk of inadvertent injury to the cord, and the fusion′s maintenance of lordosis. Results: Some would argue that inadvertent cord/root injury is greater utilizing any of the EL techniques; e.g., unilateral, bilateral, or spinous process splitting techniques. In short, why risk cord/root injury by manipulating the compressive posterior/posterolateral elements, which are already threatening neural function. Conclusion: Although the results of EL versus LF appeared comparable in the short-term in these seven articles, LF resulted in better long-term outcomes. Some would also argue that LF, utilizing an open approach offers safer bilateral neural exposure and decompression.

  14. POST - OPERATIVE NEUROLOGICAL RECOVERY PATTERN IN DEGENERATIVE CERVICAL MYELOPATHY AND RADICULOPATHY

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    Raju B

    2015-07-01

    Full Text Available OBJECTIVE : To study the neurological recovery pattern and clinical recovery after surgical intervention in patients of degenerative cervical myelopathy and radiculopathy to know the surgical outcome, at L okmanya T ilak M unicipal M edical C ollege , Mumbai, Maharashtra . METHOD : We ca rried out prospective and retrospective observational study of 30 patients with functional disability secondary to cervical degenerative myelopathy and radiculopathy who underwent surgery for decompression of the cervical spinal cord with or without spinal stabilization. March 2012 to March 2013 were studied and followed for more than 1year. All patients were operated by a single surgeon and reviewed independently. All the patients had received appropriate conservative management before undergoing surgical intervention . Data was analysed by using appropriate software. RESULTS : The study group comprised of 27 males and 3 females aged between 36 and 75 years with a mean age of 56 years that presented with functional disability secondary to cervical myelopathy and radiculopathy. Pain and neurological examination were used as criteria at sequential follow – ups. Functional outcome was assessed using Japanese Orthopaedic Association score, Oswestry Disability Index and Visual Analogue Scale. It was found that neuro logical recovery for myelopathy by mJOA score at intervals between 15 days to 3 months was significant after which recovery was occurring but was not significant. Anterior cervical discectomy with fusion for 1 - 2 levels has given good results than posterior laminectomy for 3 or more levels. Cervical radiculopathy alone has good recovery results after decompression surgery than myelopathy or myelopathy with radiculopathy. CONCLUSION: Based on this study, we found that the results of surgery for cervical spon dylotic myelopathy and radiculopathy are excellent. The best neurological and functional recovery is seen in patients with mild to moderate

  15. Modified steel basket technique for the treatment of equine cervical vertebral stenotic myelopathy - a case report

    OpenAIRE

    Frederico Fernandes Araújo; Monalisa Lukascek Castro; Luciane Laskoski; Mariana Pavelski; Ivan Deconto; Peterson Triches Dornbusch

    2015-01-01

    Cervical vertebral stenotic myelopathy (CVSM), also known as cervical ataxia or wobbler syndrome, is caused by the narrowing of the medullary canal due to a malformation of the cervical vertebrae, resulting in compression of the spinal cord and neurological alterations such as ataxia, hypermetria, weakness, and abnormal stance. The treatment options can be conservative or surgical, with varied effectiveness. The most appropriate surgical technique in the majority of cases is arthrodesis, prov...

  16. Cervical myelopathy due to single level disc herniation presenting as intramedullary mass lesion: What to do first?

    Directory of Open Access Journals (Sweden)

    Murat Sakir Eksi

    2015-01-01

    Full Text Available Cervical myelopathy (CM is mostly a degenerative process ending in myelopathic and/or radiculopathic syndromes. On T2-weighted magnetic resonance imaging (MRI, CM appears as a hyperintense area near the spondylotic spine. This high intensity signal depends on the impact of outer forces and their duration. It also determines the prognosis of the surgical candidate. A 40-year-old male patient admitted to our clinic with right upper extremity weakness and hypoesthesia that had started 2 months earlier. On neurological examination there was 2/5 motor weakness of right biceps brachii, and hypoesthesia over right C6 dermatome. Right upper extremity deep tendon reflexes were hypoactive, but lower ones were hyperactive. After clinical and radiological work-up, preliminary diagnosis was directed to a spinal intramedullary tumor. Total resection of the herniated cervical disc fragment and the mass lesion was managed. Pathology of the mass lesion was compatible with subacute infarct tissue and inflammatory response. Final diagnosis was CM under effect of cervical disc herniation. Contrast-enhanced spinal cord myelopathic lesions are very rare and resemble much more tumors and inflammatory processes. However, the principal treatment approach totally differs depending on pathology. When there are both a disc herniation and a high clinical suspicion; biopsy should be delayed. The most probable solution will be surgery for the disc disease with thorough preoperative scanning of vascular malformations; clinical and radiological close follow-up after surgery. Biopsy or surgical resection can be performed if patient deteriorates despite the primary surgery.

  17. Comparative evaluation of surgical alternatives in the treatment of acute cervical myelopathy and in the decompression of cervical spinal canal

    OpenAIRE

    Gábor Czigléczki; Zoltán Papp; Csaba Padányi; Péter Banczerowski

    2014-01-01

    Symptoms of cervical myelopathy are caused by the compression of the cervical spinal cord in the narrowed spinal canal. Several techniques including less invasive and minimally invasive methods have been developed with the aim of decompressing the cervical spinal canal, preserving posterior motion segments and paraspinal muscles as much as possible, reducing iatrogenic consequences and promoting faster recoveries of patients. The purpose of this article is to summarize these procedures and ev...

  18. Different decompressions and internal fixations for treating multilevel cervical spondylotic myelopathy: Effect of magnetic resonance image on measuring the sagittal diameter of dural sac and evaluating the recovery rate%不同减压植骨及内固定方式治疗多节段脊髓型颈椎病:MRI测量硬脊膜囊矢状径及膨胀恢复率的疗效评价

    Institute of Scientific and Technical Information of China (English)

    胡朝晖; 李兵; 李龙; 李康华; 陈雷

    2007-01-01

    BACKGROUND: Compression occurs in several horizontal spinal cords of patients with multilevel cervical spondylotic myelopathy (CSM), especially compression is attacked on both ends of spinal cord. Therefore, there are so many choices of approach and way for operation. However, which approach and way have good effects and few complications is still controversial up to now.OBJECTIVE: To observe the therapeutic effect of anterior multilevel decompression and internal fixation on multilevel CSM and compare with posterior mono-open-door vertebral canal expanding laminoplasty.DESIGN: Contrast analysis.SETTING: Department of Orthopaedics, Xiangya Hospital of South China University; Department of Orthopaedics, People's Hospital of Liuzhou.PARTICIPANTS: A total of 68 patients with multilevel CSM were selected from the Department of Orthopaedics, Xiangya Hospital of South China University from January 2000 to June 2005. All patients were divided into anterior approach surgery group (n =33) and posterior approach surgery group (n =35). Baseline data between the two groups were comparable.METHODS:①Anterior approach surgery group: All 33 patients received bone-transplanting and internal fixation through cervical spine. Among them, auto-iliac bone-graft was transplanted into 17 cases, Cage auto-bone graft combining with allogenic bone was transplanted into 11 cases, and titan-net and auto-bone combining with allogenic bone was transplanted into 5 cases. In addition, long segments were dealt with internal fixation of anterior cervical spine locking plate (CSLP). Among them, 12 cases used Orion plate, 13 cased used Zephir palte, and 8 cases used Codman plate. ②Posterior approach surgery group: Fifteen patients received total laminectomy for decompression and other twenty patients received mono-open-door vertebral canal expanding laminoplasty. After laminoplasty, all patients received negative pressure and neck support fixation for three months.MAIN OUTCOME MEASURES:

  19. Clinical efficacy of responsibility segment laminectomy and lateral mass screw fixation in the treatment of patients with cervical spondylotic myelopathy (CSM) combined with ossification of posterior longitudinal ligament (OPLL)%责任节段椎板全切侧块螺钉内固定术治疗伴后纵韧带骨化症的多节段颈椎病疗效分析

    Institute of Scientific and Technical Information of China (English)

    陈华星; 杨圣; 芦健民; 李树强; 邱兴; 廉皓屹; 付大鹏

    2013-01-01

    [目的]探讨责任节段椎板全切侧块螺钉内固定术治疗伴后纵韧带骨化症的多节段颈椎病的临床疗效.[方法]回顾性分析2007年5月~ 2010年10月手术治疗的多节段颈椎病伴后纵韧带骨化症表现的患者61例,所选多节段病例中(≥3),3个节段50例,4个节段11例.分别采用前后路两种术式,都在显微镜辅助下操作,其中颈后路责任节段椎板全切除侧块螺钉内固定术47例(A组),颈前路椎体次全切钛网植骨融合钛板内固定术14例(B组),分别记录两组手术前后JOA评分及轴性症状VAS评分,加以评定两组术后神经功能改善率(RIS)情况,通过对比分析责任节段椎板全切侧块螺钉内固定术的临床疗效.[结果] 61例患者均获得随访,随访时间在6~38个月,平均16个月.A组的JOA和VAS评分术前分别为(7.2±1.5)、(6.8±2.1)分;术后1周分别为(13.2±2.4)、(2.5±1.4)分;末次随访分别为(13.7±1.8)、(2.3±2.0)分;RIS为(59.92±13.46)%.B组术前JOA和VAS评分分别为(7.5±1.3)、(7.1±2.4)分;术后1周分别为(13.8±2.1)、(2.3±1.5)分;末次随访分别为(14.1±1.6)、(2.2±1.8)分;RIS为(62.28±14.16)%.A组、B组术后1周、末次随访JOA和VAS评分与术前比较均有显著性差异(P<0.05),两组间的术前JOA、VAS评分及术后RIS无统计学差异(P>0.05).[结论]颈前、后路治疗伴后纵韧带骨化症的多节段颈椎病均取得良好的手术疗效,少节段局灶性后纵韧带骨化应以前路为主,对于多节段连续性后纵韧带骨化尤其椎管明显狭窄者,后路责任节段椎板全切侧块螺钉内固定术在有效改善神经功能、轴性症状的同时兼顾了良好的脊柱稳定性,是一种相对安全灵活、使用范围较广的术式.%[ Objective] To observe the clinical outcome of responsibility segment laminectomy and lateral mass screw fixation in the treatment of cervical spondylotic myelopathy (CSM) combined with ossification of

  20. Langerhans Cell Histiocytosis Causing Cervical Myelopathy in a Child

    OpenAIRE

    Jang, Kun Soo; Jung, Youn Young; Kim, Seok Won

    2010-01-01

    Langerhans cell histiocytosis (LCH), a disorder of the phagocytic system, is a rare condition. Moreover, spinal involvement causing myelopathy is even rare and unusual. Here, we report a case of atypical LCH causing myelopathy, which was subsequently treated by corpectemy and fusion. A 5-year-old boy presented with 3 weeks of severe neck pain and limited neck movement accompanying right arm motor weakness. CT scans revealed destruction of C7 body and magnetic resonance imaging showed a tumora...

  1. POST - OPERATIVE NEUROLOGICAL RECOVERY PATTERN IN DEGENERATIVE CERVICAL MYELOPATHY AND RADICULOPATHY

    OpenAIRE

    Raju B; Arvind B; Anuraag G

    2015-01-01

    OBJECTIVE : To study the neurological recovery pattern and clinical recovery after surgical intervention in patients of degenerative cervical myelopathy and radiculopathy to know the surgical outcome, at L okmanya T ilak M unicipal M edical C ollege , Mumbai, Maharashtra . METHOD : We ca rried out prospective and retrospective observational ...

  2. 1H-NMR studies of cerebrospinal fluid: endogenous ethanol in patients with cervical myelopathy.

    Science.gov (United States)

    Meshitsuka, S; Morio, Y; Nagashima, H; Teshima, R

    2001-10-01

    Endogenous ethanol was observed by nuclear magnetic resonance spectroscopy in the course of screening for cerebrospinal fluid of the patients with cervical myelopathy. Ethanol was detected in 10 out of 20 patients. It seems likely that the presence of endogenous ethanol is related to the severity of myelopathy. Also, the concentration of ethanol was correlated with that of lactate in the cerebrospinal fluid. This implies that ethanol may be formed as the end product of glycolysis or in an unknown pathway in the case of severely insulted myelonic tissues.

  3. Clinical Observation 0n Treatment of Cervical Spondylotic Radiculopathy with Combined Electroacupuncture Tuina and Traction

    Institute of Scientific and Technical Information of China (English)

    华宇

    2009-01-01

    目的:观察电针、推拿结合牵引治疗神经根型颈椎病的临床疗效.方法:将120例患者根据初诊时间,按随机数字表随机分为治疗组60例,采用电针、推拿结合牵引治疗;对照组60例,采用电针、推拿治疗,两组均每天治疗1次,5次为1个疗程,疗程间休息2 d,治疗6个疗程后评价疗效.结果:治疗组总有效率及治愈率分别为93.3%和61.7%,对照组为78.3%和31.7%,两组总有效率、治愈率比较,差异有统计学意义.结论:电针、推拿、牵引三者结合治疗神经根型颈椎病疗效较好.%Objective:To observe the clinical effect of combined electroacupuncture,tuina and traction treating cervical spondylotic radiculopathy.Method:Depending on the orders of the patient's first visit,120 cases were randomized into a treatment group (60 cases),receiving electroacupuncture,tuina and traction treatment,and a control group (60 cases),receiving electroacupuncture and tuina treatment.The treatment was done once a day,and 5 times constitute one course of treatment.A 2-day interval is set between the courses.The therapeutic effect was evaluated after 6 courses of treatment.Result:The total effective rate and recovery rate in the treatment group were 93.3% and 61.7%,respectively,whereas that of the control group were 78.3% and 31.7%,respectively,showing a significant statistical difference.Conclusion:Combined acupuncture,tuina and traction worked well for cervical spondylotic radiculopathy.

  4. Functional assessment of patients with cervical myelopathy who underwent surgical treatment

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    Thiago Pereira Coutinho

    2014-03-01

    Full Text Available OBJECTIVE: Evaluate and correlate the functional response of patients with cervical myelopathy with the current clinical scores in patients who underwent surgical treatment. METHODS: We analyzed medical records of 34 patients with cervical myelopathy who underwent four different types of surgery. All patients were evaluated preoperatively and postoperatively with the application of the JOA and Nurick questionnaires. RESULTS: Functional clinical improvement was statistically significant. The mean preoperative JOA was 8.5 ± 3.06 and 10.7 ± 3.9 in the postoperative; Nurick was 3.2 ± 1.1 preoperatively and 2.8 ± 1.3 postoperatively. CONCLUSION: There is benefit with the surgical procedure in patients with cervical myelopathy. The neurological function after surgery depends on the previous function (the higher the duration of the previous symptoms, the greater the progression of the disease and, therefore, worse the neurological function and the age is not a relevant factor of improvement, as already shown in other series. The clinical functional improvement of patients is visible with surgical treatment, regardless of surgical technique.

  5. Effect of Anterior Cervical Discectomy and Fusion on Patients with Atypical Symptoms Related to Cervical Spondylosis.

    Science.gov (United States)

    Muheremu, Aikeremujiang; Sun, Yuqing; Yan, Kai; Yu, Jie; Zheng, Shan; Tian, Wei

    2016-09-01

    Background A considerable number of patients with cervical spondylosis complain about one or multiple atypical symptoms such as vertigo, palpitations, headache, blurred vision, hypomnesia, and/or nausea. It remains unclear whether surgical intervention for cervical spondylosis can also effectively alleviate those symptoms. The current study was performed to see if anterior cervical diskectomy and fusion (ACDF) offers such an extra benefit for patients with cervical spondylosis. Objective To investigate if patients who received ACDF for the treatment of cervical spondylotic myelopathy and/or radiculopathy can also achieve alleviation of certain atypical symptoms associated with cervical spondylosis after the surgery in the long run. Methods Sixty-seven patients who underwent ACDF for the treatment of cervical spondylotic myelopathy and/or radiculopathy were involved in this study. All these patients also complained about various associated atypical symptoms. They were followed up for 26 to 145 months after the surgery. Severity and frequency scores of the atypical symptoms before the surgery and at last follow-up were compared by paired t tests. Results Most patients reported significantly alleviated symptoms at the last follow-up compared with before the surgery. The severity of vertigo, headache, nausea, and palpitations were significantly alleviated at the last follow-up (with p values of p cervical spondylotic myelopathy and/or radiculopathy, but it is not effective in alleviating symptoms such as tinnitus, blurred vision, and hypomnesia. It can be considered for alleviating atypical symptoms when other treatment options prove ineffective. PMID:27168319

  6. A wake up call for cervical spondylotic myelopathy in young age: a case report

    Institute of Scientific and Technical Information of China (English)

    Krishna kumar.A; XU Xiao-feng; CUI Xue-wen; SUN Bing-wei; Deepa balachandran

    2010-01-01

    A 30 yrs male, was admitted with complains of neck pain, weakness in both upper and lower limbs for four months and mild intermittent paresthesia along his upper limbs. Physical examination showed mild sensory deficit along the lateral aspect of the upper limbs including paresthesia in the 3rd, 4th and 5th digits. Gait was normal with lower limb muscle weakness and negative babinski sign. The bowel and bladder was normal.

  7. Laminoplasty Techniques for the Treatment of Multilevel Cervical Stenosis

    Directory of Open Access Journals (Sweden)

    Lance K. Mitsunaga

    2012-01-01

    Full Text Available Laminoplasty is one surgical option for cervical spondylotic myelopathy. It was developed to avoid the significant risk of complications associated with alternative surgical options such as anterior decompression and fusion and laminectomy with or without posterior fusion. Various laminoplasty techniques have been described. All of these variations are designed to reposition the laminae and expand the spinal canal while retaining the dorsal elements to protect the dura from scar formation and to preserve postoperative cervical stability and alignment. With the right surgical indications, reliable results can be expected with laminoplasty in treating patients with multilevel cervical myelopathy.

  8. Comparative evaluation of surgical alternatives in the treatment of acute cervical myelopathy and in the decompression of cervical spinal canal

    Directory of Open Access Journals (Sweden)

    Gábor Czigléczki

    2014-01-01

    Full Text Available Symptoms of cervical myelopathy are caused by the compression of the cervical spinal cord in the narrowed spinal canal. Several techniques including less invasive and minimally invasive methods have been developed with the aim of decompressing the cervical spinal canal, preserving posterior motion segments and paraspinal muscles as much as possible, reducing iatrogenic consequences and promoting faster recoveries of patients. The purpose of this article is to summarize these procedures and evaluate their efficacy with comparing them to each other. The applicable methods are presented shortly but the differences between them are discussed in details. Comprehensive examination did not reveal the proven superiority of any techniques and in most cases the less invasive or minimally invasive treatment choices should be individually determined, considering the location and extension of pathology and the familiarity of surgeon with techniques.

  9. MR venography in cervical myelopathy before and after direct skull traction

    International Nuclear Information System (INIS)

    MR venography (MRV) was performed to evaluate the anterior cervical venous plexuses in five normal volunteers and eight patients with cervical myelopathy before and after direct skull traction. Visibility of the plexuses from C2 to C7 was evaluated and scored by five observers in those groups. The venography was performed with FISP sequences (fast imaging with steady state precession) and with the injection of Gd-derivatives. The MRV was obtained after maximum-intensity projection and 3D reconstruction. In the normal volunteers, the internal vertebral plexus (IVP), intervertebral vein (IV) and anastomotic vein (AV) were all well demonstrated. In the patients, those plexuses were less well demonstrated in comparison with the normal volunteer, particularly in C5 which is the most frequently affected area. The patient group had lower scores than the normal group. However, the score at C5 was not lower than those at non-affected sites. After treatment, MRV demonstrated those plexuses better in some cases of cervical myelopathy; although this was not evaluated statistically. (author)

  10. MR venography in cervical myelopathy before and after direct skull traction

    Energy Technology Data Exchange (ETDEWEB)

    Sekiguchi, Akira; Enomoto, Kyoko; Kato, Hiroshi [Saitama Medical School, Moroyama (Japan)

    1999-01-01

    MR venography (MRV) was performed to evaluate the anterior cervical venous plexuses in five normal volunteers and eight patients with cervical myelopathy before and after direct skull traction. Visibility of the plexuses from C2 to C7 was evaluated and scored by five observers in those groups. The venography was performed with FISP sequences (fast imaging with steady state precession) and with the injection of Gd-derivatives. The MRV was obtained after maximum-intensity projection and 3D reconstruction. In the normal volunteers, the internal vertebral plexus (IVP), intervertebral vein (IV) and anastomotic vein (AV) were all well demonstrated. In the patients, those plexuses were less well demonstrated in comparison with the normal volunteer, particularly in C5 which is the most frequently affected area. The patient group had lower scores than the normal group. However, the score at C5 was not lower than those at non-affected sites. After treatment, MRV demonstrated those plexuses better in some cases of cervical myelopathy; although this was not evaluated statistically. (author)

  11. Correlation between magnetic resonance T2 image signal intensity ratio and cell apoptosis in a rabbit spinal cord cervical myelopathy model

    Institute of Scientific and Technical Information of China (English)

    Ma Lei; Zhang Di; Chen Wei; Shen Yong; Zhang Yingze; Ding Wenyuan; Zhang Wei

    2014-01-01

    Background Cervical spondylotic myelopathy (CSM) is a common cause of disability in elderly patients.Previous studies have shown that spinal cord cell apoptosis due to spinal cord compression plays an important role in the pathology of myelopathy.Although changes in magnetic resonance imaging (MRI) T2 signal intensity ratio (SIR) are considered to be an indicator of CSM,little information is published supporting the correlation between changes in MRI signal and pathological changes.This study aims to testify the correlation between MRI T2 SIR changes and cell apoptosis using a CSM animal model.Methods Forty-eight rabbits were randomly assigned to four groups:one control group and three experimental chronic compression groups,with each group containing 12 animals.Chronic compression of the cervical spinal cord was implemented in the experimental groups by implanting a screw in the C3 vertebra.The control group underwent sham surgery.Experimental groups were observed for 3,6,or 9 months after surgery.MRI T2-weighted SIR Tarlov motor scores and cortical somatosensory-evoked potentials (CSEPs) were periodically monitored.At each time point,rabbits from one group were sacrificed to determine the level of apoptosis by histology (n=6) and Western blotting (n=6).Results Tarlov motor scores in the compression groups were lower at all time points than the control group scores,with the lowest score at 9 months (P <0.001).Electrophysiological testing showed a significantly prolonged latency in CSEP in the compression groups compared with the control group.All rabbits in the compression groups showed higher MRI T2 SIR in the injury epicenter compared with controls,and higher SIR was also found at 9 months compared with 3 or 6 months.Histological analysis showed significant apoptosis in the spinal cord tissue in the compression groups,but not in the control group.There were significant differences in apoptosis degree over time (P <0.001),with the 9-month group displaying the

  12. Prediction of surgical outcome in compressive cervical myelopathy: A novel clinicoradiological prognostic score

    Directory of Open Access Journals (Sweden)

    Rishi Anil Aggarwal

    2016-01-01

    Full Text Available Context: Preoperative severity of myelopathy, age, and duration of symptoms have been shown to be highly predictive of the outcome in compressive cervical myelopathy (CCM. The role of radiological parameters is still controversial. Aims: Define the prognostic factors in CCM and formulate a prognostic score to predict the outcome following surgery in CCM. Settings and Design: Retrospective. Materials and Methods: This study included 78 consecutive patients with CCM treated surgically. The modified Japanese Orthopaedic Association (mJOA scale was used to quantify severity of myelopathy at admission and at 12-month follow-up. The outcome was defined as "good" if the patient had mJOA score ≥16 and "poor" if the score was <16. Age, sex, duration of symptoms, comorbidities, intrinsic hand muscle wasting (IHMW, diagnosis, surgical technique, Torg ratio, instability on dynamic radiographs, and magnetic resonance imaging (MRI signal intensity changes were assessed. Statistics: Statistical Package for the Social Sciences (SPSS (version 20.0 was used for statistical analysis. The association was assessed amongst variables using logistic regression analysis. Parameters having a statistically significant correlation with the outcome were included in formulating a prognostic score. Results: Severity of myelopathy, IHMW, age, duration, diabetes, and instability on radiographs were predictive of the outcome with a P value <0.01. Genders, diagnosis, surgical procedure, Torg ratio, and intensity changes on MRI were not significantly related to the outcome. A 8-point scoring system was devised incorporating the significant clinicoradiological parameters, and it was found that nearly all patients (97.82% with a score below 5 had good outcome and all patients (100% with a score above 5 had poor outcome. The outcome is difficult to predict with a score of 5. Conclusions: Clinical parameters are better predictors of the outcome as compared to radiological findings

  13. Prediction of prognosis in cervical myelopathy by MRI

    Energy Technology Data Exchange (ETDEWEB)

    Matsuyama, Yukihiro; Sato, Koji; Iwata, Hisashi; Kameyama, Takashi [Nagoya Univ. (Japan). School of Medicine; Kawakami, Noriaki; Hashizume, Yoshio

    1998-04-01

    In this study, 44 patients with the ossification of posterior longitudinal ligament, 34 men and 10 women, ranging in age from 38 to 76 years (mean 61) were investigated. They were classified into three categories by the cervical MRI sectional image, Boomerang-type, Triangle-type and Tear-drop-type, and the relationship between these three types and clinical symptom or the results of the surgery was examined. The patients in the Triangle-type were suffered for long term and had many lesions extended over whole interspines. As a result, their spinal cords were in the decrease in the cervical cross-sectional area, so-called in atrophy, and was not expected to improve cross-sectional area or the symptom even in postoperation. On the other hand, the Boomerang-type and the Tear-drop-type were suffered for relatively short term, had the lesion on single spine and were expected, in the excellent reversibility, to improve the cross-sectional area of the spinal cord and the symptom. (K.H.)

  14. Two Cases of Klippel-Feil Syndrome with Cervical Myelopathy Successfully Treated by Simple Decompression without Fixation

    OpenAIRE

    Kim, Jin Bum; Park, Seung Won; Lee, Young Seok; Nam, Taek Kyun; Park, Yong Sook; Kim, Young Baeg

    2015-01-01

    Klippel-Feil syndrome (KFS) is a congenital developmental disorder of cervical spine, showing short neck with restricted neck motion, low hairline, and high thoracic cage due to multilevel cervical fusion. Radiculopathy or myelopathy can be accompanied. There were 2 patients who were diagnosed as KFS with exhibited radiological and physical characteristics. Both patients had stenosis and cord compression at C1 level due to anterior displacement of C1 posterior arch secondary to kyphotic defor...

  15. Electrophysiological and MRI study on poor outcome after surgery for cervical myelopathy

    Energy Technology Data Exchange (ETDEWEB)

    Kameyama, Osamu; Kawakita, Hirofumi; Ogawa, Ryokei [Kansai Medical Univ., Moriguchi, Osaka (Japan)

    1995-11-01

    Occasionally, the outcome from laminoplasty for cervical spondylosis is disappointing despite an adequate operation. Before surgery, it is difficult to diagnose the pathological extent of the involvement of the spinal cord. The purpose of this study is to determine the efficacy of magnetic resonance imaging (MRI) and of the motor evoked potentials (MEPs) for the indication of the surgery and prognosis. Retrospectively, we investigated the MEPs and the MRI of 31 patients in surgery for cervical myelopathy, involving 21 with cervical spondylosis and 10 with ossification of the posterior longitudinal ligamentum, and compared the findings from those with a poor outcome (n=3l) with the findings from those with a good outcome (n=32). The MEPs from the thenar muscle and the tibialis anterior were evoked by transcranial magnetic brain stimulation. In the poor-outcome patients, the spinal canal was narrow and lumbar spinal canal stenosis was seen in 5 cases which required lumbar laminectomy. Before operation, the MEPs from the thenar muscle could not be evoked in 5 cases while there was a remarkably prolonged central motor conduction time in the other 26 cases. MRI revealed the deformed spinal cord in the involved area, and the signal intensity of the involved spinal cord in the T2 weighted image was remarkably high. The signal intensity ratio was significantly higher in the poor-outcome patients than in the good-outcome patients. This study suggested that a high signal intensity in the T2 weighted image and a prolonged conduction time or absence of MEPs largely corresponded to the clinical and other investigative features of myelopathy responsible for a poor outcome. (author).

  16. Lift-up laminoplasty for myelopathy caused by ossification of the posterior longitudinal ligament of the cervical spine

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    Takami T

    2004-01-01

    Full Text Available Background and Aims: We have utilized lift-up laminoplasty to treat patients with myelopathy caused by ossification of the posterior longitudinal ligament (OPLL of the cervical spine. The preliminary surgical outcome with computer-assisted morphological assessment is presented. Material and Methods: The surgical technique of lift-up laminoplasty includes standard posterior exposure of the cervical spine, en-bloc laminectomy, and expansion of the cervical canal by lift-up of the laminae with custom-designed hydroxyapatite laminar spacers and stabilization of the laminae using titanium miniplates. From 1998 to 2003, 10 consecutive patients with cervical myelopathy secondary to OPLL have been treated with this method and comprehensively evaluated. Care was taken to tailor the treatment to individual patients by using different sizes of spacers to adjust the degree of expansion depending on the amount of stenosis of the cervical spine. The degree of expansion of the cervical canal was altered by design, based on the preoperative imaging simulation. Results: Preliminary surgical outcome, evaluated at 6 months after surgery, revealed a significant improvement of neurological function. Image analysis revealed that the cervical canals were significantly expanded, with a mean reduction of 13.1% in the stenosis ratio. Lift-up laminoplasty was effective in the treatment of patients with myelopathy secondary to cervical OPLL, and the amount of expansion could be individually adjusted at the discretion of the surgeon. Conclusion: Although analysis with a larger population and a longer follow-up period needs to be undertaken, our method of lift-up laminoplasty appears to be a viable choice among standard posterior cervical approaches for cervical OPLL.

  17. Intra- and inter-observer reliability of MRI examination of intervertebral disc abnormalities in patients with cervical myelopathy

    Energy Technology Data Exchange (ETDEWEB)

    Braga-Baiak, Andresa [Center for Excellence in Surgical Outcomes, Duke University Medical Center, Durham, NC (United States); Post-graduation Program, Department of Radiology, University of Sao Paulo (Brazil); Shah, Anand [Center for Excellence in Surgical Outcomes, Duke University Medical Center, Durham, NC (United States); Pietrobon, Ricardo [Center for Excellence in Surgical Outcomes, Duke University Medical Center, Durham, NC (United States); Department of Surgery, Duke University Medical Center, Durham, NC (United States); Braga, Larissa [Center for Excellence in Surgical Outcomes, Duke University Medical Center, Durham, NC (United States); University of Nebraska Medical Center, Lincoln NE (United States); Neto, Arnolfo Carvalho [Clinica DAPI, Curitiba (Brazil); Section of Diagnostic Radiology, Department of Internal Medicine, Universidade Federal do Parana (Brazil); Cook, Chad [Center for Excellence in Surgical Outcomes, Duke University Medical Center, Durham, NC (United States); Division of Physical Therapy, Duke University Medical Center, Durham, NC (United States)], E-mail: chad.cook@duke.edu

    2008-01-15

    Purpose: Intervertebral cervical disc herniation (CDH) is a relatively common disorder that can coexist with degenerative changes to worsen cervicogenic myelopathy. Despite the frequent disc abnormalities found in asymptomatic populations, magnetic resonance imaging (MRI) is considered excellent at detecting cervical spine myelopathy (CSM) associated with disc abnormality. The objective of this study was to investigate the intra- and inter-observer reliability of MRI detection of CSM in subjects who also had co-existing intervertebral disc abnormalities. Materials and methods: Seven experienced radiologists reviewed twice the MRI of 10 patients with clinically and/or imaging determined myelopathy. MRI assessment was performed individually, with and without operational guidelines. A Fleiss Kappa statistic was used to evaluate the intra- and inter-observer agreement. Results: The study found high intra-observer percent agreement but relatively low Kappa values on selected variables. Inter-observer reliability was also low and neither observation was improved with operational guidelines. We believe that those low values may be associated with the base rate problem of Kappa. Conclusion: In conclusion, this study demonstrated high intra-observer percent agreement in MR examination for intervertebral disc abnormalities in patients with underlying cervical myelopathy, but differing levels of intra- and inter-observer Kappa agreement among seven radiologists.

  18. Recurrence of cervical myelopathy secondary to a strut graft fracture 20 years after anterior decompression and fusion: a case report.

    Science.gov (United States)

    Kida, Kazunobu; Takaya, Shogo; Tadokoro, Nobuaki; Kumon, Masashi; Kiyasu, Katsuhito; Kato, Tomonari; Takemasa, Ryuichi; Ikeuchi, Masahiko; Tani, Toshikazu

    2015-08-01

    This study reports on a 70-year-old man with recurrent cervical myelopathy 20 years after anterior decompression and fusion of C4-7 using a free vascularised strut graft. The recurrent myelopathy was secondary to a kyphotic deformity of a fractured graft and residual ossification of the posterior longitudinal ligament with stenosis at C3/4. Intraoperative spinal cord-evoked potentials indicated that spinal cord traction secondary to progressive kyphosis of the cervical spine after the graft fracture was the cause. The patient underwent laminoplasty at C3 and laminectomy at C4 to decompress the stenosis at C3/4 as well as posterior cervical spinal fusion at C3-7 with pedicle screws and a lateral mass screw and a bone graft to prevent further progression of the kyphosis. At postoperative 18 months, the patient's Japanese Orthopaedic Association score had improved to 14 from 8, and he could walk without support. PMID:26321562

  19. Do intramedullary spinal cord changes in signal intensity on MRI affect surgical opportunity and approach for cervical myelopathy due to ossification of the posterior longitudinal ligament?

    OpenAIRE

    Sun, Qizhi; Hu, Hongwei; Zhang, Ying; Li, Yang; Chen, Linwei; Chen, Huajiang; Yuan, Wen

    2011-01-01

    Some controversy still exists over the optimal treatment time and the surgical approach for cervical myelopathy due to ossification of the posterior longitudinal ligament (OPLL). The aim of the current study was first to analyze the effect of intramedullary spinal cord changes in signal intensity (hyperintensity on T2-weighted imaging and hypointensity on T1-weighted imaging) on magnetic resonance imaging (MRI) on surgical opportunity and approach for cervical myelopathy due to OPLL. This was...

  20. Modified steel basket technique for the treatment of equine cervical vertebral stenotic myelopathy - a case report

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    Frederico Fernandes Araújo

    2015-08-01

    Full Text Available Cervical vertebral stenotic myelopathy (CVSM, also known as cervical ataxia or wobbler syndrome, is caused by the narrowing of the medullary canal due to a malformation of the cervical vertebrae, resulting in compression of the spinal cord and neurological alterations such as ataxia, hypermetria, weakness, and abnormal stance. The treatment options can be conservative or surgical, with varied effectiveness. The most appropriate surgical technique in the majority of cases is arthrodesis, providing quick and efficient decompression of the spinal cord. The goal of this case report is to present an equine patient with CVSM that was surgically treated using a new modified cage model. The diagnosis was based on history, clinical signs and radiographic evidence of spinal cord compression between the C3 and C4 vertebrae, after ruling out possible infectious agents. The surgical procedure for the decompression and stabilization of the point of stenosis was performed using a modified Cloward’s technique and a new cage model fixed with two screws. Evidence of fusion was obtained by periodic radiographs over six months of postoperative care. The new cage model used in this surgery proved to be efficient for the decompression and stabilization of the vertebrae, allowing arthrodesis development and remission of the clinical signs. Fixation of the cage with screws reduces the risk of migration of the implant.

  1. Clinical Presentation of Cervical Myelopathy at C1–2 Level

    Science.gov (United States)

    Takebayashi, Tsuneo; Terashima, Yoshinori; Tsuda, Hajime; Yoshimoto, Mitsunori; Yamashita, Toshihiko

    2016-01-01

    Study Design Single-center retrospective study. Purpose To clarify the clinical features of cervical myelopathy at the C1–2 level. Overview of Literature Methods for distinguishing the affected level based on myelomere symptoms or dysfunction of the conducting pathway were established. However, no symptoms have been identified as being specific to the C1–2 level segment. Methods We evaluated 24 patients with cervical myelopathy due to spinal cord compression at the C1–2 level. Preoperative neurological assessment were investigated and compared with the rate and site of compression of the spinal cord using computed tomography-myelography. Results Impaired temperature and pain sensation were confirmed in 18 of the 24 patients with that localized to the upper arms (n=3), forearm (n=9), both (n=2), and whole body (n=4). Muscle weakness was observed in 18 patients, muscle weakness extended from the biceps brachii to the abductor digiti minimi in 10 patients, and in the whole body in 8 patients. Deep tendon reflexes were normal in 10 patients, whereas hyperactive deep tendon reflexes were noted in 14 patients. The rate of spinal cord compression was significantly higher in patients with perceptual dysfunction and muscle weakness compared with those with no dysfunction. However, no significant difference in the rate and site of compression was identified in those with dysfunction. Conclusions Perceptual dysfunction and muscle weakness localized to the upper limbs was observed in 58% and 42% of patients, respectively. Neurological abnormalities, such as perceptual dysfunction and muscle weakness, were visualized in patients with marked compression.

  2. Laminoplasty Techniques for the Treatment of Multilevel Cervical Stenosis

    OpenAIRE

    Mitsunaga, Lance K.; Klineberg, Eric O.; Gupta, Munish C.

    2012-01-01

    Laminoplasty is one surgical option for cervical spondylotic myelopathy. It was developed to avoid the significant risk of complications associated with alternative surgical options such as anterior decompression and fusion and laminectomy with or without posterior fusion. Various laminoplasty techniques have been described. All of these variations are designed to reposition the laminae and expand the spinal canal while retaining the dorsal elements to protect the dura from scar formation ...

  3. Impact of Age and Duration of Symptoms on Surgical Outcome of Single-Level Microscopic Anterior Cervical Discectomy and Fusion in the Patients with Cervical Spondylotic Radiculopathy

    Directory of Open Access Journals (Sweden)

    Farzad Omidi-Kashani

    2014-01-01

    Full Text Available We aim to evaluate the impact of age and duration of symptoms on surgical outcome of the patients with cervical spondylotic radiculopathy (CSR who had been treated by single-level microscopic anterior cervical discectomy and fusion (ACDF. We retrospectively evaluated 68 patients (48 female and 20 male with a mean age of 41.2±4.3 (ranged from 24 to 72 years old in our Orthopedic Department, Imam Reza Hospital. They were followed up for 31.25±4.1 months (ranged from 25 to 65 months. Pain and disability were assessed by Visual Analogue Scale (VAS and Neck Disability Index (NDI questionnaires in preoperative and last follow-up visits. Functional outcome was eventually evaluated by Odom’s criteria. Surgery could significantly improve pain and disability from preoperative 6.2±1.4 and 22.2±6.2 to 3.5±2.0 and 8.7±5.2 (1–21 at the last follow-up visit, respectively. Satisfactory outcomes were observed in 89.7%. Symptom duration of more and less than six months had no effect on surgical outcome, but the results showed a statistically significant difference in NDI improvement in favor of the patients aged more than 45 years (P=0.032, although pain improvement was similar in the two groups.

  4. Anterior cervical discectomy combined with corpectomy treatment of multi-segmental cervical spondylotic myeiopathy%颈椎前路两种手术方式治疗多节段脊髓型颈椎病

    Institute of Scientific and Technical Information of China (English)

    巩陈; 申才良; 董福龙; 郑军; 汪卫兵

    2011-01-01

    Objective To evaluate of two different anterior cervical surgical treatment of multilevel cervical spondylotic myelopathy clinical efficacy. Methods Selected three or more segments accumulated of the spinal cord-type cervical spondylosis of 36 patients, of which 18 cases were treated with a single sub-segment corpectomy internal fixation + other disc excision alone bone graft and internal fixation( A group ), which was segmental decompression and bone graft fixation; 18 patients with two or more vertebral bodies and fusion with subtotal long segment plate fixation( B group ), which was long segment decompression and bone graft fixation. Two groups were compared with operative time , operative blood loss, hospital stay, fusion rate, neurological improvement rate and cervical physiological curvature of the situation. Results Operation time, blood loss, hospital stay in A group were lower than those in B group( P <0. 05 ). Internal fixations of both groups had not problem postoperative. Cobb’s angle compared with preoperative improvement between the two groups was statistically significant( P < 0. 05 ) ; B group anglec loss rate of postoperative follow-up was higher than that in A group( P <0. 05 ); Bone graft fusion occurred after 6 months in two groups, JOA scores had improvement in the two groups and there was no statistically significant ( P >0. 05 ). Conclusion Both methods attain good clinical results; Anterior cervical discectomy combined with corpectomy treatment of multi-segmental cervical spondylotic myeiopathy , with relatively less blood loss, shorter operative time,less trauma, retain more vertebral bone.which is a good operation method.%目的 评价颈椎前路分节段减压植骨内固定术和长节段减压植骨固定术治疗多节段脊髓型颈椎病的临床疗效.方法 选择累及≥3个节段的脊髓型颈椎病患者36例,其中18例采用分节段单个椎体次全切除植骨内固定+其它椎间盘单独切除植骨内固

  5. Two Cases of Klippel-Feil Syndrome with Cervical Myelopathy Successfully Treated by Simple Decompression without Fixation.

    Science.gov (United States)

    Kim, Jin Bum; Park, Seung Won; Lee, Young Seok; Nam, Taek Kyun; Park, Yong Sook; Kim, Young Baeg

    2015-09-01

    Klippel-Feil syndrome (KFS) is a congenital developmental disorder of cervical spine, showing short neck with restricted neck motion, low hairline, and high thoracic cage due to multilevel cervical fusion. Radiculopathy or myelopathy can be accompanied. There were 2 patients who were diagnosed as KFS with exhibited radiological and physical characteristics. Both patients had stenosis and cord compression at C1 level due to anterior displacement of C1 posterior arch secondary to kyphotic deformity of upper cervical spine, which has been usually indicative to craniocervical fixation. One patient was referred due to quadriparesis detected after surgery for aortic arch aneurysmal dilatation. The other patient was referred to us due to paraparesis and radiating pain in all extremities developed during gynecological examinations. Decompressive C1 laminectomy was done for one patient and additional suboccipital craniectomy for the other. No craniocervical fixation was done because there was no spinal instability. Motor power improved immediately after the operation in both patients. Motor functions and spinal stability were well preserved in both patients for 2 years. In KFS patients with myelopathy at the C1 level without C1-2 instability, a favorable outcome could be achieved by a simple decompression without spinal fixation. PMID:26512291

  6. Efficacy Analysis of Acupuncture Comprehensive Therapy for Cervical Spondylotic Radiculopathy%针灸为主治疗神经根型颈椎病疗效分析

    Institute of Scientific and Technical Information of China (English)

    肖家兰

    2015-01-01

    目的:观察以针灸为主的综合疗法治疗神经根型颈椎病的疗效。方法:将118例神经根型颈椎病患者随机分为治疗组(88例)和对照组(30例),治疗组给予针灸疗法(颈夹脊、肩井、肩中俞、天宗、肩髃、曲池、合谷、列缺、后溪等)配合颈椎牵引、梅花针叩刺拔罐、颈部功能锻炼等综合治疗,对照组则服用布洛芬缓释胶囊(0.3g,bid)、甲钴胺片(0.5mg,tid),观察两组临床疗效。结果:治疗组总有效率为95.5%,高于对照组的76.7%(P<0.05)。结论:针灸、牵引、梅花针叩刺拔罐、功能锻炼等综合治疗神经根型颈椎病疗效显著。%Objective:To observe the efficacy of acupuncture comprehensive therapy for cervical spondylotic radiculopathy. Methods:118 cases of patients with cervical spondylotic radiculopathy were randomly divided into treatment group (88 cases) and control group (30 cases), the treatment group treated by comprehensive therapy including acupuncture therapy (cervical Jiaji points, GB21, SI15, SI11, LI15, LI11, LI4, LU7 and SI3) com-bined with cervical traction, percussopunctator cupping and cervical functional training, while control group by orally taking Bloven sustained-re-lease capsule (0.3g, bid) and mecobalamin tablets (0.5mg, tid), observed the efficacy of two groups. Results:The total effective rate of treatment group was 95.5%, which was higher than 76.7%that of control group (P<0.05). Conclusion:The comprehensive therapy which includes acupunc-ture, traction, percussopunctator cupping and functional training has significant curative effect on cervical spondylotic radiculopathy.

  7. Successful conservative treatment of rheumatoid subaxial subluxation resulting in improvement of myelopathy, reduction of subluxation, and stabilisation of the cervical spine. A report of two cases

    Science.gov (United States)

    Oostveen, J.; van de Laar, M. A F J; Geelen, J.; de Graaff, R.

    1999-01-01

    OBJECTIVE—To report the efficacy of conservative treatment with cervical traction and immobilisation with a Halo vest, in two consecutive rheumatoid arthritis patients with progressive cervical myelopathy caused by subaxial subluxation.
METHODS—Description of neurological symptoms and signs and findings in plain radiography (PR) and magnetic resonance imaging (MRI) of the cervical spine before and after treatment of the subaxial subluxation by traction and immobilisation with a Halo vest during four months.
RESULTS—During four months of traction and immobilisation neurological examination showed a considerable improvement of the signs and symptoms of cervical myelopathy. Afterwards PR and MRI of the cervical spine showed reduction of the subaxial subluxation. Eventually firm stabilisation was obtained in both patients without surgery of the cervical spine.
CONCLUSION—Cervical traction and immobilisation with a Halo vest can be considered as an independent conservative treatment in rheumatoid arthritis patients with cervical myelopathy caused by subaxial subluxation.

 Keywords: rheumatoid arthrits; rheumatoid subaxial subluxation PMID:10343530

  8. Dynamic Compression of the Spinal Cord by Paraspinal Muscles following Cervical Laminectomy: Diagnosis Using Flexion-Extension MRI

    OpenAIRE

    Evans, Linton T.; S. Scott Lollis

    2015-01-01

    Introduction. Flexion-extension, or kinematic, MRI has been used to identify dynamic spondylotic spinal cord compression not seen with traditional static MRI. The use of kinematic MRI to diagnose postoperative complications, specifically dynamic compression, is not as well documented. The authors describe a case of dynamic spinal cord compression by the paraspinal muscles causing worsening myelopathy following cervical laminectomy. This was only diagnosed with flexion-extension MRI. Methods....

  9. Correlação clinica entre a mielopatia cervical e o índice de Torg Correlation between the clinic and the index of cervical myelopathy Torg

    Directory of Open Access Journals (Sweden)

    Agnaldo Rogério Lozorio

    2012-01-01

    Full Text Available OBJETIVO: A mielopatia cervical é uma disfunção da medula espinhal relacionada a degeneração típica do envelhecimento, cuja patologia se relaciona com a isquemia e compressão da medula. Muitos são os problemas clínicos apresentados por portadores de mielopatia, nos casos mais graves este acometimento pode levar a para ou tetraplegia quando não tratado. Devido a patologia primária desta doença ser causada por compressão gerando isquemia medular, julgamos poder existir uma correlação entre o grau de compressão e clínica dos pacientes portadores de mielopatia cervical, porém não encontramos nenhum estudo na literatura que realizou esta correlação, por existir esta dúvida na literatura é que objetivamos em nosso estudo analisar a correlação entre o grau do comprometimento clínico dos pacientes com mielopatia cervical e o índice de Torg. MÉTODOS: Estudo prospectivo, de caráter descritivo, avaliados 46 pacientes, realizado mensuração radiográfica do índice de Torg e análise clínica através da escala de JOA e Nurick. RESULTADOS: Dos 46 pacientes, 100% apresentaram Torg OBJECTIVE: Cervical myelopathy is a spinal cord dysfunction related to degeneration typical of aging. Its primary pathology is related to ischemia and spinal cord compression. Patients with myelopathy present many clinical problems; more severe cases may lead to quadriplegia if not treated in a timely manner. Because the primary pathology of this disease is caused by compression, thus generating spinal cord ischemia, we believed there must be a correlation between the degree of compression and the clinical assessment of patients with cervical myelopathy, but we did not find any study in the literature that made this correlation. Because there is doubt the literature we aimed, in our study, to analyze the correlation between the degree of clinical impairment of patients with cervical myelopathy and the Torg index. METHODS: A prospective, descriptive

  10. 脊髓型颈椎病的早期诊断%Early diagaasfle of cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    余科炜; 李家顺; 贾连顺; 袁文; 叶晓健; 石志才; 吴玉华

    2000-01-01

    目的寻找几种敏感、可靠的脊髓型颈椎病(CSM)的早期诊断方法.方法共收集106例以颈肩痛或/和肢体麻木、乏力为主诉的门诊病人的临床资料,其中CSM组64例,非CSM组42例.着重比较两组病人静态和动态Hoffmann's征、侧位X线片Pavlov比率、颈部MRI影像学表现以及颈颅磁刺激运动诱发电位(MEP)的检查结果.结果CSM组病例MRI成像均存在颈髓受压表现,其中47例(73.4%)Hoffmann's征阳性,包括15例(23.4%)动态Hoffmann's征阳性,26例(40.6%)Pavlov比率<0.75;42例接受MEP检查的CSM病人中,39例(92.9%)上肢和/或下肢CMCT延迟.结论动态Hoffmann's征和经颅磁刺激MEP检查可作为敏感的筛选手段,若结合影像学检查则有助于CSM的早期诊断.

  11. Atypical Scheuerman Disease and Cervical Spondylotic Myelopathy%非典型Scheuermann病和颈椎脊髓病

    Institute of Scientific and Technical Information of China (English)

    郑永发; 王沛

    2006-01-01

    目的:对非典型Scheuermann病所致的颈椎脊髓病的病理、影像和临床特点,与颈椎间盘突出的关系进行比较,以便评价和指导治疗.方法:颈椎脊髓病84例中有12例MRI所见确切符合非典型Scheuermann病征.行后路椎板切除减压术10例;2例移位椎间盘后方原有片状高信号影者行前路一个节段减压植骨融合术.结果:非典型Scheuermann病组和对照组年龄差异有显著意义.X线可显示终板不平整或硬化,椎体形状不规则.MRI可见单一或多个椎间隙的软骨结节,或终板不平整,相应椎体缘显示不规则高信号.结论:软骨结节为特征的非典型Scheuermann病是椎骨常见的发育异常,累及椎体的次发骨骺,多合并椎间盘向后移位、突出,是颈椎脊髓病常见的病理类型.

  12. 颈牵态下磁场电脉冲疗法对神经根型颈椎病效果观察%Efficacy Observation on Magnetic Field Electric Pulse Therapy under Cervical Traction for Cervical Spondylotic Radiculopathy

    Institute of Scientific and Technical Information of China (English)

    陈海鹏; 黄柳和

    2014-01-01

    目的:探讨颈牵态下磁场电脉冲疗法对神经根型颈椎病的疗效。方法:70例神经根型颈椎病患者分为治疗组与对照组各35例,治疗组采用颈牵态下磁场电脉冲疗法,对照组仅用颈牵引治疗及TDP照射,评价两组患者疗效、视觉模拟评分(VAS)及肌力。结果:治疗组总有效率97.14%,显著高于对照组的80.00%(P<0.05);治疗后两组患者VAS评分及最大握力均显著优于治疗前(P<0.01),且治疗组优于对照组(P<0.01)。结论:颈牵态下磁场电脉冲疗法治疗神经根型颈椎病效果显著。%Objective:To investigate the efficacy of magnetic field electric pulse therapy under cervical traction for cervical spondylotic radiculopa-thy. Methods:70 cases of patients with cervical spondylotic radiculopathy were randomly divided into treatment group (35 cases) and control group (35 cases), the treatment group treated by magnetic field electric pulse therapy under cervical traction, while control group only by cervical traction and TDP irradiation, and evaluated the efficacy, VAS score and myodynamia of two groups of patients. Results:The total effective rate of treatment group was 97.14%, which was significantly higher than 80.00% that of control group (P<0.05); after treatment, the VAS score and maximal grip strength were both significantly better than those before treatment, and treatment group was better than control group (P<0.01). Conclusion:The treat-ment of magnetic field electric pulse therapy under cervical traction has significant curative effect on cervical spondylotic radiculopathy.

  13. 马勇教授治疗神经根型颈椎病经验%Experience of Treatment for Cervical Spondylotic Radiculopathy by Professor Ma Yong

    Institute of Scientific and Technical Information of China (English)

    马少华; 李同林

    2014-01-01

    The experience of Professor Ma in treating cervical spondylotic radiculopathy emphasizes the umpire for syndrome differentia-tion,or kidney or spleen,or liver,or from the wind and dampness. Common empirical formula is Xiangbikang. Common couplet medi-cines:Fuzi-Ganjiang-Guizhi;Guizhi-Gegen-Shaoyao;Huangqi-Guizhi;Huangqi-Danggui-Jixueteng;Fuzi-Yinyanghuo.%马勇教授治疗神经根型颈椎病,注重审因辨证,或治肾,或治脾,或治肝,或治从风寒湿。常用经验方项痹康,常用药对有:附子-干姜-桂枝;桂枝-葛根-芍药;黄芪-桂枝;黄芪-当归-鸡血藤;附子-淫羊藿。

  14. Dynamic Compression of the Spinal Cord by Paraspinal Muscles following Cervical Laminectomy: Diagnosis Using Flexion-Extension MRI.

    Science.gov (United States)

    Evans, Linton T; Lollis, S Scott

    2015-01-01

    Introduction. Flexion-extension, or kinematic, MRI has been used to identify dynamic spondylotic spinal cord compression not seen with traditional static MRI. The use of kinematic MRI to diagnose postoperative complications, specifically dynamic compression, is not as well documented. The authors describe a case of dynamic spinal cord compression by the paraspinal muscles causing worsening myelopathy following cervical laminectomy. This was only diagnosed with flexion-extension MRI. Methods. The patient was a 90-year-old male presenting to the neurosurgery clinic with functional decline and cervical spondylotic myelopathy. Results. A multilevel laminectomy was performed. Following surgery the patient had progressive weakness and worsening myelopathy. No active cord compression was seen on multiple MRIs obtained in a neutral position, and flexion-extension X-rays did not show instability. A kinematic MRI demonstrated dynamic compression of the spinal cord only during neck extension, by the paraspinal muscles. To relieve the compression, the patient underwent an instrumented fusion, with cross-links used to buttress the paraspinal muscles away from the cord. This resulted in neurologic improvement. Conclusions. We describe a novel case of spinal cord compression by paraspinal muscles following cervical laminectomy. In individuals with persistent myelopathy or delayed neurologic decline following posterior decompression, flexion-extension MRI may prove useful in diagnosing this potential complication. PMID:25984378

  15. Dynamic Compression of the Spinal Cord by Paraspinal Muscles following Cervical Laminectomy: Diagnosis Using Flexion-Extension MRI

    Directory of Open Access Journals (Sweden)

    Linton T. Evans

    2015-01-01

    Full Text Available Introduction. Flexion-extension, or kinematic, MRI has been used to identify dynamic spondylotic spinal cord compression not seen with traditional static MRI. The use of kinematic MRI to diagnose postoperative complications, specifically dynamic compression, is not as well documented. The authors describe a case of dynamic spinal cord compression by the paraspinal muscles causing worsening myelopathy following cervical laminectomy. This was only diagnosed with flexion-extension MRI. Methods. The patient was a 90-year-old male presenting to the neurosurgery clinic with functional decline and cervical spondylotic myelopathy. Results. A multilevel laminectomy was performed. Following surgery the patient had progressive weakness and worsening myelopathy. No active cord compression was seen on multiple MRIs obtained in a neutral position, and flexion-extension X-rays did not show instability. A kinematic MRI demonstrated dynamic compression of the spinal cord only during neck extension, by the paraspinal muscles. To relieve the compression, the patient underwent an instrumented fusion, with cross-links used to buttress the paraspinal muscles away from the cord. This resulted in neurologic improvement. Conclusions. We describe a novel case of spinal cord compression by paraspinal muscles following cervical laminectomy. In individuals with persistent myelopathy or delayed neurologic decline following posterior decompression, flexion-extension MRI may prove useful in diagnosing this potential complication.

