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Sample records for cervical spondylotic myelopathy

  1. Surgical management of cervical spondylotic myelopathy

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    N Muthukumar

    2012-01-01

    Full Text Available Cervical spondylotic myelopathy (CSM is emerging as the most common cause of spinal cord dysfunction in the elderly worldwide. In the past decade, our understanding of the biomechanics of the spine has improved along with advances in spinal instrumentation and this has led to significant changes in the surgical management of CSM. This review will discuss the indications, advantages and limitations of different operative approaches as well as the complications and prognosis of surgery for cervical spondylotic myelopathy. Choice of surgical approach for CSM should be based on the clinical and radiological characteristics of the individual patient and not on the preferences of the surgeon.

  2. Gait Analysis in Cervical Spondylotic Myelopathy

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    Nishimura, Hirosuke; Endo, Kenji; Suzuki, Hidekazu; Tanaka, Hidetoshi; Shishido, Takaaki; Yamamoto, Kengo

    2015-01-01

    Study Design Gait analysis of patients with cervical spondylotic myelopathy (CSM) by using a sheet-type gait analysis system. Purpose The aim of this study was to compare the gait patterns of patients with CSM, evaluated by the Nurick grades, and to determine the threshold values of gait parameters predicting the occurrence of a fall by using a gait recorder. Overview of Literature Gait disorder due to CSM may progress to severe paraplegia, following even a minor trauma such as a fall. The in...

  3. 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.

  4. 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.

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

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    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.

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

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    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.

  7. Laminoplasty with lateral mass screw fixation for cervical spondylotic myelopathy in patients with athetoid cerebral palsy: A retrospective study.

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    Zhou, Hua; Liu, Zhong-Jun; Wang, Shao-Bo; Pan, Sheng-Fa; Yan, Ming; Zhang, Feng-Shan; Sun, Yu

    2016-09-01

    Although several studies report various treatment solutions for cervical spondylotic myelopathy in patients with athetoid cerebral palsy, long-term follow-up studies are very rare. None of the reported treatment solutions represent a gold standard for this disease owing to the small number of cases and lack of long-term follow-up. This study aimed to evaluate the outcomes of laminoplasty with lateral mass screw fixation to treat cervical spondylotic myelopathy in patients with athetoid cerebral palsy from a single center.This retrospective study included 15 patients (9 male patients and 6 female patients) with athetoid cerebral palsy who underwent laminoplasty with lateral mass screw fixation for cervical spondylotic myelopathy at our hospital between March 2006 and June 2010. Demographic variables, radiographic parameters, and pre- and postoperative clinical outcomes determined by the modified Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), and visual analog scale (VAS) scores were assessed.The mean follow-up time was 80.5 months. Developmental cervical spinal canal stenosis (P = 0.02) and cervical lordosis (P = 0.04) were significantly correlated with lower preoperative modified JOA scores. The mean modified JOA scores increased from 7.97 preoperatively to 12.1 postoperatively (P cerebral palsy. Laminoplasty with lateral mass screw fixation is an effective treatment for cervical spondylotic myelopathy in patients with athetoid cerebral palsy and developmental cervical spinal canal stenosis.

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

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    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

  9. Cervical Spondylotic Myelopathy presenting as mechanical neck pain: a case report.

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    Smith, Benjamin E; Diver, Claire J; Taylor, Alan J

    2014-08-01

    Cervical Spondylotic Myelopathy (CSM) is the most common type of myelopathy in adults over 55 years of age. In the early stages symptoms may include local neck pain and stiffness that might mimic the presentation of non-specific mechanical neck pain (NSMNP). The patient was a 79 year old male, who complained of eight weeks of neck pain. He had been referred for physiotherapy by his family physician with a diagnosis of NSMNP. Initial presentation was consistent with the referral, but further assessment by the physiotherapist revealed findings suggestive of CSM. He was referred for an urgent cervical MRI scan, which revealed myelomalacic changes at C3/4 due to spondylotic changes. The patient was unsuitable for manual therapy intervention and was referred to a spinal orthopaedic surgeon who performed a posterior decompression and stabilisation at C3-C5, 2 months after the initial presentation. This case report highlights the importance of considering CSM in adults over 55 years of age presenting with NSMNP, particularly as the prevalence of both increases with age. It demonstrates the need for health professionals to carry out detailed examination where CSM may be a potential differential diagnosis. Outcomes are less favourable for patients over the age of 70, therefore an urgent surgical opinion was required for this patient. Deterioration of symptoms whilst he awaited surgery demonstrates how missed diagnosis may lead to possible long term spinal cord damage, with potential medico-legal concerns for the therapist.

  10. 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.)

  11. Diffusion tensor imaging studies of cervical spondylotic myelopathy: a systemic review and meta-analysis.

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    Xiaofei Guan

    Full Text Available A meta-analysis was conducted to assess alterations in measures of diffusion tensor imaging (DTI in the patients of cervical spondylotic myelopathy (CSM, exploring the potential role of DTI as a diagnosis biomarker. A systematic search of all related studies written in English was conducted using PubMed, Web of Science, EMBASE, CINAHL, and Cochrane comparing CSM patients with healthy controls. Key details for each study regarding participants, imaging techniques, and results were extracted. DTI measurements, such as fractional anisotropy (FA, apparent diffusion coefficient (ADC, and mean diffusivity (MD were pooled to calculate the effect size (ES by fixed or random effects meta-analysis. 14 studies involving 479 CSM patients and 278 controls were identified. Meta-analysis of the most compressed levels (MCL of CSM patients demonstrated that FA was significantly reduced (ES -1.52, 95% CI -1.87 to -1.16, P < 0.001 and ADC was significantly increased (ES 1.09, 95% CI 0.89 to 1.28, P < 0.001. In addition, a notable ES was found for lowered FA at C2-C3 for CSM vs. controls (ES -0.83, 95% CI -1.09 to -0.570, P < 0.001. Meta-regression analysis revealed that male ratio of CSM patients had a significant effect on reduction of FA at MCL (P = 0.03. The meta-analysis of DTI studies of CSM patients clearly demonstrated a significant FA reduction and ADC increase compared with healthy subjects. This result supports the use of DTI parameters in differentiating CSM patients from health subjects. Future researches are required to investigate the diagnosis performance of DTI in cervical spondylotic myelopathy.

  12. A morphological comparison of cervical spondylotic myelopathy: MRI and dissection findings.

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    Tsurumi, Takamasa; Goto, Noboru; Shibata, Masakazu; Goto, Jun; Kamiyama, Akemi

    2005-03-01

    The number of people with functional disabilities has been increasing with the rapid changes of age structure in the overall population. One of the major causes of disturbances in daily activities is cervical spondylotic myelopathy (CSM). The transverse area and sagittal diameter of the spinal cord measured by MRI is reported to correlate with the clinical manifestations of CSM, the duration of the disease, and the speed of recovery after surgery in patients with CSM. The purpose of this research is to determine the morphological characteristics of CSM as seen in MRI findings including the spinal cord sagittal diameter, transverse diameter, transverse area and flatness ratio. Twenty-eight of several patients with CSM were treated conservatively after carrying out measurements by MRI. In addition, anatomical studies were carried out on the spinal cords after anatomical dissection of the vertebral column in seven cadavers with CSM. These results, when compared with the morphological analysis of the cervical spinal cord, show that there is a correlation between the transverse areas at C4, C5 and C6 levels, as those at every level of the cervical transverse areas of tissue sections in the dissection cadavers were 10-18% smaller than those in the MRI patients. These results should be taken into account for the treatment of CSM patients.

  13. 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.

  14. 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.

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

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    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.

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

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    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.

  17. Clinical report of cervical arthroplasty in management of spondylotic myelopathy in Chinese

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    Lu Ning

    2006-11-01

    Full Text Available Abstract Objectives To investigate clinical effects and manual operational point of Bryan cervical disc prosthesis in Chinese, to observe the stability and range of movement (ROM post-operatively. Methods and materials From 2003,12 to 2005,12, Bryan disc prosthesis replacement applied in 83 cases (102 levels of cervical spondylotic myelopathy (CSM after anterior decompression in our hospital. Clinical (JOA grade and Odom's scale and radiological (X-ray of flexion, extension; left and right bending position follow-up was performed. Systemic radiographic study about stability and ROM of replaced level post operationally were measured. CT or MRI scans were applied in all cases to evaluate the signs of the prosthesis deflexion and hetero-ossification in the replaced levels. Results At least 12 months follow-up were done in 65/83 of these paients. All of 83 patients were improved according to Odsm's scale. JOA score increased from average 8.7 to 15.5. There was no prosthesis subsidence. Replaced segment achieved stability and restored partial of normal ROM 4.73°(3.7°–5.9° early postoperation and 8.12°(5.8°–13.6° more than 12 months postoperation in flex and extension position. No obvious loss of lordosis was found. CT or MRI follow-up shows position deflexion of the prosthesis metal endplates ( Conclusion Byran cervical disc prosthesis restored motion to the level of the intact segment in flexion-extension and lateral bending in post-operative images. At the same time, it can achieve good anterior decompression treatment effect and immediate stability in replaced 1 or 2 levels, and which is a new choice for the treatment of CSM.

  18. Influence of hinge position on the effectiveness of opendoor expansive laminoplasty for cervical spondylotic myelopathy

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    WAN Jun

    2011-02-01

    Full Text Available 【Abstract】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. Key words: Cervical vertebrae; Spinal cord diseases; Spondylosis; Surgical procedures, operative

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

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    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.

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

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    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.

  1. Cortical Reorganization Is Associated with Surgical Decompression of Cervical Spondylotic Myelopathy

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    Andrew Green

    2015-01-01

    Full Text Available Background. Cervical spondylotic myelopathy (CSM results in sensorimotor limb deficits, bladder, and bowel dysfunction, but mechanisms underlying motor plasticity changes before and after surgery are unclear. Methods. We studied 24 patients who underwent decompression surgery and 15 healthy controls. Patients with mixed upper and lower limb dysfunction (Group A and only lower limb dysfunction (Group B were then analysed separately. Results. The sum amplitude of motor evoked potentials sMEP (p<0.01 and number of focal points where MEPs were elicited (N (p<0.001 were significantly larger in CSM patients compared with controls. For Group A (16 patients, sMEP (p<0.01 and N (p<0.001 showed similar findings. However, for Group B (8 patients, only N (p=0.03 was significantly larger in patients than controls. Group A had significantly increased grip strength (p=0.02 and reduced sMEP (p=0.001 and N (p=0.003 after surgery. Changes in sMEP (cMEP significantly correlated inversely with improved feeding (p=0.03 and stacking (p=0.04 times as was the change in number of focal points (NDiff with improved writing times (p=0.03. Group B did not show significant reduction in sMEP or N after surgery, or significant correlation of cMEP or NDiff with all hand function tests. No significant differences in H reflex parameters obtained from the flexor carpi radialis, or central motor conduction time changes, were noted after surgery. Discussion. Compensatory expansion of motor cortical representation occurs largely at cortical rather than spinal levels, with a tendency to normalization after surgery. These mirrored improvements in relevant tasks requiring utilization of intrinsic hand muscles.

  2. Diabetes and cervical myelopathy.

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    Houten, John K; Lenart, Christopher

    2016-05-01

    Diabetes may affect the typical physical findings associated with cervical spondylotic myelopathy, as coexisting diabetic neuropathy may dampen expected hyperreflexia and also produce non-dermatomal extremity numbness. Most large studies of surgically treated diabetic patients with cervical spondylotic myelopathy have focused upon infection rates rather than exploring any differences in the presenting physical signs. We conducted a retrospective study of the pattern of presenting neurological signs and symptoms and of the clinical outcomes in 438 patients surgically treated for cervical spondylotic myelopathy, 79 of whom had diabetes. Compared with non-diabetic patients, those with diabetes were slightly older and had lower preoperative modified Japanese Orthopaedic Association (mJOA) scores. Those with diabetes also had a significantly higher incidence of hyporeflexia and a higher incidence of a positive Babinski sign, but there was no difference in the appearance of the Hoffman sign. The magnitude of mJOA improvement after surgery was comparable. We conclude that diabetes may alter the typical signs and symptoms of cervical spondylotic myelopathy and suggest that knowledge of the differences may aid in securing a prompt and accurate diagnosis.

  3. 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.

  4. Functional evaluation using several evoked spinal cord potentials in elderly patients with cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    Zhenglin Li

    2006-01-01

    BACKGROUND: The recordings of evoked spinal cord potentials following epidural spinal cord stimulation are thought to be generated by volleys traversing the dorsal column pathway, and it may not directly reflect conduction defects in corticospinal tracts of cervical spinal cord. To our knowledge there has been few report using several evoked spinal cord potentials in function evaluation of the cervical spinal cord in elderly patients with cervical spondylotic myelopathy (CSM).OBJECTIVE: To investigate the function states of the cervical spinal cord in elderly patients with CSM and explore its pathophysiologic mechanism.DESIGN: Case observation.SETTING: Department of Qrthopedics for the aged, Shenzhen Pingle Hospital of Orthopedics. Department of Orthopedic Surgery, Yamaguchi University School of Medicine.PARTICIPANTS: A total of 23 elderly patients with CSM who received treatment in the Department of Orthopedic Surgery, Yamaguchi University School of Medicine of Japan from January 2003 to February 2004 were enrolled in this study. Inclusive criteria: ① Multiple intervertebral levels of cervical spinal cord compression confirmed by MRI, e.g. 3 or more than 3 levels of compressin. ② Age >70 years old. ③ Numbness and sensory disturbance in the upper limbs and showed hyperreflexia in the lower limbs. Exclusive criteria: Patients with abnormal motor and sensory nerve conduction velocities in both upper and lower limbs were excluded.METHODS: Evoked spinal cord potentials (ESCPs) following transcranial electric stimulation (TCE-ESCPs),epidural spinal cord stimulation (Spinal-ESCPs) and median nerve stimulation (MN-ESCPs) were recorded in 23 patients from posterior epidural space intraoperatively. The abnormalities of TCE-ESCPs were defined as attenuation of amplitude of the D wave. The most cranial intervertebral level showing abnormal TCE-ESCPs with a marked reduction in size of the negative peak (reduction of over 50%) was considered as the upper level of the

  5. Accuracy of diffusion tensor imaging for diagnosing cervical spondylotic myelopathy in patients showing spinal cord compression

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    Lee, Seung Bo; Chung Tae Sub; Kim, Sung Jun; Yoo, Yeon Hwa; Yoon, Choon Sik; Park, Jung Hyun [Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Lee, Young Han [Dept. of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Jeong, Eun Kee [Dept. of Radiology, Utah Center for Advanced Imaging Research, University of Utah, Salt Lake (United States); Kim, In Seong [Siemens Healthcare, Seoul (Korea, Republic of)

    2015-12-15

    To assess the performance of diffusion tensor imaging (DTI) for the diagnosis of cervical spondylotic myelopathy (CSM) in patients with deformed spinal cord but otherwise unremarkable conventional magnetic resonance imaging (MRI) findings. A total of 33 patients who underwent MRI of the cervical spine including DTI using two-dimensional single-shot interleaved multi-section inner volume diffusion-weighted echo-planar imaging and whose spinal cords were deformed but showed no signal changes on conventional MRI were the subjects of this study. Mean diffusivity (MD), longitudinal diffusivity (LD), radial diffusivity (RD), and fractional anisotropy (FA) were measured at the most stenotic level. The calculated performance of MD, FA, MD∩FA (considered positive when both the MD and FA results were positive), LD∩FA (considered positive when both the LD and FA results were positive), and RD∩FA (considered positive when both the RD and FA results were positive) in diagnosing CSM were compared with each other based on the estimated cut-off values of MD, LD, RD, and FA from receiver operating characteristic curve analysis with the clinical diagnosis of CSM from medical records as the reference standard. The MD, LD, and RD cut-off values were 1.079 × 10'-{sup 3}, 1.719 × 10{sup -3}, and 0.749 × 10{sup -3} mm{sup 2}/sec, respectively, and that of FA was 0.475. Sensitivity, specificity, positive predictive value and negative predictive value were: 100 (4/4), 44.8 (13/29), 20 (4/20), and 100 (13/13) for MD; 100 (4/4), 27.6 (8/29), 16 (4/25), and 100 (8/8) for FA; 100 (4/4), 58.6 (17/29), 25 (4/16), and 100 (17/17) for MD∩FA; 100 (4/4), 68.9 (20/29), 30.8 (4/13), and 100 (20/20) for LD∩FA; and 75 (3/4), 68.9 (20/29), 25 (3/12), and 95.2 (20/21) for RD∩FA in percentage value. Diagnostic performance comparisons revealed significant differences only in specificity between FA and MD∩FA (p = 0.003), FA and LD∩FA (p < 0.001), FA and RD∩FA (p < 0.001), MD and LD

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

    Directory of Open Access Journals (Sweden)

    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.

  7. 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.

  8. Nerve root distribution of deltoid and biceps brachii muscle in cervical spondylotic myelopathy: a potential risk factor for postoperative shoulder muscle weakness after posterior decompression.

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    Yonemura, Hiroshi; Kaneko, Kazuo; Taguchi, Toshihiko; Fujimoto, Hideaki; Toyoda, Kouichiro; Kawai, Shinya

    2004-01-01

    To investigate the nerve root distribution of deltoid and biceps brachii muscle, compound muscle action potentials (CMAPs) were recorded intraoperatively following nerve root stimulation in cervical spondylotic myelopathy. A total of 19 upper limbs in 12 patients aged 55-72 years (mean, 65.5 years) with cervical spondylotic myelopathy were examined. CMAPs were recorded from deltoid and biceps brachii muscle following C5 and C6 root stimulation. Although both C5 and C6 roots were innervated for deltoid and biceps brachii muscle in all subjects, the amplitude ratio of CMAPs (C5/C6) differed individually depending on the symptomatic intervertebral levels of the spinal cord. The C5 root predominantly innervated both deltoid and biceps brachii in patients with symptomatic cord lesions at the C4-C5 intervertebral level compared to patients with symptomatic cord lesions at the C5-C6 intervertebral level. Although no patients sustained postoperative radiculopathy in our study, severe weakness and unfavorable recovery are expected when the C5 root in patients with C4-C5 myelopathy is damaged. From the electrophysiological aspect, C4-C5 cord lesions are likely to be a potential risk factor for postoperative shoulder muscle weakness in patients with compressive cervical myelopathy.

  9. 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.

  10. 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

  11. [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)

  12. 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.

  13. Efficacy of intravenous dexmedetomidine on patient's satisfaction, comfort and sedation during awake fibre-optic intubation in patients with cervical spondylotic myelopathy posted for elective cervical fixation

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    Saikat Niyogi

    2017-01-01

    Full Text Available Background and Aims: Various anaesthetic drugs, in addition to airway block, are used for producing favourable intubation conditions during awake fibre-optic intubation (AFOI, but most of them cause respiratory depression and hypoxaemia. The aim of this study was to evaluate the efficacy of intravenous (IV dexmedetomidine (DEX on sedation, patient comfort and cardiovascular responses during AFOI in patients with cervical spondylotic myelopathy (CSM. Methods: This randomised, placebo-controlled, double-blinded, prospective study was conducted on 56 adult patients with cervical spondylotic myelopathy (CSM undergoing elective cervical fixation, who were randomly allocated into two groups - Group D and Group C. Group D patients received DEX infusion at a rate of 1 μg/kg for the first 10 min followed by 0.5 μg/kg/h and Group C received 0.9% normal saline infusion in the same manner. Airway blocks with lignocaine were given to all patients before undergoing AFOI. Patient's alertness, sedation and cardiorespiratory changes during the procedure were assessed by the Observer Assessment Awareness and Sedation (OAA/S scale. On the 1st post-operative day, patient's' comfort during AFOI was assessed by visual analogue scale (VAS. Results: Patients of Group D had an acceptable level of sedation (OAA/S score: 20 to 17 with greater comfort and satisfaction (VAS: 40–60, compared to control group (VAS: 50–90, P < 0.001.. Moreover, haemodynamic parameters were less significantly altered in the DEX group during AFOI. Conclusions: IV DEX infusion during AFOI improves patient's tolerances with an acceptable level of sedation without significant haemodynamic instability and respiratory depression.

  14. The role of DTI in early detection of cervical spondylotic myelopathy: a preliminary study with 3-T MRI

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    Kara, Batuhan [Bakirkoey Dr. Sadi Konuk Teaching Hospital, Department of Radiology, Istanbul (Turkey); Celik, Azim [General Electric Healthcare, Istanbul (Turkey); Karadereler, Selhan [Florence Nightingale Hospital, Department of Neurosurgery, Istanbul (Turkey); Ulusoy, Levent; Ganiyusufoglu, Kursat; Onat, Levent; Mutlu, Ayhan; Sirvanci, Mustafa [Florence Nightingale Hospital, Department of Radiology, Istanbul (Turkey); Ornek, Ibrahim [Florence Nightingale Hospital, Department of Neurology, Istanbul (Turkey); Hamzaoglu, Azmi [Florence Nightingale Hospital, Department of Orthopedic Surgery, Istanbul (Turkey)

    2011-08-15

    The radiological diagnosis of cervical spondylotic myelopathy (CSM) has to be made as soon as possible, since surgery performed in earlier stages during the course of CSM was reported to be more successful when compared with later stages. We hypothesized that diffusion tensor imaging (DTI) may detect CSM in earlier stages, before the appearance of signal increase in T2-weighted sequences. A total of 16 patients with neurological signs and symptoms of CSM but without hyperintensity in spinal cord on T2-weighted sequences enrolled in the study. The magnetic resonance (MR) examinations were performed on a 3-T MR imaging system. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) maps were generated on axial plane. The ADC and FA measurements in each individual were made at the level of most severe cervical canal stenosis and at a nonstenotic level. Student's t test was used to compare FA and ADC values of the spinal cord in stenotic and nonstenotic segments. We also investigated if there was a correlation between DTI parametrics and duration of clinical symptoms by using Pearson correlation analysis. All patients showed changes in DTI parametrics at stenotic segments. While FA values of the spinal cord at the stenotic level showed a statistically significant reduction, there was a statistically significant increase in the measured ADC values (p < 0.001). There was no statistical correlation between the duration of symptoms and DTI parametrics. Our preliminary findings indicate that DTI may show abnormalities in the spinal cord before the development of T2 hyperintensity on conventional sequences in patients with CSM. (orig.)

  15. Use of multivariate linear regression and support vector regression to predict functional outcome after surgery for cervical spondylotic myelopathy.

    Science.gov (United States)

    Hoffman, Haydn; Lee, Sunghoon I; Garst, Jordan H; Lu, Derek S; Li, Charles H; Nagasawa, Daniel T; Ghalehsari, Nima; Jahanforouz, Nima; Razaghy, Mehrdad; Espinal, Marie; Ghavamrezaii, Amir; Paak, Brian H; Wu, Irene; Sarrafzadeh, Majid; Lu, Daniel C

    2015-09-01

    This study introduces the use of multivariate linear regression (MLR) and support vector regression (SVR) models to predict postoperative outcomes in a cohort of patients who underwent surgery for cervical spondylotic myelopathy (CSM). Currently, predicting outcomes after surgery for CSM remains a challenge. We recruited patients who had a diagnosis of CSM and required decompressive surgery with or without fusion. Fine motor function was tested preoperatively and postoperatively with a handgrip-based tracking device that has been previously validated, yielding mean absolute accuracy (MAA) results for two tracking tasks (sinusoidal and step). All patients completed Oswestry disability index (ODI) and modified Japanese Orthopaedic Association questionnaires preoperatively and postoperatively. Preoperative data was utilized in MLR and SVR models to predict postoperative ODI. Predictions were compared to the actual ODI scores with the coefficient of determination (R(2)) and mean absolute difference (MAD). From this, 20 patients met the inclusion criteria and completed follow-up at least 3 months after surgery. With the MLR model, a combination of the preoperative ODI score, preoperative MAA (step function), and symptom duration yielded the best prediction of postoperative ODI (R(2)=0.452; MAD=0.0887; p=1.17 × 10(-3)). With the SVR model, a combination of preoperative ODI score, preoperative MAA (sinusoidal function), and symptom duration yielded the best prediction of postoperative ODI (R(2)=0.932; MAD=0.0283; p=5.73 × 10(-12)). The SVR model was more accurate than the MLR model. The SVR can be used preoperatively in risk/benefit analysis and the decision to operate.

  16. 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.

  17. Profiles of and correlation between objective and subjective outcome assessments following open-door laminoplasty for cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    Zhou Feifei; Zhang Yilong; Sun Yu; Zhang Fengshan; Pan Shengfa; Diao Yinze; Chen Xin

    2014-01-01

    Background Open-door laminoplasty is widely used in the treatment of cervical spondylotic myelopathy (CSM).This study aimed to investigate the profiles of and correlation between objective and subjective short-term outcome assessments after open-door laminoplasty for CSM.Methods We retrospectively analyzed surgical outcomes in 129 consecutive CSM patients who underwent open-door laminoplasty in Peking University Third Hospital from February 2008 to November 2011.Both objective and subjective assessments were evaluated before surgery,3 months after surgery,and 1 year after surgery.We then analyzed the profiles of and correlation between objective and subjective short-term outcomes.Results The Modified Japanese Orthopaedic Association (mJOA) score was significantly improved at 3 months (P<0.01) and 1 year (P<0.01) after surgery.Bivariate Logistic regression showed that sensory improvement contributed more to the recovery rate than motor function improvement at 3 months after surgery,while motor function contributed more to the recovery rate at 1 year after surgery.On the subjective assessment (the short form (SF)-36),there was no significant improvement at 3 months after surgery (P>0.05),while physical function (PF),role-physical (RP),and social function (SF) were notably improved at 1 year after surgery (P<O.01).Improved mJOA score correlated with improvements in PF,RP,bodily pain,general health (GH),vitality (VT),and SF (P<O.05) at 3 months after surgery; PF,GH,VT,and SF were associated with improved mJOA scores at 1 year after surgery.Conclusions Patients benefit from surgery by postoperative restitution of neurological function with early recovery of sensory function,followed by a gradual transition to motor function improvement.At the early stage of recovery,improvement in the mJOA score essentially correlated with improvements in the physical domains of the SF-36,while at the later stage,mJOA score improvement was associated with improvements in both

  18. 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.

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    Sheng Shi

    Full Text Available 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.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.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.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.

  19. 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.

  20. Laminoplasty and laminectomy for cervical sponydylotic myelopathy: a systematic review

    NARCIS (Netherlands)

    Bartels, R.H.M.A.; Tulder, M.W. van; Moojen, W.A.; Arts, M.P.; Peul, W.C.

    2015-01-01

    BACKGROUND: Cervical spondylotic myelopathy is frequently encountered in neurosurgical practice. The posterior surgical approach includes laminectomy and laminoplasty. OBJECTIVE: To perform a systematic review evaluating the effectiveness of posterior laminectomy compared with posterior laminoplasty

  1. Observation on early therapeutic effect of DISCOVER artificial cervical disc replacement for cervical spondylotic myelopathy%DISCOVER人工颈椎间盘置换术治疗脊髓型颈椎病的早期疗效观察

    Institute of Scientific and Technical Information of China (English)

    钱俊; 辛兵; 何玉泽; 郭开今

    2013-01-01

    目的 探讨应用DISCOVER人工颈椎间盘置换术治疗脊髓型颈椎病的早期临床疗效.方法 回顾性分析行DISCOVER人工颈椎间盘置换术的12例脊髓型颈椎病患者的临床资料,统计并分析患者术前和术后神经功能状态JOA评分和颈椎总活动度(ROM),进行早期疗效评估.结果 所有患者随访6个月,术后临床症状和体征明显改善或消失,JOA评分由术前的(6.79±3.62)分提高到末次随访的(15.84 ±0.89)分(P<0.05);ROM术前为(51.3 ±14.2)°,术后末次随访为(49.9±13.8)°,差异无统计学意义(P>0.05).按照Odom评定标准,末次随访时,优9例,良2例,可1例,优良率91.7%.结论 应用DISCOVER人工颈椎间盘置换术治疗脊髓型颈椎病早期疗效良好,远期效果有待进一步观察.%Objective To evaluate the early clinical efficacy of DISCOVER artificial cervical disc replacement sur gery for cervical spondylotic myelopathy. Methods The clinical data of 12 patients with cervical spondylotic myelopathy undergoing DISCOVER artificial cervical disc replacement was analyzed retrospectively. Preoperative and postoperative neurological status JOA scores and cervical range of motion (ROM) were compared and early therapeutic efficacy was e-valuated. Results All patients were followed - up for 6 months. The neurological symptoms and signs were alleviated or disappeared in all cases. The JOA score was significantly improved from 6. 79 ±3. 62 preoperatively to 15. 84 ±0. 89 at the last postoperative follow - up (P 0. 05 ). According to Odom criteria, 9 cases got excellent results, 3 cases got good results, 1 case got fair results. The rate of excellent and good results was 91.7%. Conclusion Our findings suggest that the DISCOVER cervical disc replacement for cervical spondylotic myelopathy may yield good short - term functional results. Further follow - up is necessary to evaluate mid and long - term outcome.

  2. 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

  3. Effects of robot-driven gait orthosis treadmill training on the autonomic response in rehabilitation-responsive stroke and cervical spondylotic myelopathy patients.

    Science.gov (United States)

    Magagnin, Valentina; Bo, Ivano; Turiel, Maurizio; Fornari, Maurizio; Caiani, Enrico G; Porta, Alberto

    2010-06-01

    Body weight supported treadmill training (BWSTT) assisted with a robotic-driven gait orthosis is utilized in rehabilitation of individuals with lost motor skills. A typical rehabilitation session included: sitting, standing, suspension, robotic-assisted walking at 1.5 and 2.5km/h, respectively with 50% body weight support and recovery. While the effects of robotic-assisted BWSTT on motor performances were deeply studied, the influences on the cardiovascular control are still unknown. The aim of the study was to evaluate in stroke (ST) and cervical spondylotic myelopathy (CSM) patients: (1) the autonomic response during a traditional robotic-assisted BWSTT session of motor rehabilitation; (2) the effects of 30 daily sessions of BWSTT on cardiovascular regulation. The autonomic response was assessed through symbolic analysis of short-term heart rate variability in 11 pathologic subjects (5 ST and 6 CSM patients) whose motor skills were improved as a result of the rehabilitation therapy. Results showed variable individual responses to the rehabilitation session in ST patients at the beginning of the therapy. At the end of the rehabilitation process, the responses of ST patients were less variable and more similar to those previously observed in healthy subjects. CSM patients exhibited an exaggerated vagal response to the fastest walking phase during the first rehabilitative session. This abnormal response was limited after the last rehabilitative session. We conclude that robotic-assisted BWSTT is helpful in restoring cardiovascular control in rehabilitation-responsive ST patients and limiting vagal responses in rehabilitation-responsive CSM patients.

  4. 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.

  5. 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.

  6. 颈椎动力位 MRI在脊髓型颈椎病诊治中的作用%Effect of cervical kinematic MRI in diagnosis and treatment of cervical spondylotic myelopa-thy

    Institute of Scientific and Technical Information of China (English)

    王兴武; 陆建猛; 水淼; 俞武良; 韦勇力

    2016-01-01

    目的:探讨颈椎动力位MRI在脊髓型颈椎病诊治中的作用。方法分别测量42例患者共59节病变节段在颈椎过屈、中立、过伸位时的硬膜囊中矢径与脊髓中矢径,对比两者在不同体位下的变化。结果59节病变节段,在过屈、中立、过伸位时,测出平均硬膜囊中矢径分别是:(7.63±0.90) mm,(6.48±0.82) mm,(5.85±0.89) mm;平均脊髓中矢径分别是:(6.44±0.80) mm,(5.81±0.82) mm,(5.56±0.82) mm。在过伸位时,硬膜囊中矢径与脊髓中矢径之间差值最小(0.29±0.60) mm(P<0.01),脊髓代偿空间最小。结论在脊髓型患者中,颈椎病动力位MRI可以显示脊髓在不同体位下动态受压变化,对其治疗方式的选择有极大帮助。%Objective To investigate the use of the cervical kinematic MRI in the diagnosis and treatment of cervical spondylotic myelopathy .Methods The sagittal diameter of dural sac and spinal cord in the 42 cases with total 59 le-sions segments , were measured in the over flexion , neutral and hyperextension position respectively , and the changes in different positions were evaluated .Results In the 59 lesions segments , the average sagittal diameter of dural sac was (7.63 ±0.90) mm,(6.48 ±0.82) mm,(5.85 ±0.89) mm respectively in the over flexion, neutral and hyper-extension position.And the average sagittal diameter of spinal cord was (6.44 ±0.80) mm,(5.81 ±0.82) mm, (5.56 ±0.82) mm respectively in three different positions .The minimum difference (0.29 ±0.60) mm between vectors of dural sac and spinal cord was in the extension position with a minimal spinal cord reserve space ( P <0.01).Conclusions In the cervical spondylotic myelopathy , cervical kinematic MRI can indicate the dynamic spi-nal cord compression in the different positions , and be useful in treatment .

  7. 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

  8. 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

  9. 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.

  10. 人工颈椎间盘置换术治疗脊髓型颈椎病10例临床分析%Artificial cervical disc replacement in the treatment of cervical spondylotic myelopathy clinical analysis of 10 cases

    Institute of Scientific and Technical Information of China (English)

    杨磊; 崔宏勋; 赵庆安; 饶耀剑

    2013-01-01

      目的探讨人工颈椎间盘置换术用于治疗脊髓型颈椎病的临床疗效.方法2010年6月—2012年9月,对10例保守治疗无效患者的11个节段进行了人工颈椎间盘置换术,男6例,女4例;年龄41~61岁,平均(48±0.8)岁.单节段9例,双节段1例,术后随访3~12个月.结果所有患者伤口均I期临床愈合,术中及术后没有神经和血管损伤的并发症,结合术前术后颈椎活动范围检查、神经系统症状、Odom评级、JOA评分及影像学检查,患者神经系统症状均获得满意改善,JOA评分较术前明显升高.颈椎曲度、置换节段功能活动度、置换节段上下位椎体椎间隙高度得到保持.假体未见下沉或偏移,未见异位骨化.结论颈椎人工椎间盘置换术在维持节段运动功能的同时,可取得良好的神经减压效果,人工椎间盘置换术的短中期疗效是令人满意的.%Objective To investigate the artificial cervical disc replacement for the treatment of cervical spondylotic myelopathy. Methods In 2010 June to 2012 September,10 cases of invalid conservative treatment of patients with 11 segments for the artificial cervical disc replacement,6 cases were male,4 female;age 41-61 years,mean 48±0.8 years old. 9 cases of single segment,1 cases of double segments,followed up for 3 months to 12 months. Results All patients were healed wound phase I clinical,intraoperative and postoperative no nerve and blood vessel injury,combined examination of cervical range check, neurological symptoms,Odom rating,JOA score and imaging before and after surgery,patients with nervous system symptoms were satisfactory improvement,JOA score was significantly higher than that before operation. Cervical curvature,replacement of segmental function activity,replacement segment inferior vertebral height is maintained. Prosthesis no sinking or offset, no heterotopic ossification. Conclusion Cervical artificial disc replacement in the maintenance of segmental motion

  11. 人工颈椎间盘置换术治疗脊髓型颈椎病的近期疗效%Short-term efficacy of Bryan cervical disc arthroplasty in patients with cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    梁英杰; 钟润泉; 郭东明; 温世锋

    2014-01-01

    目的:探讨Bryan人工颈椎间盘置换术治疗脊髓型颈椎病的近期疗效。方法应用Bryan人工颈椎间盘置换术治疗26例脊髓型颈椎病患者,在术前及末次随访时的颈椎X线片上测量置换节段矢状位、冠状位活动度。应用JOA评分评价术后神经功能。结果术后患者症状均明显缓解。26例均获随访,时间29~48个月。末次随访JOA评分由术前平均8.3分±4.6分增加到16.1分±5.3分,置换节段矢状位活动范围4.3°~7.2°(5.6°±2.4°);冠状位左右侧屈活动范围分别为3.1°~4.3°(3.8°±1.1°)和3.1°~4.6°(3.9°±0.9°)。随访期间假体无偏移松动或下沉,无置换节段假体周围异位骨化。结论 Bryan人工颈椎间盘置换术治疗脊髓型颈椎病近期临床效果较好,维持颈椎正常的活动范围、生理曲度和较好的生物力学稳定性。%Objective To discuss the short-term clinical and radiographic outcome of Bryan cervical disc arthroplas-ty.Methods Radiographic and clinical outcomes in 26 patients who received the Bryan cervical disc prosthesis were retrospectively reviewed.Static and dynamic X-ray was taken for measuring the range of motion.Clinical outcomes were assessed using Japanese Orthopedics Academy (JOA)scale.Results The average follow-up time was 29~48 months,and all patients were satisfied with the relief of symptoms.In the last follow-up,the average JOA scale was 16.1 ±5.3 ,while it was 8.3 ±4.6 pre-operation.The sagittal range of motion was 4.3°~7.2°(5.6°±2.4°),and the coronal range of motion was 3.1°~4.3°(3.8°±1.1°)and 3.1°~4.6°(3.9°±0.9°).No heterotopic ossifica-tion,prosthesis loosening,prosthesis migration or other complications occured.Conclusions Arthroplasty using the Bryan disc for cervical spondylotic myelopathy patients seems to be safe and provids encouraging clinical and radiolog-ic outcome in our short-term study.

  12. Comparison of rhBMP-2 versus Autogenous Iliac Crest Bone Graft for 2-Level Anterior Cervical Discectomy and Fusion for Cervical Spondylotic Myelopathy

    OpenAIRE

    2015-01-01

    Background Few studies have examined the efficacy of recombinant human bone morphogenetic protein-2 (rhBMP-2) in 2-level anterior cervical discectomy and fusion (ACDF). The purpose of this study was to compare the outcomes in a series of patients with CSM treated with 2-level ACDF with or without rhBMP-2. Material/Methods The retrospective study included a total of 146 patients with CSM. The rhBMP-2 group consisted of 73 patients who underwent 2-level ACDF with rhBMP-2. A total of 73 patients...

  13. 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

  14. 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

  15. 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.

  16. 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

  17. Surgical treatment for cervical spondylotic myelopathy with different characteristics in imaging examinations%不同影像学特点的脊髓型颈椎病的手术治疗

    Institute of Scientific and Technical Information of China (English)

    马迅; 陈辉; 曹凯; 陈晨; 冯皓宇; 霍建忠

    2014-01-01

    Objective To investigate the clinical features, operation procedures and clinical outcomes of cervical spondy-lotic myelopathy with different imageological characteristics. Methods Two hundred and twenty one cervical myelopathy with different imageological characteristics patients between November 2011 and October 2013 were involved in this retrospective study. Patients were distributed into three groups, namely mild group (A), moderate group (B) and severe group(C), based on severi-ty of complexity by imageological variables (severity of cervical spine degeneration, the number of spinal cord compression, severi-ty of spinal cord compression and difficulty in operation). Preoperative and postoperative Japanese Orthopaedic Association (JOA) score and mean recovery rate were collected to evaluate the postoperative clinical effects. Demographic data and imageological characteristics were recorded;Univariate analysis or analysis of variance was conducted to analyze the correlation between post-operative JOA recovery rate with gender, age, course of disease, severity of spinal cord compression, the number of segment with spinal cord compression, severity of disc degeneration, MRI T2 increased signal intensity, cervical instability, cervical kyphosis, developmental cervical spinal stenosis and ossification of posterior longitudinal ligament. Results There was no significant differ-ence in gender between three groups. There was significant difference in age, preoperative JOA score and improvement rate be-tween group A and group B (C). All patients received decompression and reconstruction by anterior or posterior approach. The ra-tio of anterior approach in group A, B and C was 91.1%(72/79), 79.8%(71/89), 35.8%(18/53). The last follow-up JOA recovery rate of group A, B and C was 75.4%±6.4%、67.7%±8.7%、62.8%±10.4%. The last follow-up JOA recovery rate was correlated with duration of disease, the number of spinal cord compression and severity of spinal cord

  18. 人工颈椎间盘置换联合颈前路融合术治疗多节段脊髓型颈椎病%Treatment on multilevel cervical spondylotic myelopathy by artificial cervical disc replace-ment combined with anterior cervical discectomy and fusion

    Institute of Scientific and Technical Information of China (English)

    游新茂; 叶秀益; 宋滇文; 贾连顺

    2014-01-01

    Objective To explore the clinical effects of artificial cervical disc replacement( ACDR) combined with anterior cervical discectomy fusion ( ACDF ) for the treatment of multi-segmental cervical spondylotic myelopathy ( CSM) . Methods 18 cases with multi-segmental CSM which were treated by ACDR combined with ACDF were re-viewed. The stability of artificial disc, internal fixation and bone fusion were evaluated by X-ray films before opera-tive, immediate postoperative and follow-up. The JOA scores was evaluated also at the same time. Results 18 pa-tients were followed up from 24 to 60 months ( averaged 36 ± 9. 6 months) . The range of motion of the replacement segment were 13. 8° ± 6. 5° at preoperative and 12. 5° ± 5. 3° at the final follow-up, and there was no significant difference between them(P>0. 05). The preoperative JOA scores was 9. 5 ± 1. 5, which was improved to 14. 2 ± 2. 2 in 4 months after operation; Preoperative neurological symptoms were obviously alleviated in most patients, and the improvement ratio of JOA was 62. 7% ± 11. 2%. The results were excellent in 9 patients, good in 5, fair in 2 and poor in 2. There were no patient with false of internal fixation, and the position of artificial disc was good. Conclu-sions ACDR combined with ACDF is a good procedure for multi-segmental cervical spondylotic myelopathy, it not only maintain the cervical spine alignment with saving more movement segments,but also reduce the incidence of ad-jacent segment degeneration.%目的:评价人工颈椎间盘置换联合颈前路融合术治疗多节段脊髓型颈椎病的临床效果。方法采用人工颈椎间盘置换联合颈前路融合治疗18例多节段脊髓型颈椎病患者。根据术前、术后、随访时的颈椎X线片观察人工椎间盘、内固定、植骨融合以及JOA评分改善情况。结果18例均获随访,时间24~60(36±9.6)个月。置换间隙平均活动度术前为13.8°±6.5°,末次随访时为12.5°±5.3

  19. The effect of single anterior approach for pinching cervical spondylotic myelopathy%单纯前路手术治疗“钳夹型”颈椎病的疗效

    Institute of Scientific and Technical Information of China (English)

    张颖; 王新伟; 陈华江; 杨立利; 徐盛明; 吕碧涛; 张竞; 袁文

    2012-01-01

    25.8 months (range,9-72 months).Significant differences were found between pre- and postoperative Japanese Orthopaedic Association (JOA) scores,anterior occupying rate,posterior occupying rate,and intervertebral space height,respectively.Pre- and post-operative posterior occupying rate was averagely 29.0%±10.5% and 19.9%+11.6%,respectively,and improvement rate of posterior occupying rate was 9.0%±6.1%.Regression analysis found that preoperative intervertebral space height did not relate to posterior occupying rate,while preoperative posterior occupying rate related to improvement rate of posterior occupying rate.JOA scores improved significantly after operation in patients with preoperative posterior occupying rate between 20% and 40%.However,the decompression results were poor in patients with preoperative posterior occupying rate ≥40%.Conclusion Anterior decompression and fusion can achieve satisfactory results in patients with pinching cervical spondylotic myelopathy.For patients with preoperative posterior occupying rate between 20% and 40%,the decompression results are better.

  20. Modified open-door laminoplasty for multiple-segment cervical spondylotic myelopathy%改良颈椎后路单开门椎管扩大成形术治疗多节段脊髓型颈椎病

    Institute of Scientific and Technical Information of China (English)

    孔凡磊; 聂志红; 刘中坡; 武玉江; 付秀信

    2013-01-01

    Objectives: To discuss the clinical effect of C3 laminectomy and C4-C7 open-door laminoplasty for cervical spondylotic myelopathy(CSM). Methods: From January 2009 to October 2011, 74 patients underwent extensive open-door laminoplasty, detailed as C3 laminectomy reserving attachment of musculus semi-spinalis cervicis and C4-C7 modified open-door laminoplasty. 57 patients got follow-up. Among them, there were 31 males and 26 females. The ages ranged from 50 to 71 years with a mean age of 63 years. The JOA scores were 4-11 points, with a mean of 8.5±2.0 before the operation. The range of motion was 23°-49° with a mean of 37.4°±10.3°. The cervical curvature index was 6.0%-22.0%, with a mean of (13.9±7.4)%. The preoperative and postoperative JOA scores were recorded. The JOA score and the incidence of axial symptom were reviewed. At six months after the operation, the change of ROM and cervical curvature index was noted. Results: The mean operative time was 70min ranging from 50 to 110min. The mean volume of blood loss was 230ml ranging from 150ml to 600ml. No complication such as spinal cord injury or cerebrospinal fluid leakage was noted. 41 patients had early postoperative neck pain, which resolved after corresponsive management. The rate of evident axial symptom was 15.8%. Two patients developed wound infection. Six patients were complicated with C5 nerve root palsy, which alleviated after symptomatic treatment. The patients with postoperative neurological deficit improved to different degrees. The postoperative JOA scores were 10-17 points, with a mean of 13.8±2.3 points, which showed significant difference (P<0.05). The JOA improvement rate was 29.0%-77.3%, with a mean of (57.0±19.7)%. Loss of cervical curvature index was (2.9±2.4)%. The range of motion was 18°-46° with a mean of 28.2°±10.8°, and the loss of ROM was 8.2°±5.1°. No door-re-close was noted during follow-up. Conclusions: C3 laminectomy reserving attachment of musculus semi

  1. 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.

  2. Biomechanics characteristics of four anterior cervical reconstructive techniques in the surgical management of multilevel cervical spondylotic myelopathy:a finite element model study%有限元法分析多节段颈椎病4种颈前路修复方式的生物力学特点

    Institute of Scientific and Technical Information of China (English)

    李忠海; 林斌; 唐家广; 任东风; 李利; 吴闻文; 侯树勋

    2016-01-01

    背景:多节段颈椎病因脊髓多严重受压,故多需手术去除压迫,但是对于选择何种前路修复方法最好,目前仍未达成共识。目的:利用三维有限元模型对4种颈椎前路修复方式进行对比分析,分析其生物力学特点。方法:基于健康成年男性C2-C7节段CT图像建立颈椎有限元模型。模拟4种颈椎前路修复方式分别建模,包括颈椎前路椎间盘切除融合、颈椎前路椎体次全切除融合、颈椎前路混合减压融合、颈椎前路间盘切除减压单纯Cage置入融合,计算C2/3、C6/7椎间盘以及钛板-螺钉界面应力变化情况。结果与结论:①4种颈椎前路修复方式在前屈、后伸、侧屈、旋转工况下相邻节段的椎间盘应力均为C2/3节段大于C6/7节段,而且均是颈椎前路间盘切除减压单纯Cage置入融合组椎间盘应力最小,颈椎前路椎体次全切除融合组椎间盘应力最大;②钛板-螺钉界面应力颈椎前路椎体次全切除融合组最大,颈椎前路椎间盘切除融合组最小;③结果说明,在修复多节段颈椎病的4种颈前路融合内固定方式中,颈椎前路间盘切除减压单纯Cage置入融合对于相邻节段的生物力学影响最小,理论上可以降低邻近节段退变的发病率,但该方法存在增加融合器沉降的风险。%BACKGROUND:Surgical treatment is commonly used for decompressing the spinal cord in multilevel cervical spondylotic myelopathy, but the optimum anterior cervical reconstructive method has not been determined. OBJECTIVE:To compare and analyze the biomechanical characteristics of four anterior cervical reconstructive techniques in the surgical management of multilevel cervical spondylotic myelopathy utilizing the three-dimensional finite element model. METHODS:A three-dimensional finite element model of an intact C2–7 segment was developed and validated based on healthy adult male CT images. Four additional

  3. 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.