  16. Strategies Analysis of Tongdu Tiaoshen Massage Manipulation on Treating Cervical Spondylotic Radiculopathy%通督调神推拿手法治疗神经根型颈椎病策略分析

    Institute of Scientific and Technical Information of China (English)

    杨爱国; 刘建民; 齐凤军

    2013-01-01

    通过分析神经根型颈椎病(cervical spondylotic radiculopathy,CSR)的发病机制和当前推拿手法治疗现状,发挥中医理论优势提出“通督调神”推拿手法,并介绍该手法治则、治法及可能作用机制和优势.

  17. Cervical Myelopathy Secondary to Atlanto-occipital Assimilation: The Usefulness of the Simple Decompressive Surgery

    OpenAIRE

    Kim, Kang Rae; Lee, Young Min; Kim, Young Zoon; Cho, Yong Woon; Kim, Joon Soo; Kim, Kyu Hong; Lee, In Chang

    2013-01-01

    Atlanto-occipital assimilation is one of the most common osseous anomalies observed at the craniocervical junction. Most patients with atlas assimilation show no symptom, but some have neurological problems such as myelopathy that may require surgical treatment. Occipitocervical fusion may be required if atlato-occipital assimilation is accompanied by occipito-axial instability. However, in cases of symptomatic atlas assimilation with minor cord compression without instability, simple decompr...

  18. 牵引推拿治疗神经根型颈椎病90例疗效观察%Clinical Observation on Traction and Massage Treating 90 Cases of Cervical Spondylotic Radiculopathy

    Institute of Scientific and Technical Information of China (English)

    盛强

    2013-01-01

      目的:探讨牵引推拿治疗神经根型颈椎病的疗效。方法:90例神经根型颈椎病患者均采用牵引推拿治疗,并观察其临床疗效。结果:治愈24例,显效36例,好转21例,无效9例,总有效率为90.0%。结论:牵引推拿治疗神经根型颈椎病疗效显著。%Objective:To investigate the efficacy of traction and massage treating cervical spondylotic radiculopathy. Methods:90 cases of cervical spondylotic radiculopathy were treated with traction and massage, the clinical efficacy was observed. Results:24 cases were cured, with 36 cases ef-fective, 21 cases improved and 9 cases ineffective, the total effective rate was 90%. Conclusion:The curative effects of traction and massage treating cervical spondylotic radiculopathy are significant.

  19. 旋提手法治疗神经根型颈椎病疗效与安全的研究%Effect and Safety of Rotation-traction Manipulation on Cervical Spondylotic Radiculopathy

    Institute of Scientific and Technical Information of China (English)

    刘立永; 赵宝力; 王红东

    2012-01-01

    Objective To observe the efficacy and safety of rotation-traction manipulation on cervical spondylotic radiculopathy. Methods 50 patients with cervical spondylotic radiculopathy were randomly divided into two groups (the testing group n=25, the control group n=25). The testing group was treated with rotation-traction manipulation, and the control group was treated with neck traction. Results The primary and secondary clinical effectiveness were improved in both of the two groups before and after treatment (P<0.05). Conclusion With better efficacy and safety, Rotation-traction manipulation can be used in the treatment of cervical spondylotic radiculopathy in clinic.%目的 观察颈椎旋提手法治疗神经根型颈椎病的疗效及安全性.方法 神经根型颈椎病患者50例,采用随机分组对照的临床研究方法,分为手法组25例,采用颈椎旋提手法治疗;对照组25例,采用颈椎牵引治疗.结果 两组治疗前后临床主要、次要疗效指标均有改善(P<0.05).结论 颈椎旋提手法治疗神经根型颈椎病疗效明显,安全性高,适于临床推广.

  20. A Clinical Study on the Correlation of Lower Cervical Vertebral Instability with Cervical Spondylotic Vertebral Arteriopathy%下颈椎不稳与椎动脉型颈椎病相关性的临床研究

    Institute of Scientific and Technical Information of China (English)

    李岩峰; 郑晓; 车涛; 裘敏蕾

    2012-01-01

    目的:观察比较电针与牵引治疗椎动脉型颈椎病的临床疗效,并分析其与下颈椎不稳的相关性.方法:将170例椎动脉型颈椎病患者随机分为电针组85例,牵引组85例,观察治疗效果,在治疗前后进行椎动脉型颈椎病功能量表评分,颈椎稳定性评估.结果:电针组治愈率为40.00%,总有效率96.48%;牵引组治愈率为18.85%,总有效率85.88%.2组比较差异有统计学意义(P<0.01),2组治疗前后自身比较,功能量表评分均降低,X线平片显示,其角位移和水平位移均减少,差异均有统计学意义(P<0.01),且电针组优于牵引组,差异有统计学意义(P<0.01);功能量表评分的降低与角位移和水平位移的减少具有相关性.结果:电针治疗椎动脉型颈椎病的效果优于牵引治疗,其疗效与下颈椎稳定性的改善相关.%Objective: To compare the clinical efficacy of electroacupuncture with traction in treating cervical spondylotic vertebral arteriopathy, and to analyze the correlation of cervical spondylotic vertebral arteriopathy with lower cervical vertebral instability. Methods: One hundred and seventy patients with cervical spondylotic vertebral arteriopathy were randomly allocated to a treatment group of 85 cases and a control group of 85 cases. The treatment group received electroacupuncture and the control group received traction. The therapeutic effects were evaluated. The score was counted using a function scale and lower cervical vertebral stability was assessed before and after treatment. Results:The cure rate and the total efficacy rate were 40. 0% and 96. 48% , respectively, in the treatment group and 18. 85% and 85. 88% , respectively, in the traction group; there was a statistically significant difference between the two groups (O<0. 01). The function scale score and both the angular and horizontal displacements on the X-ray plain film were decreased in the two groups after treatment as compared with before

  1. Acute spontaneous cervical disc herniation causing rapidly progressive myelopathy in a patient with comorbid ossified posterior longitudinal ligament: Case report and literature review

    Directory of Open Access Journals (Sweden)

    Harrison J Westwick

    2014-01-01

    Full Text Available Background: Ossification of the posterior longitudinal ligament (OPLL and cervical disc herniation are commonly encountered neurosurgical conditions. Here we present an unusual case of nontraumatic rapidly progressive myelopathy due to cervical disc herniation with comorbid OPLL and conduct a literature review focusing on the frequency and management of disc herniations with OPLL. Case Description: A 52-year-old healthy female presented with a 72-h history of rapid progression of dense quadriparesis with sensory deficits, with a precedent 4-week history of nontraumatic midline neck pain. Clinical examination revealed profound motor deficits below the C5 myotome. Spinal neuroimaging revealed OPLL (computed tomography [CT] and a cervical disc herniation spanning from C4/5 to C5/6 with significant retrovertebral disease (magnetic resonance imaging [MRI]. Operative management involved an anterior cervical corpectomy and instrumented fusion, with removal of both the sequestered disc material and the locally compressive OPLL. The patient recovered full motor function and independent ambulation with no residual signs or symptoms of myelopathy at the time of discharge. Conclusion: This unique case of a spontaneous cervical disc herniation in the context of OPLL causing rapidly progressive myelopathy illustrates the complementarity of CT and MRI in diagnosing the underlying cause of a rapidly progressive neurologic deficit in the absence of antecedent trauma. Though the optimal surgical management of such pathology remains uncertain; in this case, the anterior approach was motivated by the significant retrovertebral ventrally compressive sequestrum, and provided for excellent neurologic outcome. This article also reviews the occurrence/management of such acute cervical discs with OPLL.

  2. Atlas Hypoplasia and Ossification of the Transverse Atlantal Ligament: A Rare Cause of Cervical Myelopathy

    Directory of Open Access Journals (Sweden)

    Rakan Bokhari

    2012-01-01

    Full Text Available Myelopathy at the level of the atlas is rarely encountered by the practicing spine surgeon. Due to the region's unique anatomy, compression of the cord at this level is either caused by a large compressing lesion or an abnormally stenotic canal. We describe a rare instance of a congenitally stenotic canal due to a hypoplastic intact posterior arch of atlas, coexisting with an extremely rare ossified transverse ligament of the atlas. The coexistence of these two lesions has only been documented thrice before. We describe the clinical presentation, imaging findings, and favorable response to surgery.

  3. Surgical results of myelopathy secondary to the cervical disc herniation and the availability of CTD

    Energy Technology Data Exchange (ETDEWEB)

    Sho, Tomoya; Kataoka, Osamu; Washimi, Masatoshi; Fujita, Masayuki; Bessho, Yasuo (National Kobe Hospital, Hyogo (Japan))

    1990-08-01

    This study evaluated the contribution of computed tomographic discography (CTD) to the surgical indications and selection of surgical techniques in cervical disc herniation. The study population consisted of 73 patients who were diagnosed as having cervical disc herniation by CTD: Of them, hernia mass was confirmed by surgery in 64 patients (a concordance rate of 88% between CTD and surgical findings). In evaluable 40 patients receiving computed tomographic myelography (CTM), the rate of flattened spinal cord on CTM was significantly correlatd with postoperative prognosis. Flattened spinal cord was favorably improved. Higher preoperative flat rate was associated with severer cervical disc herniation. CTD provided the information concerning the positional relation in the posterior longitudinal ligament of hernia mass. Preoperative severity, preoperative rate of flattened spinal cord, and the site of protrusion of hernia mass were independent of surgical outcome. (N.K.).

  4. Efficacy Observation on Position Adjusting Method Combined with Massage Treating 112 Cases of Cervical Spondylotic Radiculopathy%调位法配合推拿治疗神经根型颈椎病112例疗效观察

    Institute of Scientific and Technical Information of China (English)

    齐笑千

    2014-01-01

    Objective:To investigate the efficacy of position adjusting chiropractic and traction method combined with massage treating cervical spon-dylotic radiculopathy. Methods:112 cases of patients with cervical spondylotic radiculopathy were all treated with position adjusting chiropractic and traction method combined with massage, to observe the clinical efficacy. Results:Among 112 patients, 52 cases were cured, 55 cases improved, 5 cas-es ineffective, the total effective rate was 95.53%. Conclusion:Efficacy of position adjusting chiropractic and traction method combined with mas-sage treating cervical spondylotic radiculopathy is significant, safe and reliable, being worthy of clinical application.%目的:探讨调位整脊法、调位牵引法配合推拿手法治疗神经根型颈椎病的疗效。方法:112例神经根型颈椎病患者均采用调位整脊法、调位牵引法配合推拿手法治疗,观察其临床疗效。结果:112例患者,治愈52例,好转55例,无效5例,总有效率为95.53%。结论:调位整脊法、调位牵引法配合推拿手法治疗神经根型颈椎病疗效显著,安全可靠,值得临床推广应用。

  5. The value of a new method for assessing the separate functions of the long tracts and involved segments in patients with cervical myelopathy

    OpenAIRE

    Hirabayashi, S; Tsuzuki, N.; Abe, R.; Saiki, K.; K. Takahashi

    2000-01-01

    In order to assess accurately lesions of the spinal cord in patients with cervical myelopathy we have developed a new method of examination, which is based on the Japanese Orthopaedic Association (JOA) scoring system. The method attempts to assess separately the functions of the long tract and any involved cord segments in respect to the period after treatment. It was used in 117 consecutive patients who were divided into 2 groups based on whether or not there was a T2-high- intensity lesion ...

  6. Unilateral ossified ligamentum flavum in the high cervical spine causing myelopathy

    OpenAIRE

    Singhal Udit; Jain Manoj; Jaiswal Awadhesh; Behari Sanjay

    2009-01-01

    High cervical ossified ligamentum flavum (OLF) is rare and may cause progressive quadriparesis and respiratory failure . Our two patients had unilateral OLF between C1 and C4 levels. MR showed a unilateral, triangular bony excrescence with low signal and a central, intermediate or high signal on all pulse sequences due to bone marrow within. There was Type I thecal compression (partial deficit of contrast media ring). The first patient had a linear and nodular OLF with calcification within t...

  7. Role of Diffusion Tensor MR Imaging in Degenerative Cervical Spine Disease: a Review of the Literature.

    Science.gov (United States)

    Banaszek, A; Bladowska, J; Podgórski, P; Sąsiadek, M J

    2016-09-01

    In the article we review the current role of diffusion tensor imaging (DTI), a modern magnetic resonance (MR) technique, in the diagnosis and the management of cervical spondylotic myelopathy (CSM), the most serious complication of degenerative cervical spine disease (DCSD). The pathogenesis of DCSD is presented first with an emphasis placed on the pathological processes leading to myelopathy development. An understanding of the pathophysiological background of DCSD is necessary for appropriate interpretation of MR images, both plain and DTI. Conventional MRI is currently the imaging modality of choice in DCSD and provides useful information concerning the extent of spondylotic changes and degree of central spinal canal stenosis; however its capability in myelopathy detection is limited. DTI is a state of the art imaging method which recently has emerged in spinal cord investigations and has the potential to detect microscopic alterations which are beyond the capability of plain MRI. In the article we present the physical principles underlying DTI which determine its sensitivity, followed by an overview of technical aspects of DTI acquisition with a special consideration of spinal cord imaging. Finally, the scientific reports concerning DTI utility in DSCD are also reviewed. DTI detects spinal cord injury in the course of DCSD earlier than any other method and could be useful in predicting surgical outcomes in CMS patients, however technical and methodology improvement as well as standardization of acquisition protocols and postprocessing methods among the imaging centers are needed before its implementation in clinical practice.

  8. Analysis of amelioration of neurological function on cervical degeneration disease after treatment with cervical spine locking plate%颈椎带锁钢板内固定术对颈椎退变性疾病神经功能改善的分析

    Institute of Scientific and Technical Information of China (English)

    赖志军; 谢惠缄; 谢唏衷; 肖建如

    2002-01-01

    Objective To discuss the clinical effect of treatment with anterior decompression, bone graft and cervical locking plate fixation for cervical degeneration disease.Method 23 patients with cervical spondylotic myelopathy and cervical ossification of the posterior longitudinal ligament have undergone the treatment of anterior cervical spine locking plate fusion.Neurological signs and symptoms were evaluated before and after surgery, and mean follow up time was 11.3 months.Result In all cases,radiography demonstrated a solid bony fusion.Additional general complications include a large wound hematoma in one and hoarseness in one.All patients' neurological function were improved.Conclusion The clinical effect of treatment with anterior decompression, bone graft and cervical locking plate fixation for cervical degeneration disease is satisfactory.

  9. Advantage of one - stage operation through combined anterior and posterior approach for the treatment of pinching cervical spondyiotic myelopathy%“钳夹型”脊髓型颈椎病一期前后路联合手术治疗的优点

    Institute of Scientific and Technical Information of China (English)

    翟明玉; 许少刚; 王春萍; 梅伟

    2012-01-01

    [目的]分析一期前后联合手术治疗“钳夹型”脊髓型颈椎病的治疗效果.[方法]本组72例,男56例,女16例;年龄23 ~ 78岁,平均57岁.病程6~15个月,平均8个月.所有病例全部采用后路椎管扩大及前路减压融合固定术.[结果]术后随访13个月~4年,平均28个月,术后疗效按JOA评分标准评定,术后1周及1、3、6个月评分均较术前增加(P<0.05);术后1周分别测量术前及术后颈椎生理曲度及椎节高度值,均较术前增加(P<0.05).[结论]钳夹型脊髓型颈椎病采用一期前后联合手术治疗是可行的;神经减压及时、充分、彻底;对改善生理曲度及椎节高度较为理想;术后稳定性好,患者康复快;不但缩短了住院时间,避免了二次手术的痛苦,而且节约了医疗费用.%[Objective] To study the feasibility and therapeutic effects of one - stage operation through combined anterior and posterior approach for the treatment of pinching cervical spondylotic myelopathy. [ Methods ] There were 72 patients, 56 were male and 16 were female, ranging in age from 23 to 78 years (average, 57 years) . The disease course ranged from 6 to 15 months ( average, 8 months) . All patients received anterior decompression and fusion , and posterior laminectomy to enlarge the spinal cannal . [Results] All the patients were followed up from 13 to 48 month. According to JOA assessment system, the score was increased at one week, one, three and six months after operation ( P < 0. 05 ) . The cervical curve and intervertebral height in postoperative group was significantly greater than those of preoperative group (P <0. 01 ) . [ Conclusion] The immediate and long - term stability of the diseased segments may be obtained by the combined anterior and posterior internal fixation in the patients with pinching cervical spondylotic myelopathy. This technique is benefit to the patients for the functional recover of the spinal cord and early rehabilitation. It is an

  10. The Validity Analysis of Cervical spondylotic radiculopathy by Multi-cervical-Unit System%颈椎多功能测试训练系统对神经根型颈椎病的疗效评定

    Institute of Scientific and Technical Information of China (English)

    黄胜杰; 王和鸣

    2011-01-01

    Objective:The Cervical spondylotic radiculopathy(CSR) patients treated with local-point cervical rotatory manipulation and cervical traction, observe and analysis the cervical function and the maximum muscle strength of isometric contraction of patients with Multi-cervical-Unit System(MCU). Method:60 CRS patients, treatment group n-30 (2 rejected, 1 ablated) and control group n-30 (1 rejected,2 ablated). The treatment group were performed with local-point cervical rotatory manipulation and cervical traction, and the control group were performed with general rotatory manipulation and cervical traction. Two groups data after treatment were statistical analysis their efficacy and detection of cervical spondylosis of cervical maximum isometric muscle strength. Results:The two practices before treatment in Cervical spine at maximum isometric muscle strength compared with their respective were significant efficacy(P0. 05). Conclusion:The Multi-cervical-Unit System is convenient, accurate and reliable, which can benefit to evaluate function of cervical spine and curative effect of local-point cervical rotatory manipulation.%目的:运用颈椎多功能测试训练系统观察神经根型颈椎病患者的颈椎功能,分析定点旋颈法结合牵引治疗对颈椎等长收缩最大肌力的影响。方法:神经根型颈椎病60例,治疗组30例(剔除2例,脱落1例),对照组30例(剔除1例,脱落2例)。治疗组采用定点旋颈法结合牵引,对照组采用颈椎牵引结合推拿。两组分别记录治疗后疗效和检测颈椎等长收缩最大肌力并进行统计学分析。结果:在颈椎等长收缩最大肌力方面,两种手法各自同治疗前比较均有显著的疗效(P<0.05);治疗后组间比较发现,前屈及后伸等长收缩最大肌力,治疗组效果更明显(P<0.05);左右侧屈等长收缩最大肌力,组间比较差异无统计学意义(P>0.05)。结论:颈椎多功能测试训练系统操作简便

  11. 整脊推拿联合超声波治疗神经根型颈椎病的疗效观察%Efficacy Observation on Chiropractic Massage Combined with Ultrasonic Treating Cervical Spondylotic Radiculopathy

    Institute of Scientific and Technical Information of China (English)

    刘军

    2013-01-01

    目的:观察整脊推拿联合超声波治疗神经根型颈椎病的临床疗效。方法:采用随机数字表法将90例神经根型颈椎病患者随机平均分为三组,推拿组采用整脊推拿治疗,超声组采用超声波治疗,联合组予整脊推拿联合超声波治疗,4周后评价三组临床疗效、症状体征评分、VAS评分及颈椎生理曲度变化情况。结果:联合组的总有效率明显高于推拿组与超声组(P<0.05);联合组症状体征评分、疼痛VAS评分较其他两组低,颈椎生理曲度评分较其他两组高(P<0.05)。结论:整脊推拿联合超声波治疗神经根型颈椎病临床疗效确切,明显改善患者颈椎生理曲度,值得临床推广应用。%Objective:To observe the clinical efficacy of chiropractic massage combined with ultrasonic treating cervical spondylotic radiculopathy. Methods:90 cases of cervical spondylotic radiculopathy were randomly divided into three groups equally with method of random digits table, mas-sage group adopted therapy of chiropractic massage, ultrasonic group treated with ultrasound, combined group treated with chiropractic massage and ultrasonic, to evaluate the clinical efficacy, symptoms and signs scores, VAS score and cervical physiological curvature of three groups after 4 weeks. Results:The total effective rate of combination group was significantly higher than that of massage and ultrasonic group (P<0.05);symptoms and signs score, VAS pain score of combination group, with higher score of cervical physiological curvature, were lower than those of two other groups (P<0.05). Conclusion:Chiropractic massage combined with ultrasonic treating cervical spondylotic radiculopathy is of exact clinical efficacy, signifi-cantly improving the cervical physiological curvature, being worthy of clinical promotion and application.

  12. Segmental anterior cervical decompression with fusion for treating multilevel cervical myelopathy%颈前路分节段减压融合治疗多节段颈椎病

    Institute of Scientific and Technical Information of China (English)

    林昊; 何仿; 李健; 崔庆元; 陈小强; 田纪伟

    2011-01-01

    Objective To evaluate the clinical value of the segmental anterior cervical decompression with fusion for treating multilevel cervical myelopathy.Methods 24 patients of multilevel cervical myelopathy with 3 or 4 consecutive segments were treated with segmental anterior cervical decompression with fusion.All patientst' cervical plain films,magnetic resonance imaging( MRI ) on preoperation and cervical plain films on postoperation were ohserved.The JOA scores of preoperation and 3 months postoperatively were collected.Results 24 cases were followed up from 3 months to 48 months, average 28 months.All patients improved their functional status in different degree.No complications such as graft nonunion and graft suhsidence occurred.The mean preoperative JOA score of all patients was ( 8.20 ±2.26 ),the postoperative of 3 months was ( 13.50 ± 1.28 ) , the average JOA recovery rate was 60.2%.Fusion rate was 100%.Conclusions The segmental anterior cervical decompression with fusion for treating multilevel cervical myelopathy appears to be effective in decompressing spinal cord, improving nerve functional status and restoring lordosis to the cervical spine with high fusion rate and fewer complications.%目的 评价颈前路分节段减压植骨融合术治疗多节段颈椎病的临床疗效.方法 对24例连续3或4个节段病变的颈椎病患者采用分节段减压融合术治疗.均行术前X线、MRI和术后X线片检查.均于术前及术后3个月进行JOA评分.结果 24例均获随访,时间3~48(28±20)个月.患者功能均有不同程度的改善.无植骨块不愈合、内置物下沉等并发症发生.JOA评分术前平均为(8.20±2.26)分,术后3个月平均为(13.50±1.28),改善率为60.2%,植骨融合率100%.结论 颈椎前路分节段减压融合术具有减压彻底、术后神经功能恢复好、恢复颈椎曲度、融合率高、并发症少等优点.

  13. Fatores prognósticos associados ao tratamento cirúrgico da mielorradiculopatia espondilótica cervical Factores pronósticos asociados con el tratamiento quirúrgico de la mielorradiculopatía cervical espondilótica Prognostic factors associated with surgical treatment of cervical spondylotic myeloradiculopathy

    Directory of Open Access Journals (Sweden)

    Alexandre Meluzzi

    2012-01-01

    de inestabilidad de White y en la escala de Kellgren. RESULTADOS: El 80% había mejorado, el 14% tuvo estabilización y el 6% presentó deterioro del cuadro neurológico. El empeoramiento neurológico no se asoció con ningún factor clínico, ambiental ni de imagen. La mejoría neurológica fue directamente proporcional a edad menor para la cirugía, ausencia de comorbilidad, signo de Hoffman, atrofia muscular, hiperintensidad de la medula espinal en la RM, período más corto de la evolución preoperatoria, mejor estado neurológico preoperatorio, y siendo inversamente proporcional al diâmetro AP del canal espinal y a las compresiones múltiples. Identificada una asociación con el tabaquismo. Más de 70 años de edad, la evolución superior a 24 meses, la atrofia muscular, la puntuación JOA igual o inferior a siete puntos y el diámetro AP del canal menor o igual a seis mm no se asociaron con a mejoría.OBJECTIVE: Identify the individual, social, environmental clinical factors and also imaging studies which correlate to the final result of neurological improvement in patients undergoing surgical treatment of cervical spondylotic myelopathy. METHODS: The clinical assessment was quantified by the deficit in JOA scale. We analyzed 200 cases of cervical myeloradiculopathy surgically treated in HC-FMUSP, from January 1993 to January 2007. The mean follow-up was 6 years and 8 months. The analysis was based on radiological criteria of instability by White and Kellgren scale. RESULTS: 80% had improved, 14% stabilized and 6% had worsened. The neurological deterioration was not associated with any clinical, environmental or imaging factor. The neurological improvement was directly proportional to the lower age at surgery, absence of co-morbidity, Hoffman sign, muscular atrophy, spinal cord hyperintensity on MRI, the shortest period of preoperative evolution, better preoperative neurological status and was inversely proportional to the AP diameter of the spinal canal and

  14. Predicting the minimum clinically important difference in patients undergoing surgery for the treatment of degenerative cervical myelopathy.

    Science.gov (United States)

    Tetreault, Lindsay; Wilson, Jefferson R; Kotter, Mark R N; Nouri, Aria; Côté, Pierre; Kopjar, Branko; Arnold, Paul M; Fehlings, Michael G

    2016-06-01

    OBJECTIVE The minimum clinically important difference (MCID) is defined as the minimum change in a measurement that a patient would identify as beneficial. Before undergoing surgery, patients are likely to inquire about the ultimate goals of the operation and of their chances of experiencing meaningful improvements. The objective of this study was to define significant predictors of achieving an MCID on the modified Japanese Orthopaedic Association (mJOA) scale at 2 years following surgery for the treatment of degenerative cervical myelopathy (DCM). METHODS Seven hundred fifty-seven patients were prospectively enrolled in either the AOSpine North America or International study at 26 global sites. Fourteen patients had a perfect preoperative mJOA score of 18 and were excluded from this analysis (n = 743). Data were collected for each participating subject, including demographic information, symptomatology, medical history, causative pathology, and functional impairment. Univariate log-binominal regression analyses were conducted to evaluate the association between preoperative clinical factors and achieving an MCID on the mJOA scale. Modified Poisson regression using robust error variances was used to create the final multivariate model and compute the relative risk for each predictor. RESULTS The sample consisted of 463 men (62.31%) and 280 women (37.69%), with an average age of 56.48 ± 11.85 years. At 2 years following surgery, patients exhibited a mean change in functional status of 2.71 ± 2.89 points on the mJOA scale. Of the 687 patients with available follow-up data, 481 (70.01%) exhibited meaningful gains on the mJOA scale, whereas 206 (29.98%) failed to achieve an MCID. Based on univariate analysis, significant predictors of achieving the MCID on the mJOA scale were younger age; female sex; shorter duration of symptoms; nonsmoking status; a lower comorbidity score and absence of cardiovascular disease; and absence of upgoing plantar responses, lower

  15. Clinical study of proprioceptive sensibility reflexotherapy in treating cervical spondylotic radiculopathy%神经根型颈椎病的本体感觉反射疗法临床疗效评价

    Institute of Scientific and Technical Information of China (English)

    罗汉华; 张雪; 郭友华; 农文恒

    2011-01-01

    目的 观察本体感觉反射疗法对神经根型颈椎病(CSR)的临床疗效,为中医手法规范化提供依据.方法 将入选的94例患者随机分为本体感觉反射疗法组(试验组)及澳式手法组(对照组)进行治疗,1次/d,15 min/次,3d为1个疗程,2个疗程后评价疗效,以颈椎关节活动度、视觉模拟疼痛评分(VAS)、压力测痛数值、颈椎病症状分级为主要指标确定手法治疗的疗效.结果 各观察指标差异均无统计学意义(P>0.05),提示两种治疗方法疗效相当.结论 通过与国际标准化澳式手法临床效果的比较,初步分析本体感觉反射疗法有一定的临床意义.%Objective To study the clinical effect on cervical spondylotic radiculopathy with proprioceptive sensibility reflexotherapy and provide a basis for standardized study of Chinese medicine treatment Methods 94 patients with cervical spondylotic radiculopathy were randomly assigned into two groups,45 patients were treated with proprioceptive sensibility reflexotherapy and 49 patients were treated with Maitland manipulation. All the patients were treated once a day with IS minutes,3 days for a course. Therapeutic evaluation was made after 2 courses. The curative effect was evaluated with the range of motion ( ROM) ,the visual analog scale ( VAS) .pressure measuring pain numerical value and the symptom grading of cervical spondylosis. Results There was no statistically significant differences between two groups in all indicators. Conclusions The proprioceptive sensibility reflexotherapy is effect on cervical spondylotic radiculopathy compare with maitland manipulation. The standardized study has clinical significance.

  16. 穴位注射配合牵引治疗神经根型颈椎病疗效观察%Observations on the Efficacy of Acupuncture Point Injection plus Traction in Treating Cervical Spondylotic Radiculopathy

    Institute of Scientific and Technical Information of China (English)

    汪崇淼; 吴耀持; 张峻峰; 黄承飞

    2012-01-01

    目的 观察穴位注射配合牵引治疗神经根型颈椎病的临床疗效.方法 将122例神经根型颈椎病患者随机分为3组,观察组42例,进行穴位注射配合牵引治疗;穴位注射组40例,进行穴位注射治疗;牵引组40例进行牵引治疗.治疗结束比较3组间疗效差异.结果 观察组总有效率为92.9%,穴位注射组总有效率为72.5%,牵引组总有效率为75.0%,观察组总有效率与穴位注射组、牵引组比较差异均有统计学意义(P<0.05),穴位注射组与牵引组比较差异无统计学意义(P>0.05).结论 穴位注射配合牵引治疗神经根型颈椎病总有效率优于单纯穴位注射及单纯牵引治疗.%Objective To investigate the clinical efficacy of acupuncture point injection plus traction in treating cervical spondylotic radiculopathy. Method One hundred and twenty-two patients with cervical spondylotic radiculopathy were randomly allocated to three groups. The observation group of 42 patients received acupuncture point injection plus traction. The acupuncture point injection group of 40 patients and the traction group of 40 patients received corresponding treatments. The therapeutic effects were compared between the three groups after treatment. Result The total efficacy rate was 92.9% in the observation group, 72.5% in the acupuncture point injection group and 75.0% in the traction group; there was a statistically significant difference between the observation group and the acupuncture point injection group or the traction group (P 0.05). Conclusion The total efficacy rate of acupuncture point injection plus traction for cervical spondylotic radiculopathy is higher than that of acupuncture point injection alone and that of traction alone.

  17. Overshunting-associated myelopathy: report of 2 cases.

    Science.gov (United States)

    Ho, Jason Man-Kit; Law, Hing-Yuen; Yuen, Shing-Chau; Yam, Kwong-Yui

    2016-09-01

    The authors present 2 cases of cervical myelopathy produced by engorged vertebral veins due to overshunting. Overshunting-associated myelopathy is a rare complication of CSF shunting. Coexisting cervical degenerative disc disease may further increase the difficulty of diagnosing the condition. Neurosurgeons and others who routinely evaluate patients with intracranial shunts should be familiar with this rare but possible diagnosis. PMID:27581312

  18. Comparison of short-term effect of two kinds of posterior internal fixation combined with ex-pansive open-door laminoplasty in the treatment of multilevel cervical myelopathy%两种后路内固定结合单开门手术治疗多节段脊髓型颈椎病的近期疗效比较

    Institute of Scientific and Technical Information of China (English)

    唐少龙; 黄庆华; 吴罗根; 周文华; 曹华敏; 陈大勇; 袁野

    2016-01-01

    目的:比较后路颈椎板成形术钉棒固定与微型钛板固定治疗多节段脊髓型颈椎病的近期疗效。方法将47例多节段脊髓型颈椎病患者随机分为两组:23例行后路颈椎板成形微型钛板固定术(微型钛板组),24例行后路颈椎板成形钉棒固定术(钉棒组)。比较两组手术时间、术中出血量、JOA评分、VAS评分、术后椎管矢状径、颈椎曲度、术后活动度影响及手术并发症等,评价两种手术方式的临床疗效。结果患者均获得随访,微型钛板组为(23.8±8.1)个月,钉棒组为(23.6±8.0)个月。两组手术时间、术中出血量、手术并发症比较差异无统计学意义(P>0.05)。 JOA评分:两组手术后均较术前显著升高(P<0.05),两组间比较差异无统计学意义(P>0.05)。颈痛VAS评分:术前钉棒组显著高于微型钛板组(P<0.05),术后两组评分均较术前显著降低(P<0.05),两组间比较差异无统计学意义(P>0.05)。颈椎矢状径:两组术后3 d和未次随访时均较术前明显改善(P<0.05),两组间比较差异无统计学意义(P>0.05)。术后3 d和末次随访时微型钛板组颈椎曲度改善明显优于钉棒组(P<0.05)。末次随访时两组活动度均较术前减少(P<0.05),钉棒组减少的度数明显大于微型钛板组( P<0.05)。结论后路颈椎板成形术钉棒固定与微型钛板固定治疗多节段脊髓颈椎病神经功能改善相似,微型钛板对颈椎的活动度影响较少。%Objective To compare the short-term clinical effect of posterior vertebral plate internal fixation combined with expansive open-door laminoplasty and posterior screw rod system fixation combined with expansive open -door laminoplasty in the treatment of multilevel cervical myelopathy .Methods Forty-seven cases with cervical spondylot-ic myelopathy were randomly divided into two groups:23 cases

  19. Clinical Analysis of Treating 50 Cases of Cervical Spondylotic Radiculopathy Patients by Traction Combined with Massage%牵引并推拿治疗神经根型颈椎病50例临床分析

    Institute of Scientific and Technical Information of China (English)

    赵立鹏; 毛艳琴

    2013-01-01

    Objective:To investigate the efficacy of treating cervical spondylotic radiculopathy by traction combined with massage. Methods:100 cas-es of patients were randomly divided into treatment group and control group, the control group used traction while the treatment group used traction and massage, and compared the efficacy of two groups. Results:The effective rate in treatment was 92.4%, higher than 76.2%in control group (P<0.05). Conclusion:Massage therapy can make up the deficiency on direction of action and intensity adjustment of traction, improve the efficacy of traction for cervical spondylotic radiculopathy, and has a certain promotional value.%  目的:探讨推拿并牵引治疗神经根型颈椎病的临床疗效。方法:将100例患者随机分为治疗组和对照组,对照组采用牵引治疗,治疗组予牵引配合推拿手法治疗,比较两组临床疗效。结果:治疗组总有效率为92.4%,高于对照组的76.2%(P<0.05)。结论:推拿手法治疗能弥补牵引在作用方向和大小调节上的不足,提高牵引治疗神经根型颈椎病的临床疗效,具有一定的推广价值。

  20. Treatment of asymptomatic spondylotic cervical cord compression combined with symptomatic cervical radiculopathy%伴颈神经根病的无症状颈椎退变性脊髓压迫的治疗

    Institute of Scientific and Technical Information of China (English)

    尹国栋; 罗剑; 陈观华; 蒲晓斌; 郭珊成; 黄志勇; 何平; 薛超; 陈菜凤

    2015-01-01

    目的:探讨伴颈神经根病的无症状颈椎退变性脊髓压迫( asymptomatic spondylotic cervical cord compression, A-SCCC)的治疗。方法回顾分析本院2009年6月~2012年6月收治的34例伴颈神经根病的A-SCCC患者病例资料,患者入院后先接受系统的非手术治疗,如果神经功能无缓解或加重,则行手术治疗,收集患者一般情况及影像学资料,于治疗前后不同时间点通过日本骨科学会( Japanese Orthopaedic Association, JOA)评分评价临床治疗效果。结果34例患者平均随访4个月,其中23例经非手术治疗获得不同程度的改善;11例改善不明显,其中8例改手术治疗,3例患者继续非手术治疗(2例症状逐渐缓解,1例出现脊髓病临床表现)。治疗后及随访期间非手术组与手术组患者JOA评分均较治疗前明显改善,差异有统计学意义(P<0.01)。结论多数伴颈神经根病的A-SCCC患者经过系统非手术治疗后病情可以缓解,部分仍需手术治疗,伴颈神经根病或脊髓高信号的A-SCCC不必预防性手术,但需密切观察病情变化。%Objective To investigate therapeutic methods of asymptomatic spondylotic cervical cord compression ( A-SCCC) combined with symptomatic cervical radiculopathy.Methods From June 2009 to June 2012,34 patients with A-SCCC combined with symptomatic cervical radiculopathy were included in this retrospective analysis. All the cases underwent anterior-posterior, lateral, excessive flexion and extension cervical spine X-ray and MRI.Age, gender, duration of disease and the Pavlov ratio were also collected.Conservative treatment to all patients accepted after admission system, the patients were underwent surgical operation without neural function recovery after normal conservative treatment.Before treat-ment and at different time points after treatment, the Japanese Orthopaedic Association (JOA) scores were calculated to evalu-ate the

  1. Dynamic Hoffmann's sign and early diagnosis of cervical spondylotic myelopathy%动态霍夫曼征与颈椎病早期诊断

    Institute of Scientific and Technical Information of China (English)

    石志才; 贾连顺; 李家顺; 侯铁胜; 袁文; 倪斌; 李明; 叶晓健

    2001-01-01

    目的:研究动态霍夫曼征(DHS)与颈椎病早期诊断的关系.方法:对96例具有动态霍夫曼征阳性的颈肩痛患者进行3~7年的定期随访,同期对122例无DHS的颈肩痛患者作为对照组进行随访.临床资料包括临床症状和体征、颈椎角位移及水平位移、椎管矢状径、Pavlov率等.结果:DHS组72例发展成颈椎病并需行手术处理,对照组11例症状进展,接受了手术治疗.DHS组颈椎管狭窄、颈椎间盘突出以及颈椎不稳等三个方面的发生率与对照组有显著差异.结论:DHS与颈椎病发病密切相关.一旦发现阳性DHS,应密切观察和预防,症状加重者宜早期手术.

  2. Magnetic resonance imaging in cervical spinal cord compression

    Directory of Open Access Journals (Sweden)

    Giovanni Giammona

    1993-09-01

    Full Text Available In patients with cervical spondylotic myelopathy MRI sometimes shows increased signal intensity zones on the T2-weighted images. It has been suggested that these findings carry prognostic significance. We studied 56 subjects with cervical spinal cord compression. Twelve patients showed an increased signal intensity (21.4% and a prevalence of narrowing of the AP-diameter (62% vs 24%. Furthemore, in this group, there was evidence of a longer mean duration of the symptoms and, in most of the patients, of more serious clinical conditions. The importance of these predisposing factors remains, however, to be clarified since they are also present in some patients without the increased signal intensity.

  3. Metabolic neuroimaging of the cervical spinal cord in patients with compressive myelopathy:a prospective study on magnetic resonance spectroscopy%颈脊髓慢性压迫症的代谢组学研究

    Institute of Scientific and Technical Information of China (English)

    张琥; 林定坤; 陈博来; 龙玉; 田铁桥; 陈树良; 陈加良; 黄思聪

    2010-01-01

    目的 探讨应用磁共振波谱技术(magnetic resonance spectroscopy,MRS) 测量颈脊髓慢性压迫症患者脊髓代谢组改变的可行性,探讨脊髓代谢组学与脊髓功能的相关性.方法 2009年1月至2010年6月行减压手术的脊髓型颈椎病(cervical spondylotic myelopathy,CSM)患者13例作为实验组,男8例,女5例;年龄37~84岁,平均58.2岁.术前进行神经系统检查、神经功能评价(JOA 评分)和MRS检查,将感兴趣区放置在脊髓受压最严重部位的相邻节段.通过MRS测得以下代谢物的浓度:氮-乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)、乳酸(Lac)、肌醇(Ins)、谷氨酰氨(Gk).15名健康志愿者为正常对照组,年龄和性别与实验组无明显差异,同样用MRS测得脊髓代谢浓度.计算以下代谢浓度的比值:NAA/Cr、Cho/Cr、Lac/Cr、Ins/Cr、Glx/Cr.结果 实验组的NAA/Cr和Glx/Cr比正常对照组明显降低(1.18 vs 2.58,P=0.023;0.56 vs 1.25,P=0.008).实验组的NAA/Cr与脊髓JOA评分呈正相关.但是两组其他代谢物浓度比值如 Cho/Cr,mI/Cr,Lac/Cr的差异均无统计学意义.实验组患者中有4例出现乳酸峰,而对照组中无一例出现乳酸峰.结论 MRS可以定量测量颈脊髓的代谢组学改变.慢性颈脊髓压迫症患者的NAA/Cr和GIx/Cr较健康志愿者明显降低,说明神经元和轴突的减少和损伤.NAA/Cr与脊髓功能的相关性,提示有评价脊髓功能的临床价值,但尚需大样本的研究来证实.

  4. Clinical significance of MRI/{sup 18}F-FDG PET fusion imaging of the spinal cord in patients with cervical compressive myelopathy

    Energy Technology Data Exchange (ETDEWEB)

    Uchida, Kenzo; Nakajima, Hideaki; Watanabe, Shuji; Yoshida, Ai; Baba, Hisatoshi [University of Fukui, Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, Eiheiji, Fukui (Japan); Okazawa, Hidehiko [University of Fukui, Department of Biomedical Imaging Research Center, Eiheiji, Fukui (Japan); Kimura, Hirohiko [University of Fukui, Departments of Radiology, Faculty of Medical Sciences, Eiheiji, Fukui (Japan); Kudo, Takashi [Nagasaki University, Department of Radioisotope Medicine, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki (Japan)

    2012-10-15

    {sup 18}F-FDG PET is used to investigate the metabolic activity of neural tissue. MRI is used to visualize morphological changes, but the relationship between intramedullary signal changes and clinical outcome remains controversial. The present study was designed to evaluate the use of 3-D MRI/{sup 18}F-FDG PET fusion imaging for defining intramedullary signal changes on MRI scans and local glucose metabolic rate measured on {sup 18}F-FDG PET scans in relation to clinical outcome and prognosis. We studied 24 patients undergoing decompressive surgery for cervical compressive myelopathy. All patients underwent 3-D MRI and {sup 18}F-FDG PET before surgery. Quantitative analysis of intramedullary signal changes on MRI scans included calculation of the signal intensity ratio (SIR) as the ratio between the increased lesional signal intensity and the signal intensity at the level of the C7/T1 disc. Using an Advantage workstation, the same slices of cervical 3-D MRI and {sup 18}F-FDG PET images were fused. On the fused images, the maximal count of the lesion was adopted as the standardized uptake value (SUV{sub max}). In a similar manner to SIR, the SUV ratio (SUVR) was also calculated. Neurological assessment was conducted using the Japanese Orthopedic Association (JOA) scoring system for cervical myelopathy. The SIR on T1-weighted (T1-W) images, but not SIR on T2-W images, was significantly correlated with preoperative JOA score and postoperative neurological improvement. Lesion SUV{sub max} was significantly correlated with SIR on T1-W images, but not with SIR on T2-W images, and also with postoperative neurological outcome. The SUVR correlated better than SIR on T1-W images and lesion SUV{sub max} with neurological improvement. Longer symptom duration was correlated negatively with SIR on T1-W images, positively with SIR on T2-W images, and negatively with SUV{sub max}. Our results suggest that low-intensity signal on T1-W images, but not on T2-W images, is correlated

  5. Clinical significance of MRI/18F-FDG PET fusion imaging of the spinal cord in patients with cervical compressive myelopathy

    International Nuclear Information System (INIS)

    18F-FDG PET is used to investigate the metabolic activity of neural tissue. MRI is used to visualize morphological changes, but the relationship between intramedullary signal changes and clinical outcome remains controversial. The present study was designed to evaluate the use of 3-D MRI/18F-FDG PET fusion imaging for defining intramedullary signal changes on MRI scans and local glucose metabolic rate measured on 18F-FDG PET scans in relation to clinical outcome and prognosis. We studied 24 patients undergoing decompressive surgery for cervical compressive myelopathy. All patients underwent 3-D MRI and 18F-FDG PET before surgery. Quantitative analysis of intramedullary signal changes on MRI scans included calculation of the signal intensity ratio (SIR) as the ratio between the increased lesional signal intensity and the signal intensity at the level of the C7/T1 disc. Using an Advantage workstation, the same slices of cervical 3-D MRI and 18F-FDG PET images were fused. On the fused images, the maximal count of the lesion was adopted as the standardized uptake value (SUVmax). In a similar manner to SIR, the SUV ratio (SUVR) was also calculated. Neurological assessment was conducted using the Japanese Orthopedic Association (JOA) scoring system for cervical myelopathy. The SIR on T1-weighted (T1-W) images, but not SIR on T2-W images, was significantly correlated with preoperative JOA score and postoperative neurological improvement. Lesion SUVmax was significantly correlated with SIR on T1-W images, but not with SIR on T2-W images, and also with postoperative neurological outcome. The SUVR correlated better than SIR on T1-W images and lesion SUVmax with neurological improvement. Longer symptom duration was correlated negatively with SIR on T1-W images, positively with SIR on T2-W images, and negatively with SUVmax. Our results suggest that low-intensity signal on T1-W images, but not on T2-W images, is correlated with a poor postoperative neurological outcome. SUVmax

  6. Clinical Observation on Chiropractic Techniques and Specific Acupoint Therapy on 30 Cases of Cervical Spondylotic Radiculopathy%整脊手法与特定穴疗法治疗神经根型颈椎病30例疗效观察

    Institute of Scientific and Technical Information of China (English)

    魏裕涛; 葛恒; 邵瑛; 魏静妍; 魏佳娜; 陈贤芝

    2013-01-01

    Objective: To observe the curative effects of chiropractic techniques and specific acupoint treating cervical spondylotic radiculopathy. Methods:30 cases of cervical spondylotic radiculopathy were randomly divided into chiropractic group and the specific group, respectively with chi-ropractic techniques and specific acupoint therapy, the clinical efficacy was compared between the two groups. Results:The total effective rate of chi-ropractic group was 93.3%, higher than that of specific group by 80%(P<0.05). Conclusion:The curative effects of chiropractic techniques treating cervical spondylotic radiculopathy are better than that of specific acupoint therapy in short term.%目的:观察整脊手法与特定穴疗法治疗神经根型颈椎病的疗效。方法:将30例神经根型颈椎病患者随机分为整脊组和特定穴组,分别施以整脊手法和特定穴疗法,比较两组临床疗效。结果:整脊组总有效率为93.3%,高于特定穴组的80.0%(P<0.05)。结论:整脊手法在短期内治疗神经根型颈椎病疗效优于特定穴疗法。

  7. Radiation myelopathy

    Energy Technology Data Exchange (ETDEWEB)

    Sutherland, I.A.; Myers, S.J.

    1976-02-01

    Myelopathy secondary to radiation is a relatively uncommon entity which was reported initially in 1941 by Ahlbom. From a total of 65 patients who were seen in our spinal injury clinic during the past four years, three patients have received a diagnosis of radiation myelopathy. This is 4.6 percent of the total number. The case histories of two patients with radiation myelopathy are presented. The clinical and pathologic features are discussed. Since the three patients with this diagnosis whose cases are followed in the clinic are still alive, the second case that is reported is taken from the files of the pathology department so that autopsy and histologic data also can be presented.

  8. Radiation myelopathy

    International Nuclear Information System (INIS)

    Myelopathy secondary to radiation is a relatively uncommon entity which was reported initially in 1941 by Ahlbom. From a total of 65 patients who were seen in our spinal injury clinic during the past four years, three patients have received a diagnosis of radiation myelopathy. This is 4.6 percent of the total number. The case histories of two patients with radiation myelopathy are presented. The clinical and pathologic features are discussed. Since the three patients with this diagnosis whose cases are followed in the clinic are still alive, the second case that is reported is taken from the files of the pathology department so that autopsy and histologic data also can be presented

  9. Cervical spondylosis with spinal cord encroachment: should preventive surgery be recommended?

    Directory of Open Access Journals (Sweden)

    Murphy Donald R

    2009-08-01

    Full Text Available Abstract Background It has been stated that individuals who have spondylotic encroachment on the cervical spinal cord without myelopathy are at increased risk of spinal cord injury if they experience minor trauma. Preventive decompression surgery has been recommended for these individuals. The purpose of this paper is to provide the non-surgical spine specialist with information upon which to base advice to patients. The evidence behind claims of increased risk is investigated as well as the evidence regarding the risk of decompression surgery. Methods A literature search was conducted on the risk of spinal cord injury in individuals with asymptomatic cord encroachment and the risk and benefit of preventive decompression surgery. Results Three studies on the risk of spinal cord injury in this population met the inclusion criteria. All reported increased risk. However, none were prospective cohort studies or case-control studies, so the designs did not allow firm conclusions to be drawn. A number of studies and reviews of the risks and benefits of decompression surgery in patients with cervical myelopathy were found, but no studies were found that addressed surgery in asymptomatic individuals thought to be at risk. The complications of decompression surgery range from transient hoarseness to spinal cord injury, with rates ranging from 0.3% to 60%. Conclusion There is insufficient evidence that individuals with spondylotic spinal cord encroachment are at increased risk of spinal cord injury from minor trauma. Prospective cohort or case-control studies are needed to assess this risk. There is no evidence that prophylactic decompression surgery is helpful in this patient population. Decompression surgery appears to be helpful in patients with cervical myelopathy, but the significant risks may outweigh the unknown benefit in asymptomatic individuals. Thus, broad recommendations for decompression surgery in suspected at-risk individuals cannot be made

  10. Randomized Controlled Clinical Study of the Clinical Efficacy of the Sun Manipulation of Rotating Treatment to Cervical Spondylotic Radiculopathy%孙氏旋转手法治疗神经根型颈椎病临床研究

    Institute of Scientific and Technical Information of China (English)

    秦毅; 李振宇; 鲁尧; 秦杰; 江建明

    2012-01-01

    目的:观察孙氏旋转手法治疗神经根型颈椎病的临床疗效.方法:采用电脑随机数字表法进行随机分配,将60例患者分为2组,每组30例.治疗组采用孙氏旋转手法治疗,对照组采用颈部牵引治疗.两组疗程均为2周.评定2组临床疗效,疼痛评分.结果:2组疗效比较差异有统计学意义(P<0.05),治疗组优于对照组.2组治疗前、后症状体征积分自身差值比较:治疗组在颈肩部的疼痛与不适、上肢疼痛与麻木、远端感觉、肌力、spurlnig试验自身积分差值的改善与对照组相比较差异有统计学意义(P<0.05),治疗组明显优于对照组;在工作和生活能力受影响、上肢腱反射减弱或消失方面比较差异无统计学意义(P>0.05).结论:孙氏旋转手法改善神经根型颈椎病疗效优于牵引疗法.%Objective:To observe the clinical efficacy of the Sun manipulation of rotating treatment to cervical spondylotic radiculopathy. Methods:60 patients were randomly divided into two groups, 30 patients in each group. The patients in experimental group were treated by the Sun manipulation of rotating; patients in control group were treated by cervical traction. All patients were treated for 2 weeks. Clinical efficacy and pain score were evaluated. Results:There were significant differences in the score of symptoms and signs, pain and discomfort of the shoulder and neck, the pain and numbness of upper limb, distal sensory and strength and the improvement of the scores by spurlnig test between the two groups (P0. 05). Conclusions:The clinical efficacy of the Sun manipulation of rotating treatment to cervical spondylotic radiculopathy was better than traction therapy.

  11. Chronic hypertrophic nonunion of the Type II odontoid fracture causing cervical myelopathy: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Mohammed F Shamji

    2016-01-01

    Conclusion: Rarely, nonunion of Type II odontoid fractures may be hypertrophic where both instability and compression cause neurological morbidity. Such cases require anterior transoral decompression, posterior cervical decompression, and instrumented fusions.

  12. Cerv iacl Traction Bonese tting and Taking Evidenced Acupoint Electro Acupuncture for Cervical Spondylotic Radiculopathy%颈牵正骨循经取穴电针治疗神经根型颈椎病的临床观察

    Institute of Scientific and Technical Information of China (English)

    黄奕斌; 冯典毅; 谢群峰; 邹琦珊

    2014-01-01

    Objective:To observe the effect of cervical traction bonesetting and taking evidenced acupoint elec-tro acupuncture on cervical spondylotic radiculopathy.Methods:120 patients who met the inclusion criteria were randomly divided into a treatment group with 60 cases and a control group with 60cases.Treat the treatment group with cervical traction, bonesetting naprapathy and taking evidenced acupoint electro acupuncture .Treat the control group with cervical traction, massage and mild frequency electric pulse therapy .The two groups were not treated with drugs, with 10 days as a course of treatment, and then evaluate the comprehensively curative effect after two courses.Results:The total effective rate of the treatment group was 98.3%, and the control group was 68.3%.The curative effect of treatment group was better than that of the control group( z=-7.125, P<0.001 ) .The integral improvement rate of the treatment group was significantly better than that of the control group,and the difference was statistically significant(t=5.972,P<0.001).Conclusion:The effect of cervical traction bonesetting and taking evidenced acupoint electro acupuncture for cervical spondylotic radiculopathy has a good efficacy.It is worthy of being popularized and applied.%目的:观察颈牵正骨结合循经取穴电针治疗神经根型颈椎病的效果。方法:将120例符合纳入标准的本病患者随机分为治疗组60例,对照组60例。对照组用颈椎牵引、颈部按摩、中频脉冲电治疗。治疗组用颈椎牵引下正骨推拿、循经取穴电针治疗。两组均不使用药物治疗,10天为一疗程,2疗程结束后评价其综合疗效。结果:治疗组总有效率为98.3%,对照组总有效率为68.3%,治疗组疗效优于对照组( z=-7.125,P<0.001)。治疗组的积分改善率明显优于对照组,差异有统计学意义( t=5.972, P<0.001)。结论:颈牵正骨结合循经取穴电针治疗神经根

  13. 正骨推拿联合理疗治疗神经根型颈椎病400例%Massage for Bone-setting and Physical Therapy in Treating 400 Cases of Cervical Spondylotic Radiculopathy

    Institute of Scientific and Technical Information of China (English)

    朱烱伟

    2014-01-01

    目的:观察正骨推拿联合理疗治疗神经根型颈椎病的临床疗效。方法:将800例患者随机分为观察组、对照组各400例,2组均采用牵引、超短波法治疗,观察组同时加用正骨推拿手法治疗。结果:症状积分治疗前2组比较无明显差异(P>0.05),治疗后2组均明显降低(P<0.05),治疗组降低更明显(P<0.05)。治愈率治疗组为40.00%,对照组为25.00%,2组比较差异显著(P<0.05)。总有效率治疗组为98.82%,对照组为90.00%,2组比较差异显著(P<0.05)。结论:正骨推拿联合理疗治疗神经根型颈椎病临床疗效显著。%Objective:To observe clinical effects of massage for bone-setting and physical therapy in treating cervical spondylotic radiculopathy. Methods:All 800 patients were randomized into the observation group and the control group, both groups received traction and ultrashort wave, the observation group were also administered with massage for bone-setting. Results: Before treating, the comparison in symptom scale of both groups presented in-significant difference (P>0.05), the scales were decreased after treating in both groups (P<0.05), the decrease of the treatment group was more notable (P<0.05). Cure rate of the treatment group was 40.00%, higher than 25.00%of the control group, the difference was remarkable (P<0.05). Total effective rate of the treatment group was 98.82%, higher than 90.00% of the control group with significant difference (P<0.05). Conclusion: Massage for bone-setting and physical therapy are effective in treating cervical spondylotic radiculopathy.

  14. 针刺治疗神经根型颈椎病系统评价%Clinical Effect of Acupuncture in Treatment of Cervical Spondylotic Radiculopathy: A Systematic Review

    Institute of Scientific and Technical Information of China (English)

    胡进; 储浩然; 孙奎; 肖伟; 宋阳春; 龙小娜

    2012-01-01

    Objective To assess and compare the clinical effects and safeties of acupuncture and traction therapy in the treatment of cervical spondylotic radiculopathy (CSR) by a systematic review. Methods A search was performed in various worldwide databases for a systematic review of randomised controlled trials of acupuncture and traction therapy for treating CSR. Methodological quality assessment was conducted according to Cochrane Handbook for Systematic Reviews of Interventions Version 5. 1. 0, and effect sizes were calculated. Meta-analysis or descriptive analysis was performed. Results Fourteen studies involving 1 542 cases were included. Acupuncture was safe in the treatment of CSR. Acupuncture showed better clinical effect than traction therapy in the treatment of CSR (RR : 1.20; 955CI: 1. 13-1. 27 vs RR : 1.14, 95%CI: 1.09-1. 20). In addition, acupuncture had better analgetic effect and could reduce recurrence. Conclusion Acupuncture is probably superior to traction therapy in the treatment of CSR, but which is not definite due to relatively low level of evidence.%目的 系统评价针刺与牵引相比较治疗神经根型颈椎病(cervical spondylotic radiculopathy,CSR)的疗效和安全性.方法 广泛检索国内外各数据库中针刺与牵引治疗CSR的随机对照试验.严格按最新版Cochrane系统评价员手册5.1进行方法学质量评价并计算其效应量,进行Meta分析或描述性分析.结果 14个研究包括1 542例病例被纳入,结果显示针刺治疗CSR是安全的;针刺治疗CSR总体疗效较牵引治疗具有优效性(RR:1.20;95% CI:1.13~1.27 vs RR:1.14;95% CI:1.09~1.20).针刺较牵引对CSR患者更具镇痛效果,且能减少复发.结论 针刺较牵引治疗CSR具有优越性,但证据等级较低,结论并不可靠.

  15. Relationship between cervical spondylotic radiculopathy and carpal tunnel syndrome%神经根型颈椎病与腕管综合征的关系

    Institute of Scientific and Technical Information of China (English)

    马彦; 崔丽英; 管宇宙; 刘明生; 杜华; 吴双; 林楠

    2015-01-01

    Objective To explore the relationship between cervical spondylotic radiculopathy (CSR) and carpal tunnel syndrome (CTS) by investigating their electrophysiological characteristics and the incidence of CSR root injury and root injury complicating with CTS.Methods One hundred and twenty-four cases of CSR diagnosed in Peking Union Medical College Hospital from September 2013 to February 2014 by electromyography (EMG) were recruited.According to the results of EMG,patients were divided into root injury and root injury complicating with CTS groups.The distal motor latency (DML),motor nerve conduction velocity (MCV),sensory nerve conduction velocity (SCV),sensory nerve action potential (SNAP),compound muscle action potential (CMAP) and spontaneous potential (SP) were compared between the two groups.Results There were 81 (65.3%) cases with root injury,11 cases with double sides injury and 29 cases with normal EMG among these 124 patients.The CMAP,DML,MCV,SCV and SNAP were normal in 76 cases,CMAP lowered 5%-12% in 3 cases,DML extended 3% and 9% in 2 cases.There were 14 cases (11.3%) with concomitant CTS (female 10 cases and male 4 cases,double sides CTS 10 cases).Among the 14 cases with concomitant CTS,there were 9 cases with simply sensory nerve conduction abnormality,SCV slowing down 26%-47%,SNAP reducing 58%-86% or normal,while other 5 cases with motor conduction abnormality as well as sensory nerve conduction abnormality,CMAP reducing 21%-78%,DML extending 27%-39% in 3 cases,MCV slowing down 32% and 40% in 2 cases.Five cases had spontaneous electricity position movement in the abductor pollicis brevis.The incidence of root injury complicating with CTS in C6 (27.4%,9/33),C7 (26.9%,7/26) and C8 (5/7) showed statistically significant difference (x2 =5.96,P < 0.01).Conclusions There is a high incidence of root injury and CTS in CSR patients,indicating a possible double crush between CSR and CTS.%目的 研究神经根型颈椎病(CSR)

  16. Tropical myelopathies.

    Science.gov (United States)

    Román, Gustavo C

    2014-01-01

    A large number of causal agents produce spinal cord lesions in the tropics. Most etiologies found in temperate regions also occur in the tropics including trauma, herniated discs, tumors, epidural abscess, and congenital malformations. However, infectious and nutritional disorders occur with higher prevalence in tropical regions. Among the most common infectious etiologies are tuberculous Pott's disease, brucellosis, and neuroborreliosis. Parasitic diseases such as schistosomiasis, neurocysticercosis, and eosinophilic meningitis are frequent causes of nontraumatic paraplegia. The retrovirus HTLV-1 is a cause of tropical spastic paraparesis. Nutritional causes of paraparesis include deficiencies of vitamin B12 and folate; endemic clusters of konzo and tropical ataxic myeloneuropathy are associated in Africa with malnutrition and excessive consumption of cyanide-containing bitter cassava. Other toxic etiologies of tropical paraplegia include lathyrism and fluorosis. Nutritional forms of myelopathy are associated often with optic and sensory neuropathy, hence the name tropical myeloneuropathies. Acute transverse myelopathy is seen in association with vaccination, infections, and fibrocartilaginous embolism of the nucleus pulposus. Multiple sclerosis and optic myelopathy occur in the tropics but with lesser prevalence than in temperate regions. The advent of modern imaging in the tropics, including computed tomography and magnetic resonance imaging, has allowed better diagnosis and treatment of these conditions that are a frequent cause of death and disability. PMID:24365434

  17. Efficacy of cervical fixed-point traction manipulation for cervical spondylotic radiculopathy: a randomized controlled trial%颈椎定点引伸手法治疗神经根型颈椎病的随机对照研究

    Institute of Scientific and Technical Information of China (English)

    蒋崇博; 王军; 郑志新; 侯京山; 马玲; 孙彤

    2012-01-01

    背景:神经根型颈椎病是临床常见病、多发病,颈椎定点引伸手法是治疗神经根型颈椎病的方法之一.目的:评价颈椎定点引伸手法治疗神经根型颈椎病的临床疗效.设计、场所、对象和干预措施:采用前瞻性随机对照设计,84例神经根型颈椎病患者均为解放军总医院康复医学科门诊患者,随机分为治疗组和对照组,每组42例.治疗组采用颈椎定点引伸手法治疗,隔日1次,共7次;对照组单纯使用颈椎电脑牵引治疗,1次/d,每次30 min,治疗14 d.主要结局指标:采用视觉模拟量表(visual analogue scale,VAS)评估疼痛强度,应用红外热成像仪采集健肢与患肢皮肤温度,并计算健、患侧上肢温度差值.结果:治疗中脱落5例,其中治疗组1例,对照组4例.治疗组治疗后VAS评分和健、患侧上肢皮肤温度差值低于治疗前(t=28.652,P<0.01; t=64.214,P<0.01);对照组治疗后VAS评分和健、患侧上肢皮肤温度差值亦低于治疗前(t=14.484,P<0.05;t=84.425,P<0.05);治疗组VAS评分和上肢温度差值治疗前后的差异较对照组明显(t=7.494,P<0.01;t=5.321,P<0.01).结论:颈椎定点引伸手法治疗神经根型颈椎病疗效优于颈椎牵引法,主要表现为缓解患者疼痛和减轻神经根压迫等.%BACKGROUND: Cervical spondylotic radiculopathy is a commonly encountered and frequently occurring disease. Traditional Chinese osteopathic manipulations may have better therapeutic efficacy than that of other methods in treating patients with cervical spondylotic radiculopathy.OBJECTIVE; To evaluate the clinical therapeutic effects of cervical fixed-point traction manipulation in treating patients with cervical spondylotic radiculopathy.DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: A prospective, randomized controlled trial was adopted. Eighty-four patients with cervical spondylotic radiculopathy were randomly divided into treatment group (n = 42) and control group (n

  18. Avaliação do tipo de diamante de benzel em pacientes portadores de mielopatia cervical Evaluación del tipo de diamante de benzel en pacientes con mielopatia cervical Evaluation of the type of benzel's diamond in patients with cervical myelopathy

    Directory of Open Access Journals (Sweden)

    Rodrigo Rezende

    2012-12-01

    medidas se encontraron 24 pacientes con diamante del tipo A (80%, 2 con tipo B (6,7% y 4 con tipo C (13,3%. CONCLUSIÓN: El diamante de Benzel del tipo "A" se encuentra en el 80% de los pacientes con mielopatía cervical en el período preoperatorio.OBJECTIVE: Diffuse the method of Benzel for calibration of cervical angulation and to assess the prevalence of each type of Benzel's diamond between 30 patients with cervical myelopathy with an indication for surgical treatment. METHODS: A retrospective study of patients with cervical myelopathy treated surgically. We analyzed lateral radiographs of cervical spine where the diamonds were measured using the techniques described by the author himself. We excluded patients who developed disease following trauma, who underwent reoperations or those who have not provided adequate lateral radiographs for measurement. RESULTS: We evaluated 30 patients, of whom 25 were male, aged between 30 and 74 years (mean 52.4 years. After completion of the measures 24 patients were found with diamond type A (80%, 2 with type B (6.7% and 4 with type C (13.3%. CONCLUSION: The Benzel diamond "A" was found in 80% of patients with cervical myelopathy in the preoperative evaluation.

  19. Therapeutic Efficacy of Wenshen Xuanbi Decoction in Treatment of Cervical Spondylotic Radiculopathy: A Report of 82 Cases%温肾宣痹汤加减治疗神经根型颈椎病82例

    Institute of Scientific and Technical Information of China (English)

    徐康; 夏建龙

    2012-01-01

    To observe the therapeutic efficacy of Wenshen Xuanbi Decoction , which is used for warming the kidney and dredging channel blockade , in the treatment of cervical spondylotic radiculopathy (CSR) .Methods A total of 168 CSR patients were randomly divided into treatment group (re=82) and control group (re?6). The patients in treatment group were orally given Wenshen Xuanbi decoction , while the others in control group were orally given Biqi Capsules (a patent traditional Chinese medicine ) . The two groups were treated for 2 treatment courses .Results The overall response rate of treatment group was significantly higher than that of control group (91.5% vs 79 .1% , P

  20. 推拿配合牵引治疗颈椎病综合征患者120例临床分析%Clinical analysis of 120 cases of cervical spondylosis treated with traction and massage

    Institute of Scientific and Technical Information of China (English)

    李敬军

    2015-01-01

    Objective:To observe clinical effects of cervical spondylosis treated with traction and massage. Methods:120 ca-ses were divided into 4 types, namely, cervical spondylotic radiculopathy, vertebral artery type, sympathetic type of cervical spondylo-sis and cervical spondylotic myelopathy according to the clinical symptoms, and treated with massage and traction. Results:The total effective rate reached 93. 33% (P<0. 01). Conclusions:Massage and traction have the curative effect on the cervical spondylosis of various types, and no negative effect has been observed.%目的::观察推拿配合牵引治疗颈椎综合征患者的临床疗效。方法:将120例患者按临床症状辩证分为神经根、椎动脉、交感神经、脊髓4型,采用推拿配合牵引进行治疗。结果:治疗总有效率达93.33%。结论:推拿配合牵引治疗颈椎综合征疗效显著,适宜于各症型的治疗,且无不良反应。

  1. Effect evaluation of combined cervical plexus block with cervical vertibra drawing for cervical spondylotic radiculopathy%颈丛阻滞配合颈椎牵引治疗神经根型颈椎病疗效观察

    Institute of Scientific and Technical Information of China (English)

    金春祥; 黄冰; 姚明; 陆雅萍; 侯健

    2014-01-01

    Objective To observe the effect of cervical plexus block combined with cervical vertebra traction treatment of cervical spondylosis of nerve root type .Methods 60 cases of nerve root type cervical spondylosis were divided into two groups by coin tossing:group A(n=32) cervical plexus block combined with cervical traction thera-py, group B( n=28) treated by cervical traction therapy ,according to the severity of pain compared two groups of treatment effect.Results after treatment,20d group 10d,30d,90d pain scores were (4.61 ±0.70)%,(3.71 ± 0.57)%,(3.30 ±0.65)%,(4.44 ±1.04)%,group B respectively (5.88 ±1.47)%,(5.61 ±1.35)%,(4.83 ± 0.86)%,(5.50 ±0.87)%,the difference between two groups was statistically significant (t=5.85,1.06,1.30, 7.51,all P<0.01).Conclusion The cervical plexus block combined with cervical traction for treatment of nerve root type of cervical spondylosis is better than the routine treatment of cervical traction ,which is suitable for promotion of primary health care units .%目的:观察颈丛阻滞配合颈椎牵引治疗神经根型颈椎病的临床疗效。方法将纳入观察的60例神经根型颈椎病患者用抛硬币法随机分为两组,甲组(n=32)行颈丛阻滞配合颈椎牵引治疗,乙组(n=28)采用单纯颈椎牵引治疗,根据疼痛程度评分对比分析两组的治疗效果。结果甲组治疗后10 d、20 d、30 d、90 d疼痛程度评分分别为(4.61±0.70)分、(3.71±0.57)分、(3.30±0.65)分、(4.44±1.04)分,乙组分别为(5.88±1.47)分、(5.61±1.35)分、(4.83±0.86)分、(5.50±0.87)分,组间比较差异均有统计学意义(t=5.85、1.06、1.30、7.51,均P<0.01)。结论颈丛阻滞配合颈椎牵引治疗神经根型颈椎病的疗效优于单纯颈椎牵引,适于在基层医疗单位推广。

  2. Clinical Effect of Percutaneous Nucleoplasty with Radiofrequency Abrasion for Treatment of Cervical Spondylotic Radiculopathy%经皮射频消融术治疗神经根型颈椎病的疗效分析

    Institute of Scientific and Technical Information of China (English)

    张顺聪; 杨志东; 梁德; 江晓兵; 晋大祥; 庄洪; 姚珍松

    2012-01-01

    [目的]探讨经皮射频消融髓核成形术治疗神经根型颈椎病的疗效及安全性.[方法]2008年1月至2010年8月应用经皮射频消融髓核成形术治疗神经根型颈椎病患者27例,比较术前、术后2周及末次随访时的疼痛视觉模拟评分(VAS)和颈部功能障碍指数(NDI),评估临床结果,以及影像学检查颈椎间盘突出、椎体间不稳定等情况,并记录手术并发症.[结果]27例患者总共手术椎间隙37个,其中单节段19例,双节段6例,三个节段2例.随访时间1年~28个月,平均19.8个月.未发现手术节段出现不稳定,未发现手术节段椎间隙出现塌陷.27例患者平均VAS评分为术前(7.84±1.47)分,术后2周减少到(2.44±1.61)分,末次随访为(3.16±1.17)分.平均NDI术前为(61.15±15.71)%,术后2周减少到(16.48±13.29)%,末次随访为(14.42±11.55)%.术后2周及末次随访VAS评分及NDI评分均较术前有显著改善,差异均有统计学意义(P<0.05).无1例患者出现脊髓、神经、大血管损伤及术后感染等并发症;无患者出现脊膜破裂脑脊液漏;无患者出现术中刀头断裂.[结论]经皮射频消融髓核成形术是一种安全的微创手术,如果适应症选择正确,能够有效治疗神经根型颈椎病.%Objective To analyze the clinical outcome and safety of percutaneous nucleoplasty with radiofrenquency abrasion for treatment of cervical spondylotic radiculopathy. Methods From January of 2008 to December of 2010, 27 patients with cervical spondylotic radiculopathy received percutaneous nucleoplasty. The scores of visual ( Continued on page 253)analog scale (VAS) and neck disability questionnaires (NDI) were evaluated before the operation, 2 weeks after the operation, and at the final follow-up. Furthermore, the herniation of intervertebral disk and intervertebral instability were monitored by imageological examination, and all of the intraoperative and postoperative complications were recorded. Results

  3. Chronological observation in early radiation myelopathy of the cervical spinal cord; Gadolinium-enhanced MRI findings in two cases

    Energy Technology Data Exchange (ETDEWEB)

    Hirota, Saeko; Yoshida, Shoji; Soejima, Toshinori (Hyogo Medical Center for Adults, Akashi (Japan)) (and others)

    Gd-enhanced MR images of two patients with clinically and histopathologically diagnosed chronic progressive radiation myelitis (CPRM) were observed chronologically. One of them had had nasopharyngeal cancer and received radiotherapy at a dose of 100 Gy to the C1-2 level of the spinal cord. She developed CPRM 25 months after the termination of radiotherapy. The other had had malignant lymphoma originating from the tonsil and received chemoradiotherapy. The dose delivered to her cervical spinal cord was 40 Gy, and she developed CPRM 30 months later. Gd-enhanced MRI in the early phase revealed a small crescent-shaped nidus with or without a very small central nonenhanced area in both cases. Enhancement was not great. At that time, patients noticed only the inability to perceive pain and temperature or paresthesia in the opposite side. In a few months, MRI revealed a much more strongly enhanced and larger nidus with enlargement of a central nonenhanced area accompanied by long segmental cord enlargement. The patients' neurological symptoms had also progressed, with hemiparesis developing, for example. (author).

  4. 中药配合牵引治疗神经根型颈椎病疗效观察%Clinical observation on treating cervical spondylotic radiculopathy in TCM combined with traction

    Institute of Scientific and Technical Information of China (English)

    曹丽萍

    2013-01-01

    目的:观察中药结合牵引治疗神经根型颈椎病的临床疗效。方法:将96例神经根型颈椎病患者随机分为两组,口服中药结合牵引治疗组50例,单纯牵引对照组46例。两组均于治疗两个疗程(4周)后行疗效评定。结果:治疗组总有效率为92%,对照组78.3%。经统计学分析,两组比较差异有统计学意义(P<0.05)。治疗组的疗效明显优于对照组。结论:中药结合牵引治疗神经根型颈椎病有确切疗效。%Objective:To investigate the efficacy of TCM combined with traction on treating cervical spondylotic radiculopathy (CSR). Methods:96 patients with CSR were randomly divided into treated group (50 cases treated with administration of TCM combined with traction) and control group (46 cases treated with simple traction) for two treatment courses (4 weeks). Results:The total efficiency was 92%in treated group and 78.3%in control group, and the difference was statistically significant between the two groups (P<0.05). Treated group was much better than the control group. Conclusion:TCM combined with traction is effective in the treatment of CSR.

  5. Does age affect surgical outcomes in patients with degenerative cervical myelopathy? Results from the prospective multicenter AOSpine International study on 479 patients

    Science.gov (United States)

    Nakashima, Hiroaki; Tetreault, Lindsay A; Nagoshi, Narihito; Nouri, Aria; Kopjar, Branko; Arnold, Paul M; Bartels, Ronald; Defino, Helton; Kale, Shashank; Zhou, Qiang; Fehlings, Michael G

    2016-01-01

    Background In general, older patients with degenerative cervical myelopathy (DCM) are felt to have lower recovery potential following surgery due to increased degenerative pathology, comorbidities, reduced physiological reserves and age-related changes to the spinal cord. This study aims to determine whether age truly is an independent predictor of surgical outcome and to provide evidence to guide practice and decision-making. Methods A total of 479 patients with DCM were prospectively enrolled in the CSM-International study at 16 centres. Our sample was divided into a younger group (<65 years) and an elderly (≥65 years) group. A mixed model analytic approach was used to evaluate differences in the modified Japanese Orthopaedic Association (mJOA), Nurick, Short Form-36 (SF-36) and Neck Disability Index (NDI) scores between groups. We first created an unadjusted model between age and surgical outcome and then developed two adjusted models that accounted for variations in (1) baseline characteristics and (2) both baseline and surgical factors. Results Of the 479 patients, 360 (75.16%) were <65 years and 119 (24.84%) were ≥65 years. Elderly patients had a worse preoperative health status (p<0.0001) and were functionally more severe (p<0.0001). The majority of younger patients (64.96%) underwent anterior surgery, whereas the preferred approach in the elderly group was posterior (58.62%, p<0.0001). Elderly patients had a greater number of decompressed levels than younger patients (p<0.0001). At 24 months after surgery, younger patients achieved a higher postoperative mJOA (p<0.0001) and a lower Nurick score (p<0.0001) than elderly patients. After adjustments for patient and surgical characteristics, these differences in postoperative outcome scores decreased but remained significant. Conclusions Older age is an independent predictor of functional status in patients with DCM. However, patients over 65 with DCM still achieve functionally significant

  6. 腕管综合征合并神经根型颈椎病患者神经传导测定特点分析%Nerve conduction characteristics of carpal tunnel syndrome patients with cervical spondylotic radiculopathy

    Institute of Scientific and Technical Information of China (English)

    徐士军; 李智琳; 杨建国; 孙玉会; 董晓柳

    2014-01-01

    Objective To analyze the nerve conduction characteristics of carpal tunnel syndrome patients with cervical spondylotic ra -diculopathy ,and to provide a better way to treat carpal tunnel syndrome .Methods Thirty patients of carpal tunnel syndrome with cer-vical spondylotic radiculopathy admitted to hospital from December 2011 to December 2012 were studied .And 30 healthy people were chosen as the control group .Distal sensory latency ( DSL) ,sensory nerve action potentials ( SNAP) ,cross-wrist sensory conduction ve-locity ( SCV) ,distal motor latency ( DML) and compound muscle action potential ( CMAP) of the median nerve and ulnar nerve were measured .We first tested sensory conduction ,and then measured motor conduction .These indicators were measured again 5 minutes af-ter median nerve compression test .Results Median nerve DSL of observation group was significantly longer than that of control group . The difference was statistically significant (P0.05). Parameters of median nerve and ulnar nerve in both observation group and control group were not significantly changed (P>0.05). Compared with control group,DSL and DML of median nerve in observation group were significantly prolonged (P 0.05).Conclusions DSL of carpal tunnel syndrome patients with cervical spondylotic radiculopathy was sig -nificantly prolonged due to pressure on the median nerve ,therefore,nerve conduction measurement contributes to the early diagnosis of carpal tunnel syndrome .%目的:探讨腕管综合征合并神经根型颈椎病患者神经传导测定特点并进行临床分析,为治疗提供可靠的依据。方法选取该院2010年12月-2012年12月收治的腕管综合征合并神经根型颈椎病患者30例,并选择同期健康体检者30例作为对照研究。测定正中神经和尺神经的感觉传导末端潜伏期( DSL )、感觉神经动作电位( SNAP )、跨腕关节感觉传导速度(SCV)、运动传导末端潜伏期(DML)及复合肌肉动作电

  7. 低头摇正法结合牵引、中频治疗神经根型颈椎病疗效观察%Efficacy Observation on Ditou Yaozheng Method Combined with Traction and Medium Frequency Treating Cervical Spondylotic Radiculopathy

    Institute of Scientific and Technical Information of China (English)

    罗卫泉; 廖洁爱; 杨兴杜

    2013-01-01

      目的:观察低头摇正法结合牵引、中频治疗神经根型颈椎病的疗效。方法:将80例患者随机分为治疗组和对照组,治疗组用低头摇正法结合牵引、中频治疗,对照组用针灸结合牵引治疗。结果:治疗组总有效率为95.0%,高于对照组的82.5%(P<0.05)。结论:低头摇正法结合牵引、中频治疗神经根型颈椎病疗效显著。%Objective:To observe the efficacy of Ditou yaozheng method combined with traction and medium frequency treating cervical spondylotic radiculopathy. Methods: 80 patients were randomly divided into treatment group and control group, treatment group with Ditou yaozheng method combined with traction and medium frequency, control group with therapy of acupuncture combined with traction. Results:The total effective rate of treatment group was 95%, higher than that of control group by 82.5%(P<0.05). Conclusion:Ditou yaozheng method combined with traction and me-dium frequency treating cervical spondylotic radiculopathy is of significant efficacy.

  8. Minimally invasive posterior cervical decompression using tubular retractor: The technical note and early clinical outcome

    Directory of Open Access Journals (Sweden)

    Jung-Woo Hur

    2014-01-01

    Full Text Available Background: The aim of this work is to present a novel decompression technique that approaches cervical spine posteriorly, but through minimal invasive method using tubular retractor avoiding detachment of posterior musculature. Methods: Six patients underwent minimally invasive posterior cervical decompression using the tubular retractor system and surgical microscope. Minimally invasive access to the posterior cervical spine was performed with exposure through a paramedian muscle-splitting approach. With the assistance of a specialized tubular retraction system and deep soft tissue expansion mechanism, multilevel posterior cervical decompression could be accomplished. This approach also allows safe docking of the retractor system on the lateral mass, thus avoiding the cervical spinal canal during exposure. A standard operating microscope was used with ×10 magnification and 400 mm focal length. The hospital charts, magnetic resonance imaging studies, and follow-up records of all the patients were reviewed. Outcome was assessed by neurological status and visual analog scale (VAS for neck and arm pain. Results: There was no significant complication related to operation. The follow-up time was 4-12 months (mean, 9 months. Muscle weakness improved in all patients; sensory deficits resolved in four patients and improved in two patients. Analysis of the mean VAS for radicular pain and VAS for neck pain showed significant improvement. Conclusions: The preliminary experiences with good clinical outcome seem to promise that this minimally invasive technique is a valid alternative option for the treatment of cervical spondylotic myelopathy.

  9. Cervical CT measurement on patients of cervical spondylotic myelopathy and its clinical significance%脊髓型颈椎病患者的颈椎CT测量及其临床意义

    Institute of Scientific and Technical Information of China (English)

    蒋振松; 张佐伦; 刘立成; 袁泽农

    2003-01-01

    目的:探讨颈椎CT测量对脊髓型颈椎病诊断和治疗的指导意义.方法:对2000年5月~2002年5月行颈椎前路手术的106例脊髓型颈椎病患者进行了系统的颈椎CT测量,并与术中环锯法所取骨芯的椎体矢状径进行比较;术前对颈脊髓功能进行了JOA评分.数据行统计学分析.结果:椎体矢状径的CT测量值与实体测量值无统计学差异,继发性椎管矢状径和有效椎管率均与临床的JOA评分密切相关,后者与临床相关性更高.结论:颈椎CT测量值可作为实际值应用.CT测量对预测脊髓型颈椎病的发病、判断脊髓的受压程度和避免手术并发症均有重要意义.对女性患者尤其应注意测量横突孔间距.

  10. Radiation myelopathy in nasopharyngeal carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Enomoto, Hiroyuki; Tsukuda, Mamoru; Kono, Hidehiro; Omata, Toshiyuki; Mochimachi, Izumi; Hasegawa, Osamu [Yokohama City Univ. (Japan). School of Medicine

    1995-08-01

    A 36-year-old woman with nasopharyngeal carcinoma developed radiation myelopathy. She was treated with radiotherapy, a total dose of about 120 Gy to the cervical spinal cord at the C1 level, chemotherapy and immunotherapy. Nine months after the final radiation therapy, she complained of a paresthesia in the distal area of the right leg. Neurological examination revealed incomplete left Brown-Sequard syndrome below the level of C5. Neurological symptoms had been progressive. The spinal MRI showed an abnormal intramedullary high intensity area enhanced by Gd-DTPA. (author).

  11. Delayed anterior cervical plate dislodgement with pharyngeal wall perforation and oral extrusion of cervical plate screw after 8 years: A very rare complication

    Directory of Open Access Journals (Sweden)

    Ravindranath Kapu

    2012-01-01

    Full Text Available We report a patient with congenital anomaly of cervical spine, who presented with clinical features suggestive of cervical compressive spondylotic myelopathy. He underwent C3 median corpectomy, graft placement, and stabilization from C2 to C4 vertebral bodies. Postoperative period was uneventful and he improved in his symptoms. Eight years later, he presented with a difficulty in swallowing and occasional regurgitation of feeds of 2 months duration and oral extrusion of screw while having food. On oral examination, there was a defect in the posterior pharyngeal wall through which the upper end of plate with intact self-locking screw and socket of missed fixation screw was seen. This was confirmed on X-ray cervical spine. He underwent removal of the plate system and was fed through nasogastric tube and managed with appropriate antibiotics. This case is presented to report a very rare complication of anterior cervical plate fixation in the form of very late-onset dislodgement, migration of anterior cervical plate, and oral extrusion of screw through perforated posterior pharyngeal wall.

  12. Application of posterior cervical lateral mass plates and screws for the treatment of multilevel cervical myelopathy%颈椎后路侧块钢板螺钉置入治疗多节段颈椎病伴颈椎失稳

    Institute of Scientific and Technical Information of China (English)

    王景续; 尹西盟; 宫树一; 邬波

    2012-01-01

    BACKGROUND: Internal fixation of the lateral masses with plate and screw has been widely used to treat cervical instability,cervical spondylolisthesis, cervical reconstruction and other injuries caused by various reasons.OBJECTIVE: To discuss the therapeutic effect of posterior cervical mass fixation assisted with joint distraction in multilevel cervical myelopathy patients.METHODS: An online search of China Academic Journals Full-text Database was performed for the related articles with the key words of “cervical vertebrae”, “lateral mass”, “internal fixation” and “bone graft”. A total of 22 articles were retained after excluding meta-analysis and repetitive studies. These articles were analyzed from three following aspects mainly: the clinical anatomy of cervical lateral mass, the fixation technique of lateral mass screw and the efficacy of lateral mass screw fixation.RESULTS AND CONCLUSION: Lateral cervical mass screw fixation belongs to posterior cervical oligo-segmental fixation. It retains the maximum active degree of cervical vertebrate, adequately decompresses the cervical spinal cord, restores the intervertebral height, maintains the cervical physiological curvature and stabilizes the unstable cervical segments. In addition, it prevents the kyphosis deformity, nerve root palsy and the aggravation of cervical spinal instability. Therefore, lateral cervical mass screw fixation is an effective way to treat multilevel cervical myelopathy accompanied with cervical spinal instability.%背景 侧块钢板螺钉内固定技术已广泛用于创伤及各种原因引起的颈椎不稳、滑脱和颈椎重建.目的 探讨后路椎板减压侧块固定辅助小关节撑开植骨融合治疗多节段颈椎病的效果.方法 作者以"颈椎,侧块,内固定,植骨"为检索词,在中国期刊全文数据库中,采用电子检索的方式进行文献检索.排除Meta 分析及重复性研究,共检索到22 篇文献,从颈椎侧块临床解剖、侧

  13. 护理干预促红细胞生成素用于脊髓型颈椎病的效果观察%Effect observation on nursing intervention of erythropoietin for cervical spondylosis myelopathy

    Institute of Scientific and Technical Information of China (English)

    曾宪娟; 熊敏

    2013-01-01

    [ Objective] To observe the effect of erythropoietin ( EPO) on spinal cord function recovery of patients with cervical spon-dylosis myelopathy, explore the influence of nursing intervention on the application effect of EPO. [ Methods ] 48 patients with cervical spondylosis myelopathy, who were treated in Spinal Surgery Department ofDongfeng Hospital Affiliated to Hubei University of Medicine from May 2010 to October 2011, were randomly divided into the intervention group and the control group. The control group (23 cases) received EPO routine nursing care, and the intervention group (25 cases) was treated with EPO in perioperative period, and was given the postoperative nursing intervention, including psychological support, family support, posture nursing, spinal nerve observation and limb function training. JOA score before operation, 1 week and 1 year after operation was adopted to evaluate the recovery rate of nerve function. [ Results] In the intervention group, the imaging examination suggested that cervical inter-body got well fusion after intervention, and internal fixation was stable without complication. JOA scores at 1 week and 1 year after operation were significantly higher than that before operation, and the improvement rate in the intervention group was significantly higher than that in the control group (P <0.05). [ Conclusion] The nursing intervention of EPO can significantly improve the nerve function recovery after operation in patients with cervical spondylosis myelopathy.%目的 观察促红细胞生成素(EPO)作用于脊髓型颈椎病患者脊髓功能恢复状况,探讨护理干预对EPO应用于脊髓型颈椎病患者神经恢复的影响.方法 将2010年5月-2011年10月间湖北医药学院附属东风医院脊柱外科收治的脊髓型颈椎病病例48例,随机分为对照组和干预组.对照组23例应用EPO行常规护理,干预组25例围手术期使用EPO,术后进行心理支持、家庭支持、体位护理,脊髓神经观

  14. Hereditary and metabolic myelopathies.

    Science.gov (United States)

    Hedera, Peter

    2016-01-01

    Hereditary and metabolic myelopathies are a heterogeneous group of neurologic disorders characterized by clinical signs suggesting spinal cord dysfunction. Spastic weakness, limb ataxia without additional cerebellar signs, impaired vibration, and positional sensation are hallmark phenotypic features of these disorders. Hereditary, and to some extent, metabolic myelopathies are now recognized as more widespread systemic processes with axonal loss and demyelination. However, the concept of predominantly spinal cord disorders remains clinically helpful to differentiate these disorders from other neurodegenerative conditions. Furthermore, metabolic myelopathies are potentially treatable and an earlier diagnosis increases the likelihood of a good clinical recovery. This chapter reviews major types of degenerative myelopathies, hereditary spastic paraplegia, motor neuron disorders, spastic ataxias, and metabolic disorders, including leukodystrophies and nutritionally induced myelopathies, such as vitamin B12, E, and copper deficiencies. Neuroimaging studies usually detect a nonspecific spinal cord atrophy or demyelination of the corticospinal tracts and dorsal columns. Brain imaging can be also helpful in myelopathies caused by generalized neurodegeneration. Given the nonspecific nature of neuroimaging findings, we also review metabolic or genetic assays needed for the specific diagnosis of hereditary and metabolic myelopathies. PMID:27430441

  15. Toxic and Metabolic Myelopathies.

    Science.gov (United States)

    Ramalho, Joana; Nunes, Renato Hoffmann; da Rocha, Antonio José; Castillo, Mauricio

    2016-10-01

    Myelopathy describes any neurologic deficit related to the spinal cord. It is most commonly caused by its compression by neoplasms, degenerative disc disease, trauma, or infection. Less common causes of myelopathy include spinal cord tumors, infection, inflammatory, neurodegenerative, vascular, toxic, and metabolic disorders. Conditions affecting the spinal cord must be recognized as early as possible to prevent progression that may lead to permanent disability. Biopsy is rarely performed, thus the diagnosis and management rely on patient׳s history, physical examination, laboratory results, and imaging findings. Here we review the clinical presentations, pathophysiological mechanisms, and magnetic resonance imaging findings of myelopathies related to metabolic or toxic etiologies. PMID:27616316

  16. Anterior cervical corpectomy: review and comparison of results using titanium mesh cages and carbon fibre reinforced polymer cages.

    Science.gov (United States)

    Kabir, Syed M R; Alabi, J; Rezajooi, Kia; Casey, Adrian T H

    2010-10-01

    Different types of cages have recently become available for reconstruction following anterior cervical corpectomy. We review the results using titanium mesh cages (TMC) and stackable CFRP (carbon fibre reinforced polymer) cages. Forty-two patients who underwent anterior cervical corpectomy between November 2001 and September 2008 were retrospectively reviewed. Pathologies included cervical spondylotic myelopathy (CSM), cervical radiculopathy, OPLL (ossified posterior longitudinal ligament), metastasis/primary bone tumour, rheumatoid arthritis and deformity correction. All patients were evaluated clinically and radiologically. Outcome was assessed on the basis of the Odom's criteria, neck disability index (NDI) and myelopathy disability index (MDI). Mean age was 60 years and mean follow-up was 1½ years. Majority of the patients had single-level corpectomy. Twenty-three patients had TMC cages while 19 patients had CFRP cages. The mean subsidence noted with TMC cage was 1.91 mm, while with the stackable CFRP cage it was 0.5 mm. This difference was statistically significant (p 0.05) or between subsidence and post-operative sagittal alignment (p > 0.05) in either of the groups. Three patients had significant subsidence (> 3 mm), one of whom was symptomatic. There were no hardware-related complications. On the basis of the Odom's criterion, 9 patients (21.4%) had an excellent outcome, 14 patients (33.3%) had a good outcome, 9 patients (21.4%) had a fair outcome and 5 patients (11.9%) had a poor outcome, i.e. symptoms and signs unchanged or exacerbated. Mean post-operative NDI was 26.27% and mean post-operative MDI was 19.31%. Fusion was noted in all 42 cases. Both TMC and stackable CFRP cages provide solid anterior column reconstruction with good outcome following anterior cervical corpectomy. However, more subsidence is noted with TMC cages though this might not significantly alter the clinical outcome unless the subsidence is significant (>3 mm).

  17. 两种前路减压术治疗相邻两节段脊髓型颈椎病的疗效比较%A comparison study of two methods for treating two-level cervical spondylitic myelopathy

    Institute of Scientific and Technical Information of China (English)

    黄小东; 方诗元; 王叙进; 孙建皖; 徐磊

    2014-01-01

    目的:比较经椎间隙减压植骨融合术( anterior cervical discectomy with fusion ,ACDF)与椎体次全切减压植骨融合术(anterior cervical corpectomy with fusion ,ACCF)对相邻两节段脊髓型颈椎病患者的临床疗效。方法回顾由同一组医师行颈前路手术治疗并成功随访的33例相邻两节段颈椎病患者,根据手术方式分为两组:A组,18例患者行颈前路椎间隙减压联合椎间融合器植骨融合术;B组,15例患者行颈前路椎体次全切除减压联合钛网植骨融合术,比较两组手术时间、术中出血量、住院时间、JOA评分、颈椎曲度变化、融合节段椎间高度及植骨融合情况。结果所有患者均获得随访,时间为12~15个月,平均13.2个月。 A组手术时间长于B组,出血量少于B组,两组参数组间比较差异有统计学意义(P<0.05)。 A组住院天数略少于B组,差异无统计学意义(P>0.05)。两组术后3天、术后1年随访JOA评分均较术前提高,JOA评分、融合节段高度及颈椎曲度与术前相比差异均有统计学意义(P<0.05);但组间JOA评分及颈椎曲度差异比较无统计学意义(P>0.05),融合节段高度差异有统计学意义(P<0.05)。两组患者随访期间均未出现内固定松动、断裂等情况。术后1年随访均达到骨性融合的标准。结论两种方法治疗双节段颈椎病均可获得满意的临床疗效,与ACDF相比,ACCF视野清楚、操作方便、手术时间短,但手术创伤大、出血量多,在维持融合节段高度方面比ACDF差,存在钛网下沉现象。%Objective To compare the clinical effects of anterior cervical discectomy with fusion ( ACDF) and anterior cervical cor-pectomy with fusion(ACCF) for treating adjacent two -level cervical spondylitic myelopathy .Methods The clinical data of 33 patients suf-fered from two-level cervical spondylosis (17 males and 16 female

  18. 两种手术方法治疗双节段脊髓型颈椎病的疗效比较研究%Case-control study of two methods in treating two-level cervical spondylitic myelopathy

    Institute of Scientific and Technical Information of China (English)

    张世民; 张兆杰; 刘昱彰; 张禄堂; 李星; 周卫; 王宏

    2013-01-01

    目的 比较经椎间隙减压植骨融合术(ACDF,A组)和保留椎体后壁的椎体次全切除减压植骨融合术(ACCF,B组)治疗双节段脊髓型颈椎病的疗效.方法 回顾性分析自2006年3月~2010年2月行手术治疗并获得随访的双节段脊髓型颈椎病32例,采用双节段椎间隙减压、植骨融合术15例,保留椎体后壁的椎体次全切除减压组17例.结果 A组手术时间及术中出血量均少于B组(P<0.05).两组术后1周、3个月及12个月JOA评分与术前比较,差异有统计学意义(P<0.05),两组各时间段比较差异无统计学意义(P>0.05).两组术后12个月复查均达到骨性融合.两组间术后1周融合节段曲度、全颈椎曲度及融合节段高度的差异无统计学意义(P>0.05).术后3个月及12个月,两组融合节段曲度和全颈椎曲度的差异无统计学意义(P>0.05),而融合节段高度A组明显高于B组(P<0.05).结论 2种方法均可获得满意的效果,ACCF视野清楚,操作更方便,但其创伤大、出血多,而且在维持融合椎体高度方面比ACDF差,存在钛网下沉现象.%Objective To compare the clinical effects between anterior cervical discectomy with fusion (ACDF) and anterior cervical compectomy with fusion (ACCF) in the treatment of two-level cervical spondylitic myelopathy.Methods From March 2006 to February 2010,the clinical data of 32 patients with two-level cervical spondylitic myelopathy who underwent ACDF (group A,15 cases) or ACCF (group B,17 cases) were retrospectively analyzed.Results Volume of loss blood during operation,operative time in group A were less than that of group B (P <0.05).Compared with that before operation,postoperative JOA score at 1 week,3 months and 12 months were improved in two groups (P <0.05),but there was no significant difference in all periods between two groups (P >0.05).All the patients obtained bone fusion at 12-month after operation between two groups.At the 1 week after operation

  19. Value of multi-slice spiral CT imaging and reformation in evaluating the clinical efficacy of tuina therapy in cervical spondylotic radiculopathy%MSCT颈椎扫描重建评价推拿手法治疗神经根型颈椎病疗效的研究

    Institute of Scientific and Technical Information of China (English)

    詹松华; 赵喜; 谭文莉; 杨烁慧; 张敏; 李欢欢; 龚志刚; 詹红生

    2011-01-01

    Objective: To analyze the clinical efficacy of tuina therapy in the cervical spondylotic radiculopathy by multi-slice spiral CT imaging and reformation. Methods: Image data of thirty patients with cervical spondylotic radiculopathy were collected. All patients were performed twice cervical multi-slice spiral CT study before and after the tuina therapy,and all clinical symptoms, signs and VAS score were recorded. The changes of cervical morphology in both MSCT studies were observed, including cervical curvature,atlantoaxial joint,the relationship of the spinous process and the midline of vertebral body position, interver-tebral foramen,intervertebral disc. These changes were comparatively analyzed with clinical symptoms and signs. Results: After tuina treatment,all patients had a significant improvement in the clinical symptoms and signs. VAS score was decreased by (8. 20 + 0. 92) points. The average values of cervical curvature before and after treatment were (1. 91 + 4. 99) mm and (5. 08 + 3. 61) mm,there was significant difference between them (P = 0. 000;t=- 4. 27). There was 80/300 narrow intervertebral foramen before treatment,the number was 35/300 after tuina therapy. The numbers of odontoid skew before and after treatment were 15/30 and 2/30. The distances from the spinous to centerline before and after treatment were (2. 11 + 1.68) mm and (0. 87 + 1. 70) mm (P = 0. 000;t=7. 53). The numbers of intervertebral disk hernia and slipped disc were 63/120 and 42/120 before and after tuina therapy. Conclusion: Tuina therapy is effective for cervical spondylotic radiculopathy by improving the cervical curvature,foraminal size and the relationship of facet joint position. Multi-slice CT imaging and reformation have an important referential value in the evaluation of clinical efficacy of tuina therapy in cervical spondylotic radiculopathy.%目的:探讨MSCT颈椎扫描重建在推拿手法治疗神经根型颈椎病(CSR)疗效评价中的价值.方法:30例临床确

  20. Efficacy Observation on Chiropractic with Release of Closed Type and Traction Treating Cervical Spondylotic Radiculopathy*%闭合型松解配合牵引下整脊治疗神经根型颈椎病的疗效观察

    Institute of Scientific and Technical Information of China (English)

    沈彤; 章瑛; 尹伦辉; 梁伟坚; 敖晓龙; 谌凌燕; 何巍

    2013-01-01

    Objective: To observe clinic effects of chiropractic with release of closed type and traction treating cervical spondylotic radiculopathy. Methods: 60 cases of patients with cervical spondylosis radiculopathy were randomly divided into treatment group and control group, treatment group received therapy of chiropractic with release of closed type and traction , and control group adopt-ed release of closed type and traction treatment, to compare with two groups of clinical efficacy and condition of pain scores before and after treatment. Results: the total effective rate of treatment group was 93.3%, higher than 80% of control group (P<0.05); The pain scores of two groups after treatment both decreased significantly (P<0.05), but the pain scores of treatment group after treat-ment were lower (P<0.05). Conclusion: Therapeutic effects on chiropractic with release of closed type and traction treating cervical spondylotic radiculopathy are distinct and operational safety, which is worthy of clinical promotion.%  目的:观察闭合型松解配合牵引下整脊治疗神经根型颈椎病的临床疗效.方法:将60例神经根型颈椎病患者随机分为治疗组及对照组,治疗组采用闭合型松解配合牵引下整脊治疗,对照组采用闭合型松解配合单纯牵引治疗,对比两组的临床疗效及治疗前后疼痛积分情况.结果:治疗组总有效率93.3%,高于对照组的80.0%(P<0.05);两组治疗后的疼痛积分均明显降低(P<0.05),但治疗组治疗后的疼痛积分低于对照组(P<0.05).结论:闭合型松解配合牵引下整脊治疗神经根型颈椎病临床疗效显著,操作安全,值得临床推广.

  1. Effect of signal intensity enhancement of the spinal cord MRI and the indications of surgical treatment in cervical spondylotic myelopathy%颈脊髓MRI信号增强与脊髓型颈椎病手术指征

    Institute of Scientific and Technical Information of China (English)

    宋海涛; 贾连顺; 袁文; 倪斌; 史建刚

    2001-01-01

    目的:探讨脊髓MRI信号增强能否作为脊髓型颈椎病(CSM)脊髓减压的指征.方法:总结87例轻型CSM病人保守治疗随访结果与颈脊髓T2加权信号增强(ISI)的关系.结果:有ISI组与无ISI组、ISI减少组与ISI无变化组治疗前、后JOA评分无明显差异;ISI减少、无变化或无ISI均不影响保守治疗满意率.结论:对轻型CSM,ISI不能作为常规脊髓减压手术的指征.

  2. 肌电图在脊髓型颈椎病诊断与鉴别诊断中的应用%Application of electromyography in the diagnosis and differential diagnosis of cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    诸兴明; 万琦; 杜宇平

    2008-01-01

    目的 探讨肌电图检查在脊髓型颈椎病诊断与鉴别诊断中的应用价值.方法 对脊髓型颈椎病(CSM)患者25例和肌萎缩侧索硬化症(ALS)患者23例行胸锁乳突肌、胸段脊旁肌和多肢体肌的常规肌电图(EMG)检查,另外还检测上肢的躯体感觉诱发电位(SEP).结果 CSM组患者三肢体肌、胸段脊旁肌和胸锁乳突肌EMG异常率分别为4.00%、4.00%、8.00%.SEP异常率为80.00%,ALS组三肢体肌、胸段脊旁肌和胸锁乳突肌EMG异常率分别为56.52%、73.91%、91.30%,SEP异常率为8.70%,2组间差异有统计学意义(P<0.01).CSM组有2例合并ALS,2例为ALS;ALS组有2例合并CSM.结论 胸锁乳突肌、胸段脊旁肌和多肢体肌的EMG检查和上肢的SEP检查有助于CSM诊断与鉴别诊断.

  3. Avaliação das técnicas cirúrgicas para tratamento da mielorradiculopatia espondilótica cervical Evaluación de las técnicas quirúrgicas para el tratamiento de la mielorradiculopatía cervical espondilótica Evaluation of surgical techniques for treatment of cervical spondylotic myeloradiculopathy

    Directory of Open Access Journals (Sweden)

    Alexandre Meluzzi

    2012-01-01

    de 200 pacientes sometidos a tratamiento quirúrgico de la mielorradiculopatía cervical en el HC-FMUSP, desde enero de 1993 a enero de 2007. La evaluación clínica se cuantificó mediante la escala de la JOA, con un segmento promedio de 06 años y 08 meses. RESULTADOS: Se observó una mejoría neurológica posoperatoria en las vías anterior y posterior, con excepción de las laminectomías sin fusión, donde hubo deterioro neurológico tardío. La vía anterior mostró una tasa significativamente mayor de complicaciones relacionadas con el déficit de fusión intervertebral, desplazamiento del injerto, síndrome de disco adyacente, disfonía, disfagia, o mala posición de injerto y placas, lesión de la raíz del nervio y tasa significativamente mayor de nueva intervención quirúrgica. En la vía posterior, mayor incidencia de inestabilidad en la cifosis posoperatoria, en la laminectomía, y en la laminoplastia no se observó esto, teniendo esta última tasas similares a las encontradas en la vía anterior. No hubo mejoría en el dolor axial en las laminoplastias y se agravó en las laminectomías, mientras que en las discectomías y las corpectomías se produjo una mejoría significativa de los síntomas. CONCLUSIÓN Las vías anterior y posterior fueron eficaces en la producción de mejoría neurológica, con excepción de las laminectomías sin fusión. La vía anterior produjo más complicaciones, pero el dolor es mejor tratado.OBJECTIVE: To evaluate the efficacy of surgical treatment of cervical spondylotic myeloradiculopathy in the production of postoperative neurological improvement, measured in points by the scale of JOA (Japanese Orthopaedic Association and the recovery rate and complications of therapy. METHODS: Analysis of medical records and imaging studies of 200 patients undergoing surgical treatment of cervical myeloradiculopathy in HC-FMUSP, from January 1993 to January 2007. Clinical evaluation was quantified by the scale of the JOA, with an

  4. Mobi-C人工颈椎间盘在颈前路手术的临床应用%Clinical study of Mobi-C cervical prosthetic disc in cervical anterior route operation

    Institute of Scientific and Technical Information of China (English)

    严力生; 罗旭耀; 钱海平; 梁伟; 鲍宏伟; 宫峰

    2011-01-01

    目的 探讨观察Mobi-C人工颈椎间盘置换技术治疗颈椎病、颈椎间盘脱出症的临床疗效.方法 自2008-10-2010-03,应用Mobi-C人工颈椎间盘置换术治疗颈椎病8例13个椎间隙、颈椎间盘脱出症5例6个间隙,对手术操作、术中出血、术后影像学检查及临床疗效等进行了分析.结果 患者手术后1周均感到上胸部紧缩感及手指麻木等神经症状明显好转,手指持物及下肢肌力增加.术后1周X线片检查显示:椎间隙高度、位置良好.随访6~23个月,根据JOA评分:从手术前的平均9.5分增加到随访时16.5分,术后改善率93.4%.X线摄片示无椎间隙的高度丢失、椎体后缘自发骨化及后凸畸形,动力性摄片未见不稳、假体移位、松动征象.术后未出现喉头水肿、伤口血肿、切口感染、声音嘶哑等并发症.结论 Mobi-C人工颈椎间盘置换术治疗颈椎病、颈椎间盘突出症能获得优良的近期疗效.%objective To observe the clinic effecl of Mobi-C artifitial cervical disc prosthesis on treating cervical spondylotic myelopathy and cervical disc protrusion. Methods From October 2(X)8 to March 2010,8 cases(13 spacs )of cervical spondylotic myelepathy anrl 5 cases(6spacs)of cervical disc protrusion were treated surgically by cervical arthroplasty using Mobi-C disc prosthesis. The material include the surgery procedures, operative time,blood loss,radiological examinations,clinical effect and complications were analyzed. Results The neurologic symptoms were relieved obviously within one week postoperative in all patients. Low limb muscle strength increased, upper limb abnormal sensation disappeared and limb moved more agile. Cervical X-ray film showed cervical curve anil position of Mobi-C prosthesis resumed normal. The intervertebral space height were maintaining original height in all cases. Followed up average 15 months (6~23 months). The average JOA score increased from 9.5 preoperative to 16.5 at followed up

  5. Clinical outcomes of selective anterior cervical corpectomy combined with segmental disectomy and fusion for treating three-level cervical myelopathy%前路选择性椎体切除结合单间隙减压植骨融合术治疗三节段脊髓型颈椎病的临床疗效

    Institute of Scientific and Technical Information of China (English)

    曹涌; 张烽; 陈向东; 姜星杰

    2011-01-01

    Objective To evaluate the clinical outcomes of selective anterior cervical corpectomy combined with segmental disectomy and fusion for treating three-level cervical myelopathy. Methods Thirtee patients of multilevel cervical myelopathy with 3 consecutive segments were treated with anterior cervical corpectomy combined with segmental disectomy and fusion. Study parameters included JOA score and grading the Odom criteria. The sagittal segmental alignment of fusion levels was measured using the Cobb method before and after surgery. Graft fusion rate was observed during final follow up. Results The patients were followed up for 12 to 39 months. The JOA score of 13 patients was higher three months after surgery than that before[(14. 6± 1.0) points vs. (11.1 ± 1.0) points] (P<0. 01). Surgical results of Odom criteria were excellent in 8 cases, good in 3 cases, fair in 2 cases. Graft fusion rate was 100%. Radiograph analysis indicated that the Cobb angle of mean segmental lordosis was 3.7 degrees before, 10.7 degrees one week later and 10.4 degrees during the final follow up. Conclusion Selective anterior cervical corpectomy combined with segmental disectomy and fusion results in high fusion rates with sufficient decompression in the treatment of three-level cervical myelopathy.%目的 分析颈前路选择性椎体次全切除十单间隙减压植骨融合术治疗三节段脊髓型颈椎病的临床疗效.方法 13例脊髓型颈椎病患者行颈前路选择性椎体次全切除十单间隙减压、自体髂骨植骨、钢板内固定术.分析术前及随访时的日本骨科协会(JOA)评分,记录术后Odom分级.测量术前、术后1周及末次随访时颈椎侧位X线片,观察术后颈椎植骨融合率、颈椎曲度(Cobb角)维持、症状及功能改善率.结果 13例患者随访12~39个月,术后3个月JOA评分为(14.6±1.0)分,明显高于术前的(11.1±1.0)分(P<0.01).术后Odom分级:优8例,良3例,一般2例,植骨融合率100%.