  4. 两种颈椎前路减压融合术治疗脊髓型颈椎病的临床疗效分析%Clinical results of anterior cervical discectomy or corpectomy in 2-level cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    张伟; 陈德玉; 杨立利; 陈宇; 田海军; 缪锦浩; 马跃

    2011-01-01

    [目的]回顾性分析比较椎间盘切除减压融合术(ACDF)和椎体次全切除减压融合术(ACCF)在治疗相邻两个节段脊髓型颈椎病的临床疗效及影像学数据.[方法]2005年4月~2007年8月,采用ACDF和ACCF治疗相邻两个节段脊髓型颈椎病156例.临床疗效采用日本骨科学会评分系统(JOA评分)对术前、末次随访的临床疗效进行评价.比较两组患者I临床疗效及手术时间、住院大数、术中失血量、颈椎活动度、颈椎曲度及节段性高度.[结果]两组的临床改善优良率无显著性差异(P>0.05),ACDF组与ACCF组术中平均出血量及手术时间有显著性差异(P<0.01),ACCF较ACDF增加,而ACCF组术后的节段性高度及颈椎前凸角较ACDF组明显降低(P<0.01).[结论]ACDF与ACCF均能达到良好的手术疗效,然而ACDF在减少术中出血量、手术时间,改善和维持术后颈椎前凸角度及节段性高度较ACCF作用明显,但ACDF要求技术较高,有较长的学习曲线.%[ Objective] To investigate clinical and radiologic outcomes after surgical treatment for 2 -level cervical spondylotic myelopathy with anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) .[ Methods] The sample included 156 patients who underwent ACDF and ACCF. Clinical symptoms were assessed based on the Japanese Orthopedic Association Scores (JOA) . All medical and surgical records were examined and analyzed, including pain - free interval, intraoperative blood loss, length of surgery, postsurgery hospital stay and radiologic parameters ( total cervical range of motion, segmental cervical range of motion, cervical lordosis, segmental height, fusion rate) . [ Results] The operation time (P <0. 01 ) and bleeding amount (P <0. 01 ) were significantly greater in the ACCF group, whereas segmental height ( P < 0.01 ) and postoperative cervical lordosis ( P < 0. 01 ) were significantly lower in the ACCF group. However, other

  5. 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

  6. 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

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    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

  7. Cervical myelopathy due to degenerative spondylolisthesis

    OpenAIRE

    Koakutsu, Tomoaki; Nakajo, Junko; Morozumi, Naoki; Hoshikawa, Takeshi; Ogawa, Shinji; Ishii, Yushin

    2011-01-01

    Objective To investigate clinical-radiological features of cervical myelopathy due to degenerative spondylolisthesis (DSL). Methods A total of 448 patients were operated for cervical myelopathy at Nishitaga National Hospital between 2000 and 2003. Of these patients, DSL at the symptomatic disc level was observed in 22 (4.9%) patients. Clinical features were investigated by medical records, and radiological features were investigated by radiographs. Results Disc levels of DSL were C3/4 in 6 ca...

  8. Comparision between single-level cervical corpectomy and two-level discectomy in two-adjacent-level cervical spondylotic myelopathy%相邻两节段脊髓型颈椎病前路不同术式的比较

    Institute of Scientific and Technical Information of China (English)

    贾小林; 谭祖键; 杨阜滨; 杨明; 万革

    2012-01-01

    [Objective] To compare the outcomes of patients treated with either anterior cervical corpectomy with fusion ( ACCF) or anterior cervical discectomy with fusion ( ACDF) for two - adjacent - level cervical spondylotic myelopathy. [ Methods ] The case histories of 67 patients underwent surgical treatment for two - adjacent - level cervical spondylotic myelopathy from June 2006 to March 2010 were retrospectively reviewed. There were 36 with a single -level corpectomy and 31 with a two -level ACDF. The following were analyzed: ( 1) perioperative parameters (hospital stays, bleeding amounts, operative times, complications) , (2) clinical parameters (Japanese Orthopedic Association scores, Visual Analog Scale scores for neck and arm pain) , and (3) radiologic parameters (sagittal alignment, cervical lordosis, total cervical range of motion, segmental range of motion, anterior and posterior body height for the fused levels, fusion rate) . [ Results ] The mean durations of follow - up were 28. 96 ± 13. 21 (ACCF) and 26. 81 ± 11. 02 (ACDF) months. Of these above parameters, operative time, bleeding amount and complication rates were significantly greater in the ACCF group, whereas postoperative cervical lordosis and segmental height were significantly lower in the ACCF group postoperatively. However, other parameters were not significantly different between the 2 groups. All radiologic parameters occurred significantly more during the first 6 weeks after surgery than after 6 weeks. The loss of posterior body height for the fused levels significantly progressed after 6 weeks in Group ACCF, with no differences in Group ACDF. [ Conclusion] Our data suggest that the two procedures yield comparable results in terms of clinical outcomes for two -adjacent - level cervical spondylotic myelopathy. However, ACDF was found to be superior to ACCF in terms of operation times, bleeding amounts, complication rates and some radiologic results. The decision to perform either ACCF or ACDF

  9. 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

  10. Anterior cervical interbody Cage placement for treatment of multilevel cervical spondylotic myelopathy: Reconstruction of spinal function%椎前路Cage植入技术治疗多节段脊髓型颈椎病重建脊柱功能的效应

    Institute of Scientific and Technical Information of China (English)

    李建光; 苗军; 夏群

    2007-01-01

    then spinal cord in patients with multilevel cervical spondylotic myelopathy. Complete decompression is very important for such patients. This study is to investigate the effect of this technique on reconstruction of spinal function.METHODS:①Thirty-eight inpatients with multilevel cervical spondylotic myelopathy admitted to Department of Spine Surgery, Tianjin Hospital between April 2003 and February 2006 were involved in this study. The involved patients, 35 male and 3 female, were aged 43-72 years, with disease course of 0.5 to 5 years. Informed consents of therapeutic regimen were obtained from all the patients.②All the patients underwent anterior cervical discectomy and cage placement operation. The patients with destabilized combination underwent titanium-plate fixation, and those with stabilized combination underwent cage implantation alone. The cage used in the experiment was made of tetragonal polyether ether ketone (Intromed Company), and titatium-plate was Zephir plate (sofarmor Danek Company). The elastic modulus of tetragonal polyether ether ketone Cage was similar to bone tissue and could allow X-ray pass through, which was easy for postoperative fusion of implanted bone. The outer design of Cage bone graft with certain angle could allow cervical physiological antecurvature well recover; Surface radian was the same as end plate, and good fitness contributed to the good fusion rate of bone graft; The sawtooth antiskid design on the surface provided good stability immediately after implantation; Elastic modulus was between os integumentale and cancellous bone that made stress-shielding and subsidence of fusion cage reduced, and had good anticausticity and biocompatibility. ③ The clinical results were evaluated with Japanese Orthopaedic. Association (JOA) scoring system before, 2,8 and 24 weeks after operation: upper limb motor function (4 points), lower limb motor function (4 points), sensation (6 points) and bladder function (3 points). Higher scores

  11. 比较4种方案治疗脊髓型颈椎病效果的系统性评价%Systematic review the effects of four operative techniques in treating cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    陈科; 陈仲; 靳安民; 张辉; 闵少雄; 段扬; 张西兵; 叶文明

    2011-01-01

    BACKGROUND: There I s still a controversy about the surgery in treating multilevel cervical spondylotic myelopathy (CSM).OBJECTIVE: To review 4 operative techniques which were used for the CSM treatment.METHODS: From 1980 to December 2010, a systematic review of retrospective cohort studies with multilevel anterior multilevelcorpectomyand fusion (AMCF), anterior cervical discectomy and fusion(ACDF), expensive laminoplasty (EXLP) anddecompressive laminectomy and fusion (DLEF) was performed to systematic evaluate the optimum treatment for CSM with over10-year follow-up.RESULTS AND CONCLUSION: A total of 1 718 articles were retrieved, finally 591 abstracts, 36 articles in full were included.Retrospective cohort studies were compared in all studies. Four studies compared AMCF+EXLP, one study comparedDLEF+EXLP, and two studies compared ACDF+EXLP. There were 3 case studies with over 10 years follow-up. Neurologicalrecovery rates in all approaches showed no difference. EXLP had a signifi cant incidence of neck pain as compared with multilevelAMCF. The rate of adjacent secondary spondylosis in ACDF was increased as compared with EXLP. AMCF+DLEF had asignificantly higher rate of graft, instrumentation, and approach related complications. AMCF+DLEF had a significant decrease inrange of motion of neck as compared with EXLP.%背景:对于多节段脊髓型颈椎病,手术治疗方式的选择尚存争议.目的:对脊髓型颈椎病的4种治疗方式进行系统评价.方法:选取1980/2010-12有关比较多节段椎体次全切除+融合、前路颈椎间盘切除+融合、椎管扩大成形及椎板切除减压+融合文章的回顾性分析,系统评价脊髓型颈椎病治疗的最佳治疗方式,并对随访超过10年的病例进行独立评价.结果与结论:共检索到1 718篇文章,筛选出591篇摘要,36篇有全文,均为回顾性队列研究.有4项研究比较了多节段椎体次全切除+融合和椎管扩大成形,1项研究比较了椎板切除减

  12. 单节段椎体自发性融合所致脊髓型颈椎病临床研究%Cervical spondylotic myelopathy caused by single-level vertebral spontaneous fusion

    Institute of Scientific and Technical Information of China (English)

    严宁; 虞舜志; 赵杉; 张晨; 侯铁胜; 贺石生

    2014-01-01

    目的:总结单节段椎体自发性融合(SLVSF)所致脊髓型颈椎病(CSM)的临床特点、影像学表现、外科处理及预后。方法回顾性分析2002年7月至2012年6月上海市第十人民医院收治的16例SLVSF患者(SLVSF组)的临床资料,患者均行前路手术,其中Ⅰ型(椎体、椎板和棘突全部融合)11例、Ⅱ型(椎体和椎板融合,棘突各自独立)5例。记录其临床特点、影像学表现、外科治疗方法、功能评分和并发症等,并与38例退变所致CSM患者(退变组)的临床资料进行比较。结果两组年龄、病程比较,差异有统计学意义(P<0.05);颈椎长度比较,差异无统计学意义(P>0.05)。SLVSF组中13例存在融合节段头端水平不稳,但无成角不稳;融合区椎管指数大于其他节段的椎管指数,差异有统计学意义(P <0.05)。两组术前Nurick评级、日本骨科学会(JOA)评分比较,差异无统计学意义(P>0.05);SLVSF组颈椎功能障碍指数(NDI)高于对照组(P<0.05)。两组术后1年上述临床指标均优于术前,差异有统计学意义(P<0.05)。结论 SLVSF患者颈椎长度正常,可与Klippel-Feil综合征相鉴别;其主要临床特点是受累节段椎体和椎间盘发育不良、融合节段头侧水平不稳和颈部疼痛症状较重。前路手术效果良好,但需要注意椎体次全切除的范围。%Objective To evaluate the clinical features, radiological characteristics, surgical options and clinical outcomes of patients with cervical spondylotic myelopathy (CSM) caused by single-level vertebral spontaneous fusion (SLVSF). Methods Sixteen consecutive patients with SLVSF (SLVSF group) treated in Shanghai 10th People's Hospital from July 2002 to June 2012 were included in this study, and they all underwent anterior sugery. Of these patients, 11 were categorized as type Ⅰ (fusion of the vertebral bodies, the lamina and

  13. 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

  14. Comparative study of artificial cervical disc replacement verus anterior cervical discectomy and fusion in the treatment of cervical spondylotic myelopathy%人工颈椎间盘置换与颈前路减压融合术治疗脊髓型颈椎病的对照研究

    Institute of Scientific and Technical Information of China (English)

    马晓勇; 陈涛平; 郭志学

    2012-01-01

    目的 比较人工颈椎间盘置换术与颈前路减压融合术治疗脊髓型颈椎病的疗效,评价其优缺点.方法 65例脊髓型颈椎病患者按照手术方式分为人工颈椎间盘置换术组(33例,行Bryan假体置换术)和颈前路减压融合术组(32例,行颈前路减压融合术).观察两组患者住院时间、术后颈部外固定时间以及术后恢复工作时间;两组患者于术前、术后3、6、12个月行日本矫形外科协会(JOA)评分,并行X线检测颈椎活动度(ROM);评价临床疗效及术后并发症.结果 人工颈椎间盘置换术组患者住院时间、术后颈部外固定时间以及术后恢复工作时间均显著短于颈前路减压融合术组(P < 0.01).两组术后12个月JOA评分均较术前明显提高(P < 0.05),两组差异无统计学意义(P > 0.05).人工颈椎间盘置换术组术后12个月单节段及双节段置换ROM较术前无显著改变(P > 0.05),颈前路减压融合术组术后12个月ROM较术前减小(P < 0.05或P < 0.01),且显著小于人工颈椎间盘置换术组(P < 0.05或P < 0.01).两组患者满意率无差异(P > 0.05).两组术后均无严重并发症发生.结论 人工颈椎间盘置换术治疗脊髓型颈椎病患者术后恢复快,住院时间短,颈部外固定时间短,使患者保持正常的颈椎活动度,临床疗效好,值得临床推广使用.%Objective To compare the efficacy of artificial cervical disc replacement verus anterior cervical discectomy and fusion (ACDF) in the treatment of cervical spondylotic myelopathy (CSM), and evaluate their advantages and disadvantages. Methods A total of 65 patients with CSM were divided into artificial cervical disc replacement group (33 patients) and ACDF group (32 patients). The hospital stay, postoperative cervical fixation time and postoperative time returning to work of the two groups were observed; the Japanese Orthopaedic Association (JOA) score and range of motion by X-ray before surgery, 3

  15. 一期后前路联合手术治疗多节段脊髓型颈椎病%One-stage anterior-posterior approach for multilevel cervical spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    刘新宇; 原所茂; 田永昊; 郑燕平; 李建民

    2012-01-01

    Objective: To evaluate the clinical results of one-stage anterior-posterior approach for multilevel cervical spondylotic myelopathy (CSM).Method:A total of 28 patients (16 males and 12 females) suffering severe CSM underwent one-stage combined anterior-posterior approach, the average age was 51.3 years (range: 32-63 years).The affected level was C2/3 in 5 cases,C3/4 in 21 cases,C4/5 in 26 cases,C5/6 in 28 cases and C6/7 in 16 cases.The clinical results including JOA scores,the number of hand action in ten seconds, hand-grip strength,visual analog scale(VAS) of axial pain,and Cobb angle of sagittal alignment(C2-C7) were assessed retrospectively .Result: The average surgical time was 6.5h,the average blood loss was 375ml.All cases, were followed up for one year.No neurological deterioration due to spinal cord injury,CSF leakage,or wound infection was noted.The JOA scores improved from preoperative 9.8±2.1 to 15.9±1.2 of 1 year later,with the average improve rate of (84.7±9.2)%.The number of hands action in ten seconds improved from preoperative 11.2±3.1 of left and 10.8±l of right to postoperative 18.2±2.6 of left and 17.8±3.9 of right,and hand-grip strength improved from preoperative 18.7±7.1kg of left and 19.2±3.6kg of right to postoperative 33.2±6.3 of left and 35.8±2.5 of right (PO.O5).A11 cases showed satisfactory decompression and good bony fusion on MRI or CT.No ASD and instrument failure were noted.Conclusion: Combined anterior-posterior approach is less invasive and can decrease postoperative axial pain;anterior approach can manage compression effectively.%目的:探讨一期后前路联合手术治疗多节段脊髓型颈椎病的临床疗效.方法:回顾性分析2009年9月~2010年7月我院收治的行一期后前路联合手术治疗的多节段脊髓型颈椎病患者28例,男16例,女12例,年龄32~63岁,平均51.3岁,病程平均5.6年.术前病变节段:3节段16例,4节段12例.其中累及C2/3节段5例次、C3/4 21例次、C4/5 26

  16. 颈前路减压cage融合术与自体髂骨块植骨钛板内固定术治疗脊髓型颈椎病的中期疗效%Anterior cervical discectomy and interbody fusion with PEEK cage or autogenous iliac crest graft for the cervical spondylotic myelopathy:a mid-term follow up results

    Institute of Scientific and Technical Information of China (English)

    贾龙; 郑燕平; 刘新宇; 王延国; 黎君彦

    2011-01-01

    目的:观察颈椎前路减压cage植骨融合术与颈椎前路减压自体髂骨块植骨融合钛板内固定术治疗脊髓型颈椎病的中期临床疗效.方法:2001年1月~2006年4月128例脊髓型颈椎病患者按照手术方式分为A、B两组,A组61例患者采用前路减压单纯PEEK cage植骨融合术治疗,其中病变节段与手术节段均为单节段22例,双节段39例;B组67例采用颈椎前路减压自体髂骨块植骨融合钛板内固定术,其中单节段27例,双节段40例.观察手术前后JOA评分、椎间高度和颈椎曲度情况.结果:A组手术时间为58.1±1.4min,术中出血量为42.4±2.0ml,B组分别为72.0±5.3min、82.7±3.9ml,两组比较差异有统计学意义(P0.05).随访24~60个月,平均36个月,末次随访时A、B组椎间融合率分别为95.2%和96.3%,两组比较差异无统计学意义(P>0.05);末次随访时每组JOA评分、椎间高度和颈椎曲度与术后比较差异无统计学意义(P>0.05).术前、术后和末次随访时JOA评分、椎间高度和颈椎曲度两组比较差异无统计学意义(P>0.05).结论:颈椎前路减压cage植骨融合术与颈椎前路减压自体髂骨块植骨融合钛板内固定术治疗脊髓型颈椎病的中期疗效均较好,但前者手术方法简单、近期并发症少.%Objective:To evaluate the mid-term clinical results of anterior cervical discectomy and interbody fusion with PEEK cage or autogenous iliac crest graft for cervical spondylotic myelopathy. Method : From January 2001 to April 2006,128 cases with cervical spondylotic myelopathy were divided into group A and B respectively.61 cases in group A underwent anterior cervical decompression and fusion (ACDF) with PEEK cage (22 single-level and 39 double-level),while 67 cases in group B underwent anterior decompression and fusion procedures with autogenous iliac crest graft (27 single-level and 40 double-level).The disc height and cervical lordotic alignment were assessed by radiographs,and JOA

  17. 经前路椎体次全切钛笼置入锁定钢板螺丝钉内固定治疗相邻两节段脊髓型颈椎病%Adjacent Two Segments Anterior Subtotal Titanium Cage into the ;Locking Plate Screw Fixation for the Treatment of Cervical Spondylotic Myelopathy

    Institute of Scientific and Technical Information of China (English)

    青祖宏; 刘明; 高巍; 何蔚; 刘杨; 李永焕

    2013-01-01

    Objective To summarize the clinical efficacy of the anterior corpectomy cut with titanium cage and locking plate screw fixation for the treatment of two adjacent cervical spondylotic myelopathy.Method August 2010~December 2012,Anterior corpectomy cut with titanium cage and locking plate screw fixation for the treatment of adjacent two segments cervical spondylotic myelopathy 25 cases,including 18 men and 7 women patients,aged 33~75 years,mean 56.5 years.In 25 patients with varying degrees of symptoms of spinal cord compression. There are 9 cases(C4/C5). There are 15 cases(C5/C6).There are 1 case(C6/C7).Observed lateral cervical spine,cervical hyperextension flexion X-rays and cervical MR, before and after surg ery and follow-up phase,so as to learn spinal cord compression,cervical stability and postoperative cervical height,curvature,titanium cage plate screw position and cervical fusion. Compared preoperative to postoperative and follow-up,pain visual analog scale (VAS) and the Japan Orthopaedics Association (JOA) pain score.Results Operative time (120±30) min,blood loss (150±50)ml.The surgery does not appear related complications.The followed up time are 2~24 months (mean 12.5 months). Nerve function significantly improved.JOA score increased from preoperative 6.2±1.1 to the last follow-up 14.3±1.5,with an average improvement rate was (82.3±11.4)%.VAS average score is 2.1 points.The follow-up period is not found that the titanium cage shift,loose screws and lesion spinal cord compression phenomenon.Conclusion Anterior corpectomy cut with titanium cage and locking plate screw fixation for the treatment of two adjacent segments of cervical spondylotic myelopathy,effectively relieve nerve compression of the spinal cord,quickly restored cervical curvature and height,reconstruction of spinal stability,shorter operative time,less bleeding, and less damage.It has created favorable conditions for the rehabilitation of neurological function in patients,which is an

  18. The application of anchoring nails in the expansive laminoplasty treating the multi-segments cervical spondylotic myelopathy%锚定钉在多节段脊髓型颈椎病单开门椎管扩大术中的应用

    Institute of Scientific and Technical Information of China (English)

    王义生; 张弛; 唐国皓; 李军伟; 李劲峰

    2012-01-01

    目的:探讨锚定钉在颈椎单开门椎管扩大术治疗多节段脊髓型颈椎病中的临床应用价值.方法:2009年1月~2011年1月,采用颈椎单开门椎管扩大术治疗多节段脊髓型颈椎病25例,男21例,女4例.年龄35~78岁,平均63.5岁.病程1.6~18年,平均3.6年.3节段18例,4节段7例.20例合并发育性或退变性颈椎管狭窄,均有颈脊髓受压症状,JOA评分3~11分,平均6.7±2.2分.均行颈椎单开门椎管扩大术,开门节段均为C3 ~C7,均采用锚定钉固定,固定节段为C3、C5、C7.结果:锚定钉均顺利置入,手术时间60~100min,平均75min.术中出血100~500ml,平均200ml,无脊髓损伤、脑脊液漏、硬膜外血肿等并发症发生.1例术后有颈肩部疼痛,给予对症处理2个月后疼痛消失.术后随访0.5~2.5年,平均1.9年,末次随访时JOA评分10~16分,平均13.8±1.4分,与术前比较差异有统计学意义(P<0.01),平均改善率为(68.1±7.5)%,优良率为88%.X线片检查显示颈椎曲度基本正常,椎管中矢状径与椎体中矢状径比值平均为1.2,锚钉无松动,无颈椎不稳及关门.结论:在颈椎单开门椎管扩大术治疗多节段脊髓型颈椎病时应用锚定钉固定开窗椎板方法简单可靠,可避免“关门”,临床疗效满意.%Objective:To investigate the clinical application value of anchoring nails in expansive laminoplas-ty treating the multi-segments cervical spondylotic myelopathy.Method: From January 2009 to January 2011, 25 patients with multi-segments cervical spondylotic myelopathy received operations of the cervical expansive laminoplasty.Among them,there were 21 male patients and 4 female patients.Their ages ranged from 35 to 78 years with a mean age of 63.5 years.The course of disease ranged from 1.6 to 18 years and a mean was 3.6 years.3 segments were involved in 18 patients,4 segments in 7 patients and 20 patients combined with developmental or degenerative cervical spinal stenosis.AU patients had

  19. Treatment of Multi - segmental Cervical Spondylotic Myelopathy Treated Posterior Unilateral Open-door Laminoplasty Combined with Centerpiece Ttitanium Plate Internal Fixation%后路单开门 Centerpiece 内固定治疗多节段脊髓型颈椎病

    Institute of Scientific and Technical Information of China (English)

    胡勇; 董伟鑫; 赵红勇; 袁振山; 孙肖阳; 马维虎; 徐荣明

    2014-01-01

    Objective To explore the clinical effect and safty of posterior unilateral open-door laminoplasty combined with Centerpiece titanium plate internal fixation for multi-segmental cervical spondylotic myelopathy. Methods From May 2010 to May 2012,32 patients with multi-segmental cervical spondylotic myelopathy were treated by posterior unilateral open door laminoplasty combined with Centerpiece titanium plate internal fixation. There were 20 males and 12 females,with a mean age of(60. 4 ± 7. 6)years(ranged 49 to 77 years). The neurofunction was evaluated by Japan Orthopaedic Association(JOA) score. The cervical curvature angle(α)was demonstrated by the cross angle between posterior vertebral body margins of C2 and C7 on cervical radiographs. Calculated cervical range of motion according to the difference of the angle of α between hyperex-tension and hyperflexion cervical radiographs. Calculated shoulder and pain VAS scores assess the range of axial symptoms. Re-sults The operative time and intraoperative blood loss were respectively 140 min(100 ~ 160 min)and 460 mL(250 ~ 800) mL. All patients were followed up from 12 to 38 months with an median of 22 months. The JOA scores was(9. 26 ± 3. 16)be-fore surgery and(12. 95 ± 2. 35)at 1 week after surgery,which showed significant differences(P ﹤ 0. 05). The improve rate of Japanese Orthopaedic Association(JOA)scores was(56. 4 ± 9. 3)% . The JOA scores was(13. 30 ± 2. 46)3 months after surgery and(13. 16 ± 1. 39)1 year after surgery,there were no significant differences when compared with the JOA scores at 1 week after surgery(P ﹥ 0. 05). The cervical curvature angle were(18. 1 ± 3. 8)° before surgery an(16. 7 ± 5. 4)° 3 months after surgery. There were no significient differences(P ﹥ 0. 05). The cervical range of motion was(35. 46 ± 11. 54)° before surgery and(30. 65 ± 8. 95)° 3 months after surgery. There were no significient differences(P ﹥ 0. 05). The VAS scores were ((3. 8 ± 1. 8)before surgery

  20. 一期后路单开门联合前路选择性减压融合术治疗多节段脊髓型颈椎病%One-stage Expansive Open-door Laminoplasty and Selective Anterior Decompression and Fusion for Multilevel Cervical Spondylotic Myelopathy

    Institute of Scientific and Technical Information of China (English)

    黄勇全; 刘先明; 黄华伟; 陈文明

    2012-01-01

    目的 评估一期后路单开门联合前路选择性减压治疗多节段脊髓型颈椎病的手术疗效.方法 对46例多节段(≥3节段)脊髓型颈椎病患者,均行后路单开门椎管成形+前路选择性椎体次全切除和(或)椎间盘切除椎间钛网、Cage或髂骨块植骨+前路钢板内固定术.术后测量颈椎曲度角评价颈椎排列,采用日本矫形外科学会(japanese orthopaedic association,JOA)评估系统评价其功能恢复情况,采用正侧位、动力位X线摄片和三维CT重建方法评估融合程度.同时,进行MRI检查,以观察脊髓减压程度和脊髓情况.结果 所有病例均获得平均24.1(12~28)个月的有效随访.JOA评分:术前为(9.0±1.2)分,术后6个月为(13.9±0.7)分,与术前比较,差异有统计学意义(P=0.007);末次随访为(14.1±0.6)分,与术前比较,差异有统计学意义(P=0.004).颈椎曲度角术前为(34.7±4.1)°,术后6个月为(37.1±5.1)°,术后6个月曲度角与术前比较,差异有统计学意义(P=0.024).术后12个月和末次随访,所有病例均已达到骨性融合,且椎管减压明显.结论 一期后路单开门联合前路选择性减压融合术是治疗多节段脊髓型颈椎病一种安全、有效的方法,在达到充分解除脊髓前后压迫的同时恢复颈椎排列,提高植骨融合率.%Objective To evaluate the curative efficacy of one-stage expansive open-door laminoplasty combined with selective anterior decompression and fusion in multilevel cervical spondylotic myelopathy. Methods Forty-six patients with multilevel cervical spondylotic myelopathy (≥3 consecutive segments) were treated with expansive open-door laminoplasty, selective anterior corpectomy,and (or) cervical reconstruction with titanium mesh cages,iliac bone graft,and anterior rigid plate fixation. The cervical curvature was determined to evaluate cervical spine arrangement. The functional recovery was assessed by Japanese orthopaedic association (JOA) scoring system

  1. 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

  2. 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

  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. 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.