  6. 心理干预联合通阳利湿法对神经根型颈椎病伴发抑郁患者疗效观察%EFFICACY OF PSYCHOLOGICAL INTERVENTION IN COMBINATION WITH TONGYANG LISHI DECOCTION ON CERVICAL SPONDYLOTIC RADICULOPATHY PATIENTS WITH DEPRESSION

    Institute of Scientific and Technical Information of China (English)

    王鹏; 李彦丽; 贾露露; 乔钢; 国延军; 陈爱民

    2014-01-01

    目的:观察马斯洛需要层次论指导下心理干预联合通阳利湿法辨证施治对神经根型颈椎病患者抑郁发作及临床症状体征的影响。方法将180例神经根型颈椎病患者随机分为对照组、治疗1组、治疗2组。对照组给予常规护理;治疗1组给予常规护理+马斯洛需要层次理论指导的心理干预;治疗2组给予常规护理+马斯洛需要层次理论指导的心理干预+通阳利湿法辨证施治。比较3组干预前后抑郁评分(17-item Hamilton Depression Rating Scale,HAMD-17)及症状体征积分。结果3组在改善抑郁评分及症状体征积分方面差异有统计学意义( P﹤0.05或﹤0.01),其中治疗2组优于治疗1组,治疗1组又优于对照组。结论马斯洛需要层次论指导下心理干预联合通阳利湿法辨证施治较以往常规护理或单独应用马斯洛需要层次论指导下心理干预,对神经根型颈椎病伴发抑郁患者有更好的疗效。%Objective To observe the influence of psychological intervention that was guided by Maslow hierarchy of needs theory in combination with Tongyang Lishi decoction on cervical spondylotic radiculopathy patients with depressive episode and clinical signs and symptoms. Methods One hundred and eighty cases of cervical spondylotic radiculopathy patients were divided into three groups:the control group,the treatment group 1 and the treatment group 2. Patients in control group received routine nursing, patients in the treatment group 1 were given routine nursing and psychological intervention by reference to Marlow hierarchy of needs theory,patients in the treatment group 2 received Tongyang Lishi decoction with dialectical nursing based on the treatment group 1. Depression scores(17-item Hamilton Depression Rating Scale,HAMD-17 )and symptom scores were compared before and after the intervention among three groups. Results There ware significant differences among the three groups in

  7. 非手术综合疗法优化方案治疗神经根型颈椎病临床观察%Clinical Observation on the Treatment of Cervical Spondylotic Radiculopathy with Optimized Scheme of Comprehensive Non-operative Therapy

    Institute of Scientific and Technical Information of China (English)

    赵灿; 白玉

    2014-01-01

    目的:观察非手术综合疗法优化方案治疗神经根型颈椎病的临床疗效。方法:将300例神经根型颈椎病患者分为治疗组和对照组,每组150例。治疗组以旋提手法为主,配合中药熏蒸、牵引等治疗,对照组采用中药熏蒸、牵引治疗。两组均连续治疗15 d。结果:治疗组脱落5例,临床控制57例,显效60例,有效18例,无效10例,有效率为93.10%;对照组脱落10例,临床控制40例,显效48例,有效32例,无效20例,有效率为85.70%。两组比较,差异有统计学意义(P<0.05)。治疗后,两组VAS评分均有改善,且治疗组优于对照组,差异有统计学意义(P<0.05)。结论:非手术综合疗法优化方案治疗神经根型颈椎病疗效显著。%Objective:To observe the curative effect on optimized scheme of comprehensive non-operative therapy in the treatment of cervical spondylotic radiculopathy.Methods:300 cases of cervical spondylotic radiculopathy were divided into a treatment group and a control group,150 cases in each.The treatment group were treated with rotating and lifting manipulation combined with herbal fumigation and traction therapy,while the control group were treated with herbal fumigation and traction therapy.Two groups were treated for 15 days. Results:In the treatment group,5 cases fell off,57 cases were clinical control,60 cases were markedly effective, 18 cases were effective and 10 cases were invalid,the effective rate being 93.10%;while in the control group,10 cases fell off,40 cases were clinical control,48 cases were markedly effective,32 cases were effective,and 20 cases were invalid,with efifciency being 85.70%.Comparing the two groups,the difference was statistically signiifcant(P<0.05). After treatment,VAS of two groups was improved,and the treatment group was better than that of the control group,the difference being statistically signiifcant(P<0.05).Conclusion:Comprehensive non

  8. Observation on the curative effect of Shi’s manipulation in the treatment of cervical spondylotic radiculopathy%石氏手法治疗神经根型颈椎病的疗效观察

    Institute of Scientific and Technical Information of China (English)

    王翔; 詹红生; 张明才; 陈元川; 石瑛; 陈东煜; 石印玉

    2015-01-01

    Objective:To observe the clinical curative effect of Shi’s manipulation in the treatment of cervical spondylotic radiculopa-thy(CSR).Methods:One hundred and twenty patients with CSR enrolled in the study were randomly divided into Shi’s group and conven-tional group,60 cases in each group.Patients in Shi’s group were treated with Shi’s manipulation for 4 consecutive weeks,while the others in the conventional group were treated with non-operative treatment such as traditional massage,acupuncture,physical therapy or drugs for 4 consecutive weeks.The neck and shoulder pain were evaluated by using visual analogue score(VAS)before treatment and after 2 and 4-week treatment respectively,and the curative effect were evaluated after the treatment according to the self-designed therapeutic effect evalu-ation standard of cervical spondylosis which was extracted from Standard for diagnosis and therapeutic effectiveness evaluation of traditional Chinese medicine syndromes.Results:The treatment were unfinished in 2 patients(Shi’s group)and 3 patients(conventional group)respec-tively.There was statistical difference in VAS scores of neck and shoulder pain between different time points,in other words,there was time effect(F =16.011,P =0.000).There was statistical difference in VAS scores of neck and shoulder pain between the 2 groups,in other words,there was group effect(F =3.498,P =0.001).The VAS scores were lower in Shi’s group compared to conventional group after 2 and 4-week treatment(5.733 +/-1.013 vs 5.830 +/-1.046 points,t =0.256,P =0.614;2.905 +/-1.214 vs 3.790 +/-1.389 points, t =13.265,P =0.000;1.219 +/-1.107 vs 2.547 +/-1.554 points,t =27.932,P =0.000).There was no interaction between time factor and grouping factor(F =1.089,P =0.299).Twenty-six patients were cured,22 got a good result,9 fair and 1 poor in the Shi’s group;while 19 patients were cured,17 got a good result,18 fair and 3 poor in the conventional group after 4-week treatment.The Shi’s group

  9. Comparison of T{sub 2}-weighted turbo-spin echo sequence and ultra-fast HASTE sequence in the diagnosis of cervical myelopathies and spinal stenoses against static and kinematic MRT of the cervical spine; Vergleich von T{sub 2}-gewichteter Turbo-Spin-Echo- und ultraschneller, HASTE-Sequenz in der Diagnostik von zervikalen Myelopathien und Spinalstenosen mit der statischen und kinematischen MRT der Halswirbelsaeule

    Energy Technology Data Exchange (ETDEWEB)

    Muhle, C.; Metzner, J.; Brinkmann, G.; Kuehn, B.; Bischoff, L.; Hutzelmann, A.; Wesner, F.; Heller, M. [Klinik fuer Radiologische Diagnostik, Christian-Albrechts-Universitaet zu Kiel (Germany)

    1997-11-01

    Purpose: The purpose of this study was to compare HASTE-sequence with T{sub 2}-weighted TSE-sequence in the detection of cervical myelopathy and cervical spinal stenosis in kinematic MRI. Methods: 24 patients with degenerative disease of the cervical spine were studied. Images were evaluated according to the following criteria: Artifacts, delineation of the vertebra, disks and degenerative changes, grade of spinal stenosis (grade 0-3) and evaluation of the cervical spinal cord. Results: Due to image blurring and artifacts, evaluation and delineation of the cervical spine was possible in all cases in the T{sub 2}-weighted TSE-sequence, but only in 23 of 24 patients using HASTE-sequence. Differentiation between osteophytes and disks was obtained in most cases (23/24) in the T{sub 2}-weighted TSE-sequence but none in the HASTE-sequence. Cervical myelopathy was observed in 4 patients in T{sub 2}-weighted TSE images but only in two cases using HASTE-sequence. Compared to T{sub 2}-weighted TSE-sequence spinal canal stenosis was underestimated using HASTE-sequence. (orig./AJ) [Deutsch] Ziel: Beurteilung von zervikalen Myelopathien und Spinalstenosen im Vergleich von ultraschneller HASTE-Sequenz sowie T{sub 2}-TSE-Sequenz. Methode: 24 Patienten mit degenerativen Halswirbelsaeulenveraenderungen wurden untersucht. Die Aufnahmen wurden hinsichtlich der Artefaktanfaelligkeit, der Darstellung von Halswirbelkoerper, Bandscheiben und degenerativen Veraenderungen, dem Grad einer Spinalstenose (Stadium 0-3) sowie der Beurteilung des Zervikalmarks ausgewertet. Ergebnisse; Aufgrund von ausgepraegten Artefakten konnten nur 23 von 24 Untersuchungen mit der HASTE-Sequenz, hingegen alle Untersuchungen mit der T{sub 2}-TSE-Sequenz ausgewertet werden. Eine Differenzierung von osteophytaeren Randanbauten von Bandscheiben und Wirbelkoerpern war in der HASTE-Sequenz gegenueber der T{sub 2}-TSE-Sequenz nur eingeschraenkt moeglich. Eine in 4 Faellen in der T{sub 2}-TSE-Sequenz diagnostizierte

  10. Comparison of outcomes and safety of using hydroxyapatite granules as a substitute for autograft in cervical cages for anterior cervical discectomy and interbody fusion

    Directory of Open Access Journals (Sweden)

    Hosein Mashhadinezhad

    2014-03-01

    Full Text Available Background:   After cervical discectomy, autogenetic bone is packed into the cage to increase the rate of union between adjacent vertebral bodies, but donor site–related complications can still occur. In this study we evaluate the use   of hydroxyapatite granules as a substitute for autograft for interbody fusion.     Methods:   From November 2008 to November 2011, 236 patients participated in this study. Peek cages were packed with autologous bone grafts taken from the iliac crest in 112 patients and hydroxyapatite (HA granules in 124 patients.   Patients were followed for 12 months. The patients’ neurological signs, results, and complications were fully recorded   throughout the procedure. Radiological imaging was done to assess the fusion rate and settling ratio.     Results:   Formation of bony bridges at the third month was higher in the autograft group versus the granule group. However, there was no difference between both groups at the 12-month follow-up assessment. No difference (     P > 0.05   was found regarding improvement in neurological deficit as well as radicular pain and recovery rate between the two groups. Conclusions:   Interbody fusion cage containing HA granules proved to be an effective treatment for cervical spondylotic radiculopathy and/or myelopathy. Clinical and neurological outcome, radiographic measurement and fusion rate   in cage containing HA are similar and competitive with autograft packed cages.

  11. Comparison of outcomes and safety of using hydroxyapatite granules as a substitute for autograft in cervical cages for anterior cervical discectomy and interbody fusion

    Directory of Open Access Journals (Sweden)

    Hosein Mashhadinezhad

    2014-03-01

    Full Text Available Background:   After cervical discectomy, autogenetic bone is packed into the cage to increase the rate of union between adjacent vertebral bodies, but donor site–related complications can still occur. In this study we evaluate the use   of hydroxyapatite granules as a substitute for autograft for interbody fusion.     Methods:   From November 2008 to November 2011, 236 patients participated in this study. Peek cages were packed with autologous bone grafts taken from the iliac crest in 112 patients and hydroxyapatite (HA granules in 124 patients.   Patients were followed for 12 months. The patients’ neurological signs, results, and complications were fully recorded   throughout the procedure. Radiological imaging was done to assess the fusion rate and settling ratio.     Results:   Formation of bony bridges at the third month was higher in the autograft group versus the granule group. However, there was no difference between both groups at the 12-month follow-up assessment. No difference (     P > 0.05   was found regarding improvement in neurological deficit as well as radicular pain and recovery rate between the two groups. Conclusions:   Interbody fusion cage containing HA granules proved to be an effective treatment for cervical spondylotic radiculopathy and/or myelopathy. Clinical and neurological outcome, radiographic measurement and fusion rate   in cage containing HA are similar and competitive with autograft packed cages.    

  12. Potencial evocado somatossensitivo e motor na espodilose cervical Somatosensory and motor evoked potentials in patients with cervical spondylosis

    Directory of Open Access Journals (Sweden)

    Daniela Oliveira de Andrade

    2005-09-01

    Full Text Available Foram estudados 54 pacientes com diagnóstico de espondilose cervical (EC com ou sem sinais clínicos de mielopatia espondilótica. Realizou-se análise retrospectiva de todos os pacientes portadores de EC investigados por ressonância magnética (RNM cervical, potenciais evocados somatossensitivos (PESS e motor (PEM de membros superiores e inferiores. A RNM foi considerada padrão-ouro e os pacientes foram divididos em três grupos. Grupo 1 (RNM sem compressão medular, Grupo 2 (apenas indentação medular e grupo 3 (compressão medular associada a alteração do sinal medular. A sensibilidade do PESS de quatro membros foi 61,9%, similar à encontrada quando realizado o PESS apenas de membros inferiores. A sensibilidade do PEM de quatro membros foi 71,4%, em membros superiores isoladamente foi 66,7% e em membros inferiores 52,4%, mostrando a importância da realização deste método nos quatro membros quando suspeita-se de mielopatia espondilótica cervical. Os resultados encontrados pelo estudo do nervo tibial no PESS e do músculo abdutor do dedo mínimo no PEM mostrou maior percentual de achados alterados que os resultados encontrados pelo estudo do nervo mediano no PESS e do músculo extensor curto dos dedos no PEM nos três grupos, sugerindo que existe um comprometimento inicial deles.This study investigated 54 patients with cervical spondylosis (CS with or without symptoms caused by cervical spondylotic myelopathy. Cervical MRI, somatosensory evoked potentials (SEPs and motor evoked potentials (MEP from upper and lower limbs of all of these patients were examined retrospectively. Were MRI findings the gold standard and the patients were classified in three groups. Group 1 (absence of spinal cord compression ; Group 2 ( presence of spinal cord indentation; Group 3 (spinal cord compression with alteration of intraspinal sign. The sensitivity of SEP of four limbs was 61.9%, the same one as the SEP of lower limbs. The sensitivity of MEP of

  13. Establishment and evaluation of a new experimental animal model of chronic cervical compressive myelopathy%绵羊慢性压迫性颈脊髓病动物模型的建立及评估

    Institute of Scientific and Technical Information of China (English)

    杨辰; 张凤山; 姜亮; 刘忠军

    2011-01-01

    Objective: To explore a new experimental animal model of chronic cervical compressive myelopathy.Method: Nine small-tailed sheep were divided into three groupscontrol group(A),l-month group(B) and 3-month group (C).The balloon was inserted into the C4/5 intervertebral space by anterior approach,and the syringe valve was fixed subcutaneously.Contrast agent was injected into the valve 0.1ml/week percutaneously.The sheep underent X-ray,CT and MRI under general anesthesia every four weeks.The Tarlov scores were assessed in each group.The spinal cord specimens at test level were examined by optical microscope and transmission electron microscope at the end of experiment.ANOVA was applied to assess the difference of Tarlov scores among three groups, and the correlation of the parameters was analyzed by Pearson method.Result:The final radiological findings showed that the average spinal canal encroachment rate was 54.6% in group B and 67.6% in group C.There were no Tarlov changes after and before pereutaneously injected.The final Tarlov score was 5 (normal)in all the sheep of group A,5 in 2 sheep and 4 in 1 sheep of group B,3 in 2 sheep and 2 in 1 sheep in group C.The gross appearance of spinal cord in test level was normal in group A,flat in group B,and depressed in group C.The pathological examination showed neuronatrophy,increased gap around the neurons,reduction of Nissl body,mild demyelinated and vacuolar degeneration in group B.while more remarkably in group C.The ultrastructural pathology showed mild degeneration of neurons,slight expansion of rough endoplasmic reticulum,mitochondrial swelling,myelin sheath release,demyelination and vacuolar degeneration of some axons in group B,while more remarkably in group C,which presented with neuronal cell membrane breakdown,nuclear pyknosis,ribosomal depigmentation and disappearance of some axons.Conclusion:The postoperative behavior,radiological results and histological examination are in accordance with the character

  14. Only fixation for cervical spondylosis: Report of early results with a preliminary experience with 6 cases

    OpenAIRE

    Atul Goel

    2013-01-01

    Aim: The author reports early post-operative outcome and preliminary experience with an alternative form of treatment of cervical degenerative or spondylotic disease leading to spinal canal stenosis that involves fixation-arthrodesis of the affected spinal segment using one or two (double insurance) transarticular screws for each joint. Materials and Methods: During the period of months from March 2013 to July 2013, six patients having cervical spondylotic cord compression were treated with t...

  15. Segmental anterior cervical decompression with fusion for treating multilevel cervical myelopathy: Comparison of fusion rates among three methods%颈前路分节段减压植骨融合术治疗多节段颈椎病:3种方法移植骨融合率的比较

    Institute of Scientific and Technical Information of China (English)

    袁文; 徐盛明; 王新伟; 张涛; 刘百峰

    2007-01-01

    院时间均明显少于/短于长节段减压组(P<0.05),平均住院费用明显高于长节段减压组(P<0.05).分节段减压组、三间隙减压组和长节段减压组术后JOA评分提高分数和植骨融合率相近(P>0.05).结论:综合植骨融合率、神经功能恢复情况、手术时间、术中出血量、住院时间多种因素,3种术式中以颈前路分节段减压植骨融合术为治疗多节段颈椎病的手术方式较佳方案.%BACKGROUND:As a traditional treatment for multilevel cervical myelopathy,nterior long-segmental decompression has the shortcomings of great operative trauma,high difficulty,low fusion rate,etc.,which can affect the postoperative efficacy.OBJ ECTIVE:To evaluate the clinical effects of three different anterior surgeries on multilevel cervical myelopathy.DESIGN:A comparative observation.SETTING:Department of Orthopaedics,Changzheog Hospital,the Second Military Medical University of Chinese PLA.PARTICIPANTS:Thirty-six patients with multilevel cervical myelopathy of 3 consecutive segments,who were surgically treated,were selected from the Department of Orthopaedics,Changzheng Hospital,the Second Military Medical University of Chinese PLA from June 1999 to June 2003,including 25 males and 11 females,35-62 years of age,the disease course ranged from 3 to 26 months. According to the clinical manifestations and imaging esults,they were diagnosed as multilevel cervical myelopathy,and they were not suffering from consecutive ossification of posterior longitudinal ligament and ossification of ligamenta flava. Informed contents were obtained from all the patients and their relatives.METHODS:All the patients were grafted with utologous bone. Autologous ilium or cancellous bone excluding vertebral body was filled into titan net or Cage,which were made of titan and characterized by high intensity,tolerance to decay,good biocompatibility,etc. According to the operative manner,the patients were divided into 3 groups:① two

  16. The natural history and clinical syndromes of degenerative cervical spondylosis.

    LENUS (Irish Health Repository)

    Kelly, John C

    2012-01-01

    Cervical spondylosis is a broad term which describes the age related chronic disc degeneration, which can also affect the cervical vertebrae, the facet and other joints and their associated soft tissue supports. Evidence of spondylitic change is frequently found in many asymptomatic adults. Radiculopathy is a result of intervertebral foramina narrowing. Narrowing of the spinal canal can result in spinal cord compression, ultimately resulting in cervical spondylosis myelopathy. This review article examines the current literature in relation to the cervical spondylosis and describes the three clinical syndromes of axial neck pain, cervical radiculopathy and cervical myelopathy.

  17. Degenerative myelopathy in dogs

    Directory of Open Access Journals (Sweden)

    Nikolovski Goran

    2010-05-01

    Full Text Available One of the chronic progressive disorders of the spinal cord in dogs is the degenerative myelopathy (DM. The most predisposed age in dog is 5 to 14 years, while rarely noted in younger, there is no gender predisposition. This disorder most commonly appears in dogs of the German shepherd breed, but it can appear in other breeds too. The main changes about this disease are degeneration of the myelin, especially in the thoracic-lumbar segments of the spinal cord and the dorsal nerve roots. The progression of the disease is slow and can last months to years. Undoubtedly, diagnosis is made by examinations of the CSF and establishing elevated level of protein segments.

  18. Fatores prognósticos associados ao tratamento cirúrgico da mielorradiculopatia espondilótica cervical Factores pronósticos asociados con el tratamiento quirúrgico de la mielorradiculopatía cervical espondilótica Prognostic factors associated with surgical treatment of cervical spondylotic myeloradiculopathy

    OpenAIRE

    Alexandre Meluzzi; Mário Augusto Taricco; Roger Schimidth Brock; Mário Rubem Pena Dias; Gilberto Nakaguawa; Vinícius Monteiro de Paula Guirado; Manoel Jacobsen Teixeira

    2012-01-01

    OBJETIVO: Identificar os fatores clínicos dos indivíduos, fatores sociais, ambientais e dos exames de imagem que se correlacionam ao resultado final de melhora neurológica em pacientes submetidos ao tratamento cirúrgico da mielopatia espondilótica cervical. MÉTODOS: A avaliação clínica foi quantificada pela escala deficitária da JOA. Analisamos 200 casos de mielorradiculopatia cervical, operados no HC-FMUSP, no período de janeiro de 1993 a janeiro de 2007. A média de segmento foi de 06 anos e...

  19. 整脊手法配合小圆枕治疗神经根型颈椎病的临床研究%Clinical Study of Chiropractic Technique Combined With Small Pillow for Treating Cervical Spondylotic Radiculopathy

    Institute of Scientific and Technical Information of China (English)

    朱震芳

    2013-01-01

    目的:观察整脊手法配合小圆枕治疗神经根型颈椎病的临床疗效.方法:将86例神经根型颈椎病患者,随机分为对照组和治疗组,每组各43例.对照组采用软组织松解手法治疗;治疗组在对照组的基础上加用整脊手法配合小圆枕治疗.结果:对照组有效率为72%,治疗组有效率为95%,两组有效率比较,差异有统计学意义(P<0.05).结论:整脊手法配合小圆枕治疗神经根型颈椎病,可有效改善或解除神经根受到刺激与压迫.%Objective: To analyze the clinical effect of chiropractic technique combined with a small pillow for treating cervical spondyl ic radiculopathy. Methods:86 cases of nerve root type of cervical spondylosis patients randomly divided into treatment group and cont group, each group of 43 cases. The control group using soft tissue release technique treatment; the treatment group was treated with c ropractic technique combined with a small pillow treatment t on the basis ofhe control group. Results:In the control group was 49% ,1 effective rate of treatment group was 72% , the difference was statistically significant ( P < 0. 05). Conclusion: Chiropractic combir treatment of small pillow for treatment of cervical spondylosis of nerve root stimulation and oppression, can effectively improve or reli< nerve root.

  20. Avaliação das técnicas cirúrgicas para tratamento da mielorradiculopatia espondilótica cervical Evaluación de las técnicas quirúrgicas para el tratamiento de la mielorradiculopatía cervical espondilótica Evaluation of surgical techniques for treatment of cervical spondylotic myeloradiculopathy

    OpenAIRE

    Alexandre Meluzzi; Mário Augusto Taricco; Roger Schimidt Brock; Mário Rubem Pena Dias; Gilberto Nakaguawa; Vinícius Monteiro de Paula Guirado; Manoel Jacobsen Teixeira

    2012-01-01

    OBJETIVO: Avaliar a eficácia do tratamento cirúrgico da mielorradiculopatia espondilótica cervical na produção de melhora neurológica pós-operatória, aferida em pontos pela escala da JOA e taxa de recuperação e as complicações do tratamento. MÉTODOS: Análise dos prontuários e os exames de imagem de 200 indivíduos submetidos a tratamento cirúrgico da mielorradiculopatia cervical no HC-FMUSP, no período de janeiro de 1993 a janeiro de 2007. A avaliação clínica foi quantificada pela escala da JO...

  1. Compressive myelopathy in fluorosis: MRI

    Energy Technology Data Exchange (ETDEWEB)

    Gupta, R.K. [MR Section, Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow-226014 (India); Agarwal, P. [MR Section, Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow-226014 (India); Kumar, S. [MR Section, Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow-226014 (India); Surana, P.K. [Department of Neurology, SGPGIMS, Lucknow-226014 (India); Lal, J.H. [MR Section, Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow-226014 (India); Misra, U.K. [Department of Neurology, SGPGIMS, Lucknow-226014 (India)

    1996-05-01

    We examined four patients with fluorosis, presenting with compressive myelopathy, by MRI, using spin-echo and fast low-angle shot sequences. Cord compression due to ossification of the posterior longitudinal ligament (PLL) and ligamentum flavum (LF) was demonstrated in one and ossification of only the LF in one. Marrow signal was observed in the PLL and LF in all the patients on all pulse sequences. In patients with compressive myelopathy secondary to ossification of PLL and/or LF, fluorosis should be considered as a possible cause, especially in endemic regions. (orig.). With 2 figs., 1 tab.

  2. A pedigree of cervical stenosis, brachydactyly, syndactyly, and hyperopia.

    Science.gov (United States)

    Iida, H; Shikata, J; Yamamuro, T; Takeda, N; Ueba, Y

    1989-10-01

    Cervical myelopathy due to developmental cervical canal stenosis occurred in a 13-year-old boy. The patient's father and aunt also had an abnormally small cervical canal, although both were asymptomatic. The patient and his family had many congenital anomalies including hereditary brachydactyly, syndactyly, and hyperopia. The association of these anomalies seems not to have been previously reported in the literature. PMID:2551554

  3. Root compression on MRI compared with clinical findings in patients with recent onset cervical radiculopathy

    NARCIS (Netherlands)

    B. Kuijper; J.T.J. Tans; B.F. van der Kallen; F. Nollet; G.J. Lycklama a Nijeholt; M. Visser

    2011-01-01

    Objectives To evaluate the occurrence of symptomatic and asymptomatic root compression caused by herniated discs and spondylotic foraminal stenosis by MRI in patients with recent onset cervical radiculopathy. Participants 78 patients with symptoms and signs of cervical radiculopathy of less than one

  4. Compression Myelopathy due to Proliferative Changes around C2 Pars Defects without Instability.

    Science.gov (United States)

    Kimura, Tetsuya; Sakai, Toshinori; Tezuka, Fumitake; Abe, Mitsunobu; Yamashita, Kazuta; Takata, Yoichiro; Higashino, Kosaku; Sairyo, Koichi

    2016-06-01

    We report a case with compression myelopathy due to proliferative changes around the C2 pars defects without instability. A 69-year-old man presented with progressive clumsy hands and spastic gait. Plain radiographs showed bilateral spondylolysis (pars defects) at C2 and fusion between C2 and C3 spinous processes. Dynamic views revealed mobility through the pars defects, but there was no apparent instability. Computed tomography showed proliferative changes at the pars defects, which protruded into spinal canal. On magnetic resonance imaging, the spinal cord was compressed and intramedullary high signal change was found. A diagnosis of compression myelopathy due to proliferative changes around the C2 pars defects was made. We performed posterior decompression. Postoperatively, symptoms have been alleviated and images revealed sufficient decompression and no apparent instability. In patients with the cervical spondylolysis, myelopathy caused by instability or slippage have been periodically reported. The present case involving C2 spondylolysis is extremely rare. PMID:27340539

  5. Cervical Disc Disease: Biomechanical Aspects

    OpenAIRE

    Kolstad, Frode

    2011-01-01

    Degenerative disc disease in the cervical spine may cause significant pain and disability. Patients present themselves with neck pain, radiculopathy, and/or myelopathy. When the symptoms do not improve with conservative treatment, surgical treatment is considered. The goal of surgical treatment is to decompress nervous structures and to restore the normal anatomical conditions of disc height, alignment, and stability.The present thesis concerns four studies involving the treatment of cervical...

  6. The relieving pain and numbness effects of minimally invasive therapy of soft tissue combined with traction chiropractic on the treatment of cervical spondylotic radiculopathy%软组织微创配合牵引下整脊对神经根型颈椎病的镇痛止麻效果

    Institute of Scientific and Technical Information of China (English)

    沈彤; 尹伦辉; 章瑛; 梁伟坚; 敖晓龙; 谌凌燕; 何巍

    2013-01-01

    Objective To observe the effect of relieving pain and numbness of minimally invasive therapy of soft tissue combined with traction chiropractic in the treatment of cervical spondylotic radiculopathy.Methods 60 patients were randomly divided into a minimally invasive therapy of soft tissue combined with traction chiropractic treatment group and minimally invasive therapy of soft tissue combined with pure traction control group with 30 cases in each group.Traction chiropractic and pure traction were all carried out for 9 times.Minimally invasive therapy of soft tissue was carried out for 3 times.The scores of the symptoms and signs of the pain on neck、shoulder and arm,neck tenderness and numbness were compared between two groups before and after treatment and on the 3rd month after treatment.Results The scores of the symptoms and signs of two groups were all improved as compared with those before treatment (P < 0.05),but the total effect in treatment group improved more than those in the conrtrol group(P < 0.05).Conclusion Minimally invasive therapy of soft tissue combined with traction chiropractic is a safe method in relieving the symptoms of the pain on neck,shoulder and arm,neck tenderness and numbness.%目的 观察软组织微创配合牵引下整脊对神经根型颈椎病的镇痛止麻效果.方法 选60例合格的神经根型颈椎病患者,随机分为软组织微创配合牵引下整脊治疗组及软组织微创配合单纯牵引对照组各30例.牵引下整脊及单纯牵引各治疗9次,软组织微创治疗3次.分析治疗前后及随访3个月后两组颈肩臂疼痛、颈部压痛及麻木症状体征积分的变化.结果 两组治疗后及随访3个月后症状体征积分均有改善(P<0.05),治疗组的症状体征积分改善优于对照组(P<0.05).结论 软组织微创配合牵引下整脊在减轻神经根型颈椎病颈肩臂疼痛、颈部压痛及麻木症状方面疗效显著,操作安全.

  7. Two children with chronic progressive radiation myelopathy

    International Nuclear Information System (INIS)

    We report two patients who developed chronic progressive radiation myelopathy (CPRM). Patient 1 was a 16-year-old boy with group IV rhabdomyosarcoma of cervical soft tissue. He underwent partial excision of the tumor and received systemic and intrathecal chemotherapy and 44 Gy of local radiotherapy (C4 through Th3). These therapies were followed by high-dose chemotherapy including thio-TEPA and busulfan with autologous bone marrow rescue. One year after the completion of the therapies, he developed CPRM. Patient 2 was a 15-year-old girl with acute lymphoblastic leukemia on the 3rd complete remission. She received 18 Gy of irradiation to whole brain during the 1st remission and another 18 Gy to whole brain and 9 Gy to spinal cord after her 1st CNS relapse. After successful reinduction therapy for the 2nd relapse in CNS and bone marrow, she underwent an allogeneic bone marrow transplantation (BMT). The preconditioning regimen consisted of 12 Gy total body irradiation, thio-TEPA and cyclophosphamide. Seven months after BMT, she developed CPRM at C0-C1 level, which was included in the area of whole-brain irradiation. In both patients, MR images showed a swelling of the cervical cord and ring-like images by gadolinium enhancement. Their neurological disability transiently responded to the administration of corticosteroid, but they developed progressive quadriplegia. Although it is reported that a dose of 45-50 Gy may be safe, these cases suggest that administration of high-dose chemotherapy combined with intrathecal chemotherapy and radiotherapy to the cord might increase the rink of developing CPRM. (author)

  8. Influence of developmental cervical stenosis on dural sac space

    Institute of Scientific and Technical Information of China (English)

    Tang Yanchao; Yu Miao; Liu Zhongjun; Sun Yu; Liu Xiaoguang

    2014-01-01

    Background This retrospective study aimed to investigate the difference of the intra-dural reserving space for spinal cord in magnetic resonance imaging (MRI) between patients with and without developmental cervical stenosis and its clinical significance.Methods A total of 264 patients with cervical spondylotic myelopathy who had decompression surgeries were recruited.The average follow-up was 29 months.Based on their lateral radiographs,they were divided into stenosis group and non-stenosis group.On the magnetic resonance images,the ratio of the sagittal diameter of the dural sac to that of the vertebral body was measured and calculated as MRI Pavlov ratio at the mid-vertebral level on T2-weighted sagittal images from C3 to C7.The ratio of the transverse area of the spinal cord to that of the dural sac was measured and calculated as occupation ratio on T2-weighted axial images at the same levels.The MRI Pavlov ratio and occupation ratio were compared between the two groups.The stenosis group was further divided into space-reserving and non-space-reserving subgroups based on the occupation ratios; then clinical parameters were compared between the two subgroups to determine the clinical significance of the reserving space.Results The MRI Pavlov ratio of the stenosis group was significantly smaller than that of the non-stenosis group at C3-C7 (P <0.01),while the occupation ratio was significantly larger only at C7 (P <0.05).For the space-reserving subgroup,the postoperative recovery rate was lower (P <0.05).The postoperative recovery rate was (23±6)% in anterior approach,larger than (-23±15)% in posterior approach (P <0.05).Conclusions Developmental cervical stenosis is associated with a smaller sagittal diameter of the dural sac,but does not lead to a significant decrease in intra-dural space available for the cord.For patients with normal intra-dural space,the recovery after anterior decompression surgery was better than posterior approach.

  9. Design of Lamifuse : a randomised, multi-centre controlled trial comparing laminectomy without or with dorsal fusion for cervical myeloradiculopathy

    NARCIS (Netherlands)

    Bartels, R.H.M.A.; Verbeek, A.L.M.; Grotenhuis, J.A.

    2007-01-01

    BACKGROUND: laminectomy is a valuable surgical treatment for some patients with a cervical radiculomyelopathy due to cervical spinal stenosis. More recently attention has been given to motion of the spinal cord over spondylotic spurs as a cause of myelopathic changes. Immobilisation by fusion could

  10. 3.OT磁共振弥散张量成像技术对轻度脊髓型颈椎病的诊断价值%Diagnostic value of 3.0T magnetic resonance spectroscopy DTI in patients with mild cervical myelopathy

    Institute of Scientific and Technical Information of China (English)

    由长城; 朱凯; 闫景龙; 关国发; 徐公平; 张志鹏; 赵伟

    2011-01-01

    目的:评价3.0T磁共振弥散张量成像技术(diffusion tensor imaging,DTI)对轻度脊髓型颈椎病的诊断价值及可行性.方法:应用3.0T高场强磁共振DTI成像序列,观察22例健康志愿者88个节段(A组)和69例轻度脊髓型颈椎病患者(依据颈髓MRI平扫结果分B、C两组,B组39例患者,硬膜囊98个节段受压、颈髓信号正常:C组30例患者,颈髓65个节段受压、颈髓信号正常)颈髓的表观扩散系数(apparentdiffusioncoefficient,ADC)及分数各向异性值(fractional anisotropy,FA),分析3组颈髓ADC值、FA值之间差异.结果:A组(C3/C4、C4/C5、C5/C6、C6/C7)共88个节段之间ADC值及FA值差异无显著性(P>0.05),故合并88个椎体数据;A、B及C组ADC值分别为0.91 ±0.34、1.17±0.35及1.32±0.36,组间比较,ADC值A组最低,B组次之,C组最高(P值均<0.05);三组平均FA值分别为0.71±0.16、0.62±0.15及0.54±0.14,A组最高,B组次之,C组最低(P值均<0.05).结论:颈髓DTI较常规MRI能够早期、准确地量化轻度脊髓型颈椎病的颈髓微结构改变,可以为临床医生更早诊断治疗轻度脊髓型颈椎病提供有利的影像学依据.%Objective ;To evaluate the diagnostic value and and the feasibility of 3.0T magnetic resonance diffusion tensor imaging (DTI) inspection to clinical mild cervical myelopathy.Method:22 healthy volunteers (Group A ) and 69 patients with mild cervical myelopathy patients were studied with 3.0T high-field magnetic resonance DTI sequence(69 patients based on cervical MR1 scan standard divided into Croup B and C, 39 patients of Group B:98 segments of spinal cord dural sac compression,spinal cord signal normal;30 patients of Group C:65 segments of spinal cord compression,spinal cord signal normal).The apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were measured intending to research and analyze spinal cord ADC values and FA values among the three groups.Result:The values of ADC and FA among the 88

  11. Follow-up Study on the Motion Range after Treatment of Degenerative Disc Disease with the Bryan Cervical Disc Prosthesis

    Institute of Scientific and Technical Information of China (English)

    YANG Shuhua; HU Yong; ZHAO Jijun; HE Xianfeng; LIU Yong; XU Weihua; DU Jingyuan; FU Dehao

    2007-01-01

    This study examined effect of a new intervertebral cervical disc prosthesis in relieving the neurological symptoms and signs, improving the patients' ability to perform daily activities, reducing pain, and maintaining the stability and segmental motion. From December 2003 to October 2004, 12 patients, who had received 14 replacements of cervical artificial discs, were followed-up for 2 to 8 months (with a mean of 5.2 months). Of them 5 had cervical spondylotic myelopathy and 7 had cervical disc herniation. The patients included 7 males and 5 females, with their age ranging from 35 to 62 y and a mean of 50.3 y. Single-level replacements were performed in 10 cases and 2 cases received two-level replacement. Operation time of the single-level surgery averaged 130±50 min and the time of two-level surgery was 165±53 min on average (from skin incision to skin suturing).Neurological or vascular complications during or after surgery was not observed. Japanese Orthopedic Association scores (JOA scores) increased from 8.6 to 15.8 on average. There was no prothesis subsidence or excursion. Replaced segments were stable and the range of motion was partially restored, being 4.68° (3.6°-6.1°) in flexion and extension position and 3.51° (2.5°-4.6°) 3.42° (2.6°-4.3°) in left and right bending position. No obvious loss of physiological curvature was noted. CT or MRI follow-up showed that excursion was less than 1.5 mm) in 2 of 14 levels and between 1.5 mm and 3 mm) in 1 of 14 levels. No ossification in the replaced levels was observed. It is concluded that satisfactory short-term results were achieved in the 12 cases of artificial disc replacements. Different from anterior cervical discectomy and fusion, the replacement could achieve quick functional recovery and did not lead to the movement limitation of cervical vertebrae. At least a 5-years follow-up was needed to assess the long-term effect of the prosthesis on its neighboring segments.

  12. Evaluation of arthrodesis and cervical alignment in the surgical results of cervical discectomy using polymethylmetacrylate Avaliação da artrodese e do alinhamento cervical após discectomia cervical com interposição de polimetilmetacrilato

    OpenAIRE

    Marcelo Luis Mudo; Andrea Vieira Amantea; Andrei Fernandes Joaquim; Mirto Nelso Prandini; Sérgio Cavalheiro

    2009-01-01

    BACKGROUND AND OBJECTIVES: Surgical treatment of cervical radiculopathy with or without myelopathy is a controversy issue, although anterior discectomy is the most common form of treatment. METHOD: We present the evaluation of the arthrodesis' rate and cervical alignment in 48 patients with cervical degenerative disease (CDD) submitted to anterior cervical discectomy with interposition of polymethylmetacrylate (PMMA). Odom and Nürick scales were used to evaluation of functional status before ...

  13. Interobserver agreement on MRI evaluation of patients with cervical radiculopathy

    Energy Technology Data Exchange (ETDEWEB)

    Kuijper, B., E-mail: kuijperb@maasstadziekenhuis.n [Department of Neurology, Medical Centre Haaglanden, The Hague (Netherlands); Department of Neurology, Maasstad Hospital, Rotterdam (Netherlands); Beelen, A. [Department of Rehabilitation, Academic Medical Centre, Amsterdam (Netherlands); Kallen, B.F. van der [Department of Neurology, Medical Centre Haaglanden, The Hague (Netherlands); Department of Radiology, Medical Centre Haaglanden, The Hague (Netherlands); Nollet, F. [Department of Rehabilitation, Academic Medical Centre, Amsterdam (Netherlands); Lycklama a Nijeholt, G.J. [Department of Neurology, Medical Centre Haaglanden, The Hague (Netherlands); Department of Radiology, Medical Centre Haaglanden, The Hague (Netherlands); Visser, M. de [Department of Neurology, Academic Medical Centre, Amsterdam (Netherlands); Tans, J. Th.J. [Department of Neurology, Medical Centre Haaglanden, The Hague (Netherlands)

    2011-01-15

    Aim: To evaluate the interobserver agreement on magnetic resonance imaging (MRI) evaluation of herniated discs, spondylotic neuroforaminal stenosis, and root compression in patients with recent onset cervical radiculopathy and in addition, to assess the added value of disclosure of clinical information to interobserver agreement. Materials and methods: The MRI images of 82 patients with less than 1 month of symptoms and signs of cervical radiculopathy were evaluated independently by two neuroradiologists who were unaware of clinical findings. MRI analysis was repeated after disclosure of clinical information. Interobserver agreement was calculated using kappa statistics. Results: The kappa score for evaluation of herniated discs and of spondylotic foramen stenosis was 0.59 and 0.63, respectively. A kappa score of 0.67 was found for the presence of root compression. After disclosure of clinical information kappa scores increased slightly: from 0.59 to 0.62 for the detection of herniated discs, from 0.63 to 0.66 for spondylotic foramen stenosis, and from 0.67 to 0.76 for root compression. Conclusion: Interobserver reliability of MRI evaluation in patients with cervical radiculopathy was substantial for root compression, with or without clinical information. Agreement on the cause of the compression, i.e., herniated disc or spondylotic foraminal stenosis, was lower.

  14. Pseudarthrosis of the Cervical Spine: Risk Factors, Diagnosis and Management

    Science.gov (United States)

    Leven, Dante

    2016-01-01

    Cervical myelopathy and radiculopathy are common pathologies that often improve with spinal decompression and fusion. Postoperative complications include pseudarthrosis, which can be challenging to diagnose and manage. We reviewed the literature with regard to risk factors, diagnosis, controversies, and management of cervical pseudarthrosis. PMID:27559462

  15. 两种不同手术方法治疗多节段受累脊髓型颈椎病的效果研究%Study on the effect of two different surgical methods in the treatment of multi segment cervical spondylosis myelopathy

    Institute of Scientific and Technical Information of China (English)

    高琦珂; 元占玺

    2016-01-01

    Objective To compare and analyze the clinical effects of two surgical methods in the treatment of multilevel cervical myelopathy.Methods The data of 86 patients with multilevel cervical spondylosis myelopathy were retrospectively analyzed from June 2011 to June 2015.48 patients treated with anterior decompression and bone graft fusion were set as A group.38 patients underwent posterior single open -door laminoplasty were set as B group. The changes of nerve function indexes were compared between the two groups before operation,6 months after opera-tion and the last follow -up.Results 6 months after operation,the JOA score of the two groups was significantly higher than before the operation,and the difference was statistically significant(tA =-6.438,tB =-7.425,P 0.05).At the last follow -up,the excellent and good rate of A group was 70.83%,that of B group was 71.05%,and there was no significant difference between the two groups (χ2 =0.00,P >0.05).Two groups of patients were successfully completed surgery,the average operation time of A group was (148.75 ±40.68)min,that of B group was (109.34 ±35.61)min,the difference between the two groups was statistically significant(t =4.711,P <0.05).The amount of bleeding in A group was (157.82 ±51.40)mL,that of B group was (235.76 ±61.55)mL,the difference was statistically significant(t =-6.399,P <0.05).Conclusion Anterior subtotal decompression and bone graft fusion and posterior single open door surgery in the treatment of multi segment cervical spondylosis myelopathy can obtain satisfactory neurological function.According to the patients'clini-cal symptoms and complications to develop a reasonable surgical plan is the key to treatment.%目的:对比分析两种手术方法治疗多节段受累脊髓型颈椎病的临床效果。方法回顾性分析2011年6月至2015年6月收治的86例多节段受累脊髓型颈椎病患者资料,其中行前路椎体次全切除减压植骨融合术48例,纳入本次研究的 A

  16. 针刺结合火龙灸法治疗肾虚督寒型神经根型颈椎病的疗效观察%Efficacy of Acupuncture Combined with Fire Dragon Moxibustion for Patients with Cervical Spondylotic Radiculopathy of Kidney-Deficiency-Cold Type

    Institute of Scientific and Technical Information of China (English)

    景福权; 汪秀梅; 牛相来; 周钰

    2016-01-01

    Objective To compare the therapeutic effects of acupuncture combined with fire dragon moxibustion and simple acupuncture therapy in the treatment of patients with cervical spondylotic radiculopathy (CSR)of kidney-deficiency-cold type.Methods Ninety kidney-deficiency-cold type CSR outpatients were randomly divided into control (acupuncture,n =40) and treatment (acupuncture + moxibustion,n = 50 )groups.Acupuncture stimulation was applied to Dazhui (GV 1 4 ),Ganshu (BL 1 8),Tianzhu (BL 1 0 )and Houxi (SI 3 ),Jiaji (EX-B 2 ),Taixi (KI 3 ),Shenmai (BL 62 ),Zusanli (ST 36 ),Shenshu (BL 23),etc once daily,5 times a week,and two weeks altogether,except the weekend.In addition,for patients of the treat-ment group,herbal medicinal powder separated-fire dargon moxibustion was applied to the patient's back from GV1 4 and Fengmen (BL 1 2)on the top to Zhibian (BL 54)area at the buttock,once every 3 days,5 times altogether.The therapeutic effect was e-valuated according to “CSR-20-points scale”including 3 aspects as neck-shoulder pain,upper-limb pain-numbness,finger numb-ness;working and daily life ability and physical conditions (Spurling tests,sensory,myodynamia and tendon reflex).Results ① After the treatment,CSR-20-points scores in both treatment and control groups were significantly increased in comparison with pre-treatment in each group (P <0.05),with the score being markedly higher in the treatment group than in the control group (P <0.05).② Of the 40 and 50 cases in the control and the treatment group,2 and 1 3 were cured,1 4 and 24 experienced a re-markable improvement,1 2 and 1 1 were effective,and 1 2 and 2 failed,with the total effective rates being 70.0%(28/40)and 96.0%(48/50),respectively.The therapeutic effect of the treatment group was notably better than that of the control group (P <0.05).Conclusion Acupuncture combined with fire dragon moxibustion is superior to simple acupuncture therapy in improving clinical symptoms of patients with CSR of kidney

  17. Electrophysiological characteristics of Hirayama disease, amyotrophic lateral sclerosis and distal cervical spondylotic amyotrophy%平山病、肌萎缩性侧索硬化及远侧型肌萎缩型颈椎病的神经电生理特点

    Institute of Scientific and Technical Information of China (English)

    金翔; 吕飞舟; 陈文钧; 夏新雷; 王立勋; 郑超君; 姜建元

    2013-01-01

    目的 探讨平山病、肌萎缩性侧索硬化及远侧型肌萎缩型颈椎病的上肢神经电生理特点.方法 回顾性分析87例平山病患者、83例肌萎缩性侧索硬化患者和28例远侧型肌萎缩型颈椎病患者的上肢神经电生理检测资料.其中87例平山病患者中,72例单侧上肢、15例双侧上肢出现肌肉萎缩;83例肌萎缩性侧索硬化患者中,30例单侧上肢、53例双侧上肢出现肌肉萎缩;28例远侧型肌萎缩型颈椎病患者中,20例单侧上肢、8例双侧上肢出现肌肉萎缩.结果 平山病患者患肢尺神经刺激的复合肌肉动作电位(compound muscle action potential,CMAP)波幅明显低于正中神经刺激的CMAP波幅,肌萎缩性侧索硬化患者患肢正中神经CMAP波幅明显低于尺神经CMAP波幅,远侧型肌萎缩型颈椎病患者正中神经和尺神经CMAP波幅降低程度相同.平山病患者的平均尺神经/正中神经(U/M)CMAP比为0.58±0.40,肌萎缩性侧索硬化为2.28±1.25,远侧型肌萎缩型颈椎病为1.31 ±0.63,三者比较差异有统计学意义.在U/M CMAP比值<0.6的患肢中,平山病有62例,肌萎缩性侧索硬化和远侧型肌萎缩型颈椎病分别只有3例和1例;在U/M CMAP比值>1.7的患肢中,肌萎缩性侧索硬化有57例,平山病有12例,远侧型肌萎缩型颈椎病有4例.所有患者双侧的运动神经和感觉神经传导速度、感觉神经动作电位波幅均正常,健肢的CMAP波幅均正常.结论 平山病患者小鱼际肌肉萎缩程度重于大鱼际肌,肌萎缩性侧索硬化患者与之相反,而远侧型肌萎缩型颈椎病患者大、小鱼际肌肉萎缩程度相似.%Objective To explore the electrophysiological charaterstics of upper extremities nerves on the patients with Hirayama disease (HD),amyotrophic lateral sclerosis (ALS),and distal cervical spondylotic amyotrophy (DCSA).Methods The data of electrophysiological examination of the upper limbs of 87 patients with HD,83 with ALS

  18. 周围神经卡压与神经根型颈椎病330例神经肌电图鉴别分析%Discriminant Analysis of Neural Electromyography of330 Cases of Peripheral Nerve Compression and Cervical Spondylotic Radiculopathy

    Institute of Scientific and Technical Information of China (English)

    苻晓慧; 黄慜; 杨萍

    2015-01-01

    Objective: To investigate the effects of neural electromyography (EMG) in the differential diagnosis of peripheral nerve compression (PNC) and cervical spondylotic radiculopathy (CSR). Methods: 100 cases of CSR patients and 230 cases of suspected PNC and other diseases patients admitted to our hospital from May 2012 to May 2015 underwent electromyography. Results: In the 100 patients with a clinical diagnosis of CSR, through the EMG, 41 cases had CSR, accounting for 41.0%; 23 cases had PNC, accounting for 23.0%; 2 cases had CSR and PNC, accounting for 2.0%; 7 cases had other diseases, accounting for 7.0%; 27 cases had no problems, accounting for 27.0%. On the other hand, through the electromyography, 18 cases in the 230 cases who were suspected as PNS and other diseases patients were diagnosed as CSR patients,, accounting for 7.8%. In all the 18 cases, 6 cases had thoracic outlet syndrome, accounting for 33.3%; 1 case had carpal tunnel syndrome, accounting for 5.6%, 1 case had pronator syndrome, accounting for 5.6%; 8 cases had PNC, accounting for 44.4%. 1 case had hand numbness, 1case had peripheral neuritis, 1 case had brachial plexus injury, each of them accounting for 5.6%; 2 cases had upper or lower limb weakness, accounting for 11.1%; 5 cases had motor neuron disease, accounting for 27.8%. Conclusion: The differential diagnosis effect of neural EMG on PNC and CRS is remarkable and it can provide a reference for clinical treatment.%目的:探讨周围神经卡压(PNC)与神经根型颈椎病(CSR)采用神经肌电图鉴别效果。方法:选取临床诊断为CSR的患者100例,及疑为PNC和其他疾病的患者230例,均为我院2012年5月—2015年5月收治,均行神经肌电图检查。结果:100例临床诊断为CSR的患者,经肌电图检查,与CSR符合41例,占41.0%;23例为各种PNC,占23.0%;CSR合并PNC2例,占2.0%;其他疾病7例,占7.0%;检测正常27例,占27.0%。反之,经

  19. Three-level cervical disc herniation

    Directory of Open Access Journals (Sweden)

    St. Iencean Andrei

    2015-09-01

    Full Text Available Multilevel cervical degenerative disc disease is well known in the cervical spine pathology, with radicular syndromes or cervical myelopathy. One or two level cervical herniated disc is common in adult and multilevel cervical degenerative disc herniation is common in the elderly, with spinal stenosis, and have the same cause: the gradual degeneration of the disc. We report the case of a patient with two level cervical disc herniation (C4 – C5 and C5 – C6 treated by anterior cervical microdiscectomy both levels and fusion at C5 – C6; after five years the patient returned with left C7 radiculopathy and MRI provided the image of a left C6 – C7 disc herniation, he underwent an anterior microsurgical discectomy with rapid relief of symptoms. Three-level cervical herniated disc are rare in adults, and the anterior microdiscectomy with or without fusion solve this pathology.

  20. 三维CT对脊髓型颈椎病的术前评估及辅助制定手术计划的价值%Three-dimension spiral computer tomograph in the preoperative evaluation and the surgical plan of cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    喻忠; 王黎明; 桂鉴超; 贾连顺

    2006-01-01

    目的探讨三维CT对脊髓型颈椎病(cervicalspondyloticmyelopathy,CSM)的术前评估的临床价值及在手术计划制定中的辅助作用.方法采用三维CT技术检查146例CSM患者,观察颈椎椎管的病理改变,测量椎管矢状径及Pavlov比率,评价椎管狭窄的程度,根据个性化颈椎的三维模型,设计个性化的手术方案,确定手术入路、螺钉安全角度和距离,标记螺钉的入点和椎管的减压范围.传统对照组122例.术后观察并发症,采用Odom标准对临床疗效进行评价.结果发现本组患者椎间盘突出129例(88.3%)、椎体后部缘骨质增生109例(74.7%)、黄韧带肥厚褶皱61例(41.8%)、后纵韧带钙化27例(18.5%)、小关节突骨质增生31例(21.2%)、椎板增厚29例(19.9%)、椎体滑脱18例(12.3%),经手术治疗所有患者术中无死亡,无喉返神经损伤、植入骨块移位、感染等并发症.术后6个月复查X线片示全部病例植骨融合良好,无钛板或螺钉松动或断裂现象.Odom临床疗效评定优良率为95.9%,对照组为84.4%,两者疗效有差别显著性(P<0.05).结论三维CT能对CSM作出准确、全面的评估,并能辅助制定手术计划,具有重要的临床价值.