  5. Relationship between improvement of cortical somatosensory evoked potential and outcome in surgery for cervical spondylotic myelopathy%皮层体感诱发电位信号改善对脊髓型颈椎病手术预后的评价

    Institute of Scientific and Technical Information of China (English)

    刘峰; 魏开斌; 范新成

    2011-01-01

    [Objective] To study the relationship between improvement of cortical somatosensory evoked potential (CSEP) and outcome in surgery for cervical spondylotic myelopathy ( CSM) . [Methods] Fifty - eight patients with CSM received CSEP examination with keypoint electromyography pre - operatively, intra - operatively and post - operatively. Acording to the CSEP variance , the patients were divided into improvement group (group A) and non - improvement group (group B) . The JOA scores before, one week and 6 months after operation were analyzed. The relationship between the changes of CSEP and JOA scores was studied. [Results] JOA scores were 8. 4 ± 1. 06, 14. 7 ± 1. 31, and 15. 4 ± 1. 26 in group A, and 8. 6 ± 1. 13 , 11. 9 ± 1. 15 , and 15. 2 ± 1. 23 in group B. Thirty - six patients showing CSEP improvement had a more rapid clinical improvement. Long-term reassessment did not show any difference between the two groups. [Conclusion] Patients with CSEP improvement had a more clinical improvement.%[目的]研究皮层体感诱发电位(cortical somatosensory evoked potential,CSEP)在脊髓型颈椎病(cervical spondylotic myelopathy,CSM)手术后出现信号改善(潜伏期缩短,或/和波幅增高)与临床症状恢复的相关性.[方法]对2008年7月~2010年5月本院收治的58例CSM患者,行术前、术中及术后CSEP监护并记录CSEP值,根据脊髓监护手术前后CSEP是否改善分为两组:波形改善组(A组),表现为波幅升高(>50%),或(和)潜伏期缩短(<5%);波形无改善组(B组).于颈椎手术术前、术后1周和6个月分别行JOA评分(Japanese Orthopaedic Association scoring system)评价神经功能,观察CSEP变化与神经功能恢复之间的关系.[结果]58例患者中36例(62.1%) CSEP出现改善;A组JOA评分术前、术后1周及术后6个月分别为8.42±1.06,14.71±1.31,15.43±1.26;B组分别为8.61±1.13,11.92±1.15,15.21±1.23.术后1周A组恢复高于B组(P<0.05),6个月后JOA评分两

  6. The imaging features and prognostic factors of mono-segmental cervical spondylotic myelopathy with lower cervical instability%单节段脊髓型颈椎病伴下颈椎不稳的影像学表现及预后因素分析

    Institute of Scientific and Technical Information of China (English)

    路宽; 丁文元; 杨大龙; 申勇; 张为; 郭旭朝; 杨思东; 王辉

    2014-01-01

    Objective To investigate the associated factors of MRI signal changes and prognosis in mono-segmental cervical spondylotic myelopathy (CSM) accompanied by instability of lower cervical spine.Methods In this retrospective study,data of 109 CSM patients who had undergone anterior cervical disectomy and fusion (ACDF) between January 2005 and June 2008 were analyzed.All patients were divided into unstable group and stable group,according to the stability of lower cervical spine.The two groups were compared in terms of spinal cord high signal on MRI T2WI and its incidence rate,JOA recovery rate six months after ACDF.The number of returned patients and the time they came back due to repeated symptoms or new symptoms caused by spinal cord compression were recorded.Besides,course of disease and physical signs including sensory hypoesthesia or disappearance,Hoffmann sign,Babinski sign and tendon reflexes were recorded.Multivariate linear regression was applied to analyze the correlation of postoperative JOA recovery rate with gender,age,preoperative JOA score,course of disease,the number of physical signs and high signal level of spinal cord.Results There was no significant difference in gender or age between the two groups.1) Occurrence rate of high signal in spinal cord was 74.3% in unstable group,which was 41.9% in stable group with significant difference.2) In unstable group,course of disease,preoperative JOA score,the numbers of physical signs and postoperative JOA recovery rate,and retreatment time were 26.9± 15.1 months,10.0±2.5 points,2.91±0.91,55.6%± 14.9%,29.1 ±6.8 months,respectively,and in stable group,17.0±9.9 months,11.2±2.4 points,2.42±0.83,69.0%± 18.0%,57.5±21.9 months,respectively.Significantly,the unstable group has longer course of disease,lower preoperative JOA score and postoperative JOA recovery rate,more physical signs,and shorter retreatment time,compared to stable group.3) Postoperative JOA recovery rate was correlated with

  7. 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

  8. 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

  9. 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.

  10. Mechanisms of Spinal Micro-adjustment Manipulations in Treating Cervical Spondylotic Radiculopathy

    Institute of Scientific and Technical Information of China (English)

    ZHU Guo-miao; SUN Wu-quan; SHEN Guo-quan; FANG Min; XIAO Yuan-chun

    2007-01-01

    On the basis of the investigation of the pathogenesis of cervical spondylotic radiculopathy, this paper studies the mechanisms of spinal micro-adjustment manipulations in recovering and improving cervical dynamic and stationary balance from the perspective of biomechanics.

  11. 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.

  12. Treatment of self-locking stand-alone anterior cervical interbody fusion for patients with single level cervical spondylotic myelopathy%自锁式颈椎前路椎间融合治疗单间隙脊髓型颈椎病

    Institute of Scientific and Technical Information of China (English)

    徐灿华; 吴增晖; 张清顺; 刘才俊

    2013-01-01

    目的:探讨自锁式颈椎前路椎间融合器治疗单椎间隙脊髓型颈椎病(CSM)的近期临床疗效。方法2010年3月至2011年12月广州军区广州总医院采用颈椎前路椎间盘髓核摘除、减压、自锁式椎间融合器植骨融合术治疗单间隙CSM患者39例,其中C3/410例、C4/517例、C5/612例。记录手术时间、术中失血量、住院时间及并发症发生情况;评估术前及术后3、6、12个月患者视觉模拟量表(VAS)评分和日本骨科学会(JOA)评分;同时测量手术前后融合节段Cobb角和椎间隙高度,判断椎间稳定性。结果手术时间(50±10)min,术中失血量(30±5)mL,住院时间(4.9±1.2)d,术后均未发现吞咽困难、伤口血肿、呼吸困难等并发症。39例患者获得随访,随访时间13~26个月(平均17.5个月)。术后3、6、12个月VAS评分、JOA评分、Cobb角及椎间高度均优于术前,差异有统计学意义(P<0.05)。按VAS评估标准,术后12个月随访时优27例、良10例、可2例,优良率95%(37/39);按JOA评分标准,术后12个月随访时优21例、良15例、可3例,优良率92%(36/39)。随访过程中未发现融合器移位、下沉、断裂,术后12个月颈椎过屈过伸位X线片判断椎间稳定率100%。结论自锁式颈椎前路椎间融合器具有良好的力学稳定性,可有效恢复颈椎生理曲度和椎间隙高度,治疗单间隙CSM具有手术创伤小、操作简单、并发症少、住院时间短等优点,椎管减压效果确切,临床症状获得有效改善。%Objective To explore short-term clinical efficacy of self-locking stand-alone anterior cervical interbody fusion (ACIF) cage for the treatment of single level cervical spondylotic myelopathy (CSM). Methods From March 2010 to December 2011, 39 patients with single level CSM (C3/4 in 10 cases, C4/5 in 17 cases and C5/6 in 12 cases) were performed anterior cervical discectomy

  13. 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

  14. [Myelopathies caused by dorsal spinal canal spondylotic stenosis. 3 cases and a review of the literature].

    Science.gov (United States)

    Bazin, A; Rousseaux, P; Bernard, M H; Peruzzi, P; Baudrillard, J C; Scherpereel, B

    1989-01-01

    Thoracic spondylotic myelopathies are exceptional, only 29 observations could be found in the literature; we intend to describe three new cases here. The patients, two women and one man, 64, 69 and 72 years old, complained of weakness of the lower limbs, more marked on one side, which had been progressing slowly from several months to eight years. Examination revealed asymmetrical paraparesis with distal sensitivity deficits without thoracic sensory level. In the first case, the myelography remained virtually unchanged in front of T11, T12; in the second and third cases, there was slight extradural compression at T9 and T10 respectively. Magnetic Resonance Imaging (M.R.I.) performed in two patients was evocative of a thoracic disk herniation. A chest CT scan enabled us to establish correct diagnosis: in the three cases irregular hypertrophy of the posterior elements was evident at T11 and T12, T9 and T10, T10 and T11 respectively, with osteophytes originating in the articular process and deeply embedded in the spinal canal. Decompressive laminectomy associated with medial facetectomy resulted in the gradual improvement of walking in all three patients. Myelography and MRI are both useful in demonstrating the level compression, usually situated in the low thoracic spine, however only the CT allows differential diagnosis with other etiologies, especially anterior compression such as disk herniation.

  15. 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

  16. Correlation between pyramidal signs and the severity of cervical myelopathy.

    Science.gov (United States)

    Chikuda, Hirotaka; Seichi, Atsushi; Takeshita, Katsushi; Shoda, Naoki; Ono, Takashi; Matsudaira, Ko; Kawaguchi, Hiroshi; Nakamura, Kozo

    2010-10-01

    A retrospective study was performed to determine the sensitivities of the pyramidal signs in patients with cervical myelopathy, focusing on those with increased signal intensity (ISI) in T2-weighted magnetic resonance imaging (MRI). The relationship between prevalence of the pyramidal signs and the severity of myelopathy was investigated. We reviewed the records of 275 patients with cervical myelopathy who underwent surgery. Of these, 143 patients were excluded from this study due to comorbidities that might complicate neurological findings. The MR images of the remaining 132 patients were evaluated in a blinded fashion. The neurological findings of 120 patients with ISI (90 men and 30 women; mean age 61 years) were reviewed for hyperreflexia (patellar tendon reflex), ankle clonus, Hoffmann reflex, and Babinski sign. To assess the severity of myelopathy, the motor function scores of the upper and lower extremities for cervical myelopathy set by the Japanese Orthopaedic Association (m-JOA score) were used. The most prevalent signs were hyperreflexia (94%), Hoffmann reflex (81%), Babinski sign (53%), and ankle clonus (35%). Babinski sign (P Babinski sign, and ankle clonus. The prevalence of the pyramidal signs correlated with increasing severity of myelopathy. Considering their low sensitivity in patients with mild disability, the pyramidal signs may have limited utility in early diagnosis of cervical myelopathy.

  17. 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

  18. Scapular Winging as a Symptom of Cervical Flexion Myelopathy

    OpenAIRE

    Yaguchi, Hiroaki; Takahashi, Ikuko; Tashiro, Jun; Tsuji, Sachiko; Yabe, Ichiro; Sasaki, Hidenao

    2007-01-01

    A 23-year-old man complained of weakness of the right arm that he first noted six years prior to his visit. Neurological examination revealed atrophy and weakness of the triceps and serratus anterior muscle on the right side, which resulted in scapular winging on that side. MRI with neck flexion revealed compression of the cervical cord enabling a diagnosis of flexion myelopathy. Proximal muscle weakness and atrophy in flexion myelopathies including Hirayama disease are extremely rare. Here, ...

  19. Cine MRI of patients with cervical myelopathy

    Energy Technology Data Exchange (ETDEWEB)

    Ukita, Yasutaka (Okayama Univ. (Japan). School of Medicine)

    1993-09-01

    Forty-six patients with cervical myelopathy were examined before and after surgery by cine magnetic resonance imaging (MRI). According to the occurrence site and degree of flow void, cerebrospinal fluid (CSF) flow void was classified into five: anterior type (flow void mainly in the anterior part of subarachnoid space), posterior type (mainly in the posteiror part), anteroposterior type (in the anterior and posterior parts), incomplete block type (flow void limited to the upper and lower parts of the block), and complete block type (no flow void). None of the 46 patients had normal CSF flow void on cine MRI before surgery. CSF flow void was seen in systolic phase on ECG (from 150 to 300 msec from R's wave) in all patients after spinal cord decompression. Postoperative CBF flow void types correlated well with surgical method, disease, and postoperative vertebral alignment. Postoperative outcome was the most excellent in the group of posterior type and the poorest in the group of anteroposterior type, showing a significant difference between the groups. Cine MRI is a useful noninvasive, dynamic method for assessing postoperative decompression effect. (N.K.).

  20. 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

  1. 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

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

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    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.

  3. 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

  4. Cervical Myelopathy Caused by Intracranial Dural Arteriovenous Fistula

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    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

  5. 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

  6. 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.

  7. 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.

  8. Addressing Stretch Myelopathy in Multilevel Cervical Kyphosis with Posterior Surgery Using Cervical Pedicle Screws

    Science.gov (United States)

    Mahesh, Bijjawara; Vijay, Shekarappa; Arun, Kumar; Srinivasa, Reddy

    2016-01-01

    Study Design Technique description and retrospective data analysis. Purpose To describe the technique of cervical kyphosis correction with partial facetectomies and evaluate the outcome of single-stage posterior decompression and kyphosis correction in multilevel cervical myelopathy. Overview of Literature Kyphosis correction in multilevel cervical myelopathy involves anterior and posterior surgery. With the advent of cervical pedicle screw-rod instrumentation, single-stage posterior kyphosis correction is feasible and can address stretch myelopathy by posterior shortening. Methods Nine patients underwent single-stage posterior decompression and kyphosis correction for multilevel cervical myelopathy using cervical pedicle screw instrumentation from March 2011 to February 2014 and were evaluated preoperatively and postoperatively with modified Japanese Orthopaedic Association (mJOA) scoring and computed tomography scans for radiological measurements. Kyphosis assessment was made with Ishihara curvature index and C2–C7 Cobb's angle. The linear length of the spinal canal and the actual spinal canal length were also evaluated. The average follow-up was 40.56 months (range, 20 to 53 months). Results The average preoperative C2–7 Cobb's angle of 6.3° (1° to 12°) improved to 2° (10° to −9°). Ishihara index improved from −15.8% (−30.5% to −4.7%) to −3.66% (−14.5% to +12.6%). The actual spinal canal length decreased from 83.64 mm (range, 76.8 to 91.82 mm) to 82.68 mm (range, 75.85 to 90.78 mm). The preoperative mJOA score of 7.8 (range, 3 to 11) improved to 15.0 (range, 13 to 17). Conclusions Single-stage posterior decompression and kyphosis correction using cervical pedicle screws for multilevel cervical myelopathy may address stretch myelopathy, in addition to decompression in the transverse plane. However, cervical lordosis was not achieved with this method as predictably as by the anterior approach. The present study shows evidence of mild

  9. 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

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    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.

  10. Cervical posterior implant fixation for multi-segment cervical spondylotic myelopathy:improves symptoms but diminishes cervical range of motion%颈椎后路植入物固定修复多节段脊髓型颈椎病:可改善症状但降低了颈椎活动度

    Institute of Scientific and Technical Information of China (English)

    赵勇; 褚言琛; 李学森; 马金龙; 邹云雯

    2015-01-01

    BACKGROUND:Cervical Open-door laminoplasty with unilateral mass screw fixation and laminectomy with bilateral mass screw fixation are both procedures that treat cervical spondylotic myelopathy by expanding the space available for the spinal cord. Effectiveness and safety of two operative methods remain unclear. OBJECTIVE:To investigate the biocompatibility of implant and host between open-door laminoplasty with unilateral mass screw fixation and laminectomy with bilateral mass screw fixation to treat multi-segment cervical spondylotic myelopathy. METHODS: Data of 117 patients with multi-segment cervical spondylotic myelopathy (≥ 3 segments) were retrospectively analyzed. Sixty-five cases underwent open-door laminoplasty with unilateral mass screw fixation (laminoplasty group). Fifty-two cases underwent laminectomy with bilateral mass screw fixation (laminectomy group). Clinical outcomes were evaluated by the Japanese Orthopaedic Association scoring system and by recovery rate. Cervical curvature index and cervical range of motion were assessed by X-ray films in both groups. RESULTS AND CONCLUSION:The average folow-up time was 28 months (range 12-59 months) in both groups. No C5 nerve root palsy occurred in the two groups. Japanese Orthopaedic Association scores were greater during final folow-up than pre-fixation in both groups (P 0.05). Cervical range of motion was lower during final folow-up than pre-fixation in both groups (P 0.05)。两组末次随访颈椎活动度均低于固定前(P <0.01)。结果说明,颈后路单开门椎管成形单侧侧块内固定与全椎板切除双侧侧块内固定在改善神经功能、缓解疼痛、减少并发症上有相似的疗效,但一定程度上降低了颈椎活动度。

  11. 脊髓型颈椎病MRI T2信号比值变化与临床表现及预后的关系%Relation of MR T2 image signal intensity ratio of cervical spondylotic myelopathy with clinical manifestations and prognosis

    Institute of Scientific and Technical Information of China (English)

    申勇; 张英泽; 王林峰; 何杰; 杨大龙; 李志远; 曹俊明

    2008-01-01

    目的 将MRI T2WI信号量化分类,同时探讨其与术前临床表现、预后三者之间的关系.方法 2005年4月至2007年7月共计73例患者,均行前路、后路或后前路联合手术.术前所有患者均行高分辨率1.5T MRI成像.于矢状面T2WI脊髓受压信号增高最明显部位计算机测量信号强度值,取兴趣区面积为0.05 cm2,再于颈7胸1椎体水平脊髓信号正常部位测量信号强度值,取兴趣区面积为0.3 cm2,计算得出两者比值(0.05 cm2面积信号强度值/0.3 cm2面积信号强度值).如T2 WI脊髓信号无明显改变,则取脊髓受压最严重部位0.05 cm2为兴趣区测量信号强度值.比值数据经对数转换、系统聚类后分为3组.结合临床表现分析相互之间的关系.结果 各组间改善率、年龄、术前JOA评分经方差分析F值、P值分别为F=22.009、P<0.001,F=6.371、P=0.003,F=5.561、P=0.006.此3项指标各组之间差异有统计学意义.各组间Babinski征及性别经卡方检验χ2值及P值分别为χ2=15.719、P<0.001,χ2=1.898、P=0.387,Babinski征各组之间差异有统计学意义,性别差异在组间无统计学意义.各组间信号比值对数、术后JOA评分及病程经秩和检验3项指标各组之间差异均有统计学意义,χ2值及P值分别为χ2=62.616、P<0.001,χ2=25.946、P<0.001,χ2=13.952、P=0.001.结论 低信号比值组即无明显T2WI高信号和轻度存在T2WI高信号患者,往往年龄相对较小,病程相对较短,减压术后效果较好.反之如果T2WI高信号逐步增高且伴随锥体束征出现,则提示预后较前者欠佳.%Objective To investigate whether the signal intensity ratio in magnetic resonance imaging (MRI) and clinical manifestations can reflect prognosis in patients with cervical compressive myelopathy. Methods Seventy-three patients with cervical compressive myelopathy treated with anterior, posterior, or posterior-anterior united decompression underwent 1.5-T MRI before surgery. T2-weighted

  12. Prevalence of complications after surgery in treatment for cervical compressive myelopathy

    Science.gov (United States)

    Wang, Tao; Tian, Xiao-Ming; Liu, Si-Kai; Wang, Hui; Zhang, Ying-Ze; Ding, Wen-Yuan

    2017-01-01

    Abstract Purpose: We aim to perform a meta-analysis on prevalence of all kinds of operation-related complications following surgery treating cervical compressive myelopathy (CCM) and to provide reference for surgeons making surgical plan. Methods: An extensive search of literature was performed in PubMed/MEDLINE, Embase, the Cochrane library, CNKI, and WANFANG databases on incidence of operation-related complications from January 2007 to November 2016. Data was calculated and data analysis was conducted with STATA 12.0 and Revman 5.3. Results: A total of 107 studies included 1705 of 8612 patients (20.1%, 95% CI 17.3%–22.8%) on overall complications. The incidence of C5 plasy, cerebrospinal fluid (CSF), infection, axial pain, dysphagia, hoarseness, fusion failure, graft subsidence, graft dislodgment, and epidural hematoma is 5.3% (95% CI 4.3%–6.2%), 1.9% (95% CI 1.3%–2.4%), 2.8% (95% CI 1.7%–4.0%), 15.6% (95% CI 11.7%–19.5%), 16.8% (95% CI 13.6%–19.9%), 4.0% (95% CI 2.3%–5.7%), 2.6% (95% CI 0.2%–4.9%), 3.7% (95% CI 2.0%–5.5%), 3.4% (95% CI 2.0%–4.8%), 1.1% (95% CI 0.7%–1.5%), respectively. Patients with ossification of posterior longitudinal ligament (OPLL) (6.3%) had a higher prevalence of C5 plasy than those with cervical spondylotic myelopathy (CSM) (4.1%), and a similar trend in CSF (12.2% vs 0.9%). Individuals after laminectomy and fusion (LF) had highest rate of C5 plasy (15.2%), while those who underwent anterior cervical discectomy and fusion (ACDF) had the lowest prevalence (2.0%). Compared with patients after other surgical options, individuals after anterior cervical corpectomy and fusion (ACCF) have the highest rate of CSF (4.2%), infection (14.2%), and epidural hematoma (3.1%). Patients after ACDF (4.8%) had a higher prevalence of hoarseness than those with ACCF (3.0%), and a similar trend for dysphagia between anterior corpectomy combined with discectomy (ACCDF) and ACCF (16.8% vs 9.9%). Conclusions: Based on our meta

  13. 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.

  14. Management of degenerative cervical myelopathy – An update

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    ANDREI F. JOAQUIM

    Full Text Available SUMMARY Introduction Degenerative cervical myelopathy (DCM is the most common cause of spinal cord dysfunction in adult patients. Patients generally present with a slow, progressive neurological decline or a stepwise deterioration pattern. In this paper, we discuss the most important factors involved in the management of DCM, including a discussion about the surgical approaches. Method The authors performed an extensive review of the peer-reviewed literature addressing the aforementioned objectives. Results Although the diagnosis is clinical, magnetic resonance imaging (MRI is the study of choice to confirm stenosis and also to exclude the differential diagnosis. The severity the clinical symptoms of DCM are evaluated by different scales, but the modified Japanese Orthopedic Association (mJOA and the Nürick scale are probably the most commonly used. Spontaneous clinical improvement is rare and surgery is the main treatment form in an attempt to prevent further neurological deterioration and, potentially, to provide some improvement in symptoms and function. Anterior, posterior or combined cervical approaches are used to decompress the spinal cord, with adjunctive fusion being commonly performed. The choice of one approach over the other depends on patient characteristics (such as number of involved levels, site of compression, cervical alignment, previous surgeries, bone quality, presence of instability, among others as well as surgeon preference and experience. Conclusion Spine surgeons must understand the advantages and disadvantages of all surgical techniques to choose the best procedure for their patients. Further comparative studies are necessary to establish the superiority of one approach over the other when multiple options are available.

  15. 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:

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

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    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. 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.

  19. Heterotopic ossification associated with myelopathy following cervical disc prosthesis implantation.

    Science.gov (United States)

    Wenger, Markus; Markwalder, Thomas-Marc

    2016-04-01

    This case report presents a 37-year-old man with clinical signs of myelopathy almost 9 years after implantation of a Bryan disc prosthesis (Medtronic Sofamor Danek, Memphis, TN, USA) for C5/C6 soft disc herniation. As demonstrated on MRI and CT scan, spinal cord compression was caused by bony spurs due to heterotopic ossification posterior to the still moving prosthesis. The device, as well as the ectopic bone deposits, had to be removed because of myelopathy and its imminent aggravation. Conversion to anterior spondylodesis was performed.

  20. Gait analysis of spastic walking in patients with cervical compressive myelopathy.

    Science.gov (United States)

    Maezawa, Y; Uchida, K; Baba, H

    2001-01-01

    To assess neurological status and to evaluate the effect of surgical decompression in patients with cervical myelopathy, we performed computerized gait analysis in 24 patients with cervical compressive myelopathy who showed spastic walking. Gait analysis was repeated during neurological follow-up that averaged 32.4 months. The gait pattern in patients with severe myelopathy was characterized by hyperextension of the knee in the stance phase without plantar flexion of the ankle in the swing phase, significantly reduced walking speed and step length, prolonged stance phase duration and decreased single-stance phase duration, and increased step width. The angle of flexion of the knee joint in the stance phase was significantly correlated with the Japanese Orthopaedic Association (JOA) score. Postoperative neurological improvement was associated with increased walking speed and decreased extension angle of the knee joint (single-stance phase and swing phase). Postoperatively, 12 patients had normalized extension of the knee in stance phase and their walking speed, cadence, stance phase duration, and single-stance phase duration, as well as step length and width, showed nonsignificant differences from these parameters in healthy controls. Our results show that kinesiological gait analysis is clinically useful for the functional assessment of the severity of spastic walking in cervical myelopathy.

  1. 脊髓型腰椎病早期诊断的前瞻性分析%Clinical analysis of early diagnosis of lumbar spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    朱同银

    2001-01-01

    目的探讨脊髓型腰椎病(Lumber Spondylotic Myelopathy,LSM)早期诊断的可行性筛选提示LSM发作的临床、影像学指标。方法根据LSM常规特征,选择30项与LSM发病有关的指标,并根据选项指标建立分析对象的人选标准,对236例患者符合选择指标病例进行2~10年(平均4.3年)的随访跟踪观察A、B、C各组的各项指标进行对比分析。结果有下肢疼痛、感觉异常,肢体动作灵活性丧失,发育性或增生性椎管狭窄,腰椎不稳,腰椎间盘突出,下肢呈间隙性跛行等16项指标与LSM发病密切相关,68例演变为早期LSM,对症治疗处理治疗后疗效良好。结论通过对临床可疑指标者密切观察和随访,腰椎病的早期诊断的可能,对其中出现神经损害征象者,宜及早对症治疗,避免对神经功能产生不可逆的损害。%Objective To probe into the feasibility of early diagnosis of lumbar spondylotic myelopathy(LSM)prospectively and to screen the premorbid signs of LSM clinically, radiologically. Method Thirty items related to the occurring of LSM were chosen as common characteristics of LSM and considered as the criteria of prospective study. 236 patients who met the criteria were studied. All patients were divided into three groups and followed up and observde for 2~10 years (mean 4. 3years), every item of each group was compared and analyzed. Result Sixty - eight patients showed LSM during investigation. Sixteen items of the criteria were related to the occurring of LSM. The significant items include lower limb pain and abnormal sensation limb numbness, lumbar canal stenosis, lower lumbar instability, lumbar intervertebral disk herniation, and delay of central motor conduct time. Conclusion LSM can be early diagnosed. The patients who meet the established criteria should be followed up and observed closely.

  2. Motor conduction measurement in myelopathy hand

    Science.gov (United States)

    Shibuya, Ryoichi; Wada, Eiji; Iwasaki, Motoki; Yonenobu, Kazuo; Yoshikawa, Hideki

    2014-01-01

    Summary We studied the relationship between intramedullary high signal intensity (IMHSI) on T2-weighted magnetic resonance images and motor conduction in the spinal cords of cervical spondylotic myelopathy (CSM) patients. There was no significant difference between the biceps or triceps central motor conduction times (CMCTs) of the patients who did and did not exhibit IMHSI, whereas the abductor pollicis brevis CMCT was significantly longer in the patients who exhibited IMHSI (p<0.05) than in those who did not. The CMCT of the abductor pollicis brevis is sensitive to the degree of damage in the cervical spinal cord. Hand dysfunction is a characteristic of CSM regardless of the cervical level affected by the condition. The motor fibers innervating the intrinsic muscles of the hand in the long tract of the cervical spinal cord are more sensitive than other motor fibers. For this reason, we consider that myelopathy hand is a characteristic impairment of CSM. Transcranial magnetic stimulation of the hand motor cortex is useful for the evaluation of cervical myelopathy. PMID:25473737

  3. 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.

  4. 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.

  5. Quality of life in symptomatic cervical myelopathy after open-door laminoplasty

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    Rodrigo Yuiti Nakao

    2015-06-01

    Full Text Available OBJECTIVE: To analyze the results obtained by open-door laminoplasty using the Newbridge(r/Blackstone plate, in cases of myelopathy associated with cervical lordosis.METHODS: From December 2010 to October 2012, eight patients between the ages of 49 and 68 underwent open-door laminoplasty with the use of the Newbridge(r fixation system for maintenance and stabilization of the cervical laminoplasty. Minimum follow-up was four months. For the evaluation of quality of life the questionnaire SF-36 was applied at the following times: preoperative, one month and three months after surgery associated with the subjective assessment of the patient regarding satisfaction with the procedure and with the Nurick neurological scale applied prior to surgery and three months later.RESULTS: According to the SF-36, there was significant improvement in the domains functional ability, general health perceptions and emotional aspects over time; regarding physical limitations and social aspects there was no improvement in the first postoperative month, only in the third month. There were no statistically significant changes observed during the period covered by this study related to pain, vitality and mental health. According to Nurick scale, there was evidence of improvement in symptoms of cervical myelopathy. Based on the subjective evaluation of the patients, surprisingly, all patients were satisfied with the surgical procedure and the results.CONCLUSION: The open-door laminoplasty technique with rigid fixation to maintain the opening is useful in improving the symptoms of cervical myelopathy associated with lordosis, leading to improved quality of life and with a high degree of patient satisfaction and fewer complications.

  6. 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.

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

    Institute of Scientific and Technical Information of China (English)

    Gbor Cziglczki; Zoltn Papp; Csaba Padnyi; Pter 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 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.

  8. Cervical flexion myelopathy in a patient showing apparent long tract signs: a severe form of Hirayama disease.

    Science.gov (United States)

    Sakai, Kenji; Ono, Kenjiro; Okamoto, Yoshiyuki; Murakami, Hideki; Yamada, Masahito

    2011-05-01

    We describe an 18-year-old male with cervical flexion myelopathy with Hirayama disease-like features who showed apparent long tract signs. He first experienced insidious-onset hand muscle weakness and atrophy at the age of 15. Subsequently, he developed sensory disturbance in his lower limb. Neurological examination revealed atrophy and weakness in the right hand and forearm, pyramidal signs in the right lower extremity, and disturbance of superficial sensation in the lower left half of the body. Cervical magnetic resonance images and computed tomographic myelography revealed anterior displacement with compression of the cervical cord in flexion that was more apparent in the right side. The right side of the cervical cord showed severe atrophy. The mechanisms of myelopathy in our patient appeared to be same as that of "tight dural canal in flexion," which has been reported to be the mechanism of juvenile muscular atrophy of the unilateral upper extremity (Hirayama disease). Patients with Hirayama disease generally show minimal sensory signs and no pyramidal signs. An autopsy case of Hirayama disease revealed confined necrosis of the cervical anterior horn without obvious changes in the white matter. Our patient's disease progression suggests that cervical flexion myelopathy patients with severe cervical cord compression in flexion may develop extensive cervical cord injury beyond the anterior horn.

  9. 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

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

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    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

  11. 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).

  12. 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.

  13. Evaluation of Melatonin for Prevention of Radiation Myelopathy in Irradiated Cervical Spinal Cord

    Directory of Open Access Journals (Sweden)

    Alireza Shirazi

    2009-01-01

    Full Text Available Objective: Radiation myelopathy (RM is known as a serious complication of head andneck radiation therapy. Furthermore, the radioprotective roles of melatonin have beeninvestigated on different tissues. The aim of this study was to assess the radio protectiveeffects of melatonin on biochemical, histopathological and clinical manifestations of RMin the rat cervical spinal cord.Materials and Methods: Four groups of rats were investigated as follows: The controlgroup was treated with vehicle. The second group (melatonin only was intraperitoneallyinjected with 100 mg/kg melatonin. The third group's (radiation cervical spinal cord areawas irradiated with 22 Gy cobalt-60 gamma-rays. The fourth group (melatonin plus irradiationreceived 100 mg/kg melatonin intraperitoneally, and after 30 minutes their spinalcord area was irradiated with 22 Gy gamma radiation. Five animals from each group wererandomly selected. 72 hours, 8 and 22 weeks after irradiation for analysis of malondialdehyde(MDA and glutathione (GSH levels, and underwent histopathological studies.Results: The MDA levels in the irradiation group were significantly higher than in the controlgroup (p<0.001. Furthermore, the GSH levels in this group were significantly lowerthan that of those in the control group (p<0.001. Administration of melatonin markedlyreduced MDA (p<0.001 and increased GSH (p<0.05 levels in this group. Demyelinationand clinical signs of myelopathy were decreased in the melatonin plus irradiation group incomparison to the irradiated group.Conclusion: Our study confirms the radioprotective effects of melatonin at early stagesof biochemical, as well as late histological and clinical changes in the spinal cord.

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

    Directory of Open Access Journals (Sweden)

    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.

  15. Ultra-low-dose recombinant human bone morphogenetic protein-2 for 3-level anterior cervical diskectomy and fusion.

    Science.gov (United States)

    Pourtaheri, Sina; Hwang, Ki; Faloon, Michael; Issa, Kimona; Mease, Samuel J; Mangels, Daniel; Sinha, Kumar; Emami, Arash

    2015-04-01

    This study evaluated the safety of 3-level anterior cervical diskectomy and fusion (ACDF) with ultra-low-dose recombinant bone morphogenetic protein-2 (rhBMP-2). Thirty-seven consecutive patients with cervical spondylotic myelopathy who were treated with 3-level ACDF and rhBMP-2 were evaluated. Complications such as airway or cervical swelling or hematoma were not observed. The rate of dysphagia was no different at 1, 2, and 6 months postoperatively compared with reports in the literature without rhBMP-2. There were significant improvements in VAS neck/arm pain, Oswestry Neck Disability Index, and cervical lordosis. The use of ultra-low-dose rhBMP-2 for 3-level ACDF may be efficacious for surgically addressing 3-level spondylotic myelopathy.

  16. Cervical flexion myelopathy in a patient showing apparent long tract signs: A severe form of Hirayama disease

    OpenAIRE

    Sakai, Kenji; Ono, Kenjiro; Okamoto, Yoshiyuki; MURAKAMI, Hideki; Yamada, Masahito

    2011-01-01

    We describe an 18-year-old male with cervical flexion myelopathy with Hirayama disease-like features who showed apparent long tract signs. He first experienced insidious-onset hand muscle weakness and atrophy at the age of 15. Subsequently, he developed sensory disturbance in his lower limb. Neurological examination revealed atrophy and weakness in the right hand and forearm, pyramidal signs in the right lower extremity, and disturbance of superficial sensation in the lower left half of the b...

  17. Efficacy and results of expansive laminoplasty in patients with severe cervical myelopathy due to cervical canal stenosis

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    Agrawal D

    2004-01-01

    Full Text Available Aims and objectives: To assess the efficacy and results of expansive laminoplasty in advanced (Nurick's Grade III or greater cervical myelopathy. Materials and Methods: We reviewed data in 24 patients who underwent cervical laminoplasty from January 1999 to December 2002. Nuricks grading was used for quantifying the neurological deficits and outcome analysis was done using Odom's criteria. A modified Hirabayashi's open door laminoplasty was done using Titanium miniplates and screws in 22 patients, autologous bone in one and hydroxyapatite spacer in one patient. Observations: There were 3 females and 21 males with a mean age of 56 years (range 39-72 years. Four patients presented in Nuricks Grade III, 15 in Grade IV and five in Grade V. MR imaging showed MSCS in 21 cases, OPLL in nine cases and ligamentum flavum hypertrophy in nine cases with cord signal changes being present in 19 cases. Results: All patients with duration of symptoms less than three years, and 50 % with duration ranging from three to six years had improvement by at least one Nurick's grade following surgery. Eighty-seven per cent Grade IV patients (ambulatory with support improved to Grade III (ambulatory without support following laminoplasty. Using Odom's criteria, 23 patients (95.8% had a good to fair outcome. Conclusions: Cord decompression with expansive laminoplasty using titanium miniplate fixation may improve the neurological outcome even in patients presenting late, and improvement by even one grade may have major 'quality of life' benefits for these patients.

  18. 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.

  19. 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

  20. Hemifacial hyperhidrosis associated with ipsilateral/contralateral cervical disc herniation myelopathy. Functional considerations on how compression pattern determines the laterality.

    Science.gov (United States)

    Iwase, Satoshi; Inukai, Yoko; Nishimura, Naoki; Sato, Maki; Sugenoya, Junichi

    2014-01-01

    Sweating is an important mechanism for ensuring constant thermoregulation, but hyperhidrosis may be disturbing. We present five cases of hemifacial hyperhidrosis as a compensatory response to an/hypohidrosis caused by cervical disc herniation. All the patients complained of hemifacial hyperhidrosis, without anisocoria or blepharoptosis. Sweat function testing and thermography confirmed hyperhidrosis of hemifacial and adjacent areas. Neck MRI showed cervical disc herniation. Three of the patients had lateral compression with welldemarcated hypohidrosis below the hyperhidrosis on the same side as the cervical lesion. The rest had paramedian compression with poorly demarcated hyperhidrosis and hypohidrosis on the contralateral side. Although MRI showed no intraspinal pathological signal intensity, lateral dural compression might influence the circulation to the sudomotor pathway, and paramedian compression might influence the ipsilateral sulcal artery, which perfuses the sympathetic descending pathway and the intermediolateral nucleus. Sweat function testing and thermography should be performed to determine the focus of the hemifacial hyperhidrosis, and the myelopathy should be investigated on both sides.

  1. CERVICAL STENOTIC MYELOPATHY IN HORSES – REPORT OF 7 CASES MIELOPATIA CERVICAL ESTENÓTICA EM EQUINOS – ESTUDO DE 7 CASOS

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    Carlos Eduardo Wayne Nogueira

    2009-09-01

    Full Text Available

    In this case report, methods to accomplish differential diagnosis for Cervical Stenotic Myelopathy with other diseases with similar symptomatology are described. Cervical Stenotic Myelopathy is an affection characterized by the narrowing of the cervical vertebrae canal, causing a spinal cord compression. This abnormality usually results of a cervical vertebral malformation during the development of the animal. Nutritional imbalances are straightly related to the development of this syndrome. Genetic influence is also described as an etiologic factor. In spite of being an orthopedic disease, it appears through nervous symptomatology, as a result of the spinal cord compression. Thus, the accomplishment of differential diagnosis is necessary for traumatic lesions, Equine Protozoal Mieloencephalitis, Equine Herpesvirus Mieloencephalitis and Equine Degenerative Mieloencephalitis. In this study diagnosis methods, like radiography and myelogram, were used to detect Cervical Stenotic Myelopathy in 7 Thoroughbred horses. The simple radiological examination showed disorders at the bone conformation, while the myelogram was important in the recognition of the site of spinal cord compression. The histopathological examination was conclusive on the detection of spinal cord compressive lesions.

    KEY WORDS: Cervical stenosis, equine, myelopathy, spinal cord, Wobbler.

    Keywords: Equine, Spinal Cord, Myelopathy, Cervical Stenosis, Wobbler

    Neste relato são descritos métodos para a realização do diagnóstico diferencial de mielopatia cervical estenótica com outras doenças que cursam com sinais clínicos semelhantes. A mielopatia cervical estenótica é uma afecção caracterizada pelo estreitamento do canal medular das vértebras cervicais, causando compressão na medula espinhal. Essa altera

  2. The application of a zero-profile implant in anterior cervical discectomy and fusion.

    Science.gov (United States)

    Wang, Zhi-dong; Zhu, Ruo-fu; Yang, Hui-lin; Gan, Min-feng; Zhang, Shi-kai; Shen, Min-jie; Chen, Chao; Yuan, Quan

    2014-03-01

    We analyzed the clinical efficacy of the Zero-P implant (Synthes GmbH Switzerland, Oberdorf, Switzerland) in the treatment of single level cervical spondylotic myelopathy. The clinical data of 47 patients with single level cervical spondylotic myelopathy were retrospectively analyzed. Twenty-two patients were treated with a Zero-P implant (Group A) and 25 with a titanium plate with cage (Group B) between January 2009 and September 2010. Operative time, intraoperative blood loss, preoperative and postoperative Japanese Orthopaedic Association (JOA) scores and JOA recovery rate, dysphagia incidence and adjacent segment degeneration rate were measured. The mean operative time in Group A and Group B was 98.18 minutes and 105.4 minutes, respectively. The average intraoperative blood loss in Group A and Group B was 87.95 ml and 92.4 ml, respectively. There were no statistical differences in operation time and intraoperative blood loss between the two groups (p>0.05). The JOA score was significantly improved in the two groups (p0.05). Dysphagia was experienced by one (4.5%) patient in Group A and eight (32%) patients in Group B, which was significantly different (p=0.044). There was no statistical significance found in the adjacent level degeneration rates between Group A and Group B (p=0.330). The Zero-P implant and traditional titanium plate with cage are effective treatments for single level cervical spondylotic myelopathy, but the Zero-P implant has a lower dysphagia incidence.

  3. 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.

  4. 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。

  5. Currently Treatment Status of Cervical Spondylotic Radiculopathy Therapy with TCM%中医药治疗神经根型颈椎病的现状

    Institute of Scientific and Technical Information of China (English)

    李盛华; 梁雄勇; 李亚军

    2011-01-01

    中医药治疗神经根型颈椎病的主要目的在于纠正颈椎的病理解剖状态,消除或缓解症状、阻止或减缓疾病进展、利于创伤恢复及疾病康复、预防疾病复发.大多数神经根型颈椎病(CSR)经中药、手法、针灸、牵引、针刀、物理治疗、综合疗法治疗可痊愈或缓解,但是在适应症、操作规范、疗效评价、安全性评价等方面还存在一些问题.%Cervical spondylotic radiculopathy was the highest incidence type of cervical spondylosis. The main purpose of traditional Chinese medicine is to correct the pathologic anatomy of the cervical spine condition, eliminate or relieve symptoms, prevent or slow disease progression, which will help trauma recovery and rehabilitation of disease,prevention of disease recurrence. Most CSR can be cured by medical treatment or in remission. However, indications,practices,efficacy evaluation,safety evaluation, there are still some problems.

  6. 神经根型颈椎病的中医药治疗进展%Progress of Treatment of Cervical Spondylotic Radiculopathy by Traditional Chinese Medicine

    Institute of Scientific and Technical Information of China (English)

    张小文; 李晶

    2015-01-01

    Cervical spondylotic radiculopathy (CSR) is a common and frequently-occurring disease which bas the highest incidence in all type of cervical spondylosis. It severely affect the life and work qualityof.the patients. For CSR, Traditional Chinese Medicine (TCM) treatment is effective, convenient and safe. This paper introduce the progress of the TCM treatment for CSR, including Chinese herb, acupuncture, moxibustion, massage, etc.%神经根型颈椎病是临床常见病、多发病,在各类型颈椎病中发病率最高,严重影响患者的日常生活和工作。中医药方法治疗本病疗效肯定,操作简便,安全性高。本文从中药、针刺、艾灸、推拿等方法入手介绍目前神经根型颈椎病的中医药治疗进展。

  7. 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.

  8. 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.

  9. The risk factors inducing spinal cord injury in cervical myelopathy patients with mild to moderate cervical cord compression%轻中度颈脊髓压迫患者产生脊髓损害症状与体征的危险因素

    Institute of Scientific and Technical Information of China (English)

    张静涛; 申勇; 张英泽; 刘法敬; 杨大龙; 曹俊明

    2013-01-01

    -segment cases and 14 three-segment cases. All of these cases underwent anterior-posterior, lateral, excessive flexion and extension cervical spine X-ray. CT and MRI. All patients were divided into two groups according to the symptoms and signs of myelopathy. Group A included 30 patients without clinical features of myelopathy. Group B included 38 patients with cervical spondylotic myelopathy. Age, gender, duration of disease, the number of segments mvolved, the Torg ratio at the most severe cord compression level, the ROM of cervical spine, cervical segmental instability, C2-C7 lofrdosis angle, the direction of spinal cord compression and high signal incidence were compared between the two groups. Results: No differences were found in terms of age, gender, duration of disease, the number of segments involved between the two groups. The mean Torg ratio at the most severe cord compression level was 90.3% and 83.6%, respectively(P<0.05); the mean ROM of cervical spine was 47.5° and 44.1°, respec-tively(P>0.05); the cervical segmental instability was 23.3% and 65.8%, respectively(P<0.05); the mean C2-C7 lordosis was 14.1° and 14.1°, respectively (P>0.05); the central type cord compression was observed in 19 patients of group A and 17 patients of group B, whereas the imcomplete central type cord compression was observed in 11 patients of group A and 21 patients of group B(P>0.05); the high signal incidence was 13.3% and 86.9%, respectively (P<0.05). Conclusions: Cervical segmental instability and spinal cord high intensity signal are the risk factors in cervical myelopathy with mild to moderate cervical cord compression, but a larger Torg ratio is a protective factor. It is still remained unclear that the direction of spinal cord compression, cervical total curvature and range of motion affect the appearance of spinal cord injury.

  10. 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。

  11. Observation of tenderness parts of cervical spondylotic radiculopathy and analysis relevant tenderness parts and spinal nerve%神经根型颈椎病压痛部位分布及其与神经节段的关系

    Institute of Scientific and Technical Information of China (English)

    于杰; 王乾; 魏戌; 甄朋超; 朱立国; 房敏; 林定坤; 李俊杰; 洪毅; 王平; 高景华; 王尚全

    2011-01-01

    Objective To ohserve tenderness parts of cervical spondylotic radiculopathy and analysis relevant tenderness parts and spinal nerve. Methods Tenderness parts of neck and shoulder of the 480 patients ( 3 patients removed) with cervical spondylotic radiculopathy were check with thumb and recoved reference to the main tenderness parts of neck and shoulder. Results Nerve root type cervical spondylosis The main spine nerve root of cervical spondylotic radiculopathy were C6 ( 53. 04% ) . C5 ( 24. 53% ) C7 ( 18. 87% ). The common tenderness points were located at the side of processus spinosus.medial angle of scapula、neck and shoulder transmigration of cowl-muscle、margo medialis scapulae. Conclusion The examination and analysis of tenderness points is important to the diagnosis and treatment ofcervical spondylotic radiculopathy.%目的 观察神经根型颈椎病压痛部位分布特征及其与神经节段的关系.方法 本组神经根型颈椎病患者480例(剔除3例),研究者以拇指逐次按压患者颈肩部进行压痛的体格检查,并参照主要颈肩压痛点记录压痛点.采用关联规则的研究方法作神经根节段与压痛部位作相关性分析.结果 神经根型颈椎病患者主要发病的神经根为C6(53.04%)、C5(24.53%)、C7(18.87%).神经根节段与压痛部位的关联分析显示压痛部位集中于受累神经根节段棘突旁、斜方肌颈肩移行部即肩井穴、斜方肌颈肩移行部即肩井穴)、肩胛骨上角即肩胛提肌止点等部位.结论 压痛点的检查与分析对于神经根型颈椎病的诊断和治疗具有重要意义.

  12. 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.