  1. 丹参舒颈丸对抗脊髓型颈椎病模型大鼠氧自由基损伤%Regulative effect of Danshen shujing wan on oxygen-derived free radical injury in rats with cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    都兴林; 田伟; 孔焕宇

    2006-01-01

    目的:观察丹参舒颈丸对脊髓型颈椎病模型大鼠血液和损伤区脊髓匀浆内超氧化物歧化酶活性和丙二醛含量的影响.方法:实验于2004-01/12在中国中医研究院骨伤科研究所中药药理试验室完成.①选用健康8周龄清洁级SD雄性大鼠60只.随机抽取10只大鼠为假手术组:只暴露颈椎椎板,不放置硅胶颗粒.其余50只均在不剪除第4,5颈椎情况下,将硅胶颗粒置于其间,造成脊髓型颈椎病模型.根据组间均衡一致的原则将造模后大鼠随机分为5组:丹参舒颈丸高、中、低剂量组、颈复康组和模型组,每组10只.造模后1周开始灌胃给药,共30 d(从造模后1周开始).丹参舒颈丸高、中和低剂量治疗组:灌胃含丹参舒颈丸(主要成分:丹参、葛根、羌活、白术、木瓜、白芍、杜仲、西红花等;批准文号:(2005)京药制字[365]第F-2181号,9g/袋;由北京万和颈椎病医院提供)生药6,3,1.5 g/kg溶液;颈复康组:灌胃含颈复康(承德中药集团有限责任公司出品;批准文号:ZZ-5464-翼卫药准字(1995)第080193号,5g/袋)生药1.7 g/kg;假手术组和模型组:灌胃等量生理盐水.②干预结束后,采用黄嘌呤氧化法和硫代巴比妥酸化学发光法测定血液超氧化物歧化酶活性和丙二醛水平.按南京建成生物工程研究所提供试剂盒说明,测定脊髓匀浆丙二醛含量及超氧化物歧化酶活性.③计量资料差异比较采用单因素方差分析和Q检验.结果:SD大鼠60只均进入结果分析.①模型组、丹参舒颈丸中剂量组和颈复康组血液超氧化物歧化酶活性明显低于假手术组和丹参舒颈丸低剂量组(P<0.05),模型组血液丙二醛水平明显高于假手术组和丹参舒颈丸低剂量组(P<0.05).②丹参舒颈丸各剂量组脊髓组织超氧化物歧化酶活性明显高于模型组和假手术组(P<0.05~0.01),模型组和颈复康组明显低于假手术组(P<0.05).丹参舒颈丸各剂量组脊髓组织丙二醛含量明显低于模型组(P<0.01),假手术组低于其他5组(P<0.05).结论:丹参舒颈丸可以降低脊髓型颈椎病模型大鼠血和脊髓内丙二醛含量,增加超氧化物歧化酶活性,从而发挥清除体内氧自由基的作用;其中低剂量丹参舒颈丸对血液中丙二醛水平和超氧化物歧化酶活性改善作用明显优于其他剂量和颈复康.

  2. 两种前路减压融合方式治疗双节段脊髓型颈椎病的疗效分析%Curative effect analysis of two kinds of anterior decompression and fusion methods for double cervical spondy-lotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    陈常华

    2014-01-01

    目的:比较前路椎间盘切除植骨融合并钛板置入内固定术( ACDF)及前路椎体次全切除植骨融合并钛板置入内固定术( ACCF)对相邻双节段脊髓型颈椎病的疗效。方法选择我院收治的76例双节段脊髓型颈椎病患者作为研究对象,将其随机分为ACCF组和ACDF组,观察2组患者围手术期相关指标、脊髓功能、颈椎正侧位和屈伸动力位X线片检查,记录Cobb’ s角及融合节段高度并评价植骨融合情况。结果2组患者手术相关指标结果显示,ACDF组患者的手术时间、出血量、住院时间等指标明显优于ACCF组(P0.05;ACDF组在术后Cobb’s角改善程度明显优于ACCF组(P 0. 05). The postoperative Cobb’s angle degree of ACDF group is better than that of AC-CF group (P<0. 05). Conclusion The effect of ACCF and ACCF on the treatment of two-level CSM were satisfactory,of which ACDF has the advantages of short operation time,less bleeding,fusion segments of Cobb’ s angle and fewer complications.

  3. Esophageal perforation after anterior cervical spine surgery: a systematic review of the literature.

    Science.gov (United States)

    Halani, Sameer H; Baum, Griffin R; Riley, Jonathan P; Pradilla, Gustavo; Refai, Daniel; Rodts, Gerald E; Ahmad, Faiz U

    2016-09-01

    OBJECTIVE Esophageal perforation is a rare but well-known complication of anterior cervical spine surgery. The authors performed a systematic review of the literature to evaluate symptomatology, direct causes, repair methods, and associated complications of esophageal injury. METHODS A PubMed search that adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines included relevant clinical studies and case reports (articles written in the English language that included humans as subjects) that reported patients who underwent anterior spinal surgery and sustained some form of esophageal perforation. Available data on clinical presentation, the surgical procedure performed, outcome measures, and other individual variables were abstracted from 1980 through 2015. RESULTS The PubMed search yielded 65 articles with 153 patients (mean age 44.7 years; range 14-85 years) who underwent anterior spinal surgery and sustained esophageal perforation, either during surgery or in a delayed fashion. The most common indications for initial anterior cervical spine surgery in these cases were vertebral fracture/dislocation (n = 77), spondylotic myelopathy (n = 15), and nucleus pulposus herniation (n = 10). The most commonly involved spinal levels were C5-6 (n = 51) and C6-7 (n = 39). The most common presenting symptoms included dysphagia (n =63), fever (n = 24), neck swelling (n = 23), and wound leakage (n = 18). The etiology of esophageal perforation included hardware failure (n = 31), hardware erosion (n = 23), and intraoperative injury (n = 14). The imaging modalities used to identify the esophageal perforations included modified contrast dye swallow studies, CT, endoscopy, plain radiography, and MRI. Esophageal repair was most commonly achieved using a modified muscle flap, as well as with primary closure. Outcomes measured in the literature were often defined by the time to oral intake following esophageal repair. Complications included

  4. Risk factors for acute postoperative neurological deterioration after cervical myelopathy%颈椎病术后早期神经功能严重恶化原因分析

    Institute of Scientific and Technical Information of China (English)

    王新伟; 袁文; 陈德玉; 唐勇; 曹鹏; 卢旭华; 周许辉; 陈华江; 陈雄生

    2009-01-01

    Objective To discuss the risk factors of neurologic deterioration secondary to cervical spinal surgery . Methods 3703 patients with cervical degenerative disease treated surgically from September 2002 to September 2007 were reviewed. 12 patients suffered with neurologic deterioration within one week after operation. Age, course of disease, extent of disease, JOA score, preoperative companied disease and cerebrospinal leak were recorded. The saggital diameter of spinal canal, Povlov ratio and dynamic spinal stenosis parameter were measured on X-ray. And the dynamic spinal stenosis were measured using a modified Rao method in which both the distance from infer-posterior edge of upper vertebral body to the super-anterior edge of the lower laminar (UV-LL) and distance from super-posterior edge of lower vertebral body to the infer-anterior edge of the upper laminar (LV-UL) were measured. And the percentage of compression of spinal cord at the narrowest level was measured on middle saggital MRI section. Result There were 9 male and 3 female were included in these patients suffered from postoperative neurologic deterioration. The average age was 51 years and the average duration of symptoms was 71 months. The average JOA score declined from 10 preoperatively to 5 postoperatively and improved to 9 at the final follow up. The preoperative diameter of spinal canal was 11.8mm and the preoperative average Pavlov ratio was 0.65. The average distance of LV-UL was 11.2mm before operation and 12.7 after operation, while the distance of UV-LL was 15.1mm before operation and 13.6 after operation. Conclusion The risk factors of acute postoperative neurologic deterioration include Patients with preoperative hypertension, diabetes mellitus, cervical stenosis, cervical dynamic stenosis and more than 3 levels to acute postoperative neurologic deterioration.%目的 分析12例颈椎病术后神经功能恶化患者的危险因素并探讨其预防措施.方法 回顾性分析2002年9

  5. Anterior cervical fusion versus minimally invasive posterior keyhole decompression for cervical radiculopathy

    Directory of Open Access Journals (Sweden)

    Richard M. Young

    2015-12-01

    Conclusion: ACDF has been demonstrated to be an effective surgical procedure in treating degenerative spine disease in patients with radiculopathy and/or myelopathy. However, in a population with isolated radiculopathy and radiological imaging confirming an anterolateral disc or osteophyte complex, the MIPKF can provide similar results without the associated risks that accompany an anterior cervical spine fusion.

  6. Anterior Neurodecompression of Kyphotic Spondylogenic Myelopathy Ranawat Grade III and Posterior Decompression of Lordotic Spine Improve Walking Ability

    OpenAIRE

    Margetić, Petra; Elabjer, Esmat; Milošević, Milan; ŠKORO, IVAN; Milanov, Bojan; Stančić, Marin

    2009-01-01

    Cervical spondylosis is common condition rarely associated with radiculomyelopathy which surgical treatment, according to meta-analysis, is not better than nonsurgical. Our hypothesis was that neurodecompression which type is chosen according to spinal alignment should result in better functional improvement comparing with nonsurgical treatment. Between January 1, 1998 and December 31, 2007 a total of 77 patients with spondylogenic myelopathy were selected for the study. The inclusion criteri...

  7. MRI in acute transverse myelopathy

    Energy Technology Data Exchange (ETDEWEB)

    Holtaas, S. (Dept. of Diagnostic Radiology, Univ. Hospital Lund (Sweden)); Basibueyuek, N. (Dept. of Diagnostic Radiology, Univ. Hospital Lund (Sweden)); Fredriksson, K. (Dept. of Neurology, Univ. Hospital Lund (Sweden))

    1993-03-01

    The MRI examinations of seven patients with acute transverse myelopathy (ATM) were analysed. The patients were examined 2-5 times during the course of their disease with short and long TR/TE spin-echo sequences in the sagittal projection. A previous history of autoimmune disorder and/or signs of infection at the onset of ATM were present in all cases. Cerebrospinal fluid analysis showed local synthesis of immunoglobulin in the nervours system in three cases and signs of infectious myelitis in one. During the acute phase four patients had local enlargement of the cord and all had increased signal on long TR/TE sequences. The outcome was grave in the majority of patients and there seemed to be a correlation between the degree of cord enlargement, persistence of increased signal intensity and limited recovery. Atrophy and remaining high signal intensity were noted on late MRI patients with poor outcome. In one patient with probable anterior spinal artery occlusion, cavitation of the cord was seen. (orig.)

  8. MRI in acute transverse myelopathy

    International Nuclear Information System (INIS)

    The MRI examinations of seven patients with acute transverse myelopathy (ATM) were analysed. The patients were examined 2-5 times during the course of their disease with short and long TR/TE spin-echo sequences in the sagittal projection. A previous history of autoimmune disorder and/or signs of infection at the onset of ATM were present in all cases. Cerebrospinal fluid analysis showed local synthesis of immunoglobulin in the nervours system in three cases and signs of infectious myelitis in one. During the acute phase four patients had local enlargement of the cord and all had increased signal on long TR/TE sequences. The outcome was grave in the majority of patients and there seemed to be a correlation between the degree of cord enlargement, persistence of increased signal intensity and limited recovery. Atrophy and remaining high signal intensity were noted on late MRI patients with poor outcome. In one patient with probable anterior spinal artery occlusion, cavitation of the cord was seen. (orig.)

  9. 零切迹颈前路椎间融合固定系统在颈前路融合术中的初步应用%The primary clinical application of Zero-p anterior cervical intervertebral fusion system for cervical intervertebral fusion

    Institute of Scientific and Technical Information of China (English)

    贺瑞; 尚希福; 张文志; 胡业丰; 许翔; 姚刚; 李旭; 段丽群; 葛畅

    2012-01-01

    Objective To revaluate the clinical effect of zero-p anterior cervical intervertebral fusion system (zero-p ACIDfor cervical anterior intervertebral fusion. Method From 2009.12 to 2010.10,24cases of patients were treated surgically by zero-p ACIF. 22 cases of single-level, 2cas- es of two-level,incloud 7 cases cervical injury and 17 cases cervical spondylotic myelopathy. Result All cases obtained follow up with average of 14months (range 12 to 20 months),all cases have no postoperative dysphagia and tardive esophageal fistula. The disc height were achieved in final follow-up respectively. Place of intervertebral fusion system has no change or loose. Conclusion Zero-p ACIF has more excellent material and mechanical properties,can effectively maintain the fusion cage height and no effect on the prevertebral tissue. It is a new means of anterior cervical fusion.%目的 探讨零切迹颈前路椎问融合固定系统(Zero-p ACIF)在颈椎前路融合术中的应用效果.方法 2009-12-2010-10,对24例(26节段)颈椎疾病患者行前路椎问零切迹椎问融合固定系统内固定,其中颈椎外伤性椎间盘突出、不稳7例,颈椎问盘疾患17例,其中双节段2例.结果 24例患者随访12~20个月,平均随访14个月,JOA评分由术前平均8.6分上升到末次随访时15.2分,术后X线片与末次X线片提示椎间高度无丢失,内固定无松动.结论 Zero-p ACIF有较优异的材料和力学性能,能有效维持融合椎间高度,对椎前组织无影响,是一种新的颈前路融合手段.

  10. Titanium luque SSI for rheumatoid spondylitis with myelopathy. Clinical results and postoperative magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Taniguchi, Mutsumi; Maruo, Soji; Tateishi, Hiroomi; Matsumoto, Manabu; Otsuka, Seiji; Yokoyama, Hiroshi [Hyogo Coll. of Medicine, Nishinomiya (Japan)

    1995-12-01

    Nineteen rheumatoid patients suffering from rheumatoid spondylitis with myelopathy were surgically treated using Luque segmental spinal instrumentation (SSI). We studied 7 cases of patients who underwent postoperative magnetic resonance imaging (MRI) evaluation after being treated with titanium Luque SSI. Titanium implants were imaged safely and there was no evidence of implant migration or local tissue heating effect. MRI also allowed postoperative cervical spine imaging without significant image distortion. This titanium Luque SSI method affords rigid fixation, allows early mobilization and MRI serial imaging in the patient`s lifelong medical care. (author).

  11. Titanium luque SSI for rheumatoid spondylitis with myelopathy. Clinical results and postoperative magnetic resonance imaging

    International Nuclear Information System (INIS)

    Nineteen rheumatoid patients suffering from rheumatoid spondylitis with myelopathy were surgically treated using Luque segmental spinal instrumentation (SSI). We studied 7 cases of patients who underwent postoperative magnetic resonance imaging (MRI) evaluation after being treated with titanium Luque SSI. Titanium implants were imaged safely and there was no evidence of implant migration or local tissue heating effect. MRI also allowed postoperative cervical spine imaging without significant image distortion. This titanium Luque SSI method affords rigid fixation, allows early mobilization and MRI serial imaging in the patient's lifelong medical care. (author)

  12. The correlationship between MMP-9 expression and the blood-spinal cord barrier disruption in chronic compressive cervical myelopathy%慢性压迫性脊髓症基质金属蛋白酶-9表达与血脊髓屏障破坏的相关性研究

    Institute of Scientific and Technical Information of China (English)

    龙厚清; 陈文立; 谢文林; 李广盛; 徐晶辉; 程星; 胡勇; 李佛保

    2015-01-01

    Objective To investigate the correlation between the expression of MMP-9 and the disruption of the blood spinal cord barrier (BSCB) in chronic cervical cord compressive myelopathy rat model.Methods 48 adult rats were randomly divided into group A (sham surgical group,n=24) and group B (spinal cord compressive group,n=24).A water-absorbing polymer sheet was implanted into the C5 epidural space on the posterolateral side to induce a chronic spinal cord compression model.BBB scores and SEP were collected 4 weeks after surgery.Expression of MMP-9 and endothelial barrier antigen (EBA) were detected immunohistochemically in different spinal cord areas of 12 rats in each group.The other 12 rats were performed with Evans blue (EB) perfusion to observe the permeability of BSCB.The results and the correlation between MMP-9 and EBA expression were analyzed.Results BBB score was lower in spinal cord compressive group than that of sham surgical group.Latency was delayed and amplitude was reduced significantly in spinal cord compressive group.Expression level of MMP-9 in spinal cord compressive group was significant higher than that in both grey matter and white matter in sham surgical group.In the contrary,EBA expression was obviously more in grey matter of sham surgical group than that in spinal cord compressive group,while it showed no significant change in white matter between the 2 groups.EB perfusion in sham surgical group was less than that in spinal cord compressive group.MMP-9 expression was correlated with EBA staining significantly.Conclusion Neurological function of spinal cord in the compression group was abnormal,with a marked decline 4 weeks after model made.The increased permeability and structural failure of BSCB in chronic spinal cord compression myelopathy,which was characterized and correlated with increment of MMP-9 expression and decrement of EBA expression concurrently.Disruption of BSCB may be correlated with distinct increasing expression of MMP-9.%

  13. 微型钛板与锚定法颈椎单开门治疗颈椎病效果的对比研究%Mini titanium plate fixation versus anchor fixation in unilateral open-door laminoplasty for treatment of multilevel cervical myelopathy

    Institute of Scientific and Technical Information of China (English)

    温世锋; 郭东明; 徐中和; 肖文德; 李菊根; 尹庆水

    2013-01-01

    Objective To evaluate clinical efficacy of mini titanium plate fixation versus anchor fixation in unilateral open-door laminoplasty for treatment of multilevel cervical myelopathy (MCM).Methods A retrospective study of fifty-five patients with MCM who had undergone unilateral open-door laminoplasty was performed.Twenty-six patients underwent surgery with mini titanium plate fixation (A group)and twenty-nine patients with anchor fixation (B group) respectively.Clinical results were assessed by comparing the following parameters between patients who were in the two groups:Japanese Orthopaedic Association (JOA) score and JOA recovery rate,and image results were measured by Ishihara's curvature index,and area of the narrowest spinal canal and spinal cord in MRI.Results Fifty patients were followed up from 6 to forty-two months with an average of (27.1 ±9.9) months.No statistically significant differences were identified in follow-up JOA score and JOA recovery rate (P>0.05).A group had larger difference between the pre-and postoperative Ishihara's curvature index,area of the narrowest spinal canal and spinal cord (P<0.05).Conclusions Satisfactory recovery of neurological function can be achieved and maintained by the two fixations,however,A group had better image results than B group.%目的 比较颈椎单开门应用两种固定技术治疗多节段脊髓型颈椎病的的临床及影像学结果.方法 55例多节段脊髓型颈椎病患者,均进行颈椎单开门椎管扩大成形术,根据内固定技术分为微型钛板固定技术(A组)26例和锚定法固定技术(B组)29例.通过比较JOA评分及改善率评价临床疗效,而影像学结果则通过比较X线颈椎曲度变化值和MRI椎管与脊髓最狭窄处面积进行评估.结果 其中50例获得随访6~42个月,平均(27.1±9.9)个月.两组患者随访时JOA评分及改善率比较差异均无统计学意义(P>0.05);而在颈椎曲度变化值、椎管与脊髓最狭窄处面积变化

  14. Observation of curative effect after treatment of cervical spondylopathy with the artifitial cervical disc prosthesis%人工颈椎间盘置换术治疗颈椎病疗效观察

    Institute of Scientific and Technical Information of China (English)

    文益民; 葛宝丰; 蓝旭; 张军华; 王世勇; 张巧娥; 李慎松

    2009-01-01

    [目的]探讨人工颈椎间盘置换术治疗颈椎病所致神经或脊髓受损的临床症状及体征的缓解情况,置换节段的稳定性,活动度的维持.[方法]对6例颈椎病患者6个椎间盘实施了颈椎前路人工颈椎间盘置换术,其中神经根型颈椎病3例,脊髓型颈椎病3例.随访时间8~39个月,平均28个月.[结果]6例患者神经、脊髓受损临床症状及体征均得到了明显的恢复和缓解.JOA评分从平均8.2增加到16.3.假体无明显下沉和偏移,置换节段稳定,颈椎活动范围得到了明显恢复.前屈和后伸活动范围平均恢复4.86°(3.3°~6.28°);左右侧屈的活动范围平均恢复3.26°(2.6°~5.1°),3.52°(2.6°~4.8°),颈椎生理弧度无明显丢失,假体节段周围无骨化.无神经及血管损伤等并发症.[结论]6例人工颈椎间盘置换术均取得了满意的近期临床疗效.与当今标准颈前路椎间盘摘除,椎体间植骨融合,钢板螺钉内固定术比较,其最大的优点是病人恢复快,颈椎活动度无明显受损.%[Objective] To investigate the treatment of nerve and spinal cord injury caused by cervical spondylopathy with the artifitial cervical disc prosthesis, relief from objective symptoms and signs, maintain stability and segmental motion. [ Methods ] Six cases of cervical spondylopathy were treated through anterior approach excision and repaired by 6 discs of artifical cervical disc replacement Among them, there were 3 cases of cervical spondylotic myelopathy and 3 of nerve root cervical syndrome. The follow - up time ranged from 8 to 39 months, averaged 28 months. [ Results] The neurologic symptom and sign in all cases had significant improvement. JOA score increased from averaged 8.2 to 16.3. There were no prosthesis subsidence or deviation. Replaced segment achived stability and restored partial of normal ROM, 4.68°(3.3°~6.28°) in flextion and extension position and 3.26°(2.6°~5.1°) ,3.52°(2.6°~4.8°) in left

  15. [Therapy of cervical rheumatoid arthritis].

    Science.gov (United States)

    Kothe, R; Wiesner, L; Rüther, W

    2004-08-01

    The rheumatoid involvement of the cervical spine can be divided into three phases. In the early stage of the disease there is an isolated atlantoaxial subluxation (AAS), followed by vertical instability and subaxial instability. If patients show clear symptoms of cervical myelopathy, which can occur during any stage of the disease, the progression cannot be stopped by conservative treatment, which is of great importance at the beginning of the cervical manifestation. Patient education, physiotherapy and immobilization with a stiff collar can significantly reduce pain. Early and effective DMARD therapy can have a positive effect on the natural history of the disease. In case of progressive instability, cervical myelopathy or severe pain operative treatment is indicated. If there is an isolated AAS, fusion can be restricted to the C1/C2 segment. The Magerl transarticular screw fixation is the preferred technique for stabilization. If there is evidence for vertical instability or severe destruction of the C0/C1 joints, occipital cervical fusion has to be performed. Durin the preoperative planning it is necessary to look for signs of subaxial instability. If this is the case, fusion should include the entire cervical spine. Transoral decompression may be necessary when there is persistent anterior compression of the myelon, typically seen in fixed AAS. Non-ambulatory myelopathic patients are more likely to develop severe surgical complications. Therefore, it is important to avoid the development of severe cervical instability by early surgical intervention. The right timing for surgery is still a matter of controversy. Future prospective randomized trials should address this topic to improve the treatment concept for the rheumatoid patient.

  16. Acquired progressive hypotonia in infancy: consider compressive cervical myelopathy.

    NARCIS (Netherlands)

    Verbeek, I.N.; Vollebregt, A.; Halbertsma, F.J.; Lindert, E.J. van; Andriessen, P.

    2011-01-01

    This case report presents a rare cause of progressive hypotonia due to a congenital bony defect of the atlas in a 2-month-old girl. The patient was initially referred to the paediatric department with feeding problems. Within days after admission she developed progressive hypotonia and showed decrea

  17. A case of acutely developed delayed radiation myelopathy

    Energy Technology Data Exchange (ETDEWEB)

    Hayashi, Shintaro; Amari, Masakuni [Geriatrics Research Inst., Maebashi (Japan). Hospital; Fukuda, Toshio; Okamoto, Koichi [Gunma Univ., Maebashi (Japan). School of Medicine

    2002-08-01

    A 66-year-old man with a history of hypertension received radiation therapy on his neck at age 61 because of laryngeal cancer (T1bN0M0). Five years after the radiation, he acutely developed dysuria, tetraparesis and dissociated sensory disturbances below bilateral Th4 level. T2 weighted MRI showed a high signal lesion affecting the central area of the spinal cord extending from C1 to C7. On the second clinical day, he developed respiratory arrest and was ventilated. The cerebrospinal fluid contained 20/mm{sup 3} (monocyte 15, neutorophil 5) white cells; protein was 52.5 mg/dl; IgG index 0.54; Q albumin was 9.6; tests for oligoclonal band and myelin basic protein were negative; a culture yielded no microorganism. He was treated with steroids and supportive measures without improvement, and died of a sudden cardiac arrest on the 8th clinical day. postmortem examination confirmed conspicuous focal spongy changes with many axonal swellings, especially in the posterior and lateral columns at cervical and Th1 levels. The pathological findings were considered to be compatible with those of delayed radiation myelopathy (DRM). In the anterior horn of the cervical cord there were lesions of diffuse racification and the proliferation of small vessels. There were no findings of hyaline vascular changes, infarction or metastasis of laryngeal cancer at the spinal cord. It is considered that hyperintensity of signals on T2-weighted may originate from racification and proliferation of small vessels in the gray matter, and these pathological changes would be intimately associated with the severe neurologic morbidity of this patient. Acute development of neurological findings and the pathological changes in the gray matter of the spinal cord are rare manifestations of DRM. (author)

  18. Myelitis or transverse myelopathy. A case presentation.

    Directory of Open Access Journals (Sweden)

    Rubén Bembibre Taboada

    2005-08-01

    Full Text Available Here is presented a brief information about the most relevant aspects of myelitis or transverse myelopathy, a syndrome of low frequency rates in our medical experience with intensive care, along with an assisted case in our clinic intensive therapy service. The patient was subjected to the diverse complementary tests, necessary for the diagnosis, and she received established treatment for this process, and so for the complications presented. It was proved a fulminant ascendant myelitis with unfavourable fast evolution.

  19. Myelitis or transverse myelopathy. A case presentation.

    OpenAIRE

    Rubén Bembibre Taboada; Dianarelys Villafuerte Delgado; Annia Alvarado Borges; Niurka Galende Hernández

    2005-01-01

    Here is presented a brief information about the most relevant aspects of myelitis or transverse myelopathy, a syndrome of low frequency rates in our medical experience with intensive care, along with an assisted case in our clinic intensive therapy service. The patient was subjected to the diverse complementary tests, necessary for the diagnosis, and she received established treatment for this process, and so for the complications presented. It was proved a fulminant ascendant myelitis with ...

  20. Operative Outcomes for Cervical Degenerative Disease: A Review of the Literature

    OpenAIRE

    Kazuya Nishizawa; Kanji Mori; Yasuo Saruhashi; Yoshitaka Matsusue

    2012-01-01

    To date, several studies were conducted to find which procedure is superior to the others for the treatment of cervical myelopathy. The goal of surgical treatment should be to decompress the nerves, restore the alignment of the vertebrae, and stabilize the spine. Consequently, the treatment of cervical degenerative disease can be divided into decompression of the nerves alone, fixation of the cervical spine alone, or a combination of both. Posterior approaches have historically been considere...

  1. Management of delayed posttraumatic cervical kyphosis.

    Science.gov (United States)

    Lopez, Alejandro J; Scheer, Justin K; Abode-Iyamah, Kingsley; Smith, Zachary A; Hitchon, Patrick W; Dahdaleh, Nader S

    2016-01-01

    We describe three patients with misdiagnosed unstable fractures of the cervical spine, who were treated conservatively and developed kyphotic deformity, myelopathy, and radiculopathy. All three patients were then managed with closed reductions by crown halo traction, followed by instrumented fusions. Their neurologic function was regained without permanent disability in any patient. Unstable fractures of the cervical spine will progress to catastrophic neurologic injuries without surgical fixation. Posttraumatic kyphosis and the delayed reduction of partially healed fracture dislocations by preoperative traction are not well characterized in the subaxial cervical spine. The complete evaluation of any subaxial cervical spine fracture requires CT scanning to assess for bony fractures, and MRI to assess for ligamentous injury. This allows for assessment of the degree of instability and appropriate management. In patients with delayed posttraumatic cervical kyphosis, preoperative closed reduction provided adequate realignment, facilitating subsequent operative stabilization. PMID:26321304

  2. Posterior approach to the degenerative cervical spine

    OpenAIRE

    Yonenobu, Kazuo; Oda, Takenori

    2003-01-01

    Laminoplasty has been gradually accepted as a treatment for choice for cervical compression myelopathy. The historical perspective of laminoplasty is described. The aims of laminoplasty are to expand the spinal canal, to secure spinal stability, to preserve the protective function of the spine, and to preserve spinal mobility. Laminoplasty is indicated in myelopathic patients with a developmentally narrow spinal canal or multiple-level involvement combined with a relatively narrow canal. Seve...

  3. The short-term efficacy of Prestige LP artificial disc single-level replacement for cervical spondylosis%Prestige LP人工椎间盘置换治疗单节段颈椎病的近期疗效

    Institute of Scientific and Technical Information of China (English)

    黄波; 卢一生; 施建东; 徐静芳; 刘振刚

    2014-01-01

    Objective To evaluate the short-term radiological and functional outcome of artifi-cial disc single-level replacement for cervical disc degenerative diseases. Methods 15 patients with cervical disc degenerative diseases underwent Prestige LP artificial disc replacement were se-lected in this study. There were 8 cases of cervical spondylotic myelopathy and 7 cases of nerve root cervical syndrome. The range of motion(ROM) of the cervical spine,ROM of treated segment and lordosis of cervical spine were reviewed respectively at preoperation and 1 month,3 months and 12 months postoperation,and the NDI scores,VAS for neck and arm pain were also reviewed respectively preoperation and the last follow-up. Results At an average of 16.3 months(range 6-24 months) follow-up,the neurologic symptom and sign in all cases had significant improvement. The NDI was significantly improved from(47.80±11.52)% to(16.20±9.34)%(P<0.05),the VAS for neck and arm pain were all significantly improved from(5.13±1.44) and (6.30±1.51) to (1.46±0. 81) and (1.14 ±0.57) respectively (P<0.05). The lordosis of cervical spine was significantly in-creased at follow up (P<0.05). The ROM of the cervical spine and ROM of treated segment re-covered to the preoperative level. There was no neurological complication during operation,and no ossification in the replaced level and no prosthesis displacement and loosening . Conclusion Our findings suggest that the Prestige LP cervical disc replacement in the treatment of cervical disc degenerative diseases has good functional short-term results, further follow-up is necessary to e-valuate mid- and long-term outcome.%目的:探讨应用Prestige LP人工椎间盘置换治疗单节段颈椎病的近期临床疗效。方法治疗单节段颈椎病患者15例,统计并分析患者术前和术后1、3、12个月随访时JOA评分、NDI脊髓功能评分、颈部及上肢疼痛VAS评分、置换节段活动度、颈椎运动范围、颈椎生理曲度等指标

  4. [Clinical and technical assessment of the cervical spine].

    Science.gov (United States)

    Dvorak, J

    1996-11-01

    In analysis of the cervical and cervicobrachial syndrome with or without signs of compression of the nerve root or spinal cord, functional assessment of the cervical spine is of great importance. Comparisons between actively performed and passively induced motion can be verified by using standardized computer-assisted assessment allowing precise documentation of the range of motion and coupled motion. The age-related normal values should be considered. The neurological assessment includes not only the cranial nerves and upper extremities but also lower extremities to avoid overlooking the signs of cervical myelopathy. In patients with compression of nerve roots or the spinal cord neurophysiology might be helpful in identifying or verifying compression. In patients with suspected myelopathy sensory evoked potentials will allow assessment of the function of the ascending spinal pathways and motor evoked potentials, assessment of the function of the descending cortical spinal pathways. PMID:8999404

  5. 现实虚拟互动技术对角度牵引治疗根型颈椎病研究%Evaluation of Therapeutic Effect of Traction at Different Angles for Cervical Spondylotic Radiculopathy by Using Real-Virtual Interaction Technique

    Institute of Scientific and Technical Information of China (English)

    陈博来; 许鸿智; 赵卫东; 樊继宏; 冯敏山; 林定坤; 宁飞鹏

    2012-01-01

    [目的]比较不同角度牵引治疗神经根型颈椎病的生物力学差异,探讨角度牵引治疗神经根型颈椎病的合适方式,为临床应用提供理论依据.[方法]符合纳入标准的33例病例实验前均拍摄颈椎CT片.患者分别接受前屈位、中立位及后伸位角度牵引,牵引前后均拍摄标准颈椎侧位X光片,测量牵引前后各节段椎间前、后隙高度的变化;对其中1位患者的颈椎CT片进行三维有限元分析,并模拟不同角度受力下颈椎的生物力学变化.[结果]不同角度牵引下椎间前、后隙高度的变化均以前屈位最为显著,从C2/3至C6/7,前屈位组各节段的椎间前、后隙高度增加值均显著大于中立位组和后伸位组(P<0.01),而其中中立位组又显著大于后伸位组(P< 0.01),三者关系为:前屈位组>中立位组>后伸位组.三维有限元分析结果显示:无论是椎间后隙或是椎间前隙,均以前屈住增加最为显著.但与在体实验相比,后伸住受力分析却显示出几乎相反的结果.[结论]单从椎间隙高度增加的角度来看,前屈位角度牵引对于神经根型颈椎病的治疗最为有利,并可以推测,C3/4、C4/5节段病变的神经根型颈椎病患者可能最适宜接受前屈位角度牵引;另一方面,建议神经根型颈椎病患者应该慎用后伸位角度牵引.%Objective To compare the differences of biomechanics at different traction angles for nerve root type cervical spondylosis, and to optimize the traction angle. Methods Thirty-three qualified patients were enrolled into the study, and took the cervical computer tomography ( CT) before experiment. The patients were given traction at anterior flexion, neutral position and posterior flexion, respectively. Before and after traction, standard lateral cervical X-rays image was carried out for the measurement of intervertebral gap height, and the cervical CT of one of the patients was chosen for three-dimensional finite

  6. Simulated Automobile and Rotary-Wing Aircraft Impacts: Dynamic Neck Response after Surgical Treatment for Cervical Spondylosis

    OpenAIRE

    White, Nicholas Alan

    2014-01-01

    Degeneration of the cervical spine is part of the normal aging process, usually occurring without clinical symptoms. Symptomatic degeneration most often occurs in the lower cervical spine, presenting as axial neck pain, radiculopathy, myelopathy, or any combination of the three. When conservative treatment does not adequately manage these symptoms, surgical intervention may be required. The longstanding surgical treatment for cervical degeneration is arthrodesis achieved through anterior cerv...

  7. Axial Neck Pain after Cervical Laminectomy with Instrumented Fusion%颈椎椎板切除融合术后轴性疼痛

    Institute of Scientific and Technical Information of China (English)

    韩雨; 张永刚; 张雪松; 陆宁; 毛克亚; 崔庚; 王征

    2011-01-01

    目的:目前已证实颈椎椎板切除融合术是治疗多阶段的脊髓型颈椎病和后纵韧带骨化病的一种安全和有效的方法.然而,颈椎椎板切除融合术后经常发生颈部轴性疼痛.本研究的目的是观察C7棘突保留与否与颈椎椎板切除融合术后轴性疼痛的关系.方法:对2006年1月~2008年12月在我院行颈椎椎板切除融合术的67个病人进行回顾性分析.将这67个病人之中保留了C7棘突的29名病人称为A组,未保留C7棘突的38名病人称为B组,对两组病人的轴性症状、颈椎曲度和颈椎曲度指数(cervi cal curbatureindex,CCI)进行评估和比较.结果:在A组中有51.7%的病人发生了早期的轴性症状,10.3%的病人发生了晚期的轴性症状,B组分别为60.5%和42.1%.B组中42.1%的病人和A组中10.3%的病人在手术后晚期有轴性症状,A组的轴性疼痛发生率低于B组,有统计学意义(p=0.001).结论:保留C7棘突可以降低颈椎椎板切除融合术后轴性症状的发生率.%Objective: It has been demonstrated that cervical laminectomy with instrumented fusion is an effective and safe method of treating multi-level cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament.However, axial neck pain is frequently encountered after cervical laminectomy with instrumented fusion.The aim of the present study was to determine clinical significance of the C7 spinous process on axial neck pain after cervical laminectomy with instrumented fusion.Methods: A total of 67 consecutive patients that underwent cervical laminectomy with instrumented fusion between Janurary 2006 and December 2008 were reviewed.The authors evaluated and compared axial neck pain 、 lordotic angle and cervical curbature index (CCI) in patients that underwent C7 spinous process preserving surgery (groupA n = 29) and in patients in which the C7 spinons process was sacrificed (groupB, n = 38).Results: Early axial pain occurred in 51.7% of

  8. Cervical dysplasia

    Science.gov (United States)

    ... by your provider. Make sure to get the HPV vaccine when it is offered to you. This vaccine prevents many cervical cancers. ... Early diagnosis and prompt treatment cures most cases of cervical ... severe cervical dysplasia may change into cervical cancer.

  9. INFLUENCE OF INTRAOPERATIVE CERVICAL POSTURE IN SINGLE SEGMENTAL CERVICAL DISC REPLACEMENT ON RESTORATION OF CERVICAL CURVE IN NEUTRAL POSITION%单节段颈椎间盘置换术中颈椎体位对术后颈椎中立位生理轴线重建的影响

    Institute of Scientific and Technical Information of China (English)

    洪瑛; 邓宇骁; 刘浩; 龚仁蓉; 安晶晶; 龚全; 李涛; 宋跃明

    2013-01-01

    after surgery. Methods Between January 2008 and August 2010, 51 patients underwent single segmental PRESTIGE LP replacement, and the clinical data were retrospectively analyzed. During the surgery, the patient was supinely placed and the lordosis of the cervical spine was mantained with a pillow placed beneath the neck. Of them, 28 were male and 23 were female, aged 30-64 years (mean, 45 years); 32 were diagnosed as having cervical spondylotic myelopathy, 7 having radiculopathy, and 12 having myelopathy and radiculopathy. The disease duration was 3-48 months (mean, 15 months). CDR was performed at Co in 5 cases, at C5.6 in 42 cases, and at C6,7 in 4 cases. The Cobb angles of the cervical alignment, targeted functional spinal unit (FSU), and targeted disc were measured by sagittal X-ray film of the cervical spine in neutral position before and after surgery, as well as the intraoperative C-arm fluroscopy of the cervical spine. Linear correlation and regression were performed to analyze the relation between cervical Cobb angle difference at intraoperation and improvement of the Cobb angles at 3 months after operation. Results The cervical Cobb angles at intraoperation and 3 months after operation were larger than those at preoperation (P < 0.05). The difference of the Cobb angle between intra- and pre-operation was (6.72 ± 9.13)° on cervical alignment, (2.10 ± 5.12)° on targeted FSU, and (3.33 ± 3.75)° on targeted disc. At 3 months after operation, the Cobb angle improvement of the cervical alignment, targeted FSU, and targeted disc was (6.30 ± 7.28), (3.99 ± 5.37), and (4.29 ± 5.36)°, respectively. There was no significant difference in the Cobb angle improvement between the targeted FSU and the targeted disc (t=-0.391, P=0.698), and between the targeted disc and the cervical alignment (t=-1.917, P=0.061), but significant difference was found between the targeted FSU and the cervical alignment (t=-2.623, P=0.012). The linear correlation between the Cobb angle

  10. Bryan total disc arthroplasty: a replacement disc for cervical disc disease

    Directory of Open Access Journals (Sweden)

    Markus Wenger

    2010-07-01

    Full Text Available Markus Wenger1, Thomas-Marc Markwalder21Neurosurgery, Klinik Beau-Site and Salem-Spital, Berne, Switzerland; 2Attending Neurosurgeon FMH, Private Practice Spine Surgery, Berne-Muri, SwitzerlandAbstract: Total disc arthroplasty is a new option in the treatment of cervical degenerative disc disease. Several types of cervical disc prostheses currently challenge the gold-standard discectomy and fusion procedures. This review describes the Bryan Cervical Disc System and presents the Bryan prosthesis, its indications, surgical technique, complications, and outcomes, as given in the literature.Keywords: cervical spine, degenerative disc disease, disc herniation, myelopathy, spine surgery, bryan prosthesis, complication, outcome

  11. Early complications of cervical spine surgery in 96 patients%颈椎手术96例早期并发症分析

    Institute of Scientific and Technical Information of China (English)

    储建军; 王涛; 裴少保; 李键; 李定滨; 王之兵

    2014-01-01

    Objective To evaluate the early complications of cervical spine surgery .Methods We retro-spectively analyzed 96 cervical spine surgery patients in our department ,including 56 cervical spondylotic myelopathy , 21 cervical fracture and/or dislocation ,11 cervical spine tumor ,5 atlantoaxial dislocation ,3 Chiari malformation .By analyzing causes of complications ,the countermeasures were developed .Results 27 patients had complications .The major complications were:death in 1 case,incision hematoma in 2 cases,incision infection in 4 cases,spine cord inju-ry or nerve root injury in 3 cases,cerebrospinal fluid leakage in 3 cases,superior laryngeal nerve and recurrent laryn-geal nerve injury in 4 cases,pulmonary infection in 5 cases,urinary tract infection in 4 cases.There were no esophage-al fistula and vertebral artery injury in these patients .The incidence rate in anterior ,posterior,anterior combined with posterior surgery was 24.6%(14/57),36.8%(7/19),40.0%(6/15) respectively.Conclusion Cervical spine surgery is likely to get early complications .Adequate preoperative preparation and improving operative techniques , timely and correctly handle the complications could reduce complications and improve cure rate .%目的:分析颈椎手术早期并发症的发生原因及处理方法。方法回顾性分析96例颈椎手术患者的临床资料,其中脊髓型颈椎病56、颈椎骨折脱位21例、颈椎肿瘤11例、寰枢椎脱位5例、Chiari 畸形3例;颈椎前路手术57例、后路手术24例,前后联合手术15例,分析早期并发症发生率、发生原因及其对策。结果96例颈椎手术中27例出现并发症,发生率为29.2%,其中死亡1例,切口血肿2例,切口感染4例,脊髓或神经损伤3例,脑脊液瘘3例,喉返神经损伤2例,喉上神经损伤2例,肺部感染5例,尿路感染4例,无食管瘘及椎动脉损伤病例。前路手术并发症发生率24.6%(14/57),后路手

  12. Value of transcranial motor evoked potentials during spinal operations

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    @@ To the Editor: We read the interesting recent article by Ding et al1 concerning the value of somatosensory evoked potentials (SEPs) in the diagnosis and prognosis of cervical spondylotic myelopathy, as well as the usefulness of monitoring intraoperative potentials in terms of safety and predictive factors.

  13. ORTHOPEDIC SURGERY

    Institute of Scientific and Technical Information of China (English)

    1996-01-01

    Purpose: To ascertain the ranges ofintervertebral motion of normal anddegenerative cervical vertebrae and evaluatethe relationship between the abnormality of thenormal cervical curvature and the pathogenesisof cervical spondylotic myelopathy (CSM).Methods: Flexion-extension latera view of thecervical spine was performed in 39 normalchildren of 13 and 14 year-old, 27 cases ofCSM, and 29 cases of normal adults to be usedas controls. The range of motion of the

  14. Nonoperative Management of Cervical Radiculopathy.

    Science.gov (United States)

    Childress, Marc A; Becker, Blair A

    2016-05-01

    Cervical radiculopathy describes pain in one or both of the upper extremities, often in the setting of neck pain, secondary to compression or irritation of nerve roots in the cervical spine. It can be accompanied by motor, sensory, or reflex deficits and is most prevalent in persons 50 to 54 years of age. Cervical radiculopathy most often stems from degenerative disease in the cervical spine. The most common examination findings are painful neck movements and muscle spasm. Diminished deep tendon reflexes, particularly of the triceps, are the most common neurologic finding. The Spurling test, shoulder abduction test, and upper limb tension test can be used to confirm the diagnosis. Imaging is not required unless there is a history of trauma, persistent symptoms, or red flags for malignancy, myelopathy, or abscess. Electrodiagnostic testing is not needed if the diagnosis is clear, but has clinical utility when peripheral neuropathy of the upper extremity is a likely alternate diagnosis. Patients should be reassured that most cases will resolve regardless of the type of treatment. Nonoperative treatment includes physical therapy involving strengthening, stretching, and potentially traction, as well as nonsteroidal anti-inflammatory drugs, muscle relaxants, and massage. Epidural steroid injections may be helpful but have higher risks of serious complications. In patients with red flag symptoms or persistent symptoms after four to six weeks of treatment, magnetic resonance imaging can identify pathology amenable to epidural steroid injections or surgery. PMID:27175952

  15. Nonoperative modalities to treat symptomatic cervical spondylosis.

    LENUS (Irish Health Repository)

    Hirpara, Kieran Michael

    2012-01-01

    Cervical spondylosis is a common and disabling condition. It is generally felt that the initial management should be nonoperative, and these modalities include physiotherapy, analgesia and selective nerve root injections. Surgery should be reserved for moderate to severe myelopathy patients who have failed a period of conservative treatment and patients whose symptoms are not adequately controlled by nonoperative means. A review of the literature supporting various modalities of conservative management is presented, and it is concluded that although effective, nonoperative treatment is labour intensive, requiring regular review and careful selection of medications and physical therapy on a case by case basis.

  16. Intradural tumor and concomitant disc herniation of cervical spine

    Directory of Open Access Journals (Sweden)

    Mihir R Bapat

    2011-01-01

    Full Text Available We report a rare patient of a simultaneous extradural and intradural compression of the cervical spinal cord due to co-existent intervertebral disc herniation and an intradural schwannoma at the same level. The intradural lesion was missed resulting in recurrence of myelopathy after a surprisingly complete functional recovery following anterior cervical discectomy. Retrospectively, it was noted that the initial cord swelling noticed was tumor being masked by the compression produced by the herniated disc. A contrast magnetic resonance imaging scan is important in differentiating intradural tumors of the spinal cord. A high index of suspicion is often successful in unmasking both the pathologies.

  17. [Acute non-traumatic myelopathy in children and adolescents].

    Science.gov (United States)

    Arroyo, Hugo A

    2013-09-01

    The term 'acute myelopathies'--referred to a spinal cord dysfunction--represent a heterogeneous group of disorders with distinct etiologies, clinical and radiologic features, and prognoses. The objective of this review is to discuss the non-traumatic acute myelopathies. Acute myelopathy can be due to several causes as infective agents or inflammatory processes, such as in acute myelitis, compressive lesions, vascular lesions, etc. The clinical presentation is often dramatic with tetraparesis or paraparesis, sensory disturbances and bladder and/or bowel dysfunction. History and physical examination are used to localize the lesion to the root or specific level of the cord, which can guide imaging. Different syndromes are recognized: complete transverse lesion, central grey matter syndrome, anterior horn syndrome, anterior spinal artery syndrome, etc). The first priority is to rule out a compressive lesion. If a myelopathy is suspected, a gadolinium-enhanced MRI of the spinal cord should be obtained as soon as possible. If there is no structural lesion such as epidural blood or a spinal mass, then the presence or absence of spinal cord inflammation should be documented with a lumbar puncture. The absence of pleocytosis would lead to consideration of non inflammatory causes of myelopathy such as arteriovenous malformations, fibrocartilaginous embolism, or possibly early inflammatory myelopathy. In the presence of an inflammatory process (defined by gadolinium enhancement, cerebrospinal fluid pleocytosis, or elevated cerebrospinal fluid immunoglobulin index), one should determine whether there is an inflammatory or an infectious cause. Different virus, bacterias, parasites and fungi have to be considered as autoimmune and inflammatory diseases that involve the central nervous system. PMID:23897140

  18. Post laminoplasty cervical kyphosis—Case report

    Science.gov (United States)

    Dugoni, D.E.; Mancarella, C.; Landi, A.; Tarantino, R.; Ruggeri, A.G.; Delfini, R.

    2014-01-01

    INTRODUCTION Cervical kyphosis is a progressive cervical sagittal plane deformity that may cause a reduction in the ability to look horizontally, breathing and swallowing difficulties, sense of thoracic oppression and social isolation. Moreover, cervical kyphosis can cause myelopathy due to a direct compression by osteo-articular structures on the spinal cord or to a transitory ischaemic injury. The treatment of choice is surgery. The goals of surgery are: nervous structures decompression, cervical and global sagittal balance correction and vertebral stabilization and fusion. PRESENTATION OF CASE In October 2008 a 35 years old woman underwent surgical removal of a cervical-bulbar ependymoma with C1–C5 laminectomy and a C2–C5 laminoplasty. Five months after surgery, the patient developed a kyphotic posture, with intense neck and scapular girdle pain. The patients had a flexible cervical kyphosis. Therefore, we decided to perform an anterior surgical approach. We performed a corpectomy C4–C5 in order to achieve the anterior decompression; we placed a titanium expansion mesh. DISCUSSION Cervical kyphosis can be flexible or fixed. Some authors have reported the use of anterior surgery only for flexible cervical kyphosis as discectomy and corpectomy. This approach is useful for anterior column load sharing however it is not required for deformity correction. CONCLUSION The anterior approach is a good surgical option in flexible cervical kyphosis. It is of primary importance the sagittal alignment of the cervical spine in order to decompress the nervous structures and to guarantee a long-term stability. PMID:25462050

  19. 人工颈椎间盘置换术患者围手术期护理体会%Cervical intervertebral disc arthroplasty patients perioperative nursing experience

    Institute of Scientific and Technical Information of China (English)

    刘丹

    2015-01-01

    颈椎间盘突出症是一种常见的退化性病变,它可以引起脊髓和神经根病变,脊髓病变甚至可能造成四肢运动功能损害、感觉异常等。人工间盘的设计理念之一是保留手术节段的活动,另一设计理念是降低临近节段退变的发生,它既能保持脊柱节段的稳定性和活动功能,又能避免临近关节受到连累,对于提高患者生活质量有实际意义。2013年11月,我科成功为一名严重脊髓型颈椎病患者实施了经颈前路减压、人工椎间盘置换术,围手术期的系统、精密的观察和护理,对手术成功起到重要作用,术后患者恢复良好,患者及其家属对手术效果均感到满意,现总结护理经验如下。%The cervical intervertebral disc herniation is a common degradation lesions, it can cause spinal cord and nerve root lesions, limb motor function caused by spinal cord lesions and may even damage, paresthesia, etc. Between artificial disc is one of the design concept of conservative surgery section of the activity, a design concept is to reduce the happening of the adjacent segment degeneration, it can maintain the stability of the spinal segment and function of activity, and can avoid near joints, small area, to improve the patients quality of life has a practical significance. In November 2013, I division success as a serious spondylotic myelopathy successfully implemented by decompression and anterior portion of artificial intervertebral disc replacement, through system, precision of perioperative observation and nursing care, for the success rate of surgery play an important role, the patient recovered well postoperatively, patients and their families were satisfied with the surgical effects are, summarized nursing experience is as follows.

  20. Choice of surgical approach for ossification of the posterior longitudinal ligament in combination with cervical disc hernia

    OpenAIRE

    Yang, Hai-song; Chen, De-yu; Lu, Xu-hua; Yang, Li–li; Yan, Wang-Jun; Yuan, Wen; Chen, Yu

    2009-01-01

    Ossification of the posterior longitudinal ligament (OPLL) is a common spinal disorder that presents with or without cervical myelopathy. Furthermore, there is evidence suggesting that OPLL often coexists with cervical disc hernia (CDH), and that the latter is the more important compression factor. To raise the awareness of CDH in OPLL for spinal surgeons, we performed a retrospective study on 142 patients with radiologically proven OPLL who had received surgery between January 2004 and Janua...

  1. 人工颈椎间盘与颈椎动态稳定器治疗颈椎病的早中期临床疗效和影像学分析%A comparison of cervical disc arthroplasty versus dynamic cervial implant in the treatment of cervical spondylopathy:a clinical and radiological study

    Institute of Scientific and Technical Information of China (English)

    关立; 陈小龙; 海涌; 刘玉增; 汪文龙; 于志毅

    2015-01-01

    ;两组患者术后6个月和末次随访与术前比较,差异均有统计学意义(P<0.01),但两组间术前及术后末次随访时差异无统计学意义(P>0.05);两组患者术前、术后6个月及末次随访时对比,手术节段椎间隙高度、手术节段和相邻节段椎间活动度差异无统计学意义(P>0.05)。Prodisc-C 组术后末次随访发现3例异位骨化,2例假体前移1 mm,DCI 组未出现异位骨化和假体移动。结论 Prodisc-C 人工颈椎间盘与 DCI 治疗颈椎病均能保留颈椎活动度,恢复和维持椎间隙高度和颈椎生理弧度,早中期疗效满意。%Objective To evaluate the clinical and radiological outcomes of cervical disc arthroplasty by Prodisc-C versus dynamic cervial implant ( DCI ) in the treatment of cervical spondylopathy.Methods All cervical spondylopathy cases undergoing cervical disc arthroplasty by Prodisc-C or dynamic cervial implant between February 2011 and February 2013 were analyzed retrospectively. There were 16 patients in anterior cervical disc arthroplasty group ( male 8, female 8 ). Age averaged 44 years ( range: 32-54 years ). There were 10 cases with cervical spondylotic myelopathy, and 6 cases with radicular spondylosis. In dynamic cervical implant group were 10 cases ( male 6, female 4 ). Age averaged 44.5 years ( range: 33-55 years ). There were 7 cases of cervical spondylotic myelopathy, and 3 cases of radicular spondylosis. Parameters as gender, age, operation time and blood loss of all the patients were analyzed. The patients were followed 1 month, 3 months, 6 months, 12 months and 24 months postoperatively. Neck disability index ( NDI ), Japanese Orthopaedic Association ( JOA ) Score and Visual Analogue Scale ( VAS ) were used to evaluate the clinical outcomes of the two groups. Anterioposterior and lateral X-ray, hyperextension and hyperflexion X-ray films before and after surgery were analyzed and cervical lordosis, the height of disc, range of motion

  2. Intravenous Injections of Human Mesenchymal Stromal Cells Modulated the Redox State in a Rat Model of Radiation Myelopathy

    Directory of Open Access Journals (Sweden)

    Jing Zhang

    2015-01-01

    Full Text Available The main aim of the present study was to assess the antioxidative effects of human umbilical cord-derived mesenchymal stromal cells (UC-MSCs in a rat model of radiation myelopathy. UC-MSCs were isolated from Wharton’s jelly (WJ of umbilical cords. An irradiated cervical spinal cord rat model (C2-T2 segment was generated using a 60Co irradiator to deliver 30 Gy of radiation. UC-MSCs were injected through the tail vein at 90 days, 97 days, 104 days, and 111 days after-irradiation. Histological damage was examined by cresyl violet/Nissl staining. The activities of two antioxidant enzymes catalase (CAT and glutathione peroxidase (GPX in the spinal cord were measured by the biomedical assay. In addition, the levels of vascular endothelial growth factor (VEGF and angiopoietin-2 (Ang-2 in the spinal cord were determined by ELISA methods. Multiple injections of UC-MSCs through the tail vein ameliorated neuronal damage in the spinal cord, increased the activities of the antioxidant enzymes CAT and GPX, and increased the levels of VEGF and Ang-2 in the spinal cord. Our results suggest that multiple injections of UC-MSCs via the tail vein in the rat model of radiation myelopathy could significantly improve the antioxidative microenvironment in vivo.