  13. MR imaging of compressive cervical myelopathy after surgery; High signal intensity of the spinal cord on T2 weighted images

    Energy Technology Data Exchange (ETDEWEB)

    Mimura, Fumitoshi; Fujiwara, Kazuhisa; Otake, Shoichiro (Tenri Hospital, Nara (Japan)) (and others)

    1990-06-01

    We reviewed the MR images of 32 patients with cervical myelopathy, showing lesions of high signal intensity in the spinal cord on the sagittal T2 weighted images (T2WI) after surgery: 16 with ossification of posterior longitudinal ligament (OPLL); 9 with spondylosis; 4 with disc herniation and 3 with trauma. All images were obtained on a superconducting 1.5 Tesla system. The lesions were classified into five groups, according to the shape and grade of signal intensity on the sagittal T2WI: (I) oval-shaped lesion of signal intensity less brighter than CSF with blurred margin, (II) longitudinal linear-shaped lesion of signal intensity similar to CSF, (III) spindle-shaped lesion of signal intensity similar to CSF, (IV) round-shaped lesion of signal intensity similar to CSF, and (V) mixed-types lesions which consisted of group I and II. The present study was summarized as follows: Oval-shaped lesions were seen in the cases of disc herniation and spondylosis with relatively short duration of the symptom, presumptively with relatively short duration of the symptom, presumptively indicative of edema. Most cases of OPLL and spondylosis showed linear-shaped lesions, suggesting necrosis and/or cavitations of the central gray matter. One case of spondylosis developed a spindle-shaped lesion, implicating syringomyelia. Round-shaped lesions were seen in the cases of spinal trauma, suggesting postraumatic cyst. In a case of mixed-typed lesion examined pre- and postoperatively, only an oval-shaped lesion decreased in size after surgery. (author).

  14. Increased low-frequency oscillation amplitude of sensorimotor cortex associated with the severity of structural impairment in cervical myelopathy.

    Directory of Open Access Journals (Sweden)

    Fuqing Zhou

    Full Text Available Decreases in metabolites and increased motor-related, but decreased sensory-related activation of the sensorimotor cortex (SMC have been observed in patients with cervical myelopathy (CM using advanced MRI techniques. However, the nature of intrinsic neuronal activity in the SMC, and the relationship between cerebral function and structural damage of the spinal cord in patients with CM are not fully understood. The purpose of this study was to assess intrinsic neuronal activity by calculating the regional amplitude of low frequency fluctuations (ALFF using resting-state functional MRI (rs-fMRI, and correlations with clinical and imaging indices. Nineteen patients and 19 age- and sex-matched healthy subjects underwent rs-fMRI scans. ALFF measurements were performed in the SMC, a key brain network likely to impaired or reorganized patients with CM. Compared with healthy subjects, increased amplitude of cortical low-frequency oscillations (LFO was observed in the right precentral gyrus, right postcentral gyrus, and left supplementary motor area. Furthermore, increased z-ALFF values in the right precentral gyrus and right postcentral gyrus correlated with decreased fractional anisotropy values at the C2 level, which indicated increased intrinsic neuronal activity in the SMC corresponding to the structural impairment in the spinal cord of patients with CM. These findings suggest a complex and diverging relationship of cortical functional reorganization and distal spinal anatomical compression in patients with CM and, thus, add important information in understanding how spinal cord integrity may be a factor in the intrinsic covariance of spontaneous low-frequency fluctuations of BOLD signals involved in cortical plasticity.

  15. Autoimmune myelopathies.

    Science.gov (United States)

    Flanagan, Eoin P

    2016-01-01

    Autoimmune myelopathies are a heterogeneous group of immune-mediated spinal cord disorders with a broad differential diagnosis. They encompass myelopathies with an immune attack on the spinal cord (e.g., aquaporin-4-IgG (AQP4-IgG) seropositive neuromyelitis optica (NMO) and its spectrum disorders (NMOSD)), myelopathies occurring with systemic autoimmune disorders (which may also be due to coexisting NMO/NMOSD), paraneoplastic autoimmune myelopathies, postinfectious autoimmune myelopathies (e.g., acute disseminated encephalomyelitis), and myelopathies thought to be immune-related (e.g., multiple sclerosis and spinal cord sarcoidosis). Spine magnetic resonance imaging is extremely useful in the evaluation of autoimmune myelopathies as the location of signal change, length of the lesion, gadolinium enhancement pattern, and evolution over time narrow the differential diagnosis considerably. The recent discovery of multiple novel neural-specific autoantibodies accompanying autoimmune myelopathies has improved their classification. These autoantibodies may be pathogenic (e.g., AQP4-IgG) or nonpathogenic and more reflective of a cytotoxic T-cell-mediated autoimmune response (collapsin response mediator protein-5(CRMP5)-IgG). The presence of an autoantibody may help guide cancer search, assist treatment decisions, and predict outcome/relapse. With paraneoplastic myelopathies the initial goal is detection and treatment of the underlying cancer. The aim of immunotherapy in all autoimmune myelopathies is to maximize reversibility, maintain benefits (while preventing relapse), and minimize side effects.

  16. 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.

  17. 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.

  18. 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

  19. 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

  20. 颈椎间盘置换治疗脊髓型颈椎病的疗效观察%EFFECTIVENESS OF CERVICAL DISC REPLACEMENT FOR CERVICAL MYELOPATHY

    Institute of Scientific and Technical Information of China (English)

    严冬雪; 肖增明; 沈翀; 黄永吉

    2012-01-01

    目的 探讨颈椎间盘置换治疗脊髓型颈椎病的疗效. 方法 2006年10月- 2008年10月,采用椎间盘置换治疗20例(26个节段)脊髓型颈椎病患者.男8例,女12例;年龄26~65岁,平均46岁.病程2~18个月,平均7个月.单节段置换14例,双节段置换6例.术后以Odom等标准评价疗效,以疼痛视觉模拟评分(VAS)评价颈、肩部及上肢疼痛情况.X线片测量假体椎间盘间隙角及颈椎过屈、过伸位活动度,观察异位骨化、骨赘形成及假体松动等情况. 结果 术后切口均Ⅰ期愈合,无严重并发症发生.20例均获随访,随访时间30~48个月,平均34个月.术后28个月按Odom等标准获优17例、良3例,颈、肩部及上肢VAS评分均较术前显著改善(P<0.05).术后30个月,20个置换节段未融合,假体活动度为(10.6±4.5)°,与上位相邻节段的(10.8±3.7)°和下位相邻节段的(7.5±4.2)°比较差异均无统计学意义(P>0.05).术后10例13个节段发生异位骨化,1例假体后方移位;其他假体无移位、下沉、松动等并发症发生. 结论 颈椎间盘置换治疗脊髓型颈椎病能维持颈椎正常活动范围和生理弯曲,但其功能和对邻近节段的影响需进一步随访.%Objective To evaluate the effectiveness of cervical disc replacement for cervical myelopathy. Methods Between October 2006 and October 2008, 20 patients (26 segments) with cervical myelopathy underwent single-level (14 segments) or bi-level (6 segments) cervical disc replacement. There were 8 males and 12 females with an average age of 46 years (range, 26-65 years). The disease duration ranged 2-18 months (mean, 7 months). The effectiveness was evaluated using visual analogue scale (VAS) score, cervical range of motion (ROM), and the Odom etal criteria. Heterotopic ossification (HO), osteophyte formation, and prosthesis loosening were observed. Results All incisions healed by first intention, with no severe complication. Twenty patients were followed

  1. Efficacy Observation on Comprehensive Therapy for Cervical Spondylotic Radiculopathy of Qi Stagnation and Blood Stasis Type%综合治疗气滞血瘀型神经根型颈椎病疗效观察

    Institute of Scientific and Technical Information of China (English)

    蒋芳华; 陈进城; 陈水金; 陈少清; 王诗忠

    2014-01-01

    Objective:To observe the efficacy of comprehensive therapy for cervical spondylotic radiculopathy of qi stagnation and blood stasis type. Methods:68 cases of patients with cervical spondylotic radiculopathy of qi stagnation and blood stasis type were randomly divided into treatment group (34 cases) and control group (34 cases), the treatment group treated by comprehensive therapy which included cervical immobilization, mas-sage, acupuncture, Chinese herbs and physiotherapy, while control group only by acupuncture and massage, then evaluated the efficacy after 2 course of treatment. Results:The total effective rate of treatment group was higher than that of control group (P<0.05), the VAS score was lower than that of control group (P<0.05), and the maximum strength of right and left lateral flexion, anteflexion, extension were all better than those of control group (P<0.05). Conclusion:Comprehensive therapy has significant curative effect on cervical spondylotic radiculopathy of qi stagnation and blood stasis type, deserves clinical promotion and application.%目的:观察综合治疗气滞血瘀型神经根型颈椎病的疗效。方法:将68例气滞血瘀型神经根型颈椎病患者随机分为治疗组(34例)和对照组(34例),治疗组采用颈部制动、推拿、针灸、中药、物理治疗等综合治疗,对照组则仅给予针灸、推拿治疗,2个疗程后评定疗效。结果:治疗组总有效率高于对照组(P<0.05),VAS评分低于对照组(P<0.05),颈椎左右侧屈、前屈和后伸最大肌力均优于对照组(P<0.05)。结论:综合治疗气滞血瘀型神经根型颈椎病疗效显著,值得临床推广应用。

  2. 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.

  3. Effects of Acupotomy on Trapezius Tension in Treating Cervical Spondylotic Radiculopathy%针刀治疗对神经根型颈椎病斜方肌肌张力的影响

    Institute of Scientific and Technical Information of China (English)

    张琥; 陆世昌; 张明才; 郑昱新; 詹红生; 匡勇; 刘印文; 卢伟达

    2011-01-01

    Objective: To observe the curative effects of acupotomy in the treatment of cervical spondylotic radiculopathy and its effects on trapezius tension. Methods: Sixty cases of cervical spondylotic radiculopathy were randomly divided into two groups: treatment group in which 30 cases were treated by acupotomy and control group in which 30 cases were treated by meloxicam, with a course of two weeks. The clinical efficacy, neck pain and trapezius tension were observed. Results: The clinical efficacy was better in the treatment group than in the control group ( P <0.05); the neck pain and trapezius tension were improved after treatment in both groups ( P < 0.05 ) , with more significant improvement in the treatment group than in the control group ( P < 0.05 ). Conclusion: Acupotomy can treat cervical spondylotic radiculopathy by improving trapezius tension and keeping balance of cervical mechanics.%目的:观察针刀治疗神经根型颈椎病的临床疗效及其对斜方肌肌张力的影响.方法:将60例神经根型颈椎病患者随机分成针刀组和美洛昔康组(各30例),分别采用针刀治疗和口服美洛昔康治疗,疗程2周;观察两组临床疗效、颈部疼痛评分及斜方肌张力变化.结果:针刀组的临床疗效优于美洛昔康组(P<0.05);两组肩颈部疼痛以及斜方肌张力均有明显改善(P<0.05),且针刀组改善优于美洛昔康组(P<0.05).结论:针刀治疗可通过改善斜方肌肌张力、恢复颈椎的生物力学平衡以治疗神经根型颈椎病.

  4. 颈椎后路单开门结合钛板内固定治疗脊髓型颈椎病%Clinical observation of posterior cervical single door joint titanium plate fixation treatment for cervical myelopathy

    Institute of Scientific and Technical Information of China (English)

    李水胜; 黄黎

    2014-01-01

    目的:探讨分析颈椎后路单开门结合钛板内固定治疗脊髓型颈椎病的临床疗效。方法回顾性分析2009年5月至2012年6月间在我院进行治疗的46例脊髓型颈椎病患者的临床记录资料。结果治疗后,治疗组的优良率为82.61%,高于对照组的52.17%,具有显著性差异(P ﹤0.05);治疗组的 JOA 评分高于对照组,ROM、颈椎屈曲、后伸角度均低于对照组,均具有显著性差异(P ﹤0.05)。结论颈椎后路单开门结合钛板内固定治疗脊髓型颈椎病的临床疗效显著,值得临床推广应用。%Objective:To investigate clinical effect of posterior cervical single door joint titanium plate fixation in treat-ment for cervical myelopathy. Methods:The clinical records of 46 patients with cervical myelopathy in our hospital from May 2009 to June 2012 were reviewed. Results:After treatment,the excellent rate of treatment group( 82. 61% )were sig-nificantly higher than that of the control group(52. 17% )(P ﹤ 0. 05). The JOA score of the treatment group was signifi-cantly higher than that of the control group and ROM,cervical flexion ,extension angles of the treatment group were lower than that of the control group( P ﹤ 0. 05 ). Conclusion:Clinical efficacy of posterior cervical single door joint titanium plate fixation in treatment for cervical myelopathy is remarkable and worthy of clinical application.

  5. Effect of Tongyang Lishi Formula on Rats with Cervical Spondylotic Radiculopathy at Acute Stage%通阳利湿方对神经根型颈椎病急性期模型大鼠的影响

    Institute of Scientific and Technical Information of China (English)

    王鹏; 乔钢; 贾露露; 国延军; 牟成林; 赵建; 崔书国; 杜景华

    2014-01-01

    目的:探讨通阳利湿方对大鼠颈神经根急性疼痛的影响。方法:首先采用椎管插线法建立神经根型颈椎病急性根性疼痛大鼠模型。将符合入组条件的大鼠随机分成对照组与治疗组2组,每组20只。术后第5天、第20天分别对大鼠自发痛、步态评分、痛阈、游泳时间进行统计。结果:通阳利湿方能显著改善模型大鼠根性疼痛的相关行为,与对照组相比差异有显著性(P <0.05)。结论:通阳利湿方能明显减轻大鼠模型颈神经根急性根性疼痛,且提示有量效关系。%Objective:to explore the effect of Tongyang Lishi formula on the acute pain of cervical spondylotic radiculopathy.Methods:Model rats with acute cervical spondylotic radiculopathy were made through patching in spinal canal. The proper rats were di-vided into control group and treatment group,20 rats in either group. The spontaneous pain,gait score,pain threshold and swimming time were statistically analyzed on the 5th and 20th day after the operation. Results:The formula could remarkably improve the behav-ior related to root pain. The difference between both group was significant (P <0.05 ). Conclusion:Tongyang Lishi formula can sig-nificantly relieve the acute pain by cervical spondylotic radiculopathy,which suggests their dose-effect relationship.

  6. 逐椎微调手法治疗神经根型颈椎病临床观察%Clinical Observation of Cervical Spondylotic Radiculopathy with Vertebral Micro-Adjustment Manipulation

    Institute of Scientific and Technical Information of China (English)

    周立武

    2009-01-01

    Objective To observe the clinical efficacy on cervical spondylotic radiculopathy treated with vertebral micro-adjustment manipulation.Methods 140 cases were randomly divided into control group and treatment group,70 cases in each one.In control group,nabumetone capsule was administered.In treatment group,vertebral micro-adjustment manipulation was adopted.The clinical efficacy was observed after treatment in two groups.Results The total effective rate was 97.14% in treatment group and 88.57% in control group,demonstrating significant difference in group comparison(P<0.05).Conclusion Vertebral micro-adjustment manipulation presents apparently superior efficacy on cervical spondylotic radiculopathy compared with medicinal therapy.It removes nerve root stimulation and compression radically and cures the disease.%目的 观察逐椎微调手法治疗神经根型颈椎病的临床疗效.方法 将140例患者按完全随机原则分为对照组与治疗组,每组70例.对照组患者采用萘丁美酮胶囊治疗,治疗组采用逐椎微调手法治疗.观察两组患者治疗后的临床疗效.结果 治疗组总有效率为97.14 %,对照组为88.57%,两组比较有显著性差异(P<0.05).结论 逐椎微调手法对神经根型颈椎病的治疗效果明显优于药物治疗,可从根本上解除神经根的刺激和压迫,达到治愈疾病的目的 .

  7. 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

  8. 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

    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 clinical effect of treatment.Results All of 34 patients were followed up for an average of 4 months, of which 23 patients got different degrees of neural function improvements after conservative treatment, and 11 patients had no obvious improvement.Eight cases without obvious improvement underwent operation, and other 3 patients refused operation treatment of who 2 cases were relieved after continued conservative treatment, and the remaining 1 case developed with clinical manifes-tations of spinal cord disease.The JOA scores in both groups were significantly improved after treatment (P<0.01).Conclu-sion Majority of patients with A-SCCC combined with symptomatic cervical can alleviate the condition after conservative treatment, some still need operation.A-SCCC combined with symptomatic cervical radiculopathy or spinal cord high intensity signal spinal cord do not need preventive operation, but still have to observe the change of the disease closely.%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

  9. 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.

  10. Adjacent level spondylodiscitis after anterior cervical decompression and fusion

    Directory of Open Access Journals (Sweden)

    Saumyajit Basu

    2012-01-01

    Full Text Available Postoperative spondylodiscitis after anterior cervical decompression and fusion (ACDF is rare, but the same occurring at adjacent levels without disturbing the operated level is very rare. We report a case, with 5 year followup, who underwent ACDF from C5 to C7 for cervical spondylotic myelopathy. He showed neurological improvement after surgery but developed discharging sinus after 2 weeks, which healed with antibiotics. He improved on his preoperative symptoms well for the first 2 months. He started developing progressive neck pain and myelopathy after 3 months and investigations revealed spondylodiscitis at C3 and C4 with erosion, collapse, and kyphosis, without any evidence of implant failure or graft rejection at the operated level. He underwent reexploration and implant removal at the operated level (there was good fusion from C5 to C7 followed by debridement/decompression at C3, C4 along with iliac crest bone grafting and stabilization with plate and screws after maximum correction of kyphosis. The biopsy specimen grew Pseudomonas aeruginosa and appropriate sensitive antibiotics (gentamycin and ciprofloxacin were given for 6 weeks. He was under regular followup for 5 years his myelopathy resolved completely and he is back to work. Complete decompression of the cord and fusion from C2 to C7 was demonstrable on postoperative imaging studies without any evidence of implant loosening or C1/C2 instability at the last followup.

  11. 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。

  12. 多节段脊髓型颈椎病与颈椎后纵韧带骨化症单开门椎管成形术疗效分析%Curative effect analysis of single door treatment of multiple segmental cervical spondy1otic myelopathy and ossification of the posterior longitudinal ligament

    Institute of Scientific and Technical Information of China (English)

    施建东; 卢一生; 刘振刚

    2015-01-01

    目的:分析多节段脊髓型颈椎病(CSM)和颈椎后纵韧带骨化症(OPLL)采用颈后路单开门椎管成形术治疗的临床疗效。方法回顾性分析采用颈后路单开门椎管成形结合微型钛板内固定术治疗的多节段CSM(CSM组)及节段性OPLL(OPLL组)共116例的临床资料,比较2组手术时间、手术失血量、手术并发症、神经功能改善情况及颈椎活动度的变化等。结果术中失血量、手术时间及手术并发症比较,差异无统计学意义(P>0.05);OPLL组神经功能改善率要低于CSM组,差异有统计学意义(P<0.05)。结论后路单开门椎管成形术可有效地治疗CSM及OPLL,术中失血量、手术时间以、颈椎活动度丢失及并发症发生率无明显差异,但OPLL患者神经功能改善情况低于CSM患者。%Objective To compare the clinical efficacy of cervical single door for multiple seg-mental cervical spondylotic myelopathy(CSM)and ossification of the posterior longitudinal ligament(O-PLL). Methods The clinical data of 116 patients with single door treatment of multiple segmental cervical spondy1otic myelopathy and ossification of the posterior longitudinal ligament were studied retrospectively. The operation time,blood loss in operation,Surgical complications,neurological function improvement and the change of range of motion were compared. Results Intraoperative blood loss, operating time and complications of the two groups were compared,there was no statistically signifi-cant difference(P>0.05);The recovery rate of JOA scores in OPLL group was significant lower than that in CSM group,the difference was statistically significant (P<0.05). Conclusion Laminoplasty is an efective procedure for the treatment of patients due to either CSM or OPLL. However,recovery of neurological function of patients with OPLL was less than that ofpatients with CSM. There is no sig-nificant difference in intraoperative blood loss

  13. 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

  14. 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.

  15. 生活方式对神经根型颈椎病患者术后早期康复的影响%The influence of lifestyle on early postoperative rehabilitation patients with cervical spondylotic radiculopathy

    Institute of Scientific and Technical Information of China (English)

    李衍朋; 孟纯阳

    2016-01-01

    目的 探讨神经根型颈椎病患者术后早期康复情况并分析其与生活方式的相关性.方法 对164例有完整随访资料并行颈椎前路手术治疗的神经根型颈椎病患者的相关资料进行回顾性分析.采用改良MacNab标准评价术后康复情况,术后3月进行随访评估临床疗效,并参考改良MacNab标准将患者分为满意组(优/良)和不满意组(可/差).预后因素包括一般资料和生活方式.生活方式包括吸烟史、酗酒史、睡眠时间、枕头高度、伏案工作时间和体育锻炼频次.采用x2检验和多因素Logistic回归分析生活方式对神经根型颈椎病术后早期康复的影响.结果 术后3月患者临床疗效满意度88.4%.x2检验显示两组间年龄(x2=5.819,P<0.05)、吸烟(x2=5.074,P<0.05)和体育锻炼频次(x2=4.430,P<0.05)差异有统计学意义,而性别、BMI、糖尿病史、酗酒史、睡眠时间、枕头高度、伏案工作时间和教育程度的比较均差异无统计学意义(P>0.05).多因素Logistic分析提示年龄>50岁(OR=3.913,95% CI=1.321 ~ 11.594,P=0.014)、吸烟(OR=3.217,95% CI=1.126~9.195,P=0.029)和体育锻炼≤3次/周(OR=3.906,95% CI=1.026~ 14.869,P=0.046)是影响神经根型颈椎病术后早期临床疗效满意度的危险因素.结论 年龄、吸烟和体育锻炼频次与神经根型颈椎病患者术后早期康复有关,年龄>50岁、吸烟和体育锻炼≤3次/周其术后早期康复相对较差.%Objective To investigate the early postoperative rehabilitation condition of patients with cervical spondylotic radiculopathy and analyze its correlation with the life style.Methods A retrospective analysis for 164 cases of cervical spondylotic radiculopathy with complete follow-up data were carried out.Using modified MacNab criteria for evaluation of postoperative recovery.The clinical efficacy was evaluated 3 months after operation,and the patients were divided into satisfactory group (excellent

  16. 针刀治疗神经根型颈椎病研究现状%Study Developments on Acupuncture-knife in the Treatment of Cervical Spondylotic Radiculopathy

    Institute of Scientific and Technical Information of China (English)

    宋渊; 李亚军; 梁雄勇

    2011-01-01

    总结近年来针刀治疗神经根型颈椎病的研究成果,认为神经根型颈椎病在各型颈椎病中发病率最高,临床中运用针刀治疗神经根型颈椎病有疗程短、见效快、疗效确切等特点,但其机理尚不十分明确,需深入研究以进一步确保其疗效.%The cervical spondylotic radiculopathy (CSR) is the one with highest incidence among all types of cervical spondylopathy.In clinic,acupuncture-knife CSR has the characteristics of short period of treatment,quick effectiveness and precise therapeutic effect. Therefore, this article has a comprehensive overview of the development of the studies on the acupuncture-knife therapy of CSR during the recent years.

  17. 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.

  18. 神经根型颈椎病的影像学特点和分型%Imaging characteristics and classification of cervical spondylotic radiculopathy

    Institute of Scientific and Technical Information of China (English)

    李曙明; 尹战海; 王莹

    2013-01-01

    [Objective] To analyze the correlation of X ray examination (radiology) and magnetic resonance imaging ( MRI) in the diagnosis of cervical spondylotic radiculopathy (CSR) . [ Methods] Totally 560 cases of CSR from April 2005 to July 2011 were retrospectively analyzed. Clinical manifestation, imaging results of radiology and MRI were compared and correla-tively analyzed. [Results] In the responsible intervertebral space, 216 cases (38. 57% ) of posterior hyperstosis from vertebral body were observed on lateral view of radiology, 187 cases (33. 39% ) of hyperstosis and stenosis of intervertebral foramen were observed on oblique view of radiology, 75 cases ( 13. 39% ) of hyperstosis were observed both on lateral and oblique view of radiology , 19 cases (3. 39% ) of hyperstosis of Luschka joint were observed on A - P view of radiology, 63 cases (11. 25% ) without obvious hyperstosis were noticed in X ray examination. Accompanied intervertebral disc herniation was discerned in 497 cases (88. 75% ) by MRI. According to the correlation analysis of radiology and MRI, CSR was classified into 5 types. The incidence of hyperstosis was highest at posterior region of intervertebral space on lateral view of X ray examination, then lateral on oblique view, posterior and lateral on lateral and oblique view, no obvious hyperstosis on both view and accompanying lateral bony hyper-plasia on A - P view sequentially. [ Conclusion] It is advisable to analyze the location and factor of nerve root compression in responsible' intervertebral space through correlative analysis of radiology and MRI. Posterolateral intervertebral discectomy and decompression of hyperstosis of nerve root canal is the key point of treatment of CSR according to the correlative imaging observation.%[目的]分析并找出神经根型颈椎病的X线片、MRI特点以及其相关性,为神经根型颈椎病的诊治提供参考依据.[方法]收集自2005年4月~ 2011年7月门诊及

  19. 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.