  3. Imaging features and differentials in surfer's myelopathy: a case report.

    Science.gov (United States)

    Teixeira, Stephanie; Moser, Franklin; Kotton, Ryan H

    2016-02-01

    Surfer's myelopathy is a rare non-traumatic cause of myelopathy found in novice surfers. We present a case of a 23-year-old female who developed acute and rapidly progressive bilateral lower extremity paraplegia, paresthesia, and anesthesia, accompanied by lower back discomfort and bowel and bladder dysfunction after surfing for the first time. She had a past history of auto-resolved lower extremity weakness that could be related to anatomy variation of spinal cord vascular supply. This individual variation could have increased the risk for ischemic myelopathy after prolonged prone position with back hyperextension on the surf board. We discuss radiological findings of acute spinal cord infarct and longitudinal extensive transverse myelitis (LETM) as possible differentials in this case. The diagnosis of surfer's myelopathy relies on a first time surfing history since the clinical and radiological presentations can be similar to other entities in some cases. Thus, we highlight the importance of a full clinical report and efficient communication between referring clinicians and radiologists for a precise and early diagnosis. PMID:26394636

  4. Radiation myelopathy after irradiation of a larynx carcinoma

    International Nuclear Information System (INIS)

    The morphological characteristics and clinical phenomena of radiation myelopathy after X-irradiation of larynx carcinoma are demonstrated. In spite of constant improvement of radiotherapy the occurrence of a radiation damage of the central nervous system must be expected and included into considerations concerning differential diagnosis

  5. Cervical instability in Klippel-Feil syndrome:case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Aaron Wessell; Peter DeRosa; Abraham Cherrick; Jonathan H.Sherman

    2015-01-01

    Background: The authors present a case of cervical myelopathy and radiculopathy in the setting of multiple Klippel-Feil syndrome abnormalities treated surgically with a single-level C3-C4 anterior cervical discectomy and fusion.We discuss the clinical presentation, radiographic findings, and various treatment options for cervical spine abnormalities in Klippel-Feil syndrome.Case Presentation: This 22-year-old female with Klippel-Feil syndrome presented with intermittent neck pain, left upper extremity weakness, and paresthesias.Preoperative MRI, CT, and X-rays of the cervical spine revealed anterolisthesis at C3/4 with unstable movement on flexion and extension imaging.In addition, there were multiple segmental fusion abnormalities including hemivertebrae and other congenital fusion abnormalities.A C3-C4 anterior cervical discectomy and fusion was performed with intervertebral disc spacer.Adequate decompression was achieved with postoperative resolution of the patient's symptoms and improvement in neurological exam.Conclusions: Single-level anterior cervical discectomy and fusion can be utilized for treatment of cervical myelopathy and radiculopathy in the setting of multiple congenital Klippel-Feil syndrome abnormalities.

  6. Preliminary results of Activ C artificial disc replacement for cervical spondylosis%Activ C人工椎间盘置换术治疗颈椎病的早期疗效

    Institute of Scientific and Technical Information of China (English)

    赵耀; 刘屹林; 王利民; 谭洪宇; 王卫东; 廖文胜; 鲍恒

    2012-01-01

    目的:观察Activ C人工椎间盘置换术治疗颈椎病的早期临床疗效,分析其临床应用价值.方法:2009年11月~2011年3月在我院接受Activ C人工椎间盘置换术并获得随访的颈椎病患者共43例(45个节段),平均年龄48.3岁,其中男18例,女25例,脊髓型颈椎病22例,神经根型颈椎病16例,混合型颈椎病5例;单节段置换41例(C3/4 2例,C4/5 17例,C5/6 21例,C6/7 1例),双节段置换2例(C4/5和C5/6 1例,C5/6和C6/7 1例).采用日本骨科协会JOA评分、颈椎活动障碍指数(NDI)和疼痛视觉模拟评分(VAS)评价术后症状改善程度,比较手术前后的颈椎曲度、手术节段及邻近上下节段活动度变化,观察统计手术并发症情况.结果:术后随访8~24个月,平均13.8个月.患者的JOA评分、NDI、颈部VAS评分、上肢VAS评分分别由术前的8.2±0.7、35.3±4.7、6.8±1.1和6.5±1.2分显著改善至末次随访时的14.7±0.4、16.2±3.4、1.3±0.8和1.8±0.9分(P均<0.05).颈椎生理曲度术前为7.97°±4.49°,末次随访时为9.15°±3.85°,手术前后无明显差异(P>0.05).置换节段活动度较术前明显增加(P<0.01),邻近上下节段活动度手术前后差异无统计学意义(P>0.05).术后人工椎间盘活动良好,无塌陷或移位,随访期间未见邻近节段明显退变,2例分别在术后7个月和10个月时异位骨化形成.结论:Activ C人工椎间盘置换术可有效改善颈椎病患者的临床症状,维持颈椎的生理曲度和活动度,早期临床疗效满意.%Objectives: To investigate the early clinical effects of cervical Activ C artificial disc replacement. Methods: 43 patients(mean age 48.3 years; 18 males and 25 females) of cervical spondylosis with a total of 45 levels involved underwent anterior cervical decompression and Activ C implantation between November 2009 and March 2011. There were 22 cases of cervical spondylotic myelopathy, 16 cases of cervical spondy-lotic radiculopathy and 5 cases of mixed

  7. Treatment of Portosystemic Shunt Myelopathy with a Stent Graft Deployed through a Transjugular Intrahepatic Route

    Energy Technology Data Exchange (ETDEWEB)

    Jain, Deepak, E-mail: deepakjain02@yahoo.com; Arora, Ankur, E-mail: aroradrankur@yahoo.com [Institute of Liver and Biliary Sciences, Department of Radiology (India); Deka, Pranjal, E-mail: drpranjaldeka@gmail.com [Institute of Liver and Biliary Sciences, Department of Hepatopancreatobiliary Surgery (India); Mukund, Amar, E-mail: dramarmukund@gmail.com; Bhatnagar, Shorav, E-mail: drshorav@yahoo.com [Institute of Liver and Biliary Sciences, Department of Radiology (India); Jindal, Deepti, E-mail: deepijindal@rediffmail.com; Kumar, Niteen, E-mail: drniteenkumar@gmail.com; Pamecha, Viniyendra, E-mail: viniyendra@yahoo.co.uk [Institute of Liver and Biliary Sciences, Department of Hepatopancreatobiliary Surgery (India)

    2013-08-01

    A case of surgically created splenorenal shunt complicated with shunt myelopathy was successfully managed by placement of a stent graft within the splenic vein to close the portosystemic shunt and alleviate myelopathy. To our knowledge, this is the first report of a case of shunt myelopathy in a patient with noncirrhotic portal fibrosis without cirrhosis treated by a novel technique wherein a transjugular intrahepatic route was adopted to deploy the stent graft.

  8. Cervical Cancer

    Centers for Disease Control (CDC) Podcasts

    2007-03-06

    Did you know that cervical cancer rates differ by race/ethnicity and region? Or that cervical cancer can usually be prevented if precancerous cervical lesions are found by a Pap test and treated? Find out how getting regular Pap tests can save a woman's life.  Created: 3/6/2007 by National Breast and Cervical Cancer Early Detection Program.   Date Released: 4/25/2007.

  9. High cervical and lumbar canal stenosis of varied etiology : a case report.

    Directory of Open Access Journals (Sweden)

    Arunkumar M

    2002-01-01

    Full Text Available Developmental stenosis without any significant spondylotic changes frequently occurs at C3 vertebra or below, and typically extends to C6-C7. However, high cervical focal canal stenosis is unusual. A case of cervical canal segmental stenosis at C2-3 level in addition to a developmental stenosis of the lumbar region, in a 45 year old male, has been presented in this article. The dynamics of the spinal canal in relation to the likely pathology of such conditions are reviewed. We speculate that focal segmental stenosis in the high cervical region may be due to a possible premature fusion of the neurocentral synchondrosis of the cartilage, or due to an abnormal rotary biomechanics which can result in facetal hypertrophy.

  10. MRI findings in acute idiopathic transverse myelopathy in children

    International Nuclear Information System (INIS)

    To describe the clinical and MRI findings in three children with acute idiopathic myelopathy (AIM). Retrospective review of the clinical presentation, MRI findings and outcome of three patients diagnosed with acute idiopathic transverse myelitis. Of note was the swift onset of symptoms in all patients, without any preceding illness or history of vaccination in two of the patients, and the rapid resolution of symptoms on steroid therapy in all the patients. MRI showed T2-weighted hyperintensity and patchy enhancement with gadolinium, but the extensive cord involvement did not correlate with the severity of presentation or outcome. Our findings do not support that MRI evidence alone of diffuse myelopathy is a predictor of poor outcome in childhood AIM. (orig.)

  11. MRI findings in acute idiopathic transverse myelopathy in children

    Energy Technology Data Exchange (ETDEWEB)

    Andronikou, Savvas; Albuquerque-Jonathan, Glenda; Hewlett, Richard [Department of Paediatric Radiology, Red Cross Children' s Hospital, University of Cape Town and School of Child and Adolescent Health, Klipfontein Road, Cape Town (South Africa); Wilmshurst, Jo [Department of Paediatric Neurology, Red Cross Children' s Hospital, University of Cape Town and School of Child and Adolescent Health, Cape Town (South Africa)

    2003-09-01

    To describe the clinical and MRI findings in three children with acute idiopathic myelopathy (AIM). Retrospective review of the clinical presentation, MRI findings and outcome of three patients diagnosed with acute idiopathic transverse myelitis. Of note was the swift onset of symptoms in all patients, without any preceding illness or history of vaccination in two of the patients, and the rapid resolution of symptoms on steroid therapy in all the patients. MRI showed T2-weighted hyperintensity and patchy enhancement with gadolinium, but the extensive cord involvement did not correlate with the severity of presentation or outcome. Our findings do not support that MRI evidence alone of diffuse myelopathy is a predictor of poor outcome in childhood AIM. (orig.)

  12. Effects of single-level dynamic cervical implantation on the cervical alignment and range of motion%单节段颈椎动态稳定器植入术对颈椎曲度和活动度的影响

    Institute of Scientific and Technical Information of China (English)

    李忠海; 侯树勋; 吴闻文; 虞舜志; 侯铁胜

    2013-01-01

    Objective To observe the changes of the cervical alignment and range of motion ( ROM ) after single-level dynamic cervical implant ( DCI ) implantation for patients with cervical spondylosis, and to evaluate its safety and efifciency. Methods From August 2009 to January 2012, 17 patients with cervical spondylosis were received and treated according to the indications of DCI implantation, including 4 cases of cervical spondylotic myelopathy and 13 cases of cervical spondylotic radiculopathy. There were 7 males and 10 females, with a mean age of 43.4 years old ( range;36-53 years ). The affected segments included C3~4 in 1 case, C4~5 in 6 cases, C5~6 in 6 cases and C6~7 in 4 cases. Anterior cervical discectomy and DCI implantation after spinal canal decompression were performed on 17 patients. The ROM of DCI implantation segments and adjacent segments preoperatively and in the latest follow-up was measured, as well as the Cobb’s angle of DCI implantation segments at functional spinal unit ( FSU ) and the overall cervical alignment Cobb’s angle from C2~7. The adjacent segment degeneration was evaluated according to Miyazaki classiifcation of cervical disc degeneration. Results All patients were followed up for a mean period of 19.4 months ( range;12-41 months ). The ROM of DCI implantation segments was ( 7.8±2.2 ) ° preoperatively and ( 8.4±2.5 ) ° in the latest follow-up respectively, without statistically signiifcant difference ( P>0.05 ). The ROM at adjacent segment level was ( 8.3±1.9 ) ° and ( 8.7±2.1 ) ° preoperatively and ( 8.5±2.1 ) ° and ( 8.8±2.4 ) ° in the latest follow-up respectively, without statistically signiifcant difference ( P>0.05 ). The Cobb’s angle of DCI implantation segments at FSU was ( 0.4±5.1 ) ° preoperatively and ( 3.7±5.5 ) ° in the latest follow-up respectively, with statistically signiifcant differences ( P0.05 ). All patients gained MRI follow-up. Disc degeneration up to 1 grade occurred to 3 of 34 ( 9%) adjacent

  13. 慢性颈脊髓压迫的磁共振质谱成像%Magnetic resonance spectroscopy study of the chronic compression of cervical spinal cord.

    Institute of Scientific and Technical Information of China (English)

    张琥; 杜炎鑫; 林定坤; 陈博来; 田铁桥; 陈树良; 陈加良; 蔡懿

    2011-01-01

    Objective To evaluate the clinical application of magnetic resonance spectroscopy ( MRS ) in chronic compression of cervical spinal cord, and to study the risk factors of symptomatic rnyelopathy. Methods Tirty - four patients with MRI -proved compressed cervical spinal cord, were divided into two groups according to JOA scores: symptomatic group ( Group Ⅰ , n = 15 ) and presymptomatic group ( Group Ⅱ, n = 19 ). Fifteen aged - matched healthy volunteers were enrolled in control group ( Group Ⅲ ). Preoperative neurological examination, functional assessment, and cervicai spine MR spectroscopy were carried out in patients preoperatively. Voxels were placed at the adjacent level to the maxis compressive level. The main metabolite concentration ratios, including N -acetylaspartate/creatine ( NAA/Cr ),choline/creatine ( Cho/Cr ), myoinositol/creatine ( mI/Cr ), lactate/creatine( Lac/Ct ) and glutamate/creatine ( Glx/Cr), were obtained. Results Total 49 cases succeeded to have MR spectroscopy. Epidural compression, spinal cord compression and abnormal signal were observed in 4, 30 and 17 cases, respectively. When comparing with those in Group Ⅲ, significant reduction of NAA/Cr and Glx/Cr were revealed in Group Ⅰ ( P <0. 01 ); so was significant reduction of Glx/Cr in Group Ⅱ ( P <0. 05 ). Glx/Cr was proved as a protective factor for cervical spondylotic myelopathy ( Wald x2=3. 951, P <0. 05, OR =0. 23 ), while altered MRI signal was a risk factor ( Wald x2 = 13. 561, P < 0. 001, OR =35. 991 ). Conclusion MRS provides useful semi - quantitative estimates of the cellular biochemistry of the spinal cord in patients with chronic compression. Reduced ratios of NAA/Cr and Glx/Cr in patients with CSM indicates the axonal and neuronal loss in cervical spinal cord. Seventy percent of the patients with spondylotic cervical cord compression had significant Lac peaks, which further supports the role of ischemia in the pathophysiology of chronic compression. The

  14. Total cervical disk replacement with a prestige LP® prosthesis: clinical and functional outcomes

    Directory of Open Access Journals (Sweden)

    Rafael Osório Rocha

    2014-01-01

    Full Text Available Objective: To determine the clinical and functional results of short- and medium-term cervical arthroplasty with the Prestige LP® prosthesis for the treatment of compressive myelopathy, radiculopathy and axial pain with radiculopathty. Methods: This retrospective study, conducted from 2009 to 2012, included 18 patients. Only 16 were found for the second stage of research, conducted in 2011 and 2012. Pre- and postoperative assessments were carried out using the CSOQ (Cervical Spine Outcomes Questionnaire. Odom criteria were used only in the postoperative evaluation. Both were translated and adapted to the local culture. Results: There was no postoperative radiculopathy or other complications requiring prolonged hospitalization. In most patients, there was a significant improvement in axial pain and radiculopathy, and there was only one indication of conversion to fusion. Conclusions: In selected cases of cervical degenerative disc disease, herniated cervical disc and compressive myeolopathy, cervical arthroplasty proved to be an effective and safe treatment in the short and medium terms.

  15. Cervical radiculopathy.

    Science.gov (United States)

    Iyer, Sravisht; Kim, Han Jo

    2016-09-01

    Cervical radiculopathy is a common clinical scenario. Patients with radiculopathy typically present with neck pain, arm pain, or both. We review the epidemiology of cervical radiculopathy and discuss the diagnosis of this condition. This includes an overview of the pertinent findings on the patient history and physical examination. We also discuss relevant clinical syndromes that must be considered in the differential diagnosis including peripheral nerve entrapment syndromes and shoulder pathology. The natural history of cervical radiculopathy is reviewed and options for management are discussed. These options include conservative management, non-operative modalities such as physical therapy, steroid injections, and operative intervention. While the exact indications for surgical intervention have not yet been elucidated, we provide an overview of the available literature regarding indications and discuss the timing of intervention. The surgical outcomes of anterior cervical decompression and fusion (ACDF), cervical disc arthroplasty (CDA), and posterior cervical foraminotomy (PCF) are discussed. PMID:27250042

  16. 颈椎椎板成形术后脊髓后移的相关因素分析%Analysis of related factors of posterior shifting of the spinal cord after cervical laminoplasty

    Institute of Scientific and Technical Information of China (English)

    刁垠泽; 孙宇; 王少波; 张凤山; 潘胜发; 刘晓光; 刘忠军

    2013-01-01

    spondylotic myelopathy with developmental cervical stenosis and 13 cases of ossification of the posterior longitudinal ligament.Twenty one cases underwent modified open-door laminoplasty using anchor method,and the other 22 cases underwent laminoplasty with preservation of the unilateral muscular ligament complex.According to midsagittal T2-weighted MRI in the neutral position,several parameters indicating shift distance of the spinal cord and dural sac were measured at each level before operation and at 3 months after operation:shift of anterior margin of the spinal cord (SAMSC),shift of posterior margin of the spinal cord (SPMSC),shift of anterior margin of the dural sac (SAMDS) and shift of posterior margin of the dural sac (SPMDS).The line connecting the top of dens and posterior inferior angle of T1 was defined as E line and the length was E.The length of perpendicular line from each base point to E line was Px (x =1-6).The parameter (100×Px/E) was used to represent local curvature at each level,and the curvature index (CI)was used to represent the global curvature of the cervical spine.Then correlation analyses of the parameters above were performed.Results There was no significant change in SAMDS at different level after surgery,however SAMSC,SPMSC and SPMDS changed significantly and synchronously.At the level of C5 and C6,SPMSC was maximum,but not correlated to CI.Actually,SPMSC was correlated to the local curvature and highly correlated to SPMDS at the same level.Conclusion After cervical laminoplasty,posterior shifting of the spinal cord was highly correlated to posterior shifting of the dural sac at the same level,weakly correlated to local curvature and not correlated to the global curvature of the cervical spine.

  17. Intracranial dural arterio-venous fistula presenting with progressive myelopathy.

    LENUS (Irish Health Repository)

    Ogbonnaya, Ebere Sunny

    2011-01-01

    Spinal dural arterio-venous fistula (DAVF) is rare and usually involves the thoracic segments. The classical presentation is a slowly progressive ataxia. Clinical presentation of intracranial DAVF depends on the site of the DAVF, as well as the vessels involved. Patients may present with pulsatile tinnitus, occipital bruit, headache, dementia, visual impairment as well as neurological deterioration distant from the DAVF as a result of venous hypertension and cortical haemorrhage. The authors present a rare case of progressive myelopathy secondary to an intracranial DAVF.

  18. 经口咽入路行环枢融合术对脊髓功能恢复的疗效观察%The curative effect of atlantoaxial fusion using transoral qpproach for the recovery of myelopathy

    Institute of Scientific and Technical Information of China (English)

    谢林; 金明熙; 金哲; 吕刚

    2002-01-01

    Objective To present the operative results of 17 patients with atlantoaxial diseases using transoral approach.Methods 17 patients received operation of atlantoaxial fusion using transoral approach.The average age is 27 years old(12~ 47 years).Results All patients had achieved primary healing without any complications.The fusion rate was 100% .The average recovery rate (JOA score system) of myelopathy was 48% .Conclusions Transoral approach was an ideal approach for upper cervical diseases.The infection rate could be lowered down to the minimum if the patients were properly managed perioperatively.Atlantoaxial fusion could be achieved through this approach without instrumentation.

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

    Energy Technology Data Exchange (ETDEWEB)

    Soo, M.; Tran-Dinh, H.D.; Quach, T.; Downey, J.; Pohlmann, S. [Westmead Hospital, Westmead, NSW (Australia). Department of Radiology; Dorsch, N.W.C. [Westmead Hospital, Westmead, NSW (Australia). Department of Neurosurgery

    1997-11-01

    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 spondylitic 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. (authors). 22 refs., 3 tabs., 3 figs.

  20. Clinical significance of perioperative methylprednisolone on anterior cervical decompression operation%甲泼尼龙在颈椎前路减压术中的应用

    Institute of Scientific and Technical Information of China (English)

    刘建东; 卢承志; 林斌; 周亮; 张文龙; 姚猛飞

    2013-01-01

    Objective To investigate the effects of methylprednisolone (MP) on patients with cervical spondylotic myelopathy (CSM) underwent anterior decompression.Methods Fifty patients scheduled for elective anterior decompression were randomly divided into two groups of 25 each:control group (C) and methylprednisolone group (MP).Group MP received methylprednisolone 30 mg/kg and group C received same volume of normal saline instead of methylprednisolone as control Blood samples were taken from vein for determination of plasma TNF-α,IL-6 and SOD concentrations before induction of anesthesia (T1),1 h after (T2),6 h after (T3) and 24 h (T4) after termination of operation.All of these was estimated by enzyme-linked immunosorbent assay (ELISA).Results There was no significant difference between two groups in plasma TNF-α,IL-6 and SOD level at T1.The level of TNF-α,IL-6 at T2-T4 and SOD at T2-T3 was significantly increased compared with that before operation in both groups.However,the plasma concentrations of TNF-α and IL-6 were significantly lower at T2-T4 while the concentration of SOD was significantly higher at T2-T3 in group MP than those in group C.Conclusion Methylprednisolone can reduce the increased amplitude of plasma levels of TNF-α and IL-6,whereas enhance the increased amplitude of the plasma SOD levels in anterior cervical decompression operation.In other words,Methylprednisolone posseses the effect to decrease ischemical reperfusion injury and down-regulate inflammatory response during operation.%目的 探讨甲泼尼龙(MP)在脊髓型颈椎病(CSM)前路减压术中的应用价值.方法 选择行颈椎前路减压术的CSM 50例,随机分为甲泼尼龙组(MP组)和对照组(C组),每组25例.MP组给予MP 30 mg/kg,C组予与等容量生理盐水.分别于麻醉诱导前(T1),术后1 h(T2),术后6 h(T3),术后24 h(T4)抽取静脉血,用酶联免疫吸附法(ELISA)测定血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及超氧化

  1. MR findings of subacute necrotizing myelopathy: case report

    Energy Technology Data Exchange (ETDEWEB)

    Na, Dong Gyu; Chang, Kee Hyun; Han, Moon Hee; Kim, Hyun Jip; Kim, Chong Jai; Chi, Je G. [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1994-04-15

    Subacute necrotizing myelopathy(SNM) is a rare non-tumorous disease of spinal cord characterized by subacute clinical course of progressive neurological deterioration. We report MR findings of a patient with pathologically proved SNM. 1 case of pathologically proved subacute necrotizing myelopathy. The patients was a 56-year-old man with progressive motor weakness and sensory loss of the lower extremities, and urinary and fecal incontinence for 11 months. Spine MRI revealed diffuse enlargement of the thoracic spinal cord from T2 to T7 level. Signal intensity of the expanded spinal cord was isointense relative to normal cord on T1-weighted image and hyperintense on proton-density and T2-weighted images. On contrast enhanced T1-weighted image, there was diffuse homogeneous enhancement in the expanded cord lesion. MR demonstration of stable persistence of spinal cord lesion or atrophy over months or years with clinical findings of gradual progressive neurologic deterioration may be helpful in the diagnosis of SNM.

  2. [A case of HTLV-1 associated myelopathy with pulmonary involvement].

    Science.gov (United States)

    Araki, J; Kaku, M; Mashimoto, H; Fukuda, Y; Asai, S

    1989-11-01

    A 70-year-old woman was admitted complaining of gait disturbance and difficulty in urination. Neurological examination showed myelopathy and both serum and CSF anti ATLA antibodies were positive. A diagnosis of HTLV-associated myelopathy (HAM) was made and steroid therapy was initiated. Chest X-ray film on admission showed no abnormality, but three months later, diffuse fine nodular and reticular shadows appeared in both lung fields. The patients had no respiratory symptom. The results of pulmonary function tests were normal, aside from a mild obstructive defect as indicated by reduced V25. Arterial blood gas was also normal. Bronchoalveolar lavage studies showed increased total cell counts and an increased proportion of T-cells. The histological findings of the transbronchial lung biopsy specimen were bronchiolitis and alveolitis. Subsequently, within the next eight months the abnormal shadows on chest X-ray cleared gradually on maintenance dosage of prednisolone, 10 mg/day. Possible relationships between HAM and the pulmonary lesions were discussed. PMID:2625816

  3. Myelopathy due to intrathecal chemotherapy: report of six cases.

    Science.gov (United States)

    Bay, Ali; Oner, Ahmet Faik; Etlik, Omer; Yilmaz, Cahide; Caksen, Huseyin

    2005-05-01

    Intrathecal chemotherapy and systemic chemotherapy are used for both prophylaxis and treatment of central nervous system disease in hematologic malignancies. However, intrathecal treatment has some adverse effects, such as arachnoiditis, progressive myelopathy, and leukoencephalopathy. The authors describe six children in whom myelopathy and adhesive arachnoiditis developed after administration of intrathecal chemotherapy including methotrexate, cytosine arabinoside, and prednisolone. Urinary retention and incontinence, the main presenting complaints in all patients, developed within 12 hours after intrathecal therapy and spontaneously resolved within 7 days. Two patients were unable to walk. In these two, weakness in the lower extremities gradually recovered by 1 month but urinary incontinence did not improve. None of the children had sensory loss. On follow-up periodic recurrent urinary tract infection was noted in four patients. MRI findings corresponded to arachnoiditis. No response was recorded on tibial nerve somatosensory evoked potentials in all patients. Intrathecal chemotherapy, especially methotrexate, can cause spinal cord dysfunction in children with acute lymphoblastic leukemia and non-Hodgkin's lymphoma. Arachnoiditis should be kept in mind as a causative factor in recurrent urinary tract infection in patients receiving intrathecal chemotherapy.

  4. Gabapentin for analgesia after operation of cervical spine anterior cervical observation%加巴喷丁用于颈椎前路颈椎手术后镇痛的疗效观察

    Institute of Scientific and Technical Information of China (English)

    蔡兵; 文传兵; 牟玲

    2012-01-01

    目的 探讨加巴喷丁用于经前路颈椎手术的超前镇痛作用.方法 选择ASAⅠ~Ⅱ级40例择期经前路颈椎手术患者,随机分成两组,G组(n =20)于手术开始前2h口服加巴喷丁胶囊300mg,C组(n=20)于手术开始前2h口服维生素E胶囊.所有患者在手术结束后1h、4h、8h、12h及24h时进行疼痛视觉模拟评分(VAS)情况;采用Ramsay镇静评分评价患者的镇静情况;观察可能出现的恶心、呕吐、嗜睡、眩晕、呼吸抑制等不良反应.结果 G组术后1h、4h及8hVAS评分均低于C组(P<0.05);与C组比较,G组术后恶心、呕吐发生率更低(P<0.05);嗜睡、眩晕及呼吸抑制的发生率在两组相似.结论 加巴喷丁超前镇痛可以增强经前路颈椎手术后的镇痛效果,能降低术后恶心呕吐发生率的作用.%Objective To evaluate the efficacy of preemptive analgesia with gabapentin for oral use in anterior approaches for cervical spondylotic myelopathy. Methods 40 patients ASA Ⅰ ~ Ⅱ grade aged 21 ~ 70 undergoing laparoscopic cholecystec-tomy were randomly divided into two groups(n =20) : Group 1 ,the gabapentin group (G) and group 2, the C group. The G group were given a bolus of 300mg gabapentin for oral use 2 hours before operation while the C group were given a bolus of vita-mine E for oral use 2 hours before before operation. The pain scores VAS (visual analog scale) , Ramsay sedation score, nausea, vomiting, drowsiness, giddiness, Respiratory depression and other adverse reactions were recorded inl , 4,8,12, and 24 hour postoperation respectively. Results In group G , the VAS score were lower than group C at the 1 hour postoperation,4 hour posto-peration and 8 hour postoperation ( P < 0. 05 ) . The complaint of nausea, vomiting in group G were lower than group C (P < 0. 05). There were no differences in complaint of drowsiness, giddiness, Respiratory depression between the two groups. Conclusion Preemptive analgesia with gabapentin via

  5. Evaluation of arthrodesis and cervical alignment in the surgical results of cervical discectomy using polymethylmetacrylate Avaliação da artrodese e do alinhamento cervical após discectomia cervical com interposição de polimetilmetacrilato

    Directory of Open Access Journals (Sweden)

    Marcelo Luis Mudo

    2009-09-01

    Full Text Available BACKGROUND AND OBJECTIVES: Surgical treatment of cervical radiculopathy with or without myelopathy is a controversy issue, although anterior discectomy is the most common form of treatment. METHOD: We present the evaluation of the arthrodesis' rate and cervical alignment in 48 patients with cervical degenerative disease (CDD submitted to anterior cervical discectomy with interposition of polymethylmetacrylate (PMMA. Odom and Nürick scales were used to evaluation of functional status before and after surgery. Cervical spine X-rays were used to access arthrodesis and alignment, at least 2 years after the procedure. RESULTS: Excellent and good results (Odom I and II were obtained in 91% of the patients with radiculopathy and in 69% of those with myelopathy. Using the chi square test of independence (1% of significance, there was no association between excellent and good clinical results with the presence of arthrodesis verified in cervical X-rays. The presence of cervical alignment had association with good results, whereas the misalignment was associated with unfavorable outcomes. Two patients died: one cervical hematoma and other from graft migration with cord compression. CONCLUSIONS: Cervical alignment was more important than fusion to achieve good surgical results in CDD.TEMA E OBJETIVO: O tratamento cirúrgico da radiculopatia cervical com ou sem mielopatia é um tema controverso, embora a discectomia por via anterior seja uma das formas mais comuns de tratamento. MÉTODO: Apresentamos a avaliação da artrodese cervical e do alinhamento pós operatório em 48 pacientes com doença degenerativa cervical (DDC submetidos a discectomia por via anterior seguida da interposição de polimetilmetacrilato (PMMA. As escalas de Odom e de Nurick foram utilizadas para avaliar o status funcional dos pacientes antes e após a cirurgia. Radiografias da coluna cervical foram utilizadas para avaliar a artrodese e o alinhamento cervical, pelo menos 2 anos ap

  6. Cervical Stenosis

    Science.gov (United States)

    ... Accumulation of pus in the uterus is called pyometra. Symptoms Before menopause, cervical stenosis may cause menstrual ... present but not cause symptoms. A hematometra or pyometra can cause pain or cause the uterus to ...

  7. Cervical spondylosis

    Science.gov (United States)

    ... Past neck injury (often several years before) Past spine surgery Ruptured or slipped disk Severe arthritis Small fractures ... Kshettry VR. Cervical spondylosis. In: Benzel EC, ed. Spine Surgery . 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap ...

  8. Cervical Cancer

    Science.gov (United States)

    ... Cervical cancer is caused by a virus called HPV. The virus spreads through sexual contact. Most women's bodies are able to fight HPV infection. But sometimes the virus leads to cancer. You're at higher risk ...

  9. Cervical Cancer

    Science.gov (United States)

    ... 162 KB) This information in Spanish (en español) Female reproductive system Select image to view larger Related ... D., FACS, Captain, U.S. Public Health Service Medical Director, National Breast and Cervical Cancer Early Detection Program, ...

  10. Challenges of cervical reconstruction for destructive spondyloarthropathy in renal osteodystrophy.

    Science.gov (United States)

    Elder, Benjamin D; Petteys, Rory J; Sciubba, Daniel M; Wolinsky, Jean-Paul

    2016-08-01

    Patients with end stage renal disease on hemodialysis may present with destructive spondyloarthropathy of the spine, most commonly in the subaxial cervical and lumbar spine, often with severe stenosis and instability. However, surgical management of these patients is challenging due to a high pseudarthrosis rate, poor bone quality, and medical frailty. We present a 49-year-old man on hemodialysis who presented with C4-C5 vertebral body destruction and a focal kyphotic deformity with myelopathy. The patient underwent a 360 degree decompression and reconstructive procedure that resulted in posterior instrumentation failure. Several salvage techniques were used in order to adequately stabilize the spine while preserving the patient's remaining cervical motion. PMID:27052255

  11. Myelopathy in systemic lupus erythematosus: a case report and a review of the literature.

    Science.gov (United States)

    Hamming, L; van der Meulen, R; Vergouwen, A; Siegert, C

    2015-07-01

    Myelopathy, a severe condition characterised by paraparesis, sensory deficits and sphincter dysfunction, is one of the neuropsychiatric manifestations that have been described in patients with systemic lupus erythematosus (SLE). SLE-associated myelopathy may confront clinicians with a challenging decision-making process due to the broad differential diagnosis, the lack of disease-specific findings, and the urgency to initiate immunosuppressive therapy early in the course of the disease to favourably affect outcome. PMID:26228194

  12. Only fixation for cervical spondylosis: Report of early results with a preliminary experience with 6 cases

    Directory of Open Access Journals (Sweden)

    Atul Goel

    2013-01-01

    Full Text Available Aim: The author reports early post-operative outcome and preliminary experience with an alternative form of treatment of cervical degenerative or spondylotic disease leading to spinal canal stenosis that involves fixation-arthrodesis of the affected spinal segment using one or two (double insurance transarticular screws for each joint. Materials and Methods: During the period of months from March 2013 to July 2013, six patients having cervical spondylotic cord compression were treated with transarticular method of screw fixation of the involved segments. The operation involved section of the spinous process at its base, opening up of the facet joint, denuding of articular cartilage, placement of intraarticular cavity bone graft chips and insertion of either a single or two transarticular screws at each level. The fixation was done in four levels in four patients and at two levels in two patients. Japanese Orthopedic Association score, visual analog scale (neck pain and Odom′s criteria were used to monitor the clinical status of the patients before and after the surgery and at follow-up. Results: Immediate post-operative and a relatively short-term post-operative outcome was remarkably gratifying. During the average period of follow-up of 6 months (range: 3-8 months; there was varying degree of recovery of symptoms. The procedure resulted in firm stabilization and fixation of the spinal segment and provided a ground for arthrodesis. No patient worsened after treatment. During the period of follow-up, all patients showed remarkable and progressive recovery in symptoms. Conclusions: Vertical instability and telescoping, listhesis or overriding of the facets on physical activity seems to be the defining phenomenon in pathogenesis of cervical spondylotic disease. The clinical outcome in our patients suggest that only fixation of the spinal segment can be a rationale form of treatment. Transarticular method of treatment is a simple, safe and

  13. A review of fibrocartilaginous embolic myelopathy and different types of peracute non compressive intervertebral disc extrusions in dogs and cats

    Directory of Open Access Journals (Sweden)

    Luisa eDe Risio

    2015-08-01

    Full Text Available This review discusses terminology, pathologic, clinical and magnetic resonance imaging findings, treatment, outcome and prognostic factors of fibrocartilaginous embolic myelopathy (FCEM, acute non-compressive nucleus pulposus extrusion (ANNPE and intradural/ intramedullary intervertebral disc extrusion (IIVDE. FCEM, ANNPE, and IIVDE have a similar clinical presentation characterised by peracute onset of neurologic dysfunction that is generally non progressive after the initial 24-48 hours. Differentiating between these conditions can be challenging, however certain clinical and imaging findings can help. FCEM can occur in both adult and immature animals, whereas ANNPE or IIVDE have been reported only in animals older than 1 year. In dogs, ANNPE and IIVDE most commonly occur in the intervertebral disc spaces between T12 and L2, whereas FCEM has not such site predilection. In cats, FCEM occurs more frequently in the cervical spinal cord than in other locations. Data on cats with ANNPE and IIVDE is limited. Optimal magnetic resonance imaging (MRI definition and experience in neuroimaging can help identify the findings that allow differentiation between FCEM, ANNPE, and IIVDE. In animals with ANNPE and IIVDE the affected intervertebral disc space is often narrowed and the focal area of intramedullary hyperintensity on T2-weighted images is located above the affected intervertebral disc

  14. Diagnosis and treatment of vertebral artery injury in cervical spine surgery%颈椎手术中并发椎动脉损伤的诊断与治疗

    Institute of Scientific and Technical Information of China (English)

    王少波; 孙宇; 刁垠泽; 李迈; 张凤山

    2012-01-01

    目的 探讨颈椎手术中并发椎动脉损伤的发生原因、治疗及预防.方法 回顾性分析2002年10月至2012年4月颈椎手术中并发椎动脉损伤的7例患者资料,男6例,女1例;年龄23~65岁,平均48.9岁;脊髓型颈椎病5例,颈椎外伤合并C4.5半脱位1例,氟骨症致颈椎管狭窄1例.椎动脉损伤均为单侧,左侧4例,右侧3例.分析颈椎手术中并发椎动脉损伤的原因、处理过程及预后.结果 颈椎前路手术4例,其中2例用环钻减压时偏离中线损伤椎动脉,1例切除稚间盘时刮匙过于偏外损伤椎动脉,1例颈椎外伤患者由于C4,5半脱位造成椎动脉迂曲,减压时冲击式咬骨钳损伤椎动脉.颈椎后路手术3例,其中2例为行C4侧块螺钉固定时钻头偏外损伤椎动脉;1例氟骨症致颈椎管狭窄者在切除寰椎后弓时咬骨钳损伤椎动脉,术中出现椎动脉损伤后,迅速填塞压迫止血并关闭伤口,但术后4周发生迟发性出血,采用椎动脉栓塞止血及颈后路血肿清除术治疗.7例患者均未发生脑梗塞,其中2例患者术后出现-过性头晕.结论 椎动脉损伤是颈椎手术的严重并发症,其损伤原因与手术失误、解剖变异等有关;采用直接压迫及椎动脉栓塞治疗效果确切.%Objective To investigate cause,diagnosis,treatment and prevention of vertebral artery injury in cervical spine surgery.Methods Data of 7 patients with vertebral artery injury caused by cervical spine surgery from October 2002 to April 2012 were retrospectively analyzed.There were 6 males and 1 female,aged from 23 to 65 years (average,48.9 years).The reasons of cervical spine surgery were as follows:cervical spondylotic myelopathy (5 cases),traumatic subluxation of C4 and C5 (1 case),and cervical spinal stenosis due to skeletal fluorosis (1 case).All cases had unilateral vertebral artery injury,including 4 cases in the left side and 3 cases in the right side.The cause,treatment and prognosis of

  15. A Prospective Study of the Functional Outcome of Anterior Cervical Discectomy With Fusion in Single Level Degenerative Cervical Disc Prolapse

    Science.gov (United States)

    Kamani, Mayur M; Shetty, Vikram; Rai, H. Ravindranath; Hegde, Deepak

    2016-01-01

    Introduction Cervical spondylotic myelo-radiculopathy is a form of spinal cord dysfunction syndrome and usually accompanies age related degeneration of the spine. Aim To determine the functional outcome of anterior cervical discectomy with fusion and plating in single level degenerative cervical disc prolapse. Materials and Methods A total of 20 patients diagnosed with degenerative single level cervical disc prolapse who presented to the Department of Orthopaedic Surgery, Justice KS Hegde Charitable Hospital, Mangalore from the period of November 2012 to May 2014 were enrolled in the study. Complete clinical and radiological evaluation of the patients was done. A trial of conservative management was tried in all these patients for a period of two months. They were taken up for surgery only when conservative management had failed. Scoring of neck function before the surgery was done as per the Modified Japanese Orthopaedic Association (MJOA) score. All patients underwent anterior cervical discectomy and fusion (ACDF) with tricortical iliac crest bone grafting. Fixation was performed with titanium locking cervical plates. All patients were reviewed at 6 weeks and 6 months postoperatively. Assessment of neck function was done as per the MJOA scoring during all the reviews. Radiographic assessment was also done during all the reviews. The complications noted were documented. The statistical analysis was done using percentages; the arithmetic mean was calculated using SPSS software (version 16.0). Results Amongst the 20 patients included in the study, 1 patient died postoperatively due to oesophageal rupture. of the remaining 19 patients reviewed and followed up, all of them had improvement of symptoms and were reported to be in the ‘mild category’ as per the MJOA score. One patient developed dysphonia, in the immediate postoperative period due to recurrent laryngeal nerve palsy which recovered in a period of three months postoperative. Conclusion Single level

  16. Tantalum trabecular metal implants in anterior cervical corpectomy and fusion: 2-year prospective analysis.

    Science.gov (United States)

    King, V; Swart, A; Winder, M J

    2016-10-01

    Anterior cervical decompression for two or more cervical spondylotic levels can be performed using either multiple anterior cervical discectomies and fusion or anterior cervical corpectomy and fusion (ACCF). A variety of options for ACCF implants exist but to our knowledge, there is no clinical data for the use of tantalum trabecular metal implants (TTMI) for ACCF. A retrospective review was performed of prospectively collected data for ten patients undergoing ACCF with TTMI between 2011 and 2012. Radiological outcome was assessed by measuring the change in cervical (C) lordosis (fusion Cobb and C2-C7 Cobb), graft subsidence (anterior/posterior, determined by the subsidence of anterior/posterior body height of fused segments; cranial/caudal, determined by the cranial/caudal plate-to-disc distances) and rate of fusion using lateral cervical X-rays of patients at 0, 6, 12 and 24months post-operatively. The Neck Disability Index (NDI) assessed clinical outcome pre-operatively and at 6, 12 and 24months post-operatively. Cervical lordosis (Cobb angle of fused segment) was 5.2° (± 4.2°) at 0months and 6.0° (± 5.7°) at 24months post-operatively. Graft subsidence was observed to occur at 6months post-operatively and continued throughout follow-up. Anterior, posterior and caudal subsidence occurred more in the first 12months post-operatively than in the following 12months (p<0.05). Average pre-operative NDI was 45%. Average NDIs were 18%, 13% and 10% at 6, 12 and 24months post-operatively, respectively. ACCF patients treated with TTMI demonstrated stable cervical lordosis over 2years of follow-up and 100% fusion rates after 2years. Measures of subsidence appeared to decrease with time. Patients experienced improved clinical outcomes over the 2-year period. PMID:27515543

  17. Design of Lamifuse: a randomised, multi-centre controlled trial comparing laminectomy without or with dorsal fusion for cervical myeloradiculopathy

    Directory of Open Access Journals (Sweden)

    Grotenhuis J André

    2007-11-01

    Full Text Available Abstract Background laminectomy is a valuable surgical treatment for some patients with a cervical radiculomyelopathy due to cervical spinal stenosis. More recently attention has been given to motion of the spinal cord over spondylotic spurs as a cause of myelopathic changes. Immobilisation by fusion could have a positive effect on the recovery of myelopathic signs or changes. This has never been investigated in a prospective, randomised trial. Lamifuse is an acronyme for laminectomy and fusion. Methods/Design Lamifuse is a multicentre, randomised controlled trial comparing laminectomy with and without fusion in patients with a symptomatic cervical canal stenosis. The study population will be enrolled from patients that are 60 years or older with myelopathic signs and/or symptoms due to a cervical canal stenosis. A kyphotis shape of the cervical spine is an exclusion criterium. Each treatment arm needs 30 patients. Discussion This study will contribute to the discussion whether additional fusion after a cervical laminectomy results in a better clinical outcome. ISRCT number ISRCTN72800446

  18. Symptomatic ossification of the posterior longitudinal ligament of the cervical spine: pictorial essay

    International Nuclear Information System (INIS)

    Symptomatic ossification of the posterior longitudinal ligament (OPLL) of the cervical spine is a rare but well documented condition. It is the causative factor in up to 5% of cases presenting with cervical radiculopathy or myelopathy. Computed tomography is the modality of choice in showing the distinctive characteristics and extent of the disease. Magnetic resonance imaging (MRI) is sensitive in detecting cord compression and its attendant complications. Cervical OPLL commonly affects those of middle and advanced age, and the condition is noted to be particularly common in Japanese, although other racial groups are also affected. A 'mushroom' or 'hill' shape on axial CT typifies OPLL. A sharp radiolucent line separating the posterior vertebral margin from the superficial component of the ossified ligament is a characteristic feature. Copyright (1999) Blackwell Science Pty Ltd

  19. Radiation myelopathy in over-irradiated patients: MR imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Alfonso, E.R. [Radiology Service, Hospital Clinico Universitario, Zaragoza (Spain); Gregorio, M.A. de [Radiology Service, Hospital Clinico Universitario, Zaragoza (Spain); Mateo, P. [Radiation Oncology Service, Hospital Clinico Universitario, Zaragoza (Spain); Esco, R. [Radiation Oncology Service, Hospital Clinico Universitario, Zaragoza (Spain); Bascon, N. [Radiation Oncology Service, Hospital Clinico Universitario, Zaragoza (Spain); Morales, F. [Neurology Service, Hospital Clinico Universitario, Zaragoza (Spain); Bellosta, R. [Radiation Oncology Service, Hospital Clinico Universitario, Zaragoza (Spain); Lopez, P. [Radiation Oncology Service, Hospital Clinico Universitario, Zaragoza (Spain); Gimeno, M. [Hospital Miguel Servet, Zaragoza (Spain); Roca, M. [Radiology Service, Hospital Miguel Servet, E-50 009 Zaragoza (Spain); Villavieja, J.L. [Radiology Service, Hospital Clinico Universitario, Zaragoza (Spain)

    1997-04-01

    The objective of this work is to report the MRI findings in patients with radiation myelopathy due to accidental local over-irradiation syndrome. Eight patients (seven males and one female) were suffering from over-irradiation syndrome as a result of treatments from a malfunctioning linear electron accelerator. The mean accidental estimated dose was 136 Gy delivered to the ``open-neck`` (seven cases) and to the thoracic wall (one case), during a mean of 5.4 sessions (range 1-9 sessions). Paresthesia and weakness in the upper extremities were the earliest symptoms (87.5 %), with evolution to paralysis in all patients. No patient is alive (mean survival time 64 days). In all cases MRI was negative for neurologic lesions in the acute phase (< 90 days from irradiation; Radiation Therapy Oncology Group scoring system). Late signs of radiation myelitis manifested as high-intensity signals on T2-weighted images in three patients, and as Gd-DTPA enhancement of T1-weighted images in one case. Autopsies performed on four patients who died in acute phase showed morphologic alterations in white matter: edema in 75 %, and necrosis and glial reaction as well as obliterative vasculitis in all cases. In cases of over-irradiation, MRI may be normal in acute phase even if the patients have severe neurologic deficit, as positive MRI findings appear only in delayed radiation myelitis. (orig.). With 3 figs., 2 tabs.

  20. Surgical treatment for ossification of the posterior longitudinal ligament in the cervical spine.

    Science.gov (United States)

    An, Howard S; Al-Shihabi, Laith; Kurd, Mark

    2014-07-01

    Although classically associated with patients of East Asian origin, ossification of the posterior longitudinal ligament (OPLL) may cause myelopathy in patients of any ethnic origin. Degeneration of the PLL is followed by endochondral ossification, resulting in spinal cord compression. Specific genetic polymorphisms and medical comorbidities have been implicated in the development of OPLL. Patients should be evaluated with a full history and neurologic examination, along with cervical radiographs. Advanced imaging with CT and MRI allows three-dimensional evaluation of OPLL. Minimally symptomatic patients can be treated nonsurgically, but patients with myelopathy or severe stenosis are best treated with surgical decompression. OPLL can be treated via an anterior (ie, corpectomy and fusion) or posterior (ie, laminectomy and fusion or laminoplasty) approach, or both. The optimal approach is dictated by the classification and extent of OPLL, cervical spine sagittal alignment, severity of stenosis, and history of previous surgery. Anterior surgery is associated with superior outcomes when OPLL occupies >50% to 60% of the canal, despite increased technical difficulty and higher complication rates. Posterior surgery is technically easier and allows decompression of the entire cervical spine, but patients may experience late deterioration because of disease progression. PMID:24966248

  1. A comparison of myelopathy associated with megavoltage irradiation and remote cancer

    Energy Technology Data Exchange (ETDEWEB)

    Brown, W.J.; Kaga, A.R.

    1978-03-01

    Two middle-aged women with malignancy of the aerodigestive tract were treated by megavoltage irradiation. Both subsequently developed transverse myelopathy. The diagnosis of radiation myelitis was rendered in one. The other was thought to have metastatic compression of the spinal cord; in this case, evidence was such that radiation myelopathy also was appropriate. The irradiation dose-time relationships in both patients were biologically low compared to published isoeffect curves available in the literature. The first patient had injury within the irradiated region and the main neurological damage was found there. In the second patient the entire spinal cord was necrotic, clearly placing the second case outside the radiation myelopathy syndrome. Gross and microscopic examinations of the tissues of these two patients show that the remote effects of malignancy upon the central nervous system can imitate the clinical picture of radiation myelitis.

  2. [Cervical radiculopathy].

    Science.gov (United States)

    Kuijper, B

    2014-10-01

    Cervical radiculopathy is a common cause of pain in the arm. It is caused by nerve root compression in the neck, as a consequence of a herniated disc, or spondyliotic foraminal stenosis. It causes severe pain, especially during the first few weeks, and paraesthesias in the forearm and hand. Patients also suffer from neck pain and loss of strength in the relevant arm. The arm pain can be exacerbated by certain movements of the head; these should be avoided as much as possible. Diagnosis can be made on the basis of history and physical examination. The pain generally disappears without active patient treatment. A semi-rigid cervical collar is recommended to accelerate pain relief. In cases of persistent pain, surgery will be considered. In such cases an MRI should be performed to show the cause and level of nerve root compression. PMID:26185991

  3. PRESENT SCENARIO OF NON TRAUMATIC QUADRIPARESIS IN A TEACHING HOSPITAL

    Directory of Open Access Journals (Sweden)

    Radha Krishnan

    2015-04-01

    Full Text Available AIMS & OBJECTIVES: Patients presenting with acute quadriparesis may pose therapeutic challenge to the treating physician especially the development of bulbar palsy and respiratory paralysis and require intensive monitoring and treatment in acute clinical and respiratory care units. So this study was conducted to know the etiology of cases of non - traumatic Quadriparesis and its outcome. MATERIALS AND METHODS: 50 adult patients admitted in medical and neurology wards with non - traumatic quadriparesis were prospectively studied b etween October ’2012 to September ’2014at Government General Hospital, Kakinada, a teaching hospital with rural referrals. OBSERVATIONS AND RESULTS: In the study cohort of 50 cases the age of patients ranged from 13 to 80 years with more number of male patients. 29 patients (58% presented with flaccid and 21 cases (42% with spastic quadriparesis. Guillian barre syndrome with 18 (36% cases was the most common cause of quadriparesis followed by Spondylotic myelopathy 11 cases ( 22% and Hypokalemic perio dic paralysis in 8 cases (16%. Transverse Myelitis. Caries spine. Secondaries cervical spine, spinal epidural abscess were in other cases.7 (14% patients had cranial nerve dysfunction. 4(8% patients had facial nerve palsy . CONCLUSION: Guillian barre syn drome constituted the most common cause of nontraumatic quadriparesis, followed by Spondylotic myelopathy, Transverse Myelitis. Caries spine. S econdaries cervical spine, spinal epidural abscess . AIDP and Hypokalemic periodic paralysis were the most frequen t causes of flaccid quadriparesis while Spondylotic myelopathy was the most common cause of spastic quadriparesis . M.R.I was the most useful and appropriate investigation . Severity of paralysis and need for ventilator support were associated with poor prog nosis in patients with acute flaccid quadriparesis . Decompressive surgery in spondylotic myelopathy had good recovery after surgery. Patient recovery was

  4. 颈前路多节段融合术后吞咽困难的原因分析%Analysis on the causes of dysphagia after multilevel anterior cervical discectomy and fusion

    Institute of Scientific and Technical Information of China (English)

    祁敏; 梁磊; 王新伟; 陈华江; 曹鹏; 袁文

    2013-01-01

    Objective To investigate incidence and related factors of dysphagia after fusion with an anterior cervical plate plus cage or a stand-alone cage (Zero-p cage) following anterior cervical discectomy procedure for treating multilevel cervical spondylotic myelopathy (MCSM).Methods From September 2008to September 2011,226 patients with MCSM underwent anterior cervical discectomy and fusion using an anterior cervical plate plus cage (118 patients,P&C group) or a stand-alone cage (108 patients,Zero-p group).Neurological function was evaluated by Japan orthopedic association (JOA) scores before and after operation.Cervical X-rays were taken to assess the graft fusion,internal fixation related complications and the thickness of the prevertebral soft tissue.The Bazaz dysphagia score and Swallowing Quality of Life questionnaire were used to assess the incidence and degree of dysphagia.Results The average follow-up time was 2.4years (range,1.0 to 3.5 years).The incidence of dysphagia was 41.53% in P&C group,while 33.33% in Zero-p group at 2 days after operation.The thickness of the prevertebral soft tissue in P&C group was significantly thicker than that in Zero-p group at 2 days and 2 months after surgery.In Zero-p group,the incidence of dysphagia was 43.1% in patients who underwent operation from C3 to C6,while 22% in patients who underwent operation from C4 to C7.Conclusion Dysphagia is common after multilevel anterior cervical discectomy and fusion.The choice of implants and the extent of operation are important influencing factors of postoperative dysphagia.The use of stand-alone cage can decrease the incidence of dysphagia.The operation at higher levels has a higher incidence of dysphagia.%目的 比较多节段颈前路椎间盘切除减压融合术中采用传统钢板+cage和“零切迹”颈椎椎间融合器植入患者术后吞咽困难的发生情况,并分析其原因.方法 2008年9月至2011年9月,接受颈前路椎间盘切

  5. New titanium spacer for cervical laminoplasty. Initial clinical experience. Technical note

    International Nuclear Information System (INIS)

    Many commercially available hydroxyapatite (HA) spacers for cervical laminoplasty have been introduced but have disadvantages such as lack of plasticity, easy cracking, and occasional difficulty in fixation by sutures. Here we present the short-term results of a newly designed titanium spacer (Laminoplasty Basket) in open-door cervical laminoplasty, and evaluated clinically and radiologically. The titanium box-shaped spacer with two arms for fixation was easily inserted and fixed into the laminoplasty space with 4-mm or 5-mm length screws after the posterior cervical arch was repositioned for the canal expansion. Twenty-one patients with cervical myelopathy due to spondylosis or ossification of the longitudinal ligament or developmental narrow canal observed for more than 6 months postoperatively were enrolled in this study. The neurological condition of these patients improved from 9.4 points on the Japanese Orthopaedic Association scale preoperatively to 13.5 points at 6 months after surgery. Postoperative radiological evaluation showed no laminar closure or implant failure and cervical spine curvature was maintained. These results seemed to have no significant difference compared with those using HA spacers. This titanium spacer is a potential substitute for conventional HA or other similar devices in cervical laminoplasty. (author)

  6. An Outcome Study of Anterior Cervical Discectomy and Fusion among Iranian Population.

    Science.gov (United States)

    Haghnegahdar, Ali; Sedighi, Mahsa

    2016-01-01

    Background and Aim. First-line treatment strategy for managing cervical disc herniation is conservative measures. In some cases, surgery is indicated either due to signs/symptoms of severe/progressive neurological deficits, or because of persistence of radicular pain despite 12 weeks of conservative treatment. Success for treatment of cervical disc herniation using ACDF has been successfully reported in the literature. We aim to determine the outcome of ACDF in treatment of cervical disc herniation among Iranians. Methods and Materials/Patients. In a retrospective cohort study, we evaluated 68 patients who had undergone ACDF for cervical disc herniation from March 2006 to March 2011. Outcome tools were as follows: (1) study-designed questionnaire that addressed residual and/or new complaints and subjective satisfaction with the operation; (2) recent (one week prior to the interview) postoperative VAS for neck and upper extremity radicular pain; (3) Japanese Orthopaedic Association Myelopathy Evaluation Questionnaire (JOACMEQ) (standard Persian version); and (4) follow-up cervical Magnetic Resonance Imaging (MRI) and lateral X-ray. Results. With mean follow-up time of 52.93 (months) ± 31.89 SD (range: 13-131 months), we had success rates with regard to ΔVAS for neck and radicular pain of 88.2% and 89.7%, respectively. Except QOL functional score of JOAMEQ, 100% success rate for the other 4 functional scores of JOAMEQ was achieved. Conclusion. ACDF is a successful surgical technique for the management of cervical disc herniation among Iranian population.