  20. Clinical observation on "Jinbi Decoction" for cervical spondylotic radiculopathy: A report of 150 cases%筋痹方治疗神经根型颈椎病150例临床观察

    Institute of Scientific and Technical Information of China (English)

    叶秀兰; 李晓锋; 李军

    2012-01-01

    目的 观察筋痹方治疗神经根型颈椎病的临床疗效.方法 对150例神经根型颈椎病病例给予筋痹方加减治疗,疗程28天,观察治疗前、治疗后和停药3个月患者症状、体征情况,并评价临床疗效.结果 150例病例中,痊愈58例,好转80例,无效12例,治愈率为38.67%,总有效率为92.00%.治疗前后比较,颈肩部疼痛与不适、上肢疼痛与麻木、手指麻木、工作和生活能力、椎间孔挤压试验及腱反射各项指标评分差异均有统计学意义(P<0.05,P<0.01);治疗后3个月随访与治疗前比较,各项指标差异均有统计学意义(P<0.05,P<0.01);治疗后3个月随访与治疗后比较,各项指标差异无统计学意义(P>0.05).结论 以内服筋痹方为主的中药治疗神经根型颈椎病具有良好的近期疗效.%Objective To observe the clinical efficacy of " Jinbi Decoction" for the treatment of cervical spondylotic radiculopathy. Methods One hundred and fifty cases were treated by modified "Jinbi Decoction" for 28 days. The signs and symptoms were observed, and the clinical efficacy was evaluated before treatment and after treatment for 3 months. Results Fifty-eight cases were cured, 80 were improved and 12 cases got no effects; the cure rate was 38.67% ; the total effective rate was 92.00%. The pain and discomfort of neck and shoulder, pain and numbness of limbs, numbness of finger, viability, indexes of spurling test and tendon reflex before treatment were statistically different from after treatment ( P 0.05). Conclusion Taking "Jinbi Decoction" orally has recently curative effect for the treatment of cervical spondylotic radiculopathy.

  1. Acupotome and spinal balancing in the treatment of cervical spondylotic arteriopathy%针刀松解术结合脊柱调衡治疗椎动脉型颈椎病

    Institute of Scientific and Technical Information of China (English)

    罗青锋; 李敏

    2015-01-01

    目的:观察针刀松解术结合脊柱调衡治疗椎动脉型颈椎病的临床疗效。方法将40例椎动脉型颈椎病患者随机等分为治疗组与对照组。针刀松解术结合脊柱调衡为治疗组,常规电针联合推拿为对照组;观察2组治疗后的临床疗效。结果治疗组治愈率和总有效率为70%、95%,对照组为40%、80%;2组疗效比较差异有统计学意义( P<0.05)。结论针刀松解术结合脊柱调衡通过恢复颈椎内外生物力学平衡治疗椎动脉型颈椎病。%Objective To observe the efficacy of the combined therapy of acupotome andSpinal balancing .Methods The 40 patients with cervical spondylosis of vertebral artery type were randomly divided into two groups .The treatment group were treated with acupotome and spinal balancing ,and those in control group with electro-acupuncture and massage therapy . Then observe the clinical efficacy of the two groups after treatment .Results In treatment group ,the curative rate was 70%and the total effective rate was 95% .In control group ,the curative was 40% and the total effective rate was 80% .There was a significant difference between twogroups ( P<0 .05 ) .Conclusion The combined treatment of acupotome and spinal bal-ancing could treat cervical spondylotic arteriopathy by restoring the cervical biomechanical balance inside and outside .

  2. 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

  3. Magnetic resonance imaging atlas of the cervical spine musculature.

    Science.gov (United States)

    Au, John; Perriman, Diana M; Pickering, Mark R; Buirski, Graham; Smith, Paul N; Webb, Alexandra L

    2016-07-01

    The anatomy of the cervical spine musculature visible on magnetic resonance (MR) images is poorly described in the literature. However, the correct identification of individual muscles is clinically important because certain conditions of the cervical spine, for example whiplash associated disorders, idiopathic neck pain, cervical nerve root avulsion and cervical spondylotic myelopathy, are associated with different morphological changes in specific muscles visible on MR images. Knowledge of the precise structure of different cervical spine muscles is crucial when comparisons with the contralateral side or with normal are required for accurate description of imaging pathology, management and assessment of treatment efficacy. However, learning the intricate arrangement of 27 muscles is challenging. A multi-level cross-sectional depiction combined with three-dimensional reconstructions could facilitate the understanding of this anatomically complex area. This paper presents a comprehensive series of labeled axial MR images from one individual and serves as a reference atlas of the cervical spine musculature to guide clinicians, researchers, and anatomists in the accurate identification of these muscles on MR imaging. Clin. Anat. 29:643-659, 2016. © 2016 Wiley Periodicals, Inc.

  4. 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.

  5. Clinical and magnetic resonance imaging features of compressive cervical myelopathy with traumatic intervertebral disc herniation in cynomolgus macaque (Macaca fascicularis)

    Science.gov (United States)

    Choi, Yun-Jung; Park, Hye-Jin; Sohn, Chul-Ho; Jung, Kyeong Cheon; Park, Seong Hoe

    2016-01-01

    Intervertebral disc herniation (IVDH) with nucleus pulposus extrusion, traumatic or not, is a devastating clinical condition accompanied by neurological problems. Here we report a cynomolgus macaque suffering from acute and progressive neurological dysfunction by a blunt trauma due to neck collar, an animal handling device. Tetraplegia, urinary incontinence, decreased proprioception, and imperception of pain were shown on physical and neurological examinations. MRI sagittal T2 weighted sequences revealed an extensive protrusion of disc material between C2 and C3 cervical vertebra, and this protrusion resulted in central stenosis of the spinal cord. Histopathologic findings showed a large number of inflammatory cells infiltrated at sites of spinal cord injury (SCI). This case is the first report of compressive cervical SCI caused by IVDH associated with blunt trauma. PMID:28053621

  6. Clinical and radiological profile of Hirayama disease: A flexion myelopathy due to tight cervical dural canal amenable to collar therapy

    Directory of Open Access Journals (Sweden)

    K M Hassan

    2012-01-01

    Full Text Available Background: Hirayama disease (HD is benign focal amyotrophy of the distal upper limbs, often misdiagnosed as motor neuron disease. Routine magnetic resonance imaging (MRI is often reported normal. Objective: To study the clinicoradiological profile of hand wasting in young males. Materials and Methods: Patients presenting with insidious-onset hand wasting from March 2008 to May 2011 were evaluated electrophysiologically. Cervical MRI in neutral position was done in 11 patients and flexion contrast imaging was done in 10 patients. Results: All patients were males less than 25 years of age, with median age 23 years, except one patient who was 50 years old. Duration of illness was 3 months to 3 years. All (100% had oblique amyotrophy, four (36% cold paresis, 10 (91% minipolymyoclonus and three (27% had fasciculations. Regional reflexes were variably absent. Two patients (18% had brisk reflexes of lower limbs with flexor plantars. Electromyography (EMG showed chronic denervation in the C7-T1 myotomes. Neutral position MRI showed loss of cervical lordosis in 10/11 (91%, localized lower cervical cord atrophy in 9/11 (82%, asymmetric cord flattening in 11/11 (100% and intramedullary hyperintensity in 2/11 (18%; flexion study showed loss of dural attachment, anterior displacement of dorsal dura, epidural flow voids in 9/10 (90% and enhancing epidural crescent in 10/10 (100%. Clinical profile, imaging and electrophysiological findings of the patient aged 50 years will be described in detail as presentation at this age is exceptional. Collar therapy slowed progression in most cases. Conclusion: Clinical features of HD corroborated well with electrophysiological diagnosis of anterior horn cell disease of lower cervical cord. While dynamic contrast MRI is characteristic, routine studies have a high predictive value for diagnosis. Prompt diagnosis is important to institute early collar therapy.

  7. Tourette's syndrome with cervical disc herniation.

    Science.gov (United States)

    Lin, Jainn-Jim; Wang, Huei-Shyong; Wong, Mun-Ching; Wu, Chieh-Tsai; Lin, Kuang-Lin

    2007-03-01

    Tourette's syndrome is manifested in a broad spectrum of motor, vocal, and behavioral disturbances. Movement disorders, such as tics, may contribute to the development of cervical myelopathy owing to the effects of involuntary movements on the neck. However, the association of cervical myelopathy with motor tics of the head and neck is rare. We report here a case of a violent, repetitive neck extension due to Tourette's syndrome that developed cervical myelopathy caused by cervical disc herniation.

  8. 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

  9. 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).

  10. 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.

  11. 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).

  12. 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.

  13. Establishment and Preliminary Assessment of Traditional Chinese Medical Clinical Pathway for Cervical Spondylotic Radiculopathy%神经根型颈椎病中医临床路径的建立和初步评价

    Institute of Scientific and Technical Information of China (English)

    陈博来; 林定坤; 孔畅; 张琥; 陈炳坤; 苏国义; 吴江林; 赵兵德

    2011-01-01

    in both groups. Results After treatment, the symptoms were relieved or disappeared in both groups.The average hospitalization time and average hospitalization fee were decreased, and patients' satisfaction was increased in the treatment group (P <0. 05 or P <0. 01 compared with those in the control group). Conclusion It is feasible to establish TCM-CP for cervical spondylotic radiculopathy, which will supply standardization of clinical practice for the doctors, shorten hospitalization time, reduce hospitalization fee, and increase patients' satisfaction.

  14. Value of MRA-MRI in the diagnosis and treatment of cervical spondylotic arteriopathy%MRA-MRI在椎动脉型颈椎病诊断与治疗中的指导作用

    Institute of Scientific and Technical Information of China (English)

    张小卫; 尹战海; 刘凯; 王金堂

    2011-01-01

    Objective:To explore the value of combining magnetic resonance angiography-magnetic resonance imaging (MRA-MRI) combination in the diagnosis and treatment of cervical spondylotic arteriopathy(CSA).Method:Clinical data of 103 cases of CSA were retrospectively reviewed.CSA patients underwent MRA to determine the morphology and course of the vertebral artery,and MRI to determine the external and internal factors influencing the morphology of vertebral artery.The results were used to classify the pathology of CSA and the treatment protocols were determined based on this classification.Clinical outcomes were evaluated by Nagashima criteria.Results:Based on MRA results,CSA was categorized into 4 types: Ⅰ.Local narrowing, Ⅱ.Tortuous, Ⅲ.Whole range narrowing(obstruction) and Ⅳ.Normal type.Resection of luska joint,enlargement of cervical transverse foramen were performed on type Ⅰ and Ⅱ evidenced with external compression on MRA,and the excellent-to-good rate was 86.7% ;CSA patients due to cervical spine instability underwent intervertebral fusion with the excellent-to-good rate of 84.6%;while for type Ⅲ and Ⅳ,conservative treatment was indicated with the excellent-to-good rate of 77.0%.Conclusion:MRA-MRl classification is valuable on selection of treatment protocol for CSA.%目的:探讨椎动脉磁共振造影(MRA)与磁共振成像(MRI)联合应用对椎动脉型颈椎病(CSA)诊断与治疗的指导意义.方法:回顾性分析2004年11月~2009年11月103例CSA患者的临床资料.患者均行MRA和MRI检测,对CSA进行诊断分型,并依据分型选择手术治疗方式或非手术治疗.根据Nagashima疗效评价标准随访临床疗效及MRA及MRI检查.结果:MRA-MRI可将CSA分为局部狭窄型、迂曲型,全程变细(闭塞)型和正常型.MRA局部狭窄型、迂曲型中MRI显示椎动脉狭窄部化存在外在压迫因素者行钩椎关节切除、横突孔切开,术后疗效优良率达86.7%;MRA-MRI判定颈椎不稳导致CSA者

  15. Cervical Stenosis, Myelopathy and Radiculopathy

    Science.gov (United States)

    ... the spinal cord travels. As part of the normal aging process, the discs lose some of their water content and start bulging out as we get older. In some patients, however, the bulging of the disc and other arthritic changes between the vertebrae results in narrowing of the ...

  16. Initial experience with extreme angle cervical screw for treatment of trauma and cervical spondylosis.

    Science.gov (United States)

    Mehta, Ankit I; Babu, Ranjith; Bagley, Carlos A; Grossi, Peter M; Gottfried, Oren N

    2014-03-01

    In this study, we have described our initial experience and surgical technique of extreme angle screw placement in the cervical and upper thoracic spine of a cohort of patients undergoing posterior fusion. This extreme angle screw facilitates rod placement without need for any coronal contouring of the rod or offset connectors despite the varied entry site locations for posterior instrumentation and the different trajectories and pathways of these screws. From ruary 2011 to July 2011, extreme angle screws were placed in twenty consecutive adult patients who underwent posterior cervical, occipital-cervical or cervical-thoracic fusions. The primary diagnosis was cervical spondylotic myelopathy (13), trauma (4), and pseudoarthrosis with stenosis (3). Eight patients had gross instability. A total of 196 screws were placed; half of the cases involved instrumentation at or within the C3-7 segments (10) and the others included constructs extending to occipital bone, C2, T1, or T2 (10). Of all twenty cases, there were no perioperative hardware complications. At long-term follow-up, two patients required reoperation, one for hardware failure and the other for single level symptomatic pseudoarthrosis. We conclude that extreme angle screw use in the posterior cervical spine provides an evolution in posterior instrumentation that maximizes the biomechanical strength of a construct, allows for easy rod placement, and may improve the restoration of sagittal alignment. Overall, extreme angle screws facilitate rod placement even for screws offset from the natural plane of the rod, thereby avoiding the need for coronal contouring or placement of offset connectors.

  17. 前列地尔注射液治疗椎动脉型颈椎病的短期疗效观察%Observation of short term effect of Alprostadil Injection on cervical spondylotic vertebral arteriopathy

    Institute of Scientific and Technical Information of China (English)

    袁忠治; 李继云; 汤晨逢; 杨昀焯; 刘刚

    2009-01-01

    目的 探讨前列地尔注射液治疗椎动脉型颈椎病的短期疗效.方法 选取我院骨科住院和门诊治疗的椎动脉型颈椎病患者52例,平均年龄47岁.将患者随机分为治疗组28例和对照组24例.给对照组患者颈椎牵引、颈部理疗和功能锻炼.将丹参20 ml溶于低分子右旋糖酐500 ml静脉点滴,1次/d,连用10 d.给治疗组患者除对照组所用治疗措施外,另加前列地尔注射液10 μg溶于5%葡萄糖液250 ml缓慢静脉点滴,1次/d,连用10 d.用椎动脉型颈椎病功能评定量表进行疗效评价.治疗组或对照组组内作治疗前后自身对比,治疗组与对照组作治疗后对比.结果 治疗组或对照组治疗前后的功能状态和心理功能均有明显差异(P<0.05);治疗组与对照组治疗后比较,在功能状态和心理功能两方面均有明显差异(P<0.05).结论前列地尔注射液对椎动脉型颈椎病有明显短期疗效.%Objective To study the short term effects of Alprostadil Injection on cervical spondylotic vertebral arteriopathy(CSA). Methods 52 cases of patients with CSA, average age of 47 years old, were ran-domly divided into treatment group (n=28 ) with Alprostadil Injection and control group (n=24). The control group were treated with cervical traction, physical therapy, functional exercise, and 20 ml Danshen solusion plus 500 ml Dextran 40 iv drop once a day for 10 days. The treatment group were treated with 20 μg Alprostadil In-jection plus 250 ml 5% glucose iv drop, besides control group treatments, once a day for 10 days. The curative effects of Alprostadil Injection were evaluated by CSA functional scale, compared before and after treatment in the same group and between two groups after treatment. Results The reshs display significant difference before and after treatment both in the treatment group and the control group(P<0.05) ;while the effects of the treat-ment group are better than the control group (P<0.05 ). Conclusion Alprostadil

  18. 电针配合穴位注射用于神经根型颈椎病的临床研究%Clinical research on cervical spondylotic radiculopathy treated by electroacupuncture incorporate with acupuncture point injection

    Institute of Scientific and Technical Information of China (English)

    顾雯烨; 赵凡平; 章奕飞; 周绮

    2013-01-01

    目的 观察电针配合穴位注射治疗神经根型颈椎病的临床疗效.方法 收集2011年2月至2012年11月程家桥社区卫生服务中心及社区站点门诊患者103例,采用函数RAND产生随机数及相应随机编号将患者随机分为三组,电针组34例采用电针治疗,穴位注射组34例采用穴位注射治疗,观察组35例采用电针配合牵引治疗,治疗结束后比较3组间疗效差异.结果 ①临床疗效比较:观察组总有效率为91.4% (32/35),电针组总有效率为73.5% (24/34),穴位注射组总有效率为70.6% (25/34),观察组总有效率与电针组、穴位注射组比较差异均有统计学意义(Z=1.721,P<0.05),电针组与穴位注射组比较差异无统计学意义(Z=2.473,P>0.05).②NDI评分比较:观察组、电针组、穴位注射组NDI评分[治疗前分别为(12.32±5.03)分、(12.96±6.10)分、(12.79±5.07)分,治疗后分别为(7.40±4.12)分、(6.08±3.60)分、(6.08±3.60)分]与同组治疗前比较,差异均有统计学意义(P均<0.05),观察组治疗后疗效优于电针组和穴位注射组(P均<0.05).③症状体征疗效比较:治疗结束后,观察组在颈臂疼痛、臂手麻木、椎间孔挤压试验方面的改善,与电针组、穴位注射组比较,差异有统计学意义(Z值分别为2.603、2.862、2.307,P<0.05);三组间在颈部功能活动、颈椎病变节段压痛方面比较,差异无统计学意义(Z值分别为1.414、1.572,P>0.05).结论 电针配合穴位注射治疗神经根型颈椎病疗效优于单纯电针及单纯穴位注射治疗.%Objective To investigate the clinical efficacy of electroacupuncture incorporate with acupuncture point injection in treating cervical spondylotic radiculopathy.Methods 103 cases from Chen Jia Qiao Community Health Service Centre and other community centers during February 2011 to November 2012 were collected and randomly allocated into three group:a electroacupuncture group of 34 cases; an acupuncture point

  19. 针刺配合中药离子导入对神经根型颈椎病IL-1β的影响及疗效观察%The Effect of Acupuncture and Chinese Medicine Iontophoresis on IL - 1β of Cervical Spondylotic Radiculopathy

    Institute of Scientific and Technical Information of China (English)

    安雪; 张红星; 周利; 邹然; 唐雷; 祁青

    2012-01-01

    目的:观察针刺配合中药离子导入疗法对神经根型颈椎病患者血清IL - 1β的影响及其临床疗效.方法:将90例神经根型颈椎病患者随机分为治疗组(针刺加中药离子导入组)、对照1组(针刺组)、对照2组(中药离子导入组),每组各30例,观察各组疗法治疗神经根型颈椎病的临床疗效,并于治疗前、后分别测定患者血浆IL - 1β含量,进行比较.结果:治疗组疗效优于两个对照组,各组血浆IL - 1β含量均降低,组内比较有显著性差异(P<0.01),治疗组与对照组相比降低更明显(P<0.01).结论:针刺配合中药离子导入可降低神经根型颈椎病患者血浆IL -1β的含量,具有良好的临床疗效.%Objective: To observe the clinical efficacy and influence on the level of IL - 1βof acupuncture and chinese medicine iontophoresis in patients with cervical spondylotic radiculopathy. Methods;90 cases with cer-viqal spondylotic radiculopathy were randomly divided into treatment group ( acupuncture and chinese medicine iontophoresis group) , control group 1 ( acupuncture group) , control group 2 ( chinese medicine iontophoresis group) , every 30 cases in each group, observe the clinical efficacy of every group, and plasma IL - 1β was measured before and after treatment. Results;Treatment group was better than control group, and the analgesic effect of two groups of two controls, plasma concentrations, reduction of IL -1β had a significant difference ( P <0. 01). The treatment group had a lower tendency compared with the control group ( P < 0. 01 ). Conclu-sion ; The comprehensive therapy can reduce IL - 1β plasma levels of cervical spondylotic radiculopathy, which has a good clinical curative effect.

  20. Effectiveness of Acupuncture Plus Traditional Chinese Medicine Iontophoresis for Cervical Spondylotic Radiculopathy%针刺配合中药离子透入治疗神经根型颈椎病

    Institute of Scientific and Technical Information of China (English)

    安雪; 张红星; 周利; 黄国付; 邹然; 唐雷; 祁青

    2011-01-01

    Objective: To observe the influence of acupuncture and traditional Chinese medicine iontophoresis on the level of PGE2 in patients with cervical spondylotic radiculopathy (CSR) and clinical effectiveness. Methods:Ninety patients with CSR were randomly divided into treatment group (acupuncture and TCM iontophoresis group),control group 1 (acupuncture group), control group 2 (TCM iontophoresis group), 20 cases in each group. The clinical effectiveness and plasma PGE2 levels were measured before and after treatment. Results: After treatment 14 times, the total scores of symptoms & signs and functional status, and PGE2 levels were significantly reduced as compared with those before treatment in all groups. The curative rate and total effective rate in treatment group were higher than in control groups 1 and 2 (P<0.05). Conclusion; Acupuncture combined with traditional Chinese medicine iontophoresis can significantly improve the symptoms and signs of patients with CSR, reduce the plasma PGE2 levels and promote the recovery of function.%目的:观察针刺配合中药离子透入对神经根型颈椎病(CSR)患者血浆PGE2浓度的影响及其临床疗效.方法:90例CSR患者随机分为针药组、对照1组和对照2组各30例,分别采用针刺加中药离子透入治疗与针刺治疗、中药离子透入治疗.治疗前后采用神经根型颈椎病20分量表评定患者临床症状体征和功能状态及临床疗效;测定血浆PGE2浓度.结果:治疗14次后,症状体征及功能状态总积分、PGE2浓度,3组均较治疗前明显下降,积分差值比较,针刺组明显大于对照1、2组(P<0.05,0.01);临床疗效比较,针刺组临床治愈率及总有效率均明显高于对照1、2组(P<0.05).结论:针刺配合中药离子透入治疗可明显改善CSR患者的临床症状、体征,降低血浆PGE2的浓度,显著提高临床疗效,促进功能恢复.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. Carpal tunnel syndrome with cervical spondylotic radiculopathy:a clinical and electrophysiological study%腕管综合征合并神经根型颈椎病的临床与电生理特点

    Institute of Scientific and Technical Information of China (English)

    汪仁斌; 刘尊敬; 汪伟; 董明睿; 孙少杰; 毛坤; 焦劲松; 严莉

    2015-01-01

    Objective To study the clinical and electrophysiological characteristics of carpal tunnel syndrome (CTS) with cervical spondylotic radiculopathy (CSR) and simple-CTS,and compare the effect of double crush with that of simple entrapment on a nerve and investigate the association between CTS and CSR.Method From January 2011 to August 2014,clinical data from 96 patients with double crush syndrome (DCS,CTS with CSR) and 165 patients with simple-CTS were examined,and the electrophysiologic parameters of median nerve in patients with DCS were compared with that in patients with simple-CTS.Results In 96 patients with DCS,most of them were female;neck and shoulder pain or simultaneously accompanied by numbness and pain of upper limb was observed in 34 patients,upper limb symptoms and hand weakness and muscle atrophy were observed in the other 62 patients,124 median nerves with abnormal conduction were found in these DCS patients,including 68 cases with unilateral abnormalities and 28 cases with bilateral abnormalities.Cervical radiculopathies of the C5-7 mainly involved in patients with DCS.223 median nerves with abnormal conduction found in the 165 patients with simple-CTS,including 107 cases with unilateral abnormalities and 58 cases with bilateral abnormalities.The average sensory nerve conduction velocity (SCV),motor nerve conduction velocity (MCV) and distal motor latency (DML) of median nerve for DCS and simple-CTS were(32 ±7) m/s vs (35 ±5) m/s,(55 ±7) m/s vs (57 ±5) m/s and (4.6 ± 1.6) ms vs (4.0 ± 0.8) ms,respectively,and their corresponding amplitudes were 6.4 μV vs 9.5 μV,10.9 mV vs 13.1 mV and 11.3 mV vs 14.1 mV,respectively.The SCV,MCV and DML and their corresponding amplitude of DCS were significantly greater decreased than that of simple-CTS (P < 0.01).Conclusion DCS is a common clinical syndrome,and patients with DCS may have neck and shoulder symptoms in addition to the common manifestations of simple-CTS.Abnormal conduction of median nerve of