  7. Outcomes of managing the surgical site infection with local vancomycin following posterior cervical surgery%颈后路术中局部应用万古霉素对术后手术部位感染的影响

    Institute of Scientific and Technical Information of China (English)

    刘祥; 徐宏光; 赵泉来; 高智; 肖良

    2016-01-01

    through posterior access in our hospital between January 2013 and December 2014,with regard to the indicators suggestive of infections,including the temperature,erythrocyte sedimentation rate(ESR),C-reaction protein(CRP), neutrophil ratio and lymphocyte ratio,before and after surgery.Patients were allocated to group A(n=27,male) and group B(n=25,female).The age of patients ranged from 32 to 68 years,with an average of 52.25 ±11.00 years.In 52 cases,42 were associated with cervical spondylotic myelopathy or cervi-cal spondylotic radiculopathy,9 with cervical instability due to neck trauma,and 1 with intraspinal tumor.Results:Operation was successful in the 52 ca-ses,and no operative or perioperative death occurred.All patients were followed up for 3 months.At day 7 after operation,the temperature was (37.78 ± 0.60)℃ and (36.66 ±0.31)℃;ESR,(31.00 ±8.49)mm/h and (14.19 ±1.30)mm/h;CRP,(26.77 ±9.92)mg/L and (6.50 ±1.88)mg/L;the neutrophil ratio,(80.58 ±4.06)% and (56.92 ±3.11)%;the lymphocyte ration,(12.88 ±1.61)% and (23.08 ±3.77)%,respectively,for the group A and B(P<0.05).The difference was also significant between the two groups regarding the temperature,ESR,CRP,neutrophil ratio and lympho-cyte ratio at day 1 and 3,in the first and third month after operation (P<0.05).Slight incision inflammation occurred in 9 cases in group A that had addi-tional 5 days of hospital stay on average than group B .Conclusion:Local vancomycin may effectively reduce the incision infection for patients receiving cervical surgery by posterior access as well as hospital stay and medical costs.

  8. Balantidium coli: an unrecognized cause of vertebral osteomyelitis and myelopathy.

    Science.gov (United States)

    Dhawan, Shashi; Jain, Deepali; Mehta, Veer Singh

    2013-03-01

    Balantidium coli is a ciliated protozoan parasite that primarily infects primates and pigs. It is the largest protozoan to infect humans and is a well-known cause of diarrhea and dysentery. Extraintestinal disease is uncommon, and extraintestinal spread to the peritoneal cavity, appendix, genitourinary tract, and lung has rarely been reported. The authors describe a case of vertebral osteomyelitis with secondary cervical cord compression caused by B. coli. The patient was a 60-year-old immunocompetent man presenting with quadriplegia of short duration. Magnetic resonance imaging of the cervical spine showed extradural and prevertebral abscess at the C3-4 level. Drainage of the abscess, C3-4 discectomy, and iliac bone grafting were performed. Histologically B. coli was confirmed in an abscess sample. To the best of the authors' knowledge, involvement of bone by B. coli has never been reported, and this case is the first documented instance of cervical cord compression due to B. coli osteomyelitis of the spine in the literature. PMID:23259539

  9. Initial curative effect comparision of ano-hydroxyapatite polyamide-66 cage and polyetheretherketone cage on anterior cervical intervertebral disc discectomy and fusion%n-HA/PA66与PEEK cage在颈前路椎间盘切除减压术后椎间隙重建的比较研究

    Institute of Scientific and Technical Information of China (English)

    刘显宏; 欧云生; 蒋电明; 权正学; 张乐; 陈鑫; 胡侦明

    2012-01-01

    目的 观察比较纳米羟基磷灰石/聚酰胺66颈椎融合器(n-HA/PA66 Cage)与聚醚醚酮颈椎融合器(PEEK Cage)在颈前椎间盘切除减压术后椎间隙植骨重建的初期疗效.方法 回顾性分析2008年6月~2011年6月手术治疗资料完整的57例颈椎病患者,行颈前路椎间盘切除减压Cage植骨融合钛钉板系统内固定治疗,其中31例采用n-HA/PA66 cage,26例采用PEEK cage.术后随访包括影像学及临床疗效评价,影像学评价包括术前、术后正侧位片、动力位片观察植骨融合率、塌陷率、颈椎曲度及手术节段椎间隙高度情况;临床疗效采用Odom标准评定.结果 n-HA/PA66组患者6月时获得97.7%植骨融合,PEEK组融合率100%,两组融合率无统计学差异(P> 0.05);n-HA/PA66组术后颈椎丢失的角度为(2.06±1.77)°较PEEK组(2.39±1.56)°稍低,两组数据无统计学差异(P=0.384);n-HA/PA66组与PEEK组术后平均椎间隙丢失高度无统计学意义(0.46 ±0.52 mm,0.41 ±0.18 mm,P=.599),其中n-HA/PA66组出现l例患者1个节段塌陷,塌陷率2.3%,与PEEK组塌陷率(0%)比较无统计学差异(P=0.372);PEEK组获得81%临床优良率对比n-HA/PA66组77%的优良率无统计学差异(P=0.757).结论 颈前路椎间盘切除减压后,n-HA/PA66与PEEK cage椎间隙植骨融合并内固定治疗颈椎病的初期临床疗效与影像学结果均较好且相似.%Objective To evaluate the preliminary efficacy using polyetheretherketone cage (PEEK Cage) and Nano-hydroxyapatite polyamide/66 cage (n-HA/PA66 Cage) composites for reconstruction following anterior cervical interveitebral discectomy and fusion (ACDF) in cervical spondylosis. Methods We performed a retrospective study of patients (57 cases, 3 leases in n-HA/PA66 group, 26 cases in PEEK group) with cervical spondylopathy who underwent ACDF by two different cages between June 2008 and June 2011. Cervical pathologies included cervial spondylotic myelopathy and cervical

  10. Cervical Synovial Cyst Causing Cervical Radiculomyelopathy: Case Report and Review of the Literature.

    Science.gov (United States)

    Corredor, José A; Quan, Gerald

    2015-08-01

    Study Design Case report. Objective Synovial cysts in the subaxial cervical spine are rare and are most commonly reported at the cervicothoracic junction. Only six cases of symptomatic C5-C6 synovial cysts have been reported in the literature; the condition is usually treated with decompressive laminectomy. We present a patient with a synovial cyst arising from the C5-C6 facet joint, associated with spondylolisthesis, and causing radiculomyelopathy. The patient was treated with a posterior excision of the cyst, decompressive laminectomy, and fusion. Methods A 67-year-old man had vertebral canal stenosis at C5-C6 secondary to a synovial cyst and spondylolisthesis with symptoms and signs of radiculopathy and myelopathy. Surgical management involved C5-C6 posterior decompressive laminectomy and excision of the cyst and C4-C6 instrumented fusion with lateral mass screws and rods. A literature review of symptomatic cervical synovial cysts is presented. Results The imaging studies identified grade I spondylolisthesis and a 3.3 × 4.3-mm extradural lentiform-like mass associated with focal compression of the spinal cord and exiting the C6 nerve root. After the surgery, the patient had an immediate full recovery and was asymptomatic by the 6-month examination. No operative complications were reported. The histologic report confirmed the presence of a synovial cyst. Conclusions C5-C6 is an unusual localization for symptomatic synovial cysts. Similar cases reported in the literature achieved excellent results after cyst excision and decompressive laminectomy. Because spondylolisthesis plus laminectomy are risk factors for segmental instability in the cervical spine, we report a case of a C5-C6 facet synovial cyst successfully treated with posterior laminectomy and C4-C6 fusion. PMID:26225291

  11. Remarkable recovery in an infant presenting with extensive perinatal cervical cord injury

    Science.gov (United States)

    Ul Haq, Israr; Gururaj, A K

    2012-01-01

    Cervical-cord damage is a complication of a difficult delivery, and results in spinal shock with flaccidity progressing to spastic paralysis. Conventionally, outlook for such patients is extremely poor and most will recover only slightly from quadriplegia and autonomic dysfunction. Here, we report a case in which the extent of damage considerably contrasted with the outcome and recovery. A full-term baby girl born by difficult vaginal delivery displayed bilateral flaccid paralysis of the lower limbs with absent spontaneous movements, weakness of both upper limbs, hyporeflexia in all limbs and axial hypotonia. MRI of cervicothoracic spine exhibited raised signal intensity in the dorsal aspects of C7 to T1 signifying myelopathy. MRI at 4 months revealed a near-total transection of the cervical cord. However, at 6 months, the child could move all lower limbs independently with a marked increase in power. There was no spasticity, wasting or incontinence. Reflexes had also returned. PMID:23230249

  12. Comparison of clinical signs and outcomes between dogs with presumptive ischemic myelopathy and dogs with acute noncompressive nucleus pulposus extrusion.

    Science.gov (United States)

    Fenn, Joe; Drees, Randi; Volk, Holger A; De Decker, Steven

    2016-10-01

    OBJECTIVE To compare clinical signs and outcomes between dogs with presumptive ischemic myelopathy and dogs with presumptive acute noncompressive nucleus pulposus extrusion (ANNPE). DESIGN Retrospective study. ANIMALS 51 dogs with ischemic myelopathy and 42 dogs with ANNPE examined at 1 referral hospital. PROCEDURES Medical records and MRI sequences were reviewed for dogs with a presumptive antemortem diagnosis of ischemic myelopathy or ANNPE. Information regarding signalment, clinical signs at initial examination, and short-term outcome was retrospectively retrieved from patient records. Long-term outcome information was obtained by telephone communication with referring or primary-care veterinarians and owners. RESULTS Compared with the hospital population, English Staffordshire Bull Terriers and Border Collies were overrepresented in the ischemic myelopathy and ANNPE groups, respectively. Dogs with ANNPE were significantly older at disease onset and were more likely to have a history of vocalization at onset of clinical signs, have spinal hyperesthesia during initial examination, have a lesion at C1-C5 spinal cord segments, and be ambulatory at hospital discharge, compared with dogs with ischemic myelopathy. Dogs with ischemic myelopathy were more likely to have a lesion at L4-S3 spinal cord segments and have long-term fecal incontinence, compared with dogs with ANNPE. However, long-term quality of life and outcome did not differ between dogs with ischemic myelopathy and dogs with ANNPE. CONCLUSIONS AND CLINICAL RELEVANCE Results revealed differences in clinical signs at initial examination between dogs with ischemic myelopathy and dogs with ANNPE that may aid clinicians in differentiating the 2 conditions. PMID:27654163

  13. Treatments for primary aneurysmal bone cysts of the cervical spine: experience of 14 cases

    Institute of Scientific and Technical Information of China (English)

    Wang Chao; Liu Xiaoguang; Jiang Liang; Yang Shaomin; Wei Feng; Wu Fengliang; Liu Zhongjun

    2014-01-01

    Background Aneurysmal bone cyst (ABC) is a benign lesion with the potential to be locally aggressive.The optimal treatment of cervical spine lesions remains controversial.This retrospective study was designed to evaluate the different treatments for primary ABCs of the cervical spine.Methods This series included eight men and six women diagnosed between 2002 and 2012.A retrospective review of the hospital charts,operating room reports,office charts,and radiographs was performed.The data collected included patient age,sex,radiological features,pathology,treatment method,outcomes,and complications from biopsies and treatments.The mean age at diagnosis was 17.5 years old with a range of 6-35 years.All patients had experienced local pain for a mean of 7.3 months (range,0.5-18.0 months),and three patients had neurological deficits (one with radiculopathy and two with myelopathy).The Frankel classification before treatment was E in 12 cases,D in one case,and C in one case.Results Four patients received radiotherapy alone.Ten patients underwent surgery,including five total spondyiectomies,two local resections,and three curettages.Three patients received preoperative selective arterial embolization,and four received adjuvant radiotherapy.The mean follow-up time was 44.5 months (range 12-96 months),and no recurrence was identified.Three patients with neurological deficits achieved complete recovery,as noted at the final follow-up examination.One patient received radiotherapy without appropriate immobilization as prescribed and developed C1-C2 subluxation with severe spinal cord compression but without myelopathy.He refused further treatment.Conclusions The results can be achieved by different treatments (surgical resection/curettage,selective arterial embolization,and radiotherapy) for ABC of the cervical spine.Reconstruction of stability is also important for the treatment of cervical ABC.

  14. Neurophysiological evaluation of patients with degenerative diseases of the cervical spine

    Directory of Open Access Journals (Sweden)

    Ilić Tihomir V.

    2011-01-01

    Full Text Available Bacground/Aim. Diagnostic protocol for patients with degenerative diseases of the cervical spine demands, in parallel with neuroimaging methods, functional evaluation through neurophysiological methods (somatosensitive and motor evoked potentials and electromyoneurography aiming to evaluate possible subclinical affection of spinal medula resulting in neurological signs of long tract abnormalities. Considering diversities of clinical outcomes for these patients, complex diagnostic evaluation provides a prognosis of the disease progression. Methods. The study included 21 patients (48.24 ± 11.01 years of age with clinical presentation of cervical spondylarthropathy, without neuroradiological signs of myelopathy. For each patient, in addition to conventional neurophysiological tests (somatisensory evoked potentials - SSEP, motor evoked potentials - MEP, electromyoneurography - EMG, nerve conduction studies, we calculated central motor conduction time (CMCTF, as well the same parameter in relation to a different position of the head (maximal anteflexion and retroflexion, so-called dynamic tests. Results. Abnormalities of the peripheral motor neurone by conventional EMNeG was established in 2/3 of the patients, correponding to the findings of root condution time. Prolonged conventional CVMPF were found in 29% of the patients, comparing to 43% CVMPF abnormalities found with the dynamic tests. In addition, the SSEP findings were abnormal in 38% of the patients with degenerative diseases of the cervical spine. Conclusion. An extended neurophysiological protocol of testing corticospinal functions, including dynamic tests of central and periheral motor neurons are relevant for detection of subclinical forms of cervical spondylothic myelopathy, even at early stages. In addition to the conventional neurophysiological tests, we found usefull to include the dynamic motor tests and root conduction time measurement in diagnostic evaluation.

  15. Magnetic resonance imaging of the cervical and thoracic spine and the spinal cord

    International Nuclear Information System (INIS)

    Magnetic resonance imaging (MR), using a 0.3 T resistive scanner with an iron core and a vertical magnetic field, was evaluated in patients with different diseases affecting the cervical and thoracic spine and the spinal cord. The results indicate that MR is well suited as the procedure of choice for emergency examination of patients with spinal cord symptoms, for examination of patients with suspected spinal multiple sclerosis and for pre-operative evaluation of patients with rheumatoid arthritis with neurological symptoms emanating from the cranio-cervical junction. In patients with cervical radiculapathy and/or myelopathy, caused by spondylosis or disk herniation, MR was found to be equivalent with myelography and CT myelography but MR has several practical advantages. MR at 0.3 T using a vertical magnetic field provided information comparable to that reported from examinations performed with superconducting MR scanners. In order to optimize the MR examinations of the spine, the signal characteristics of different coils available when using a vertical magnetic field were determined by phantom studies. Recommendations for optimal coil selection for different levels of the cervical and thoracic spine are given. In addition, the paramagnetic contrast medium gadolinium-DTPA was administered intravenously to patients with suspected spinal multiple sclerosis. Enhancement of clinically active lesions in the cervical spinal cord was observed. Serial MR examinations with gadolinium-DTPA showed that a decrease in enhancement could be correlated with decrease in clinical symptoms and signs. (author)

  16. 人颈椎椎体终板软骨细胞退变模型的建立及其意义%Establishment and significance of an in vitro model of degeneration of human cervical endplate chondrocytes

    Institute of Scientific and Technical Information of China (English)

    徐宏光; 彭红心; 程加峰; 吕坤

    2011-01-01

    目的 建立人颈椎椎体终板软骨细胞退变模型,观察人正常颈椎椎体和退变颈椎椎体终板软骨细胞的形态及表征.方法 选择2010年7月至2011年7月49例颈椎骨折、脱位(19例)及颈椎病(30例)患者术中取出的颈椎终板软骨,用酶消化法分别分离培养人正常颈椎椎体终板软骨细胞(对照组)和退变颈椎椎体终板软骨细胞(颈椎病组);用倒置显微镜和HE染色法观察细胞形态学变化;四甲基偶氮唑蓝(MTT)法绘制细胞生长曲线;甲苯蓝染色及反转录-PCR(RT-PCR)法对终板软骨细胞进行鉴定;RT-PCR法检测终板软骨细胞特征性基因蛋白多糖、Ⅱ型胶原及Ⅰ型胶原的表达.结果 人颈椎椎体终板软骨细胞表达特征性蛋白多糖、Ⅱ型胶原及Ⅰ型胶原,其生长情况及细胞表型类似于关节软骨细胞.对照组原代终板软骨细胞以多角形为主,增殖速度较快;而颈椎病组原代终板软骨细胞以梭形为主,细胞增殖速度较慢.颈椎病组原代终板软骨细胞表达的蛋白多糖基因(0.695 ±0.052)和Ⅱ型胶原基因(0.726 ±0.035)均低于对照组(0.950±0.032、0.907±0.078,t=7.263、3.681,P=0.002、0.021),Ⅰ型胶原基因则高于对照组(0.795±0.028比0.552±0.070,t=-5.560,P=0.005).结论 成功建立了人颈椎椎体终板软骨细胞退变模型,为椎间盘退变机制研究提供了较好的细胞学基础,解决了以前一直以动物细胞模型为研究对象的局限性.%Objective To establish an in vitro model of degeneration of human cervical endplate chondrocytes and observe the morphology and phenotypes of endplate chondrocytes in normal and degenerative cervical vertebral endplates.Methods Cartilage endplates of 49 patients were divided into control group ( n =19 ) with cervical vertebral fracture or dislocation and experiment group ( n =30) with cervical spondylotic myelopathy.Endplate chondrocytes were isolated by enzyme digestion and cultured in vitro

  17. Visuo-proprioceptive interactions in degenerative cervical spine diseases requiring surgery.

    Science.gov (United States)

    Freppel, S; Bisdorff, A; Colnat-Coulbois, S; Ceyte, H; Cian, C; Gauchard, G; Auque, J; Perrin, P

    2013-01-01

    Cervical proprioception plays a key role in postural control, but its specific contribution is controversial. Postural impairment was shown in whiplash injuries without demonstrating the sole involvement of the cervical spine. The consequences of degenerative cervical spine diseases are underreported in posture-related scientific literature in spite of their high prevalence. No report has focused on the two different mechanisms underlying cervicobrachial pain: herniated discs and spondylosis. This study aimed to evaluate postural control of two groups of patients with degenerative cervical spine diseases with or without optokinetic stimulation before and after surgical treatment. Seventeen patients with radiculopathy were recruited and divided into two groups according to the spondylotic or discal origin of the nerve compression. All patients and a control population of 31 healthy individuals underwent a static posturographic test with 12 recordings; the first four recordings with the head in 0° position: eyes closed, eyes open without optokinetic stimulation, with clockwise and counter clockwise optokinetic stimulations. These four sensorial situations were repeated with the head rotated 30° to the left and to the right. Patients repeated these 12 recordings 6weeks postoperatively. None of the patients reported vertigo or balance disorders before or after surgery. Prior to surgery, in the eyes closed condition, the herniated disc group was more stable than the spondylosis group. After surgery, the contribution of visual input to postural control in a dynamic visual environment was reduced in both cervical spine diseases whereas in a stable visual environment visual contribution was reduced only in the spondylosis group. The relative importance of visual and proprioceptive inputs to postural control varies according to the type of pathology and surgery tends to reduce visual contribution mostly in the spondylosis group.

  18. Cervical Cancer Screening

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    ... Cancer found early may be easier to treat. Cervical cancer screening is usually part of a woman's health ... may do more tests, such as a biopsy. Cervical cancer screening has risks. The results can sometimes be ...

  19. Tratamento cirúrgico por via anterior na mielopatia cervical espondilótica com seguimento mínimo de dez anos Tratamiento quirúrgico por vía anterior en la mieolopatía cervical espondilótica con seguimiento mínimo de diez años Anterior decompression and fusion for spondilotic cervical mielopathy with a minimal ten-year follow-up

    Directory of Open Access Journals (Sweden)

    Rui Peixoto Pinto

    2010-06-01

    promedio de 11.9 años. Ocurrieron cinco óbitos: tres pacientes en el postoperatorio inmediato, uno durante el primer año y uno durante el restante periodo. En promedio, fueron operados 2.7±1.0 niveles por paciente (1 a 4. El valor promedio de Nurick pre operatorio fue de 3.8±0.9. Hubo una mejora significativa del estado neurológico un año después de la cirugía (2.2±1.1; pOBJECTIVE: cervical spondylotic myelopathy (CSM is a common cause of spinal cord dysfunction in the adult population. The treatment implies early surgical decompression. The objective was to present a retrospective study of anterior decompression and arthrodesis for CSM with a minimal ten years follow-up. METHODS: patients operated between January 1990 and December 1994 were evaluated for sex, age, number of levels operated, functional evaluation with Nurick scale preoperatively, one year after surgery and at the final revision that took place in 2004, evidence of consolidation and complications. RESULTS: 91 patients were evaluated, 69 male, 22 female, with a mean age of 56.6 years (42-86 and mean follow-up of 11.9 years. Five deaths occurred: three patients died in the immediate postoperative period, one in the first year and one during the follow-up. A mean of 2.7±1.0 levels for patient was performed (1-4. The mean value of preoperative Nurick was 3.8±0.9. There was a significant improvement in neurological condition after one year (2.2±1.1; p<0.001, and between preoperative period and final evaluation (2.3±1.2; p<0.001. The degradation between the first year and the final evaluation was statistically significant (p=0.004. There was a strong correlation between age and the number of operated levels (r=0.391; p=0.01, age and initial neurologic status (r=0.238; p=0.05, initial neurological status and number of operated levels (r=0.251; p=0.05 and sex and number of operated levels, with women being operated for more levels (r=0.208; p=0.05. There was also a stronger neurological deterioration

  20. Cervical Cancer Stage IA

    Science.gov (United States)

    ... historical Searches are case-insensitive Cervical Cancer Stage IA Add to My Pictures View /Download : Small: 720x576 ... Large: 3000x2400 View Download Title: Cervical Cancer Stage IA Description: Stage IA1 and IA2 cervical cancer; drawing ...

  1. Danazol a new perspective in the treatment of htlv-l associated myelopathy (preliminary report

    Directory of Open Access Journals (Sweden)

    Ailton Melo

    1992-09-01

    Full Text Available We investigated the efficacy of danazol treatment in eight patients with HTLV-l associated myelopathy/tropical spastic paraparesis (HAM/TSP. Treatment with danazol yielded clinical improvement of urinary control and gait disturbances in 7 out of the 8 patients. The improvement was noted within 15 days of danazol administration. Analysis of factors of relevance to the clinical improvement with danazol showed that the beneficial response was preferentially found in females.

  2. Spinal Cord Kinking in Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum

    Institute of Scientific and Technical Information of China (English)

    Ting Wang; Min Pan; Chu-Qiang Yin; Xiu-Jun Zheng; Ya-Nan Cong; De-Chun Wang; Shu-Zhong Li

    2015-01-01

    Background:Ossification of the ligamentum flavum (OLF) is being increasingly recognized as a cause of thoracic myelopathy.This study was to describe a rare clinical entity of spinal cord kinking (SK) in thoracic myelopathy secondary to OLF.Methods:The data of 95 patients with thoracic myelopathy secondary to OLF were analyzed retrospectively.The incidence and location of SK were determined using preoperative magnetic resonance imaging (MRI).The clinical presentation and radiological characteristics in patients with SK were analyzed.Posterior en bloc laminectomy with OLF was performed,and the surgical results were evaluated.Results:SK was found in seven patients (7.4%) based on preoperative MRI.The patients included one male and six females with an average age of 55.6 years (range,48-64 years).Five patients presented with radiculomyelopathy and two presented with typical thoracic myelopathy of spastic paraparesis.In all cases,the kinking was located just above the end of the spinal cord where the conus medullaris (CM) was compressed by the OLF.The degree of SK varied from mild to severe.The tip of the CM was located between the upper third of T1 1 to the lower third of L 1,above the lower edge of L 1.With an average follow-up of 30.4 months,the modified Japanese Orthopedic Association score significantly improved from 5.7 ± 1.8 preoperatively to 8.9 ± 1.4 postoperatively (t =12.05;P < 0.0001) with an improvement rate of 63.1 ± 12.3%.Conclusions:SK is a rare radiological phenomenon.It is typically located at the thoracolumbar junction,where the CM is compressed by the OLF.Our findings indicate that these patients may benefit from a posterior decompressive procedure.

  3. Get Tested for Cervical Cancer

    Science.gov (United States)

    ... Cervical Cancer Print This Topic En español Get Tested for Cervical Cancer Browse Sections The Basics Overview ... be cured. How often should I get screened (tested)? How often you should get screened for cervical ...

  4. Cervical cancer - screening and prevention

    Science.gov (United States)

    Cancer cervix - screening; HPV - cervical cancer screening; Dysplasia - cervical cancer screening ... Almost all cervical cancers are caused by HPV (human papilloma virus). HPV is a common virus that spreads through sexual contact. Certain ...

  5. Treatment Option Overview (Cervical Cancer)

    Science.gov (United States)

    ... Cancer Prevention Cervical Cancer Screening Research Cervical Cancer Treatment (PDQ®)–Patient Version General Information About Cervical Cancer ... Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) depends on ...

  6. Cervical Total Disc Arthroplasty

    OpenAIRE

    Basho, Rahul; Hood, Kenneth A.

    2012-01-01

    Symptomatic adjacent segment degeneration of the cervical spine remains problematic for patients and surgeons alike. Despite advances in surgical techniques and instrumentation, the solution remains elusive. Spurred by the success of total joint arthroplasty in hips and knees, surgeons and industry have turned to motion preservation devices in the cervical spine. By preserving motion at the diseased level, the hope is that adjacent segment degeneration can be prevented. Multiple cervical disc...

  7. Preventing cervical cancer globally.

    Science.gov (United States)

    Schmeler, Kathleen M

    2012-11-01

    Cervical cancer is one of the leading causes of cancer and cancer-related deaths among women worldwide. More than 85% of cases and deaths occur in the developing world where the availability of effective screening is limited. In this issue of the journal, Pierce and colleagues (beginning on page 1273) describe a novel technique using a high-resolution microendoscope (HRME) to diagnose cervical dysplasia. This perspective reviews the limitations of existing cervical cancer screening methods currently in use in low-resource settings and the potential for HRME imaging to contribute to cervical cancer prevention in the developing world.

  8. Extensive arachnoid ossification with associated syringomyelia presenting as thoracic myelopathy. Case report and review of the literature.

    Science.gov (United States)

    Slavin, K V; Nixon, R R; Nesbit, G M; Burchiel, K J

    1999-10-01

    The authors present the case of progressive thoracic myelopathy caused by the extensive ossification of the arachnoid membrane and associated intramedullary syrinx. Based on their findings and results of the literature search, they describe a pathological basis for this rare condition, discuss its incidence and symptomatology, and suggest a simple classification for various types of the arachnoid ossification. They also discuss the magnetic resonance imaging features of arachnoid ossification and associated spinal cord changes. The particular value of plain computerized tomography, which is highly sensitive in revealing intraspinal calcifications and ossifications, in the diagnostic evaluation of patients with a clinical picture of progressive myelopathy is emphasized. PMID:10505510

  9. Biomechanical evaluation of DTRAX® posterior cervical cage stabilization with and without lateral mass fixation

    Science.gov (United States)

    Voronov, Leonard I; Siemionow, Krzysztof B; Havey, Robert M; Carandang, Gerard; Patwardhan, Avinash G

    2016-01-01

    Introduction Lateral mass screw (LMS) fixation with plates or rods is the current standard procedure for posterior cervical fusion. Recently, implants placed between the facet joints have become available as an alternative to LMS or transfacet screws for patients with cervical spondylotic radiculopathy. The purpose of this study was to evaluate the biomechanical stability of the DTRAX® cervical cage for single- and two-level fusion and compare this to the stability achieved with LMS fixation with rods in a two-level construct. Methods Six cadaveric cervical spine (C3–C7) specimens were tested in flexion–extension, lateral bending, and axial rotation to ±1.5 Nm moment without preload (0 N) in the following conditions: 1) intact (C3–C7), 2) LMS and rods at C4–C5 and C5–C6, 3) removal of all rods (LMS retained) and placement of bilateral posterior cages at C5–C6, 4) bilateral posterior cages at C4–C5 and C5–C6 (without LMS and rods), and 5) C4–C5 and C5–C6 bilateral posterior cages at C4–C5 and C5–C6 with rods reinserted. Results Bilateral posterior cervical cages significantly reduced range of motion in all tested directions in both single- and multilevel constructs (P<0.05). Similar stability was achieved with bilateral posterior cages and LMS in a two-level construct: 0.6°±0.3° vs 1.2°±0.4° in flexion–extension (P=0.001), (5.0°±2.6° vs 3.1°±1.3°) in lateral bending (P=0.053), (1.3°±1.0° vs 2.2°±0.9°) in axial rotation (P=0.091) for posterior cages and LMS, respectively. Posterior cages, when placed as an adjunct to LMS, further reduced range of motion in a multilevel construct (P<0.05). Conclusion Bilateral posterior cages provide similar cervical segmental stability compared with a LMS and rod construct and may be an alternative surgical option for select patients. Furthermore, supplementation of a lateral mass construct with posterior cages increases cervical spine stability in single- and multilevel conditions. PMID

  10. Comparative assessment of diagnostic value of electrodiagnostic methods and radiologic evaluations in patients with clinical signs of cervical radiculopathy

    Directory of Open Access Journals (Sweden)

    S.A. Moosavi

    2006-01-01

    Full Text Available Background and purpose: Cervical radiculopathy is one of the most common diseases that must be diagnosed early and properly to prevent its serious side effects. For this purpose different paraclinical methods such as MRI, X-ray, EMG, NCV and SSEP are used. Each of these methods has its limitations and some of them are expensive or invassive. The aim of this study was to compare the electrodiagnostic and radiologic methods in diagnosis of cervical radiculopathy.Materials and Methods: In this study 36 patients (22 Female, l4 Male with complaint of cervical pain radiated to upper limbs were evaluated. The evaluation included EMG, NCV, MRI, X-ray and SSEP. Exclusion criteria were fracture dislocation and infection of bone joints or soft tissues .MRI and X-ray were performed in MRI centers of Isfahan, Sepahan and Alzahra hospital in Isfahan city. MRI was graded on severity of 1 to 3. EMG, NCV and SSEP were performed in electrodiagnostic center of Alzahra hospital by one professional technician. Results were compared with text books and analyzed by SPSS software.Results: Sensitivity of SSEP was 28.6% and specifity was 100%. Partial agreement between SSEP and MRI existed in moderate and severe cervical involvements (P = 0.005. Frequencies of abnormalities were: EMG 50%, NCV 5.6%, X-ray 33.3% and MRI 77.8%.Conclusion: This study shows that SSEP has lower value than EMG in diagnosis of cervical radiculopathy. Also in a patient with cervical radiculopathy, cervical MRI and EMG of upper limbs are necessary. SSEP abnormalities in the presence of moderate and severe MRI changes such as myelopathy, are more valuable. Therefore, SSEP in cervical radiculopathy is recommended before surgery.

  11. Neurogenic bladder following myelopathies: Has it any correlation with neurological and functional recovery?

    Directory of Open Access Journals (Sweden)

    Nitin Menon

    2014-01-01

    Full Text Available Objectives: To observe neurogenic bladder pattern in patients with myelopathy by performing urodynamic study (UDS and to observe whether it has any correlation with functional and neurological recovery. Patients and Methods: This prospective study was conducted with 90 patients with myelopathy, both traumatic and non-traumatic (males = 65 in a university tertiary research hospital in India between January 2011 and December 2013. Mean age was 33.5 ± 13.2 years (range 15-65 years, mean duration of injury was 82.63 ± 88.3 days (range 14-365 days and mean length of stay (LOS in the rehabilitation unit 42.5 ± 23.3 days (range 14-130 days. The urodynamic study was performed in all the patients to assess the neurogenic bladder pattern. Management was based on the UDS findings. Functional recovery was assessed using Barthel index (BI scores and spinal cord independence measures (SCIM scores. Neurological recovery was assessed using ASIA impairment scale (AIS. We tried to correlate neurogenic bladder patterns with recovery. Results: Fifty patients (55.6% had overactive detrusor with 25 each had detrusor sphincter dyssynergia (DSD and synergic sphincter. Thirty-eight patients had hypoactive/acontractile detrusor and two had normal studies. No significant correlation observed between neurogenic bladder pattern and change in BI scores (P = 0.696, SCIM scores (P = 0.135 or change in ASIA status (P = 0.841 in the study. Conclusions: More than half of the patients with myelopathies had overactive detrusor with or without dyssynergic sphincter according to the urodynamic study. Neurogenic bladder patterns had no significant correlation with functional and neurological recovery in these patients.

  12. An Outcome Study of Anterior Cervical Discectomy and Fusion among Iranian Population.

    Science.gov (United States)

    Haghnegahdar, Ali; Sedighi, Mahsa

    2016-01-01

    Background and Aim. First-line treatment strategy for managing cervical disc herniation is conservative measures. In some cases, surgery is indicated either due to signs/symptoms of severe/progressive neurological deficits, or because of persistence of radicular pain despite 12 weeks of conservative treatment. Success for treatment of cervical disc herniation using ACDF has been successfully reported in the literature. We aim to determine the outcome of ACDF in treatment of cervical disc herniation among Iranians. Methods and Materials/Patients. In a retrospective cohort study, we evaluated 68 patients who had undergone ACDF for cervical disc herniation from March 2006 to March 2011. Outcome tools were as follows: (1) study-designed questionnaire that addressed residual and/or new complaints and subjective satisfaction with the operation; (2) recent (one week prior to the interview) postoperative VAS for neck and upper extremity radicular pain; (3) Japanese Orthopaedic Association Myelopathy Evaluation Questionnaire (JOACMEQ) (standard Persian version); and (4) follow-up cervical Magnetic Resonance Imaging (MRI) and lateral X-ray. Results. With mean follow-up time of 52.93 (months) ± 31.89 SD (range: 13-131 months), we had success rates with regard to ΔVAS for neck and radicular pain of 88.2% and 89.7%, respectively. Except QOL functional score of JOAMEQ, 100% success rate for the other 4 functional scores of JOAMEQ was achieved. Conclusion. ACDF is a successful surgical technique for the management of cervical disc herniation among Iranian population. PMID:27635392

  13. An Outcome Study of Anterior Cervical Discectomy and Fusion among Iranian Population

    Directory of Open Access Journals (Sweden)

    Ali Haghnegahdar

    2016-01-01

    Full Text Available Background and Aim. First-line treatment strategy for managing cervical disc herniation is conservative measures. In some cases, surgery is indicated either due to signs/symptoms of severe/progressive neurological deficits, or because of persistence of radicular pain despite 12 weeks of conservative treatment. Success for treatment of cervical disc herniation using ACDF has been successfully reported in the literature. We aim to determine the outcome of ACDF in treatment of cervical disc herniation among Iranians. Methods and Materials/Patients. In a retrospective cohort study, we evaluated 68 patients who had undergone ACDF for cervical disc herniation from March 2006 to March 2011. Outcome tools were as follows: (1 study-designed questionnaire that addressed residual and/or new complaints and subjective satisfaction with the operation; (2 recent (one week prior to the interview postoperative VAS for neck and upper extremity radicular pain; (3 Japanese Orthopaedic Association Myelopathy Evaluation Questionnaire (JOACMEQ (standard Persian version; and (4 follow-up cervical Magnetic Resonance Imaging (MRI and lateral X-ray. Results. With mean follow-up time of 52.93 (months ± 31.89 SD (range: 13–131 months, we had success rates with regard to ΔVAS for neck and radicular pain of 88.2% and 89.7%, respectively. Except QOL functional score of JOAMEQ, 100% success rate for the other 4 functional scores of JOAMEQ was achieved. Conclusion. ACDF is a successful surgical technique for the management of cervical disc herniation among Iranian population.

  14. An Outcome Study of Anterior Cervical Discectomy and Fusion among Iranian Population

    Science.gov (United States)

    Haghnegahdar, Ali

    2016-01-01

    Background and Aim. First-line treatment strategy for managing cervical disc herniation is conservative measures. In some cases, surgery is indicated either due to signs/symptoms of severe/progressive neurological deficits, or because of persistence of radicular pain despite 12 weeks of conservative treatment. Success for treatment of cervical disc herniation using ACDF has been successfully reported in the literature. We aim to determine the outcome of ACDF in treatment of cervical disc herniation among Iranians. Methods and Materials/Patients. In a retrospective cohort study, we evaluated 68 patients who had undergone ACDF for cervical disc herniation from March 2006 to March 2011. Outcome tools were as follows: (1) study-designed questionnaire that addressed residual and/or new complaints and subjective satisfaction with the operation; (2) recent (one week prior to the interview) postoperative VAS for neck and upper extremity radicular pain; (3) Japanese Orthopaedic Association Myelopathy Evaluation Questionnaire (JOACMEQ) (standard Persian version); and (4) follow-up cervical Magnetic Resonance Imaging (MRI) and lateral X-ray. Results. With mean follow-up time of 52.93 (months) ± 31.89 SD (range: 13–131 months), we had success rates with regard to ΔVAS for neck and radicular pain of 88.2% and 89.7%, respectively. Except QOL functional score of JOAMEQ, 100% success rate for the other 4 functional scores of JOAMEQ was achieved. Conclusion. ACDF is a successful surgical technique for the management of cervical disc herniation among Iranian population. PMID:27635392

  15. Delayed myelopathy secondary to stab wound with a retained blade tip within the laminae: case report.

    Science.gov (United States)

    Wang, Hui; Ma, Lei; Ding, Wen-Yuan

    2015-01-01

    Delayed neurologic deficit after a stab wound with a retained foreign body near the spinal canal is unusual, adequate radiological examination is fundamental in detecting retained foreign bodies, especially the CT scan, surgical extraction of the foreign body is the primary task and the surgical outcome is satisfactory. Here, we report a rare case of delayed myelopathy caused by spinal stenosis secondary to broken blade tip within thoracic laminae in an old man, who was injured in a knife attack 39 years ago. The incidence, clinical presentation, diagnosis and prognosis are discussed.

  16. Radiological case: cervical teratoma

    OpenAIRE

    Macedo, F.

    2011-01-01

    We present a case of a third trimester fetus with a cervical mass. Fetal MRI was performed to better evaluate the extension of the mass and the risk of obstruction of the airway in the neonatal period. MRI is very useful in the evaluation of fetal cervical masses.

  17. CDC's Cervical Cancer Study

    Science.gov (United States)

    ... in Cancer Moonshot Stay Informed CDC’s Cervical Cancer Study Language: English Español (Spanish) Recommend on Facebook Tweet ... year. As part of CDC’s Cervical Cancer (Cx3) Study, we surveyed a sample of both health care ...

  18. Clinical effect of Jiaji Point Injection under traction on the treatment of intractable cervical spondyiotic radiculopathy%牵引下行夹脊穴穴位注射治疗顽固性神经根型颈椎病30例临床观察

    Institute of Scientific and Technical Information of China (English)

    曾顺军; 范志勇; 粟漩; 曹淑华

    2011-01-01

    目的 观察牵引状态下行夹脊穴穴位注射治疗顽固性神经根型颈椎病的临床疗效.方法 将60例顽固性神经根型颈椎病患者随机分为2组,治疗组30例在牵引状态下行夹脊穴穴位注射,对照组30例常规予以颈椎病推拿配合颈椎牵引.2组均10 d为1个疗程,1个疗程后统计疗效,随访6个月比较2组复发率.结果 治疗组总有效率93.3%,对照组总有效率73.3%,2组比较差异有统计学意义(P<0.05),治疗组疗效优于对照组.治疗组复发率12.0%,对照组复发率58.8%,2组复发率比较差异有统计学意义(P<0.05),治疗组远期疗效优于对照组.结论 牵引状态下行夹脊穴穴位注射是治疗顽固性神经根型颈椎病的有效的方法.%Objective To observe clinical curative effect of Jiaji point Injection under traction on the treatment of intractable cervical spondylotic radiculopathy. Methods 60 patients with intractable cervical spondylotic radiculopathy patients were randomly divided into treatment group and control group. Treatment group was given Jiaji point Injection under traction. Control group was given routine cervical traction and massage of cervical spondylosis. The course was ted days in two groups. The effect was calculated after a course. For 6 months follow - up recurrence rates of 2 groups was compared. Results The total effective rate in treatment group was 93.3% and 73.3% in control group. There was significant difference( P <0.05). The treatment group was superior to that in control group. The recurrence rate in treatment group( 12.0% ) was lower than that in control group(58.5%, P <0.05 ). Conclusion Jiaji Point Injection under traction was an effective therapy for the treatment of intractable cervical spondylotic radiculopathy.

  19. Single-stage Anterior and Posterior Fusion Surgery for Correction of Cervical Kyphotic Deformity Using Intervertebral Cages and Cervical Lateral Mass Screws: Postoperative Changes in Total Spine Sagittal Alignment in Three Cases with a Minimum Follow-up of Five Years.

    Science.gov (United States)

    Ogihara, Satoshi; Kunogi, Junichi

    2015-01-01

    The surgical treatment of cervical kyphotic deformity remains challenging. As a surgical method that is safer and avoids major complications, the authors present a procedure of single-stage anterior and posterior fusion to correct cervical kyphosis using anterior interbody fusion cages without plating, as illustrated by three consecutive cases. Case 1 was a 78-year-old woman who presented with a dropped head caused by degeneration of her cervical spine. Case 2 was a 54-year-old woman with athetoid cerebral palsy. She presented with cervical myelopathy and cervical kyphosis. Case 3 was a 71-year-old woman with cervical kyphotic deformity following a laminectomy. All three patients underwent anterior release and interbody fusion with cages and posterior fusion with cervical lateral mass screw (LMS) fixation. Postoperative radiographs showed that correction of kyphosis was 39° in case 1, 43° in case 2, and 39° in case 3. In all three cases, improvement of symptoms was established without major perioperative complications, solid fusion was achieved, and no loss of correction was observed at a minimum follow-up of 61 months. We also report that preoperative total spine sagittal malalignment was improved after corrective surgery for cervical kyphosis and was maintained at the latest follow-up in all three cases. The combination of anterior fusion cages and LMS is considered a safe and effective procedure in cases of severe cervical kyphotic deformity. Preoperative total spine sagittal malalignment improved, accompanied by correction of cervical kyphosis, and was maintained at last follow-up in all three cases. PMID:26119893

  20. MRI and PET Imaging in Predicting Treatment Response in Patients With Stage IB-IVA Cervical Cancer

    Science.gov (United States)

    2016-06-24

    Cervical Adenocarcinoma; Cervical Adenosquamous Carcinoma; Cervical Squamous Cell Carcinoma; Cervical Undifferentiated Carcinoma; Recurrent Cervical Carcinoma; Stage IB2 Cervical Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage IIIA Cervical Cancer; Stage IIIB Cervical Cancer; Stage IVA Cervical Cancer

  1. Open-door-Laminoplastie bei zervikaler Myelopathie mithilfe eines Titan-Miniplättchensystems (Arch-Laminoplastie: Erste klinische Erfahrungen

    Directory of Open Access Journals (Sweden)

    Burtscher J

    2009-01-01

    Full Text Available Der Autor berichtet von ersten klinischen Erfahrungen mit einer speziellen Laminoplastietechnik bei Patienten, die an spondylogener zervikaler Myelopathie leiden. Zwischen Juni 2007 und Februar 2009 wurden 20 Patienten mit zervikaler Myelopathie aufgrund einer mehrsegmentalen zervikalen Spondylose und Spinalkanalstenose mithilfe einer speziellen Open-door-Laminoplastietechnik operiert. Diese Technik nützt ein Titan-Miniplättchensystem, um die aufgeklappten Wirbelbögen zu fixieren. Der durchschnittliche postoperative Beobachtungszeitraum beträgt 9 Monate, das durchschnittliche Patientenalter 63 Jahre. Insgesamt wurden 68 Etagen laminoplastiert. Die Klinik der Patienten wurde mithilfe der modifizierten JOA-Skala beurteilt. Die klinische Evaluierung der zervikalen Myelopathie erfolgte vor sowie drei und sechs Monate nach der Operation. Insgesamt sind zwei Patientengruppen mit oben beschriebener Technik chirurgisch versorgt worden. Gruppe 1 umfasst 14 Patienten mit zervikaler Myelopathie ohne klinische und/oder radiologische Zeichen der Instabilität, normaler zervikaler Lordose oder nur relativer Streckstellung der Halswirbelsäule (HWS, aber ohne Kyphose. Gruppe 2 umfasst 6 Patienten, die im Rahmen einer geplanten ventro-dorsalen Operation zuerst laminoplastiert wurden. Im Beobachtungszeitraum ist von den 68 operierten Etagen bei 20 Patienten keines der verwendeten Titan-Miniplättchensysteme disloziert. Klinische Verbesserungen konnten bei allen Patienten nachgewiesen werden. Die Verbesserung der Klinik schwankt zwischen 2 (Minimum und 7 Score-Punkten (Maximum. Die durchschnittliche klinische Verbesserung liegt bei 4,3 Score-Punkten pro Patient. Vier Patienten erholten sich vollständig. Ein Patient aus Gruppe 1 beklagte nach Laminoplastie verstärkte Nackenschmerzen. In Gruppe 1 sind im postoperativen Beobachtungszeitraum keine klinischen und/oder radiologischen Hinweise für Instabilität und Fehlstellungen (Kyphosierung aufgetreten. Die

  2. Mielopatia por deficiência de vitamina B12 apresentando-se como mielite transversa Myelopathy due to vitamin B12 deficiency presenting as transverse myelitis

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    Luiz Felipe Rocha Vasconcellos

    2002-03-01

    Full Text Available As manifestações neurológicas associadas à deficiência de vitamina B12 incluem polineuropatia, mielopatia, demência e neuropatia óptica. O diagnóstico laboratorial é feito através da dosagem sérica de cianocobalamina ou homocisteína e da excreção urinária de ácido metilmalônico. No estudo anatomopatológico observa-se na microscopia a destruição da mielina e de axônios vistos na substância branca. A região mais comumente afetada é o cordão posterior cervical e/ou torácico. O acometimento da coluna lateral é raro, ocorrendo em casos graves e avançados. O tratamento consiste na reposição de vitamina B12 e a resposta depende da gravidade do quadro e do tempo transcorrido entre o inicio dos sintomas e inicio do tratamento. Relatamos o caso de um paciente que apresentou, como manifestação de deficiência de vitamina B12, mielite transversa. O estudo morfológico da medula demonstrou comprometimento dos tractos cortico-espinhais lateral e anterior, da coluna dorsal e ainda do tracto espino-talâmico.Vitamin B12 deficiency may induce neuropathy, myelopathy, dementia and optic neuropathy. The diagnosis is established by vitamin B12, homocysteine and methylmalonic acid measurements. Myelin and axon destruction in the white matter of the spinal cord are observed. The posterior column of the cervical and thoracic level is the most common involved area. The involvement of the anterior column is restricted to advanced and relatively severe cases. Treatment is based on vitamin B12 injections, and the prognosis depends on the stage of vitamin deficiency and deterioration at treatment onset. We report a case with transverse myelitis due to vitamin B12 deficiency. This picture is relatively uncommon, however, we believe patients with transverse myelitis should have vitamin B12 studies as part of the diagnosis work up.

  3. The relation between location of cervical cord compression and the location of myelomalacia

    Energy Technology Data Exchange (ETDEWEB)

    Smorgick, Yossi; Anekstein, Yoram [Assaf Harofeh Medical Center, Spine Unit, Zerifin (Israel); Tel-Aviv University, Sackler Faculty of Medicine, Tel-Aviv (Israel); Tal, Sigal [Assaf Harofeh Medical Center, Department of Radiology, Zerifin (Israel); Yassin, Amit; Tamir, Eran; Mirovsky, Yigal [Department of Orthopedic Surgery, Zerifin (Israel); Tel-Aviv University, Sackler Faculty of Medicine, Tel-Aviv (Israel)

    2015-05-01

    The purpose of this study was to examine the relationship between the location of the cervical cord compression and the increased signal intensity within the cervical cord on T2-weighted imaging (T2WI) in patients with cervical myelopathy and myelomalacia. We reviewed 1,615 MRI reports from January 2011 to May 2013 from a single institution. Of the 1,615 reports reviewed, 168 patients were diagnosed with increased signal intensity within the cervical spine on T2WI. After applying the exclusion criteria 82 patients were included in the study. The MRIs of these 82 patients were then reviewed and the location of the increased signal intensity on T2WI in relation to the location of the pressure on the spinal cord was recorded. In more than 50 % of the cases the lesions with increased signal intensity on T2WI either were located distal to the pressure on the spinal cord or started at the level of the pressure and extended to an area distal to the pressure. In 26 out of the 92 lesions with increased signal intensity on T2WI, the lesion started proximal to the pressure on the spinal cord and extended distal to it. In only 3 out of the 92 lesions, the lesion with increased signal intensity on T2WI was solely located proximal to the pressure on the spinal cord. In 5 other cases the lesion with increased signal intensity on T2WI started proximal to the level of pressure on the spinal cord and extended into the level of pressure on the spinal cord (p < 0.001; Table 1). Cervical myelomalacia may appear proximal, distal or at the level of the compressed cord. It rarely appears solely proximal to the pressure area on the cord. (orig.)

  4. MRI morphometric characterisation of the paediatric cervical spine and spinal cord in children with MPS IVA (Morquio-Brailsford syndrome).

    Science.gov (United States)

    Solanki, Guirish A; Lo, William B; Hendriksz, Christian J

    2013-03-01

    Nearly all children with MPS IVA develop skeletal deformities affecting the spine. At the atlanto-axial spine, odontoid hypoplasia occurs. GAG deposition around the dens, leads to peri-odontoid infiltration. Transverse/alar ligament incompetence causes instability. Atlanto-axial instability is associated with cord compression and myelopathy, leading to major morbidity and mortality. Intervention is often required. Does the presence of widened bullet shaped vertebra in platyspondily encroach on the spinal canal and cause spinal stenosis in MPS IVA? So far, there have been no standardised morphometric measurements of the paediatric MPS IVA cervical spine to evaluate whether there is pre-existing spinal stenosis predisposing to compressive myelopathy or whether this is purely an acquired process secondary to instability and compression. This study provides the first radiological quantitative analysis of the cervical spine and spinal cord in a series of affected children. MRI morphometry indicates that the MPS IVA spine is narrower at C1-2 level giving an inverted funnel shape. There is no evidence of a reduction in the Torg ratio (canal-body ratio) in the cervical spine. The spinal canal does not exceed 11 mm at any level, significantly smaller than normal historical cohorts (14 mm). The sagittal diameter and axial surface area of both spinal canal and cord are reduced. C1-2 level cord compression was evident in the canal-cord ratio but the Torg ratio was not predictive of cord compression. In MPS IVA the reduction in the space available for the cord (SAC) is multifactorial rather than due to congenital spinal stenosis. PMID:23404316

  5. Operative stabilization of the remaining mobile segment in ankylosed cervical spine in systemic onset - juvenile idiopathic arthritis: A case report

    Science.gov (United States)

    Suhodolčan, Lovro; Mihelak, Marko; Brecelj, Janez; Vengust, Rok

    2016-01-01

    We describe a case of a 19-year-old young man with oligoarthritis type of juvenile idiopathic arthritis, who presented with several month duration of lower neck pain and progressive muscular weakness of all four limbs. X-rays of the cervical spine demonstrated spontaneous apophyseal joint fusion from the occipital condyle to C6 and from C7 to Th2 with marked instability between C6 and C7. Surgical intervention began with anterolateral approach to the cervical spine performing decompression, insertion of cage and anterior vertebral plate and screws, followed by posterior approach and fixation. Care was taken to restore sagittal balance. The condition was successfully operatively managed with multisegmental, both column fixation and fusion, resulting in pain cessation and resolution of myelopathy. Postoperatively, minor swallowing difficulties were noted, which ceased after three days. Patient was able to move around in a wheelchair on the sixth postoperative day. Stiff neck collar was advised for three months postoperatively with neck pain slowly decreasing in the course of first postoperative month. On the follow-up visit six months after the surgery patient exhibited no signs of spastic tetraparesis, X-rays of the cervical spine revealed solid bony fusion at single mobile segment C6-C7. He was able to gaze horizontally while sitting in a wheelchair. Signs of myelopathy with stiff neck and single movable segment raised concerns about intubation, but were successfully managed using awake fiber-optic intubation. Avoidance of tracheostomy enabled us to perform an anterolateral approach without increasing the risk of wound infection. Regarding surgical procedure, the same principles are obeyed as in management of fracture in ankylosing spondylitis or Mb. Forestrier. PMID:27458558

  6. Operative stabilization of the remaining mobile segment in ankylosed cervical spine in systemic onset - juvenile idiopathic arthritis: A case report.

    Science.gov (United States)

    Suhodolčan, Lovro; Mihelak, Marko; Brecelj, Janez; Vengust, Rok

    2016-07-18

    We describe a case of a 19-year-old young man with oligoarthritis type of juvenile idiopathic arthritis, who presented with several month duration of lower neck pain and progressive muscular weakness of all four limbs. X-rays of the cervical spine demonstrated spontaneous apophyseal joint fusion from the occipital condyle to C6 and from C7 to Th2 with marked instability between C6 and C7. Surgical intervention began with anterolateral approach to the cervical spine performing decompression, insertion of cage and anterior vertebral plate and screws, followed by posterior approach and fixation. Care was taken to restore sagittal balance. The condition was successfully operatively managed with multisegmental, both column fixation and fusion, resulting in pain cessation and resolution of myelopathy. Postoperatively, minor swallowing difficulties were noted, which ceased after three days. Patient was able to move around in a wheelchair on the sixth postoperative day. Stiff neck collar was advised for three months postoperatively with neck pain slowly decreasing in the course of first postoperative month. On the follow-up visit six months after the surgery patient exhibited no signs of spastic tetraparesis, X-rays of the cervical spine revealed solid bony fusion at single mobile segment C6-C7. He was able to gaze horizontally while sitting in a wheelchair. Signs of myelopathy with stiff neck and single movable segment raised concerns about intubation, but were successfully managed using awake fiber-optic intubation. Avoidance of tracheostomy enabled us to perform an anterolateral approach without increasing the risk of wound infection. Regarding surgical procedure, the same principles are obeyed as in management of fracture in ankylosing spondylitis or Mb. Forestrier. PMID:27458558

  7. MRI morphometric characterisation of the paediatric cervical spine and spinal cord in children with MPS IVA (Morquio-Brailsford syndrome).

    Science.gov (United States)

    Solanki, Guirish A; Lo, William B; Hendriksz, Christian J

    2013-03-01

    Nearly all children with MPS IVA develop skeletal deformities affecting the spine. At the atlanto-axial spine, odontoid hypoplasia occurs. GAG deposition around the dens, leads to peri-odontoid infiltration. Transverse/alar ligament incompetence causes instability. Atlanto-axial instability is associated with cord compression and myelopathy, leading to major morbidity and mortality. Intervention is often required. Does the presence of widened bullet shaped vertebra in platyspondily encroach on the spinal canal and cause spinal stenosis in MPS IVA? So far, there have been no standardised morphometric measurements of the paediatric MPS IVA cervical spine to evaluate whether there is pre-existing spinal stenosis predisposing to compressive myelopathy or whether this is purely an acquired process secondary to instability and compression. This study provides the first radiological quantitative analysis of the cervical spine and spinal cord in a series of affected children. MRI morphometry indicates that the MPS IVA spine is narrower at C1-2 level giving an inverted funnel shape. There is no evidence of a reduction in the Torg ratio (canal-body ratio) in the cervical spine. The spinal canal does not exceed 11 mm at any level, significantly smaller than normal historical cohorts (14 mm). The sagittal diameter and axial surface area of both spinal canal and cord are reduced. C1-2 level cord compression was evident in the canal-cord ratio but the Torg ratio was not predictive of cord compression. In MPS IVA the reduction in the space available for the cord (SAC) is multifactorial rather than due to congenital spinal stenosis.

  8. Immunotherapy for Cervical Cancer

    Science.gov (United States)

    In an early phase NCI clinical trial, two patients with metastatic cervical cancer had a complete disappearance of their tumors after receiving treatment with a form of immunotherapy called adoptive cell transfer.

  9. Cervical motion segment replacement

    OpenAIRE

    Bryan, Vincent E.

    2002-01-01

    When symptoms bring to light a cervical spine degenerative disc process that requires surgical intervention, a symptom relieving procedure such as decompression, followed by functional restoration, arthroplasty, offers the benefit of prophylaxis of accelerated spondylosis at the operated level. In addition, by altering the biomechanical stress factors at adjacent levels, theoretically it should offer prophylactic benefit at these levels as well. The design requirements for a cervical disc pro...

  10. Radiation myelopathy in patients treated for carcinoma of bronchus using a six fraction regime of radiotherapy

    International Nuclear Information System (INIS)

    The adoption of a six-fraction regime of radiotherapy for patients with locally advanced carcinoma of the bronchus was followed by the appearance of radiation myelitis in eight cases. These were among a group of 130 patients given radiotherapy with anterior and posterior treatment fields, without shielding of the spinal cord. Radiation myelitis was found only in those where the calculated spinal-cord dose exceeded 3350 cGy(rad). The possible precipitating factors in the eight patients who suffered myelopathy were compared with those in the remaining 62 patients who also received spinal-cord doses calculated to be greater than 3350 cGy(rad). Only one difference was found - the haemoglobin concentration was significantly higher in those who suffered neuropathy compared with those who did not (P=0.05). (U.K.)

  11. Wall-eyed bilateral internuclear ophthalmoplegia (webino syndrome and myelopathy in pyoderma gangrenosum

    Directory of Open Access Journals (Sweden)

    Marco Aurélio Lana

    1990-12-01

    Full Text Available A 35-year-old female with pyoderma gangrenosum developed paraparesis with a sensory level at L1. Three months later she complained of diplopia and was found to have bilateral internuclear ophthalmoplegia with exotropia and no ocular convergence. The term Webino syndrome has been coined to design this set of neuro-opthalmologic findings. Although it was initially attributed to lesions affecting the medial longitudinal fasciculus and the medial rectus subnuclei of the oculomotor complex in the midbrain the exact location of the lesion is still disputed. In the present case both myelopathy and Webino syndrome were probably due to vascular occlusive disease resulting from central nervous system vasculitis occurring in concomitance to pyoderma gangrenosum.

  12. Case of chronic progressive radiation myelopathy with a CT myelogram simulating intramedullary tumor

    Energy Technology Data Exchange (ETDEWEB)

    Kanemaru, Kazutomi; Kamo, Hisaki; Yamao, Satoshi; Akiguchi, Ichiro; Kameyama, Masakuni

    1985-05-01

    A 58-year-old man underwent a right middle lobectomy in June, 1975, for poorly differentiated adenocarcinoma of the lung. Postoperative irradiation was given to the hilus (6100 rads), and to the right supraclavicular area (6000 rads). In 1980, 60 months after completion of irradiation, the patient noticed weakness of his legs particularly on the left side. In 1982, he noticed the girdle sensation in the upper thoracic region, and paresthesia in the lateral side of the right thigh. In Dec 1983, micturition disturbance appeared, and gait disturbance progressed, he was admitted to the Kyoto University Hospital. Neurological examination revealed an incomplete left Brown-Sequard syndrome with diminution of pain and thermal sensation on the right lower limb, and weakness and spasticity particularly on the left lower limb. Conventional myelogram with CT myelogram showed spinal cord swelling from T-2 through T-5. No extramedullary lesion was found. Laminectomy was performed through T-1 to T-6. When the dura was opened, the cord was swollen and necrotic with a cyst formation. Microscopic examination of the thickened part of the cord showed necrosis and gliosis. The lesion was correspond to the cord segments exposed to the radiation, and a diagnosis of radiation myelopathy was made. Several cases of radiation myelopathy with definite swelling of the cord at myelography were reported, but myelography in these cases was performed at most within 11 months after the onset. In this case, myelography was performed three years after the onset, and revealed difinite swelling of the cord due to a cyst formation. (author).

  13. Cervical syphilitic lesions mimicking cervical cancer: a rare case report

    Directory of Open Access Journals (Sweden)

    Xiaoqing Zhu

    2015-02-01

    Full Text Available A woman presented to the hospital due to postcoital vaginal bleeding. The patient was initially diagnosed with cervical carcinoma by clinicians at a local hospital. However, a biopsy of the cervical lesions revealed chronic inflammation and erosion of the cervical mucosa, and the rapid plasma reagin ratio titer was 1:256. The patient was eventually diagnosed with syphilitic cervicitis and treated with minocycline 0.1 g twice a day. The patient was cured with this treatment.

  14. Eight years of follow-up after laminectomy of calcium pyrophosphate crystal deposition in the cervical yellow ligament of patient with Coffin–Lowry syndrome

    Science.gov (United States)

    Morino, Tadao; Ogata, Tadanori; Horiuchi, Hideki; Yamaoka, Shintaro; Fukuda, Mitsumasa; Miura, Hiromasa

    2016-01-01

    Abstract Background: We report 8 years of follow-up after decompression to treat cervical myelopathy in a patient with Coffin–Lowry syndrome (CLS). CLS is a rare X-linked semidominant syndrome associated with growth and psychomotor retardation, general hypotonia, and skeletal abnormalities. In this patient, the spinal cord was compressed by calcium pyrophosphate crystal deposition in the cervical yellow ligament (YL). To date, only 1 report has described clinical features after surgery for calcified cervical YL in CLS. Methods: A 15-year-old male with tetraplegia secondary to compression of the cervical spinal cord induced by a hypoplastic posterior arch of C1 and calcification of the YL from C2 to C7 was treated surgically with laminectomy from C1 to C7. The patient's history, clinical examination, imaging findings, and treatment are reported. The patient was incapable of speech because of mental retardation, so he could not describe his symptoms. Gait disturbance worsened over the 2 months before admission to our hospital. At admission, the patient could not move his extremities, and tendon reflexes of the upper and lower extremities were significantly increased. Computed tomography of the cervical spine showed YL calcification from C2 to C7. Magnetic resonance imaging showed consecutive compression of the cervical spinal cord. We diagnosed quadriplegia secondary to cervical cord damage and performed emergency surgery. Results: During C1–C7 laminectomy, YL calcification in C2–C7 was observed. The calcification was confirmed as calcium pyrophosphate by crystal analysis. Quadriplegia gradually resolved, and almost disappeared by 2 weeks after the operation. Cervical hyperlordosis was observed in radiographs starting from 1 month after the operation, but it has not progressed and is not associated with any symptoms. Conclusions: The efficacy of decompression continued, and no postoperative complications have occurred during at least 8 years of follow-up. PMID

  15. Treatment of 100 Cases of Cervical Spondylotic Radiculopathy by Electroacupuncture of Jiaji (Ex-B2) plus Oblique Needling Ashi Point

    Institute of Scientific and Technical Information of China (English)

    LI Xiao-qing; ZHOU Wei-guang

    2006-01-01

    One hundred patients were diagnosed with cervicalspondylotic radiculopathy definitely by symptoms, signs and X-ray examination. The therapeutic method was acupuncture of Jiaji(Ex-B 2) on the affected segment and the upper and lower vertebrae close together. After the arrival of qi, the needles were connected to acupuncture therapeutic instrument. Meanwhile, the numb, heavy and uncomfortable area on the shoulder and upper limb, where something like cord could be touched, was selected as Ashi point. The needle was inserted perpendicularly into the skin on the place that the cord was most obvious and inserted obliquely and deeply along the cord. After 3-4 courses of treatment, 90 cases got marked effectiveness and 10 cases got effectiveness.%100例患者经症状,体征和X线检查确诊为神经根型颈椎病,治疗方法是针刺病变节段及上下相邻两节脊椎夹脊穴得气后,接针灸治疗仪,同时在肩部及上肢选取麻、沉不适区,触及条索状物,为阿是穴,从条索最明显处垂直刺入皮肤,沿条索纵向斜刺深入.3~4疗程后显效90例,有效10例.

  16. Human Papillomavirus and Cervical Cancer

    OpenAIRE

    D. Jenkins(University of York, UK)

    2003-01-01

    Of the many types of human papillomavirus (HPV), more than 30 infect the genital tract. The association between certain oncogenic (high-risk) strains of HPV and cervical cancer is well established. Although HPV is essential to the transformation of cervical epithelial cells, it is not sufficient, and a variety of cofactors and molecular events influence whether cervical cancer will develop. Early detection and treatment of precancerous lesions can prevent progression to cervical cancer. Ident...

  17. INTERFERON BETA-1A TREATMENT IN HTLV-1-ASSOCIATED MYELOPATHY/TROPICAL SPASTIC PARAPARESIS: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Graça Maria de Castro Viana

    2014-09-01

    Full Text Available Here a young patient (< 21 years of age with a history of infective dermatitis is described. The patient was diagnosed with myelopathy associated with HTLV-1/tropical spastic paraparesis and treated with interferon beta-1a. The disease was clinically established as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP, and laboratory tests confirmed the presence of antibodies to HTLV-1 in the cerebrospinal fluid (CSF. Mumps, cytomegalovirus, Epstein-Barr virus, schistosomiasis, herpes virus 1 and 2, rubella, measles, varicella-zoster toxoplasmosis, hepatitis, HIV, and syphilis were excluded by serology. The patient was diagnosed with neurogenic bladder and presented with nocturia, urinary urgency, paresthesia of the lower left limb, a marked reduction of muscle strength in the lower limbs, and a slight reduction in upper limb strength. During the fourth week of treatment with interferon beta-1a, urinary urgency and paresthesia disappeared and clinical motor skills improved.

  18. Deep cervical infection?

    Directory of Open Access Journals (Sweden)

    Bernardo T

    2012-06-01

    Full Text Available Introduction: Inflammatory cervical swelling may have several causes. The jugular vein thrombosis is a rare entity, often forgotten. Most frequently arises due to a cervical sepsis by the use of a central venous catheter or intravenous drug abuse (drug addicts. Rarely, is secondary to a hypercoagulability state associated with a visceral carcinoma (Trousseau Syndrome. Material and Methods: The authors present the case of a 65 years old male, who used the ENT Emergency Service due to a painful left cervical swelling with local and systemic inflammatory signs of 3 days duration. Results: An cervical ultrasound suggested a neck abscess. CT was performed and confirmed the ultrasound results. Because of its location in the path of the internal jugular vein, we requested re-evaluation by CT with intravenous contrast and doppler ultrasound, obtaining the diagnosis of thrombosis of the internal jugular vein. Further studies were conduct to clarify the hypercoagulability state, since the patient had no known predisposing factor. Finally the diagnosis of unresectable gastric carcinoma was made. Discussion and Conclusion: The ENT must be aware and be able to understand any cervical imagiologic studies. A deep knowledge of the anatomical imagiología is important for the diagnosis of jugular thrombosis. When we have a case of spontaneous jugular thrombosis, we must look for possible visceral carcinoma.

  19. Contribution of Galvanic Vestibular Stimulation for the Diagnosis of HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis

    OpenAIRE

    Matos Cunha, Luciana Cristina; Campelo Tavares, Maurício; Tierra Criollo, Carlos Julio; Labanca, Ludimila; Cardoso dos Santos Couto Paz, Clarissa; Resende Martins, Henrique; de Freitas Carneiro-Proietti, Anna Bárbara; Utsch Goncalves, Denise

    2013-01-01

    Background and Purpose Galvanic vestibular stimulation (GVS) is a low-cost and safe examination for testing the vestibulospinal pathway. Human T-lymphotropic virus 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a slowly progressive disease that affects the vestibulospinal tract early in its course. This study compared the electromyographic (EMG) responses triggered by GVS of asymptomatic HTLV-1-infected subjects and subjects with HAM/TSP. Methods Bipolar galvanic s...

  20. The degenerative cervical spine.

    Science.gov (United States)

    Llopis, E; Belloch, E; León, J P; Higueras, V; Piquer, J

    2016-04-01

    Imaging techniques provide excellent anatomical images of the cervical spine. The choice to use one technique or another will depend on the clinical scenario and on the treatment options. Plain-film X-rays continue to be fundamental, because they make it possible to evaluate the alignment and bone changes; they are also useful for follow-up after treatment. The better contrast resolution provided by magnetic resonance imaging makes it possible to evaluate the soft tissues, including the intervertebral discs, ligaments, bone marrow, and spinal cord. The role of computed tomography in the study of degenerative disease has changed in recent years owing to its great spatial resolution and its capacity to depict osseous components. In this article, we will review the anatomy and biomechanical characteristics of the cervical spine, and then we provide a more detailed discussion of the degenerative diseases that can affect the cervical spine and their clinical management. PMID:26878769

  1. Single level cervical disc herniation: A questionnaire based study on current surgical practices

    Directory of Open Access Journals (Sweden)

    Abrishamkar Saeid

    2009-01-01

    Full Text Available Background: Operative procedures like simple discectomy, with or without fusion and with or without instrumentation, for single level cervical disc herniation causing neck pain or neurological compromise have been described and are largely successful. However, there is a debate on definitive criteria to perform fusion (with or without instrumentation for single level cervical disc herniation. Hence, we conducted a questionnaire based study to elicit the opinions of practicing neurosurgeons. Materials and Methods: About 148 neurosurgeons with atleast 12 years of operative experience on single level cervical disc herniation, utilizing the anterior approach, were enrolled in our study. All participating neurosurgeons were asked to complete a practice based questionnaire. The responses of 120 neurosurgeons were analysed. Results: The mean age of enrolled surgeons was 51 yrs (range 45-73 with mean surgical experience of 16.9 yrs (range 12-40 yrs on single level cervical disc herniation. Out of 120 surgeons 10(8% had 15-25 years experience and always preferred fusion with or without instrumentation and six (five per cent with 17-27 yrs experience had never used fusion techniques. However, 104 (87% surgeons with 12-40 yrs experience had their own criteria based on their experiences for performing fusion with graft and instrumentation (FGI, while. 85 (75% preferred auto graft with cage. Conclusions: Most of surgeons performed FGI before the age of 40, but for others, patient criteria such as job (heavier job, physical examination (especially myelopathy and imaging findings (mild degenerative changes on X-ray and signal change in the spinal cord on MRI were considered significant for performing FGI.

  2. Cervical spine chordoma

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    Díez-González L

    2012-03-01

    Full Text Available Chordomas are neoplasms that arise from notochord embryonic remnants, been the sacrococcygeal spine the main site of involvement; the cervical spine site is uncommon and it account for less than 10% of chordomas. Because of their slow growth, the diagnosis is delayed until they reach a large size, despite which they are locally aggressive tumours due to their relation to critical neurovascular structures and present a high rate of local recurrence. Radical surgery is the elective treatment and proton radiotherapy is used when residual tumour tissue and recurrences.Because of the uncommonness of this pathology, we report a case of a patient with cervical chordoma.

  3. CERVICAL NECROTIZING FASCIITIS

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    G. Dimofte

    2009-05-01

    Full Text Available Cervical necrotizing fasciitis is an unusual encounter in the general surgical practice, but is a life-threatening condition requiring early recognition and adequate surgical treatment. We present the case of a 65 year old male patient referred to our department from a General Hospital. Large excisions of both superficial and deep cervical fascia were required together with necrotic skin on a very large surface. Rapid recovery with early sterilization allowed adequate skin grafting with good results. We advocate for aggressive debridment with excision in viable healthy tissue, with no concern for the future reconstruction followe by early grafting of the skin defect.

  4. Prevent Cervical Cancer

    Science.gov (United States)

    ... Risk? What Are the Symptoms? What Should I Know About Screening? Statistics Related Links Inside Knowledge Campaign What CDC Is Doing Research AMIGAS Fighting Cervical Cancer Worldwide Stay Informed Printable Versions Standard quality PDF [PDF-877KB] High-quality PDF for professional ...

  5. Prevent Cervical Cancer!

    Centers for Disease Control (CDC) Podcasts

    2015-01-08

    Cervical cancer can be prevented. Listen as two friends—one a doctor—talk about screening tests and early detection. Learn what test you might need.  Created: 1/8/2015 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 1/8/2015.

  6. Cervical silicone lymphadenopathy.

    Science.gov (United States)

    Gilbert, Latoni Kaysha; Thiruchelvam, Janavikulam

    2016-07-01

    A patient presented to the department of oral and maxillofacial surgery with a rare case of cervical silicone lymphadenopathy. She had a painless ovoid mass in the left side of her neck and had had cosmetic breast augmentation 10 years before. Radiological imaging and core biopsy examination were consistent with silicone lymphadenopathy. PMID:26830068

  7. Proprioceptive neuromuscular facilitation in HTLV-I-associated myelopathy/tropical spastic paraparesis

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    Vera Lúcia Santos de Britto

    2014-01-01

    Full Text Available Introduction: Human T cell lymphotropic virus type I-associated myelopathy/tropical spastic paraparesis (HAM/TSP can impact the independence and motricity of patients. The aims of this study were to estimate the effects of physiotherapy on the functionality of patients with HAM/TSP during the stable phase of the disease using proprioceptive neuromuscular facilitation (PNF and to compare two methods of treatment delivery. Methods: Fourteen patients with human T cell lymphotropic virus type I (HTLV-I were randomly allocated into two groups. In group I (seven patients, PNF was applied by the therapist, facilitating the functional activities of rolling, sitting and standing, walking and climbing and descending stairs. In group II (seven patients, PNF was self-administered using an elastic tube, and the same activities were facilitated. Experiments were conducted for 1h twice per week for 12 weeks. Low-back pain, a modified Ashworth scale, the functional independence measure (FIM and the timed up and go test (TUG were assessed before and after the interventions. Results: In the within-group evaluation, low-back pain was significantly reduced in both groups, the FIM improved in group II, and the results of the TUG improved in group I. In the inter-group analysis, only the tone was lower in group II than in group I. Conclusions: Both PNF protocols were effective in treating patients with HAM/TSP.

  8. Etanercept-Induced Myelopathy in a Pediatric Case of Blau Syndrome

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    Fabiola Caracseghi

    2011-01-01

    Full Text Available Blau syndrome is a rare autoinflammatory disorder within the group of pediatric granulomatous diseases. Mutations in nucleotide-binding oligomerization domain 2 (NOD2/CARD15 are responsible for this condition, which has an autosomal dominant pattern of inheritance and variable expressivity. The clinical picture includes arthritis, uveitis, skin rash, and granulomatous inflammation. Central nervous system involvement is seldom reported, although some isolated cases of seizures, neurosensorial hearing loss, and transient cranial nerve palsy have been described. Treatment consists of nonsteroidal anti-inflammatory drugs, corticosteroids, and immunosuppressive agents, among which anti-tumor-necrosis-factor-alpha (TNF-α biologic agents, such as etanercept, play an important role. Among the major adverse effects of TNF-α inhibitors, demyelinating disease, multiple sclerosis, and acute transverse myelitis have been reported in adults. We describe a case of pediatric Blau syndrome affected by etanercept-induced myelopathy, manifesting as a clinical syndrome of transverse myelitis. The patient experienced rapid recovery after etanercept was discontinued. To our knowledge, this is the first such case reported in the literature and, possibly, the one with the latest onset, following 8 years of treatment. We discuss the etiopathogenic mechanisms of this reaction and possible explanations for the imaging findings.

  9. Psychogenic movement disorder in human T-lymphotropic virus type 1 associated myelopathy

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    Marzia Puccioni-Sohler

    2016-01-01

    Full Text Available Human T-lymphotropic virus type 1 (HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP is a chronic inflammatory disorder of the spinal cord. Acute cases of HAM/TSP and those complicated by movement disorders are rarely reported. Otherwise, psychiatric disturbances are very frequent in infected patients. It can evolve to psychogenic disorders. The case of a 46-year-old woman with acute HAM/TSP complicated by depression and psychogenic movement disorders (chorea of the hands and dystonia-like facial symptoms is reported. Brain magnetic resonance imaging revealed non-specific small white matter lesions. The involuntary movements arose suddenly and disappeared when the patient was distracted. Two years of psychotherapy and psychiatric follow-up induced complete remission of the symptoms. The association of psychogenic movement disorders and HAM/TSP, increasing the range of neurological manifestations associated with HTLV-1, is related here. Early diagnosis of psychogenic movement disorders is very important to improve the prognosis and treatment of the two conditions, thereby improving the quality of life of HAM/TSP patients and avoiding irreversible sequelae.

  10. Possible etiologies for tropical spastic paraparesis and human T lymphotropic virus I-associated myelopathy

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    V. Zaninovic'

    2004-01-01

    Full Text Available The epidemiology of tropical spastic paraparesis/human T lymphotropic virus I (HTLV-I-associated myelopathy (TSP/HAM is frequently inconsistent and suggests environmental factors in the etiology of these syndromes. The neuropathology corresponds to a toxometabolic or autoimmune process and possibly not to a viral disease. Some logical hypotheses about the etiology and physiopathology of TSP and HAM are proposed. Glutamate-mediated excitotoxicity, central distal axonopathies, cassava, lathyrism and cycad toxicity may explain most cases of TSP. The damage caused to astrocytes and to the blood-brain barrier by HTLV-I plus xenobiotics may explain most cases of HAM. Analysis of the HTLV-I/xenobiotic ratio clarifies most of the paradoxical epidemiology of TSP and HAM. Modern neurotoxicology, neuroimmunology and molecular biology may explain the neuropathology of TSP and HAM. It is quite possible that there are other xenobiotics implicated in the etiology of some TSP/HAMs. The prevention of these syndromes appears to be possible today.

  11. Cervical spinal canal narrowing and cervical neurologi-cal injuries

    OpenAIRE

    Zhang, Ling; Chen, Hai-Bin; Wang, Yi; ZHANG Li-ying; Liu, Jing-cheng; WANG Zheng-guo

    2012-01-01

    【Abstract】Cervical spinal canal narrowing can lead to injury of the spinal cord and neurological symptoms in-cluding neck pain, headache, weakness and parasthesisas. According to previous and recent clinical researches, we investigated the geometric parameters of normal cervical spinal canal including the sagittal and transverse diameters as well as Torg ratio. The mean sagittal diameter of cervical spinal canal at C 1 to C 7 ranges from 15.33 mm to 20.46 mm, ...

  12. Cetuximab, Cisplatin, and Radiation Therapy in Treating Patients With Stage IB, Stage II, Stage III, or Stage IVA Cervical Cancer

    Science.gov (United States)

    2014-12-29

    Cervical Adenocarcinoma; Cervical Adenosquamous Carcinoma; Cervical Small Cell Carcinoma; Cervical Squamous Cell Carcinoma; Stage IB Cervical Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage IVA Cervical Cancer

  13. Cisplatin and Radiation Therapy Followed by Paclitaxel and Carboplatin in Treating Patients With Stage IB-IVA Cervical Cancer

    Science.gov (United States)

    2016-03-16

    Cervical Adenocarcinoma; Cervical Adenosquamous Carcinoma; Cervical Squamous Cell Carcinoma; Stage IB Cervical Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage IIIA Cervical Cancer; Stage IIIB Cervical Cancer; Stage IVA Cervical Cancer

  14. Operations for cervical incompetence.

    Science.gov (United States)

    Branch, D W

    1986-06-01

    At present, cervical cerclage is indicated in those patients with a classic history of cervical incompetence. For the majority of these patients, a postconceptional cerclage procedure is better suited because it is done after the fetus has been evaluated ultrasonographically for obvious abnormalities and after the risk for spontaneous abortion is past. The greatest experience is with the Shirodkar and the McDonald procedures; allowing for operator differences, neither appears to have an important advantage. The transabdominal cervicoisthmic cerclage may be a useful postconceptional procedure in the selected patient whose cervix is either markedly foreshortened, deeply lacerated, or infected. Preconceptional cerclages are best reserved for those rare patients in whom a markedly foreshortened incompetent cervix is associated with early second-trimester pregnancy losses (preconceptional isthmic cerclage) or in whom the cervix has a single, identifiable scar or deep laceration extending through the internal os (Lash procedure). PMID:3522005

  15. Surgical treatment of cervical disc herniation%颈椎间盘突出症的手术治疗

    Institute of Scientific and Technical Information of China (English)

    吴洁石; 包聚良; 徐瑞生; 陆华; 王刊石; 王雪松; 薛骏

    2012-01-01

    目的 探讨颈椎间盘突出症的临床病理特点、临床分型及手术要点.方法 回顾性分析1999年1月至2010年10月接受手术治疗的颈椎间盘突出症患者的临床资料.结果 颈椎间盘突出症128例,均经手术治疗.其中脊髓型96例,神经根型22例,混合型10例.脊髓型和混合型颈椎间盘突出症使用JOA评分,由术前(12.30±1.05)分至术后(16.70±1.11)分.神经根型颈椎间盘突出症使用VSA评分:由术前(8.10±1.37)分至术后(0.30±0.19)分.结论 认识其游离压迫物和硬膜囊、后纵韧带、神经结构之间的相互关系,正确选择手术方案和手术细节可以确保手术安全性和有效率.%Objective To study the pathology,clinical classification and surgical treatment of cervical disc herniation.Methods The clinical data of patients of cervical disc herniation from January 1999 to October 2010 were collected.Results All the 128 cases of cervical disc herniation were surgically treated.Among the 128 cases,96 cases with myelopathy,22 cases with radiculopathy and 10 cases with both.JOA and VSA scores were used to evaluate the surgical effectiveness respectively for myelopathy and radiculopathy.JOA score was improved from 12.30 ± 1.05 before to 16.70 ± 1.11after operation.VSA score was improved from 8.10 ± 1.37 before to 0.30 ±0.19 after operation.Conclusions The high safety and effectiveness of surgery for cervical disc herniation could be achieved both by the awareness of the pathological characteristics of how the sequestrated disc materical relates to the nerve structure in the canal and by paying attention to specific operation details.

  16. [Preventing cervical cancer].

    Science.gov (United States)

    Simon, P; Noël, J-C

    2015-09-01

    The incidence of cervical cancer has hopefully been dropping down in our industrialized countries since the introduction of both primary and secondary prevention. Nevertheless, it is still lethal in one out of two affected women though the introduction of cytological screening has dramatically reduced the mortality. Progressive diffusion of anti-HPV vaccination, the broadening of the viral types concerned, its association with existing screening measures and finally the introduction of viral detection as a screening tool must optimize the results already obtained.

  17. SUPERFICIAL CERVICAL PLEXUS BLOCK

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    Komang Mega Puspadisari

    2014-01-01

    Full Text Available Superficial cervical plexus block is one of the regional anesthesia in  neck were limited to thesuperficial fascia. Anesthesia is used to relieve pain caused either during or after the surgery iscompleted. This technique can be done by landmark or with ultrasound guiding. The midpointof posterior border of the Sternocleidomastoid was identified and the prosedure done on thatplace or on the level of cartilage cricoid.

  18. Case Studies - Cervical Cancer

    Centers for Disease Control (CDC) Podcasts

    2010-10-15

    Dr. Alan Waxman, a professor of obstetrics and gynecology at the University of New Mexico and chair of the American College of Obstetricians and Gynecologists (ACOG) committee for the underserved, talks about several case studies for cervical cancer screening and management.  Created: 10/15/2010 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Division of Cancer Prevention and Control (DCPC).   Date Released: 6/9/2010.

  19. Future Directions - Cervical Cancer

    Centers for Disease Control (CDC) Podcasts

    2009-10-15

    Dr. Alan Waxman, a professor of obstetrics and gynecology at the University of New Mexico and chair of the American College of Obstetricians and Gynecologists (ACOG) committee for the underserved, talks about possible changes in cervical cancer screening and management.  Created: 10/15/2009 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Division of Cancer Prevention and Control (DCPC).   Date Released: 6/9/2010.

  20. [Pediatric orthopedic cervical spine problems].

    Science.gov (United States)

    Helenius, Ilkka

    2016-01-01

    Treatment-requiring diseases of the cervical spine in children are rare. The most common cases requiring medical assessment and treatment are acute torticollis and various accidents. A torticollis having lasted for more than a week should be recognized, because it can be treated by skull traction. Cervical spine fractures in children under school age are very rare, the most common being a fracture of the base of the dens of the second cervical vertebra. Cervical spine instability is almost always associated with an underlying disease. PMID:27400588

  1. Subacute post-traumatic ascending myelopathy (SPAM: Two cases of SPAM following surgical treatment of thoracolumbar fractures

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    Kamran Farooque

    2014-01-01

    Full Text Available To report two cases of traumatic paraplegia who developed Sub-acute Post-Traumatic Ascending Myelopathy (SPAM following surgical decompression.We hereby report two cases (both 35yr old male with traumatic paraplegia that developed ascending weakness at 3rd and 5th Post-Op day respectively following surgical decompression. Both the patients experienced remarkable improvement in Neurology after treatment with steroids. The authors conclude by emphasizing on minimum cord handling during surgical decompression of the spinal cord to avoid this potentially life threatening complication.

  2. Significance of cervical length and cervical gland area in cervical maturation

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    Channaveeregowda Savitha

    2016-08-01

    Results: Amongst 160 pregnant women who were induced (20 women were excluded has they underwent LSCS for some other reasons during latent phase cervical length by sonography 4. Cervical length 4. Conclusions: Sonographically detected cervical gland area and cervical length was evaluated in predicting response to induction. Absent CGA and CL < 2cm was associated with greater incidence of successful labor induction. This results show the CL and CGA has significant role in predicting outcome of labor. [Int J Reprod Contracept Obstet Gynecol 2016; 5(8.000: 2634-2639

  3. Urodynamic profile of patients with neurogenic bladder following non-traumatic myelopathies

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    Anupam Gupta

    2013-01-01

    Full Text Available Objective: To observe the urodynamic profile of the patients following non-traumatic myelopathies (NTMs with neurogenic bladder. Setting: Neurological rehabilitation department of university tertiary research hospital. Materials and Methods: Seventy-nine patients (44 men with monophasic NTM, with the age range 8-65 years (31.0 ± 16.0 years, were admitted for inpatients′ rehabilitation. Length of stay in rehabilitation ranged from 6 to 120 days (32.0 ± 24.8 days. Fifty-six patients (70.9% had spinal lesion above D10, 17 had lesion between D10 and L2 (21.5%, and 6 (7.6% had cauda equina syndrome. All patients had neurogenic bladder with urinary complaints. Urodynamic study (UDS was performed in all patients. Results: UDS showed 71.4% patients (40/56 had neurogenic detrusor overactivity (NDO with or without sphincter dyssynergy (DSD with lesion above D10; only 52.9% patients (9/17 had NDO with or without DSD detrusor with lesion between D10 and L2; and majority (5/6 patients had underactive detrusor in the cauda equina group. Bladder management was based on the UDS findings. No significant correlation was found (P > 0.05 between detrusor behavior and the level, severity (ASIA Impairment Scale of spinal injury, or gender using chi-square test. Conclusions: Neurogenic bladder following NTM was observed in all patients. UDS suggested predominantly NDO in lesions above D10 and mixed pattern in between D10 and L2 lesions. No significant correlation was found between detrusor behavior and the level or severity of NTM in the study.

  4. Genetic testing of canine degenerative myelopathy in the South African Boxer dog population

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    Gareth E. Zeiler

    2013-02-01

    Full Text Available Canine degenerative myelopathy (DM is a progressive disease process that is diagnosed late in life and mainly affects the pelvic limbs. Factors that make an ante-mortem definitive diagnosis of DM include: an insidious onset and clinical manifestation that mimics other disease processes of the pelvic limbs (hip dysplasia, cranial cruciate ligament rupture, etc. or there may even be concurrent disease processes, old-age onset and lack of reliable diagnostic methods. Until recently, South African dog owners had to submit samples to laboratories overseas for genetic testing in order to confirm an affected dog (homozygous A/A and to aid in the ante-mortem diagnosis of DM. Only affected dogs have been confirmed to manifest the clinical signs of DM. This study aimed to verify whether genetic testing by a local genetic laboratory was possible in order to detect a missense mutation of the superoxide dismutase gene (SOD1 that is implicated in causing the clinical signs of DM. The study also aimed to detect and map the inheritance of this disease process in a local Boxer dog population where the pedigree of the sampled population was known. Venous blood collected from Boxer dogs using a simple random sampling technique. The samples were genotyped for the SOD1:c.118G>A polymorphism. Carrier and affected Boxer dogs were detected. A pedigree that demonstrated the significance of inheriting a carrier or affected state in the population was mapped. The present study concludes that genotyping of the missense mutation in Boxer dogs is possible in South Africa. There are carrier and affected Boxer dogs in the local population, making DM a plausible diagnosis in aged dogs presenting with pelvic limb pathology.

  5. Probabilities of Radiation Myelopathy Specific to Stereotactic Body Radiation Therapy to Guide Safe Practice

    Energy Technology Data Exchange (ETDEWEB)

    Sahgal, Arjun, E-mail: arjun.sahgal@rmp.uhn.on.ca [Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON (Canada); Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada); Weinberg, Vivian [University of California San Francisco Helen Diller Family Comprehensive Cancer Center Biostatistics Core, San Francisco, California (United States); Ma, Lijun [Department of Radiation Oncology, University of California at San Francisco, San Francisco, California (United States); Chang, Eric [Department of Radiation Oncology, University of Southern California and University of Texas MD Anderson Cancer Center, University of Texas, Houston, Texas (United States); Chao, Sam [Department of Radiation Oncology and Neurosurgery, Cleveland Clinic, Cleveland, Ohio (United States); Muacevic, Alexander [European Cyberknife Center Munich in affiliation with University Hospitals of Munich, Munich (Germany); Gorgulho, Alessandra [Department of Neurosurgery, University of California at Los Angeles, Los Angeles, California (United States); Soltys, Scott [Department of Radiation Oncology, Stanford University, Stanford, California (United States); Gerszten, Peter C. [Departments of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States); Ryu, Sam [Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan (United States); Angelov, Lilyana [Department of Radiation Oncology and Neurosurgery, Cleveland Clinic, Cleveland, Ohio (United States); Gibbs, Iris [Department of Radiation Oncology, Stanford University, Stanford, California (United States); Wong, C. Shun [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada); Larson, David A. [Department of Radiation Oncology, University of California at San Francisco, San Francisco, California (United States)

    2013-02-01

    Purpose: Dose-volume histogram (DVH) results for 9 cases of post spine stereotactic body radiation therapy (SBRT) radiation myelopathy (RM) are reported and compared with a cohort of 66 spine SBRT patients without RM. Methods and Materials: DVH data were centrally analyzed according to the thecal sac point maximum (Pmax) volume, 0.1- to 1-cc volumes in increments of 0.1 cc, and to the 2 cc volume. 2-Gy biologically equivalent doses (nBED) were calculated using an {alpha}/{beta} = 2 Gy (units = Gy{sub 2/2}). For the 2 cohorts, the nBED means and distributions were compared using the t test and Mann-Whitney test, respectively. Significance (P<.05) was defined as concordance of both tests at each specified volume. A logistic regression model was developed to estimate the probability of RM using the dose distribution for a given volume. Results: Significant differences in both the means and distributions at the Pmax and up to the 0.8-cc volume were observed. Concordant significance was greatest for the Pmax volume. At the Pmax volume the fit of the logistic regression model, summarized by the area under the curve, was 0.87. A risk of RM of 5% or less was observed when limiting the thecal sac Pmax volume doses to 12.4 Gy in a single fraction, 17.0 Gy in 2 fractions, 20.3 Gy in 3 fractions, 23.0 Gy in 4 fractions, and 25.3 Gy in 5 fractions. Conclusion: We report the first logistic regression model yielding estimates for the probability of human RM specific to SBRT.

  6. Uterine didelphys with cervical incompetence

    OpenAIRE

    Aher Gautam S, Gavali Urmila G, Kulkarni Meghana

    2013-01-01

    Uterine didelphys represents a uterine malformation where the uterus is present as a paired organ. There is presence of double uterine bodies with two separate cervices, and often a double or septate vagina as well. We report a case of single pregnancy in the right sided uterine body of a didelphic uterus with cervical incompetence.

  7. Uterine didelphys with cervical incompetence

    Directory of Open Access Journals (Sweden)

    Aher Gautam S, Gavali Urmila G, Kulkarni Meghana

    2013-04-01

    Full Text Available Uterine didelphys represents a uterine malformation where the uterus is present as a paired organ. There is presence of double uterine bodies with two separate cervices, and often a double or septate vagina as well. We report a case of single pregnancy in the right sided uterine body of a didelphic uterus with cervical incompetence.

  8. Radiotherapy of Cervical Cancer.

    Science.gov (United States)

    Vordermark, Dirk

    2016-01-01

    Curative-intent radical radiotherapy of cervical cancer consists of external-beam radiotherapy, brachytherapy, and concomitant chemotherapy with cisplatin. For each element, new developments aim to improve tumor control rates or treatment tolerance. Intensity-modulated radiotherapy (IMRT) has been shown to reduce gastrointestinal toxicity and can be used to selectively increase the radiotherapy dose. Individualized, image-guided brachytherapy enables better adaptation of high-dose volumes to the tumor extension. Intensification of concomitant or sequential systemic therapy is under evaluation. PMID:27614991

  9. Electrodiagnosis of cervical radiculopathy.

    Science.gov (United States)

    Hakimi, Kevin; Spanier, David

    2013-02-01

    Cervical radiculopathy is a common diagnosis with a peak onset in the fifth decade. The most commonly affected nerve root is C7, C6, and C8. The etiology is often compressive, but may arise from noncompressive sources. Patients commonly complain of pain, weakness, numbness, and/or tingling. Examination may reveal sensory or motor disturbance in a dermatomal/myotomal distribution. Neural compression and tension signs may be positive. Diagnostic tests include imaging and electrodiagnostic study. Electrodiagnostic study serves as an extension of the neurologic examination. Electrodiagnostic findings can be useful for patients with atypical symptoms, potential pain-mediated weakness, and nonfocal imaging findings.

  10. Muscular weakness represents the main limiting factor of walk, functional independence and quality of life of myelopathy patients associated to HTLV-1

    Directory of Open Access Journals (Sweden)

    Renata Costa Caiafa

    2016-04-01

    Full Text Available ABSTRACT HTLV-1-associated myelopathy is a progressive disabling disease associated with gait abnormalities. Objective To identify and quantify the main muscles affected by weakness and spasticity, their impact on gait, functional capacity and on quality of life of HTLV-1-associated myelopathy patients. Method We evaluated lower limbs muscular strength according to the Medical Research Council scale, spasticity according to the modified Ashworth scale, daily activities according to the Barthel Index and quality of life according to the Short-Form Health Survey-36 of 26 HTLV-1-associated myelopathy patients. Results The muscles most affected by weakness included the dorsal flexors and knee flexors. Spasticity predominated in the hip adductor muscles and in plantar flexors. Assistance for locomotion, minimal dependence in daily activities, limitations in functional capacity and physical aspects were the most common findings. Conclusion The impairment of gait, functional dependence and quality of life were predominantly a consequence of intense muscle weakness in HTLV-1-associated myelopathy patients.

  11. GENETIC INSTABILITY IN CERVICAL CARCINOMA

    Institute of Scientific and Technical Information of China (English)

    赵旻; 伍欣星; 邱小萍; 李晖; 戴天力; 谭云

    2002-01-01

    Objective: The role of human papillomavirus (HPV) in the development of cervical carcinoma has been clearly established but other factors could be involved in cervical tumorigenesis such as loss of heterozygosity (LOH) and microsatellite instability (MI). The aim of the present study was to investigate the genetic instability in cervical carcinoma tissues and provide evidence for discoveringnew tumor suppressor genes and screening diagnostic molecular marker of cervical carcinoma. Methods: Fifty primary cervical carcinoma samples from high-incidence area were analyzed by PCR for HPV16 infection, LOH and microsatellite instability. Results: HPV16 was detected in 88% of the cases. Sixty-six percent of total cases showed LOH with no more than 3 different loci per case. The highest frequency of the allelic loss was found in D18S474 (18q21, 40.5%). MI was detected in 4 cases (8%) only. Conclusion: Different percentages of LOH on specific chromosomal regions were found and MI was very infrequent in cervical carcinoma. The putative suppressor gene(s) could be located on specific chromosome regions such as 18q, and genetic instability could be involved in cervical tumorigenesis.

  12. Two cases of cervical disc disease with intramedullary pathological changes, which are responsible for their neurological syndromes, on delayed CT myelography

    International Nuclear Information System (INIS)

    We report two cases of cervical disc disease with myelopathy classified as of motor system syndrome type showing small contrast accumulation within the spinal cord on delayed CT myelography. In our two cases, high density spots on delayed CT myelography were bilaterally localized within the spinal cord, and believed represent pathological changes of the spinal cord, such as collection of microcavities or cystic necrosis. In case 1, the high density areas seemed to be localized in the anterior horn and corticospinal tract, and in case 2, they seemed to be localized in the corticospinal tract. The patient in case 1 produced signs and symptoms resembling motor neurone disease and lesion could not be differentiated from the latter. Delayed CT myelography showed that the cause of the upper limb amyotrophy was attributed to an anterior horn disorder and that of pyramidal tract sign to a corticospinal tract disorder. Therefore, we could differentiate the lesion from motor neurone disease on delayed CT myelography in case 1. In conclusion, we emphasize that delayed CT myelography can demonstrate the intramedullary pathological changes in the cervical disc disease and is useful in distinguishing between cervical disc disease simulating motor neurone disease and the latter. (author)

  13. Hemangiopericytoma of the cervical spine

    Directory of Open Access Journals (Sweden)

    Raghvendra V Ramdasi

    2014-01-01

    Full Text Available A 28-year-old male presented with neck pain and dysesthesias in the right upper limb. On examination, he had a firm, well-defined midline posterior cervical mass discernible on palpation at the mid-cervical level. He had no neurological deficit. Neuroradiology revealed a variegated enhancing cervical mass is arising from C3 lamina. The mass extended into the right extradural space eroding the C3 lamina and posteriorly into the intermuscular plane. The tumor was excised totally. Histopathology of the tumor showed features of hemangiopericytoma (HPC. The patient underwent postoperative radiotherapy. Primary osseous spinal HPC are rare malignant extra-axial tumors that tend to recur and metastasize. Only two cases of primary osseous HPC have been reported earlier to involve the cervical spine. The clinical presentation and management of the present case with a review of the literature is presented.

  14. Glycoprotein and Glycan in Tissue and Blood Samples of Patients With Stage IB-IVA Cervical Cancer Undergoing Surgery to Remove Pelvic and Abdominal Lymph Nodes

    Science.gov (United States)

    2016-10-26

    Cervical Adenocarcinoma; Cervical Adenosquamous Carcinoma; Cervical Small Cell Carcinoma; Cervical Squamous Cell Carcinoma, Not Otherwise Specified; Stage IB Cervical Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage IVA Cervical Cancer

  15. Reoperations Following Cervical Disc Replacement

    OpenAIRE

    Skovrlj, Branko; Lee, Dong-Ho; Caridi, John Michael; Cho, Samuel Kang-Wook

    2015-01-01

    Cervical disc replacement (CDR) has emerged as an alternative surgical option to cervical arthrodesis. With increasing numbers of patients and longer follow-ups, complications related to the device and/or aging spine are growing, leaving us with a new challenge in the management and surgical revision of CDR. The purpose of this study is to review the current literature regarding reoperations following CDR and to discuss about the approaches and solutions for the current and future potential c...

  16. Congenital irreducible atlantoaxial dislocation associated with cervical intramedullary astrocytoma causing progressive spastic quadriparesis

    Directory of Open Access Journals (Sweden)

    Chatley Anooj

    2008-01-01

    Full Text Available Simultaneous presence of congenital irreducible atlantoaxial dislocation (AAD and cervical intramedullary astrocytoma has not been previously described and may cause disabling myelopathy. This 55-year-old lady presented with suboccipital pain, spastic quadriparesis, Lhermitte′s phenomenon and sphincteric disturbances. Lateral radiographs and magnetic resonance imaging showed irreducible AAD, occipitalized atlas, C2-3 fusion, and,an intramedullary tumor from C2-5 level iso-to-hypointense, non-enhancing, except in a small segment in the dorsal C2 level. A suboccipital craniectomy with C2-5 laminectomy revealed a greyish-white tenacious tumor. The tumor was decompressed using a C2-5 midline myelotomy and duroplasty. An occipitocervical lateral mass fixation was performed. Histopathology revealed a low-grade astrocytoma. At three-month follow-up, her spasticity had decreased and quadriparesis and sphincteric disturbances were persisting. Postoperative lateral radiographs and intrathecal contrast CT scan showed a stable occipitocervical construct. Thus, the suboccipital craniectomy and laminectomy with midline myelotomy and duroplasty facilitated space for progressively expanding intramedullary astrocytoma with irreducible AAD; the lateral mass fixation provided stability at the craniovertebral junction.

  17. [The modified method registration of kinesthetic evoked potentials and its application for research of proprioceptive sensitivity disorders at spondylogenic cervical myelopathy].

    Science.gov (United States)

    Gordeev, S A; Voronin, S G

    2016-01-01

    Цель исследования — анализ эффективности использования модифицированного (пассивное сгибание/разгибание кисти) и «стандартного» (пассивное сгибание кисти) методов кинестетических вызванных потенциалов для исследования проприоцептивной чувствительности у здоровых испытуемых и пациентов со спондилогенной шейной миелопатией. Материал и методы. В исследовании приняли участие 14 здоровых испытуемых, 4 женщины и 10 мужчин (средний возраст — 54,1±10,5 года), и 8 пациентов, 2 женщины и 6 мужчин (средний возраст — 55,8±10,9 года), со спондилогенной шейной миелопатией. При клиническом исследовании проверялось мышечно-суставное чувство. Был разработан модифицированный метод регистрации кинестетических вызванных потенциалов, который отличается от «стандартного» возможностью организации цикла из нескольких пассивных движений, причем каждое новое движение отличается от предыдущего по направлению. Результаты и заключение. Показано, что модифицированный метод регистрации кинестетических вызванных потенциалов обеспечивает повышение достоверности результатов исследования кинестетической чувствительности за счет различного характера движений. У пациентов по сравнению со здоровыми обнаружено достоверное увеличение латентных периодов ранних компонентов ответа. Модифицированный метод регистрации кинестетических вызванных потенциалов может быть использован для объективной диагностики нарушений проприоцептивной чувствительности у больных со спондилогенной шейной миелопатией.

  18. Analysis of 16 Patients with Jumping Multilevel Cervical Spondylostic Myelopathy.%"跳跃型"多节段脊髓型颈椎病16例治疗

    Institute of Scientific and Technical Information of China (English)

    林斌; 练克俭; 郭林新; 郭延杰; 刘庆军; 郭志民; 陈建庭; 金大地

    2002-01-01

    目的探讨"跳跃型"多节段脊髓型颈椎病的病情特点与治疗方法.方法 16例"跳跃型"多节段脊髓型颈椎病患者,男性11例,女性5例,平均年龄53.4岁,平均病程14个月,病变累及跳跃的2个功能节段者11例,累及跳跃的3个功能节段者5例,术前JOA评分为8.1分.对于跳跃一个节段累及2个功能节段的病例采用受累节段减压融合+跳跃节段融合+内固定,对于累及2个节段以上或跳跃间隙大于2个节段者采用受累节段减压融合+头颈胸石膏外固定.结果 16例获平均18个月随访,手术有效率93.8%,优良率68.7%,术后JOA评分平均为14.5分,所有病例均获骨性融合,无假关节形成.结论跳跃型多节段脊髓型颈椎病病情复杂,采用多节段减压融合+内固定或可靠的外固定,可获良好治疗效果.

  19. Comparison of MRI pulse sequences for investigation of lesions of the cervical spinal cord

    Energy Technology Data Exchange (ETDEWEB)

    Campi, A.; Pontesilli, S.; Gerevini, S.; Scotti, G. [San Raffaele Hospital, Milan (Italy). Dept. of Neuroradiology

    2000-09-01

    Small spinal cord lesions, even if clinically significant, can be due to the low sensitivity of some pulse sequences. We compared T2-weighted fast (FSE), and conventional (CSE) spin-echo and short-tau inversion-recovery (STIR)-FSE overlooked on MRI sequences to evaluate their sensitivity to and specificity for lesions of different types. We compared the three sequences in MRI of 57 patients with cervical spinal symptoms. The image sets were assessed by two of us individually for final diagnosis, lesion detectability and image quality. Both readers arrived at the same final diagnoses with all sequences, differentiating four groups of patients. Group 1 (30 patients, 53 %), with a final diagnosis of multiple sclerosis (MS). Demyelinating lesions were better seen on STIR-FSE images, on which the number of lesions was significantly higher than on FSE, while the FSE and CSE images showed approximately equal numbers of lesions; additional lesions were found in 9 patients. The contrast-to-noise ratio (CNR) of 17 demyelinating lesions was significantly higher on STIR-FSE images than with the other sequences. Group 2, 19 patients (33 %) with cervical pain, 15 of whom had disc protrusion or herniation: herniated discs were equally well delineated with all sequences, with better myelographic effect on FSE. In five patients with intrinsic spinal cord abnormalities, the conspicuity and demarcation of the lesions were similar with STIR-FSE and FSE. Group 3, 4 patients (7 %) with acute myelopathy of unknown aetiology. In two patients, STIR-FSE gave better demarcation of lesions and in one a questionable additional lesions. Group 4, 4 patients (7 %) with miscellaneous final diagnoses. STIR-FSE had high sensitivity to demyelinating lesions, can be considered quite specific and should be included in spinal MRI for assessment of suspected demyelinating disease. (orig.)

  20. Analysis of digitized cervical images to detect cervical neoplasia

    Science.gov (United States)

    Ferris, Daron G.

    2004-05-01

    Cervical cancer is the second most common malignancy in women worldwide. If diagnosed in the premalignant stage, cure is invariably assured. Although the Papanicolaou (Pap) smear has significantly reduced the incidence of cervical cancer where implemented, the test is only moderately sensitive, highly subjective and skilled-labor intensive. Newer optical screening tests (cervicography, direct visual inspection and speculoscopy), including fluorescent and reflective spectroscopy, are fraught with certain weaknesses. Yet, the integration of optical probes for the detection and discrimination of cervical neoplasia with automated image analysis methods may provide an effective screening tool for early detection of cervical cancer, particularly in resource poor nations. Investigative studies are needed to validate the potential for automated classification and recognition algorithms. By applying image analysis techniques for registration, segmentation, pattern recognition, and classification, cervical neoplasia may be reliably discriminated from normal epithelium. The National Cancer Institute (NCI), in cooperation with the National Library of Medicine (NLM), has embarked on a program to begin this and other similar investigative studies.

  1. Prevention program of cervical cancer - Enrique Pouey

    International Nuclear Information System (INIS)

    This work is about the first basic objectives in the prevention of cervical cancer in Uruguay. The Papanicolaou test, the biopsia, and the colposcopy are important studies for the early cervical cancer detection

  2. A Combined Therapy for Cervical Spondylopathy

    Institute of Scientific and Technical Information of China (English)

    李佳

    2004-01-01

    @@ Cervical spondylopathy is a common disease frequently encountered in the middle-aged and old people. It is a consequence of degeneration, strain or deformation of the physiological curvature of the cervical vertebral body.

  3. Preventing Cervical Cancer with HPV Vaccines

    Science.gov (United States)

    Cervical cancer can be prevented with HPV vaccines. NCI-supported researchers helped establish HPV as a cause of cervical cancer. They also helped create the first HPV vaccines, were involved in the vaccine trials, and contribute to ongoing studies.