  6. 多方法评价仰卧位屈颈牵引治疗神经根型颈椎病的随机对照研究%Randomized Controlled study on Multi-method Evaluation of the Clinical Value of Supine Cervical Vertebra Traction with Neck Flexion in the Treatment of Cervical Spondylotic Radiculopathy

    Institute of Scientific and Technical Information of China (English)

    王一; 蔚浩; 周睿

    2016-01-01

    Objective To probe into the clinical value of supine cervical vertebra traction with neck flexion in treating cervical spondylotic radiculopathy.Methods From August 2011 to December 2013,71 patients were divided randomly into a treatment group of 36 cases and a control group of 35 cases.They were treated respectively with supine cervical vertebra traction with neck flexion,and cervical vertebra traction on a sitting position.Both groups had acupuncture,moxibustion,massage and medium frequency electrotherapy.The period of observation was 15 days.We evaluated the results by surveying physiological curvature of the cervical spine on lateral radiograph,and visual analogue scale (VAS),neck disability index (NDI),criteria of diagnosis and therapeutic effect of syndromes in traditional Chinese medicine syndrome and clinical assessment scale for cervical spondylosis (CASCS) were also used.Results Physiological curvature of cervical spine was much improved in both groups after treatment (P < 0.05).The distance of cervical vertebra arc between vertebral anterior edge sequences in treatment group before treating was (4.07±3.63) mm and it was (9.03±4.31) mm after treatment.For the control group,those two numbers were respectively (4.13±3.02) and (8.87±3.97)mm.There was no significant difference in the distance of cervical vertebra arc and its increase between vertebral anterior edge between the two groups after treatment.There was significant difference in the efficiency rate between the two groups (P < 0.05) (treatment group 100.00%,control group 97.14%).When cured rate and cured-markedly effective rate were added,the treatment group (80.56%) was much better than the control group (51.43%) (P < 0.01).As to VAS score,NDI and CASCS scores,both groups got much better after treatment (P < 0.01).For VAS,the treatment group decreased from 8.43±0.75 before treatment to 1.40±0.61 after treatment,while the control group from 8.35±0.78 before treatment to 2.55±0

  7. 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

  8. 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

  9. 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

  10. 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

  11. Motor tic disorder and traumatic cervical myelopathy: a case report Trastorno de tic motor y mielopatía cervical traumática: relato de caso Transtorno de tique motor e mielopatia cervical traumática: relato de caso

    Directory of Open Access Journals (Sweden)

    Ericson Sfredo

    2011-01-01

    Full Text Available The association between motor tics and cervical myelopathy is rare and not well understood. Only a few papers in the literature reported this disorder until the present date. This is a case report of a cervical myelopathy case secondary to a motor tic disorder. A 23-year-old male with a 10-year history of motor tic disorder, involving sudden forced extension of the head and cervical spine. Disturbed tactile sensation and kinetic posturing that progressed to the Lhermitte sign every time he made the movement were detected over the last six months. Magnetic resonance imaging (MRI showed hyperintense intramedullary lesion at C2-C3, degeneration at C3-C4, and no signs of spinal cord compression. On sagittal view, functional MRI with head extension showed anterior compression with protrusion of the intervertebral disc and posterior compression of the yellow ligaments causing spinal cord stenosis. Anterior discectomy and fixation of C3-C4 were performed. There were no complications. The patient showed improvement and the motor tics were controlled by haloperidol. The patient remains symptom-free after 2 years of follow-up. Uncontrolled motor tics can compromise spinal cord function. Functional MRI can reproduce the abnormal movements and clarify the physiopathology.La asociación entre tics motores y mielopatía cervical es rara y no es bien comprendida. Pocos estudios, que analizan este disturbio, han sido encontrados en la literatura hasta el momento. Este es el relato de un caso de mielopatía cervical secundaria a tics motores. Paciente masculino de 23 años con historial de trastorno de tic motor desde hace diez años, involucrando extensión forzada de la cabeza y columna cervical. En los últimos seis meses, se diagnosticaron deficiencias de sensaciones táctiles y postura cinética que progresaron hacia la señal de Lhermitte, cada vez que el paciente se movía. La Resonancia Magnética (RM reveló lesión intramedular hiperintensa al nivel de

  12. Zero-P interbody fusion clinical efficacy in treatment of cervical myelopathy%Zero-P椎间融合术治疗脊髓型颈椎病的临床疗效

    Institute of Scientific and Technical Information of China (English)

    刘敏强; 谢敏; 毛吉刚; 何大川; 徐晓杰

    2015-01-01

    目的:探讨颈椎前路椎间融合固定系统(Zero -P)治疗脊髓型颈椎病的临床疗效。方法:回顾性分析2010年6月~2013年6月在我院手术治疗的脊髓型颈椎病患者88例,根据手术方法不同分为Zero-P组行前路椎间盘切除Zero-P内固定、cage组行前路椎间盘切除椎间融合与钢板内固定,每组各44例。比较2组手术情况及临床疗效。结果:Zero-P组手术时间、术中出血量及住院时间显著优于cage组,2组比较具有统计学意义(P<0.01);2组术前、术后3个月及终访JOA评分、融合率比较差异均无统计学意义;术后Zero-P组出现1例髂骨供区轻度酸痛;cage组出现2例钛板松动未融合,1例明显吞咽异物感。结论:Zero-P椎间融合术手术时间短、术中出血少、融合率高,且术后并发症少,值得临床推广。%Objective:To investigate the road before cervical interbody fusion fixation system ( Zero-P) treatment of cervical myelop-athy clinical efficacy.Methods:A retrospective analysis of June 2010 June 2013 in our hospital surgical treatment of patients with cervical myelopathy 88 cases, according to the surgical methods were divided into groups of rows before the Zero-P discectomy Zero-P fixation, cage group anterior discectomy and interbody fusion with plate fixation, 44 cases in each group.Were compared surgical and clinical effi-cacy.Results:Zero-P operative time, blood loss and length of hospital stay was significantly better than the cage group between the two groups was statistically significant ( P <0.01);the two groups before surgery, three months and a final visit JOA score, integration There was no significant difference in the rate;after Zero-P group had one case of mild iliac crest donor site pain;cage group had two cases ti-tanium loose unfused, one case of obvious foreign body sensation swallowing.Conclusion:Zero-P interbody fusion could shorten opera-tive time, less blood

  13. 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

  14. The use of autologous cervical laminae as bone graft in anterior cervical discectomy and fusion in patients undergoing one-stage posteroanterior cervical surgery

    Directory of Open Access Journals (Sweden)

    Xu XIONG

    2015-04-01

    Full Text Available Objective To evaluate the effectiveness and radiographic outcomes of using autologous cervical laminae as bone graft in anterior discectomy and fusion (ACDF in patients with one-stage posteroanterior surgery for cervical spinal stenosis (cervical spondylotic myelopathy. Methods From January 2010 to June 2013, 37 patients with cervical spinal stenosis underwent surgical treatment in our hospital. Fifteen of them underwent one-stage posteroanterior cervical surgery using autologous cervical laminae as bone graft in ACDF (group A, and 22 patients underwent one-stage posteroanterior procedure using autologous iliac bone as bone graft in ACDF (group B. The operative time, intraoperative blood loss, fusion rate, VAS score, JOA score and height of intervertebral space were compared between the two groups. Results The operative time was 102.7±13.9 min in group A and 128.9±12.3 min in group B, showing significant difference between two groups (t=–6.031, P=0.00. The intraoperative blood loss was 170.3±25.7 ml in group A and 191.1±32.0 ml in group B, and also showing significant difference between them (t=–2.097, P=0.04. All the patients were followed up from 6 months to 42 months (mean, 17.4 months. At 6 months after the surgery, the fusion rate of bone graft was 94.4% (14/15 in group A and 100% (22/22 in group B, and no significant difference was found between two groups (χ2=1.507, P=0.220. The postoperative VAS score, JOA score and intervertebral height were significantly improved compared with those before surgery in both groups (P0.05. Conclusion In anterior cervical discectomy and fusion during one-stage posteroanterior cervical surgery, the use of autologous cervical laminae as bone graft is feasible. DOI: 10.11855/j.issn.0577-7402.2015.02.12

  15. 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

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    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

  16. 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.

  17. 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

  18. 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

  19. 肌萎缩性侧索硬化症与脊髓型颈椎病的锥体束征对比观察%Comparison on the pyramidal sign of amyotrophic lateral sclerosis and cervical spondilotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    谭来勋; 徐金梅

    2012-01-01

    Objective To investigate the differences of the pyramidal sign on amyotrophic lateral sclerosis ( ALS ) and cervical spondilotic myelopathy ( CSM ). Methods There were 50 cases of ALS and 50 cases of CSM enrolled. The differences of the appearance rates of the original symptoms and the clinical signs as determined by visiting doctor, such as the pain in the neck and shoulders, the atrophy with fasciculations and fibrillations of tongue muscle and pathological signs were compared between the two groups. Results The appearance rates of the weakness of lower extremities was the first symptoms of ALS, the ball paralysis and the atrophy with fasciculations and fibrillations of tongue muscle and the disappearance of tendon reflex of ALS as visiting doctor were higher than those of CSM ( P <0. 01 ). Whereas the appearance rates of the weakness of upper extremities was the first symptoms of CSM with the pain in the neck and shoulders and the pathological signs as visiting doctor, such as Babinski sign, Shodock sign and Openham sign of CSM, were higher than those of ALS ( P <0. 01 ). In both group of cases, there were weakness and atrophy of the extremities. And the clinical signs were elicited in all cases such as the tendon hyperreflexia, the clonus of patellar or ankle and the signs of Rossolimo and Hoffmann. Conclusion There may be appeared deep hyperreflexia in patient with either ALS or CSM, but the positive rate of pathological sign is much lower than that of the patient with CSM,with the lowest positive rate of Babinski sign.%目的 探讨肌萎缩性侧索硬化症(ALS)和脊髓型颈椎病(CSM)锥体束征的差异.方法 纳入ALS和CSM患者各50例,详细询问病史、神经系统检查,行头颈部MR、四肢和胸锁乳突肌肌电图检查;分别比较2组患者的首发症状,就诊时颈肩疼痛、舌肌萎缩、肌束颤动及病理征等临床征象阳性率的差异.结果 ALS组的首发症状以下肢无力和延髓麻痹为主,就诊时舌肌委

  20. 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.

  1. 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.

  2. Cervicitis

    Science.gov (United States)

    ... much growth of normal bacteria in the vagina (bacterial vaginosis) can also cause cervicitis. ... under a microscope (may show candidiasis , trichomoniasis , or bacterial vaginosis) Pap test Tests for gonorrhea or chlamydia Rarely, ...

  3. 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.

  4. Dynamic Radiographic Analysis of Sympathetic Cervical Spondylosis Instability

    Institute of Scientific and Technical Information of China (English)

    Jun Qian; Ye Tian; Gui-xing Qiu; Jian-hua Hu

    2009-01-01

    Objective To investigate the correlation between subaxial cervical spine instability and cervical spondylotic sympathetic symptoms as well as the difference of cervical spondylotic subaxial instability between male and female patients. Methods We analyzed retrospectively 318 surgical cases of cervical spondylosis treated at Department of Orthopedic Surgery of Peking Union Medical College Hospital between July 2003 and December 2007. All cases were divided into group A without sympathetic symptoms (n=284) and group B with sympathetic symptoms (n=34). Angular and horizontal translation values between two adjacent vertebral bodies from C2 to C7 were measured separately on hyperflexion and hyperextension lateral cervical spine radiographs. Fisher's exact test was used to evaluate the correlation between subaxial cervical instability and sympathetic symptoms. Intragroup correlation between patient gender and subaxial cervical instability was also evaluated. Results Subaxial instability incidences in groups A and B were 21.8% (62/284) and 55.9% (19/34), respectively. Statistical analysis indicated a definite correlation between subaxial cervical instability and sympathetic symptoms (P=0.000). Among patients without sympathetic symptoms, subaxial instability incidences were 21.4% (37/173) in males and 22.5% (25/111) in females, respectively (P=0.883). While among patients with sympathetic symptoms, subaxial instability incidences were 27.3% (3/11) in males and 69.6% (16/23) in females, respectively, indicating significant difference (P=0.030). Subaxial instability was most commonly seen at C4-C5 intervertebral space in sympathetic cervical spondylosis patients. Conclusions High correlation exists between subaxial cervical spine instability and cervical spondylotic sympathetic symptoms, especially in female patients. Hyperextension and hyperflexion radiographs of cervical spine are important to assess sympathetic cervical spondylotic subaxial instability.

  5. 刃针闭合松解联合牵引下复位治疗神经根型颈椎病的临床研究%Clinical study on curing the cervical spondylotic radiculopathy with the methods of Blade needle closed loosing and reduction with traction at the same time

    Institute of Scientific and Technical Information of China (English)

    高尚明; 郭海; 赵晓峰; 皇玲玲; 朱丽丽; 王自平

    2012-01-01

    Objective:To observe the effects of curing the cervical spondylotic radiculopathy with the methods of Blade needle closed loosing and reduction with traction at the same time. Methods:From May 2006 to May 2009,65 patients with cervical spondylotic radiculopathy were divided into treatment group and control group according the random number table produced by SAS Software. There were 18 males and 17 females in the treatment group,age in range from 42 to 73 years old with an average of(61.3±6.4) years,course of disease was from 8 to 42 months with an average of(23.8±13.8) months, preop-eratively cervical functional score was from 4 to 17 scores with the mean of (11.45±3.31) scores. And in the control group, including 14 males and 16 females, aged from 44 to 76 years old with an average of (62.4±8.8) years, course of disease was from 7 to 43 months with an average of(24.4± 16.8) months, preoperatively cervical functional score was from 4 to 18 scores with the mean of (11.40±3.24) scores. The patients of treatment group were treated with Blade needle closed loosing the specific pain point on the neck and shoulder, then immediately underwent traction and reduction after operation. And the patients of control group were treated with traditional traction. The cervical functional score were compared between the two groups at 10,20,180 d after treatment,including pain of neck and shoulder,limitation of motion of neck,tenderness of neck,numbness and muscle weakness of upper limb. Results: ? At the 10th day after treatment,the total score of treatment group was (15.43±3.46) scores,which was obviously higher than that of control group's(13.17±3.18) scores(P<0.01). In different symptoms, treatment group also was better than that of control grou (P<0.05), so as in the tenderness of neck, and especially in the limitation of motion of neck and muscle weakness of upper limb decreased obviously (P<0.01). ?At the 20th day after treatment,the total score of treatment group was

  6. Alcoholic Myelopathy and Nutritional Deficiency

    Science.gov (United States)

    Koike, Haruki; Nakamura, Tomohiko; Ikeda, Shohei; Takahashi, Mie; Kawagashira, Yuichi; Iijima, Masahiro; Katsuno, Masahisa; Sobue, Gen

    2017-01-01

    A patient with chronic alcoholism presented with myelopathy and low serum folate and cobalamin levels. A 42-year-old alcoholic man had gait disturbance for 4 months. A neurological examination revealed marked spasticity with increased deep tendon reflexes and extensor plantar responses of the lower limbs. His cobalamin level was decreased and his serum folate level was particularly low. His plasma ammonia level was not increased. Abstinence and folic acid and cobalamin supplementation stopped the progression of his neurological deficits. This case indicates that nutritional deficiency should be monitored closely in patients with chronic alcoholism who present with myelopathy. PMID:28049986

  7. 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.

  8. Cervical spine alignment, sagittal deformity, and clinical implications: a review.

    Science.gov (United States)

    Scheer, Justin K; Tang, Jessica A; Smith, Justin S; Acosta, Frank L; Protopsaltis, Themistocles S; Blondel, Benjamin; Bess, Shay; Shaffrey, Christopher I; Deviren, Vedat; Lafage, Virginie; Schwab, Frank; Ames, Christopher P

    2013-08-01

    This paper is a narrative review of normal cervical alignment, methods for quantifying alignment, and how alignment is associated with cervical deformity, myelopathy, and adjacent-segment disease (ASD), with discussions of health-related quality of life (HRQOL). Popular methods currently used to quantify cervical alignment are discussed including cervical lordosis, sagittal vertical axis, and horizontal gaze with the chin-brow to vertical angle. Cervical deformity is examined in detail as deformities localized to the cervical spine affect, and are affected by, other parameters of the spine in preserving global sagittal alignment. An evolving trend is defining cervical sagittal alignment. Evidence from a few recent studies suggests correlations between radiographic parameters in the cervical spine and HRQOL. Analysis of the cervical regional alignment with respect to overall spinal pelvic alignment is critical. The article details mechanisms by which cervical kyphotic deformity potentially leads to ASD and discusses previous studies that suggest how postoperative sagittal malalignment may promote ASD. Further clinical studies are needed to explore the relationship of cervical malalignment and the development of ASD. Sagittal alignment of the cervical spine may play a substantial role in the development of cervical myelopathy as cervical deformity can lead to spinal cord compression and cord tension. Surgical correction of cervical myelopathy should always take into consideration cervical sagittal alignment, as decompression alone may not decrease cord tension induced by kyphosis. Awareness of the development of postlaminectomy kyphosis is critical as it relates to cervical myelopathy. The future direction of cervical deformity correction should include a comprehensive approach in assessing global cervicalpelvic relationships. Just as understanding pelvic incidence as it relates to lumbar lordosis was crucial in building our knowledge of thoracolumbar deformities, T

  9. Magnetic resonance imaging of the cervical region

    Energy Technology Data Exchange (ETDEWEB)

    Tjoerstad, K.; Kaass, B.; Svihus, R.

    1987-11-01

    Magnetic resonance imaging (MRI) of the cervical region was carried out on 139 patients in a ten-month period. 64 patients came from Rogaland Central Hospital and 75 from the rest of Norway. A retrospective questionnaire was filled in by the referring physicians. MRI seems to be of great value in the diagnosis of cervical vertebrogenic myelopathy, multiple sclerosis, syringomyelia, and intraspinal tumors. Besides its diagnostic superiority, at least in patients with cervical myelopathy, MRI has definite economic advantages compared to CT and myelography.

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

    Science.gov (United States)

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

    2016-01-01

    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

  11. 前路减压植骨钢板内固定术治疗脊髓型颈椎病14例临床分析%Treatment of Cervical Spondylotic Myelopathy With Aliquot Ablation of Anterior Cervical Vertebrae and Bone Grafting

    Institute of Scientific and Technical Information of China (English)

    赵江涛; 李洪涛; 宫云昭

    2009-01-01

    目的 观察颈前路减压植骨融合钢板内固定术治疗脊髓型颈椎病的临床疗效.方法 对2006年3月至2008年9月在我院行颈前路减压植骨融合钢板内固定术的14例脊髓型颈椎病患者的临床资料及随访情况进行回顾性分析.结果 本组14例病例均获得随访,平均15个月.所有植骨在3-4个月内融合,融合率100%.术后6个月日本骨科学会评分平均为15.3分.平均改善率为82.6%,其中优12例,良2例.结论 颈前路减压植骨铜板内固定治疗脊髓型颈椎病,是一种实用,且疗效满意的外科手术方法.

  12. 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.

  13. Severe Facet Joint Arthrosis Caused C7/T1 Myelopathy: A Case Report

    Directory of Open Access Journals (Sweden)

    Toshimi Aizawa

    2009-01-01

    Full Text Available Cervical myelopathy is caused by degenerative processes of the spine including intervertebral disc herniation and posterior spur usually developing at C3/4 to C5/6. C7/T1 single level myelopathy is very rare because of the anatomical characteristics. Facet joint arthrosis can be a cause of cervical myelopathy but only a few cases have been reported. The authors report an extremely rare case of C7/T1 myelopathy caused by facet joint arthrosis. A 58-year-old male presented with hand and gait clumsiness. The radiological examinations revealed severe C7/T1 facet joint arthrosis with bony spur extending into the spinal canal, which compressed the spinal cord laterally. The T1 spinous process indicated nonunion of a “clay-shoveler's” fracture, which suggested that his cervico-thoracic spine had been frequently moved, and thus severe arthrosis had occurred in the facet joints. A right hemilaminectomy of C7 and C7/T1 facetectomy with single level spinal fusion led to complete neurological improvement.

  14. 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

  15. Complete paraplegia resulting from surfer's myelopathy.

    Science.gov (United States)

    Takakura, Tomokazu; Yokoyama, Osamu; Sakuma, Fujiko; Itoh, Ryousuke; Romero, Ray R

    2013-09-01

    Three patients with diagnoses of surfer's myelopathy (24-31 yrs old; two men, one woman) were admitted to our rehabilitation hospital. All three patients were novice surfers and had a typical clinical course of onset: rapid progression of paraplegia after back pain while taking surfing lessons. Despite months of rehabilitation at our hospital, in all three patients, complete paraplegia (T9-T12) and bladder-bowel dysfunction remained. Our case profiles suggest that the neurologic outcome of surfer's myelopathy is potentially catastrophic, as has been suggested in previous reports. Surfer's myelopathy has been estimated to be an ischemic thoracic myelopathy. From our case profiles and review of the literature, not only the prolonged prone hyperextended posture of paddling but also the repetitive mechanical stress caused by flexion-extension of the spinal column may be related to its pathogenesis. To prevent surfer's myelopathy and to avoid progressive deterioration of neurologic function, increased education and awareness are essential.

  16. 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.

  17. 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.

  18. 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

  19. 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

  20. Inflammatory, vascular, and infectious myelopathies in children.

    Science.gov (United States)

    Verhey, Leonard H; Banwell, Brenda L

    2013-01-01

    Acute nontraumatic myelopathies of childhood include inflammatory, infectious, and vascular etiologies. Inflammatory immune-mediated disorders of the spinal cord can be categorized as idiopathic isolated transverse myelitis, neuromyelitis optica, and multiple sclerosis. In recent years, human T-cell lymphotropic virus type 1, West Nile virus, enterovirus-71, and Lyme disease have been increasingly recognized as infectious etiologies of myelopathy, and poliomyelitis remains an important etiology in world regions where vaccination programs have not been universally available. Vascular etiologies include vasculopathies (systemic lupus erythematosus, small vessel primary angiitis of the central nervous system), arteriovenous malformations, and spinal cord infarction (fibrocartilaginous embolism, diffuse hypoxic ischemia-mediated infarction). Vascular myelopathies are less common than inflammatory and infectious myelopathies, but are more likely to lead to devastating clinical deficits. Current therapeutic strategies include acute anti-inflammatory treatment and rehabilitation. Stem cell transplantation, nerve graft implantation, and stimulation of endogenous repair mechanisms represent promising strategies for spinal cord repair.

  1. 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.

  2. The value of MR and other methods in evaluation of cervical spondylosis; Wartosc badania MR i innych metod obrazowania w ocenie stopnia zaawansowania spondylozy szyjnej

    Energy Technology Data Exchange (ETDEWEB)

    Konopka, M.; Rejniak, I.; Kluczewska, E.; Baron, J.; Collie, D. [Pracownia Rezonansu Magnetycznego, Instytut Pediatrii w Budowie, Katowice (Poland) and Zaklad Diagnostyki Obrazowej, Centrum Medyczne Ksztalcenia Podyplomowego, Centralny Szpital Kliniczny, Warsaw-Miedzylesie (Poland) and Western General Hospital, Edinburgh (United Kingdom)

    1995-12-31

    38 patients with clinical symptoms of myelopathy, radiculopathy and neck pain have undergone X-ray and MR examinations in order to estimate spinal canal and degenerative changes of cervical vertebral column. The correlation between degree of degenerative changes and myelopathy or radiculopathy or neck pain was established on MR. In patients with myelopathy advanced degeneration changes (2. and 3. degree) were observed more often than in radiculopathy and neck pain. Disorders of mobility and cervical spine instability were found in 50%. Focal changes with high signal on T2 images in cervical cord were found in 2 cases. (author) 17 refs, 4 figs , 7 tabs

  3. 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.

  4. Clinical study on three-dimensional dynamic and static equilibrium rehabilitation modality in the treatment of non-myelopathy type cervical spondylosis%应用三维动静态平衡康复模式治疗非脊髓型颈椎病的临床研究

    Institute of Scientific and Technical Information of China (English)

    孙献武; 于香兰; 邵海燕; 孙大为; 王俊涛; 于金秀; 张洪翠

    2015-01-01

    Objective:To observe the clinical curative effects of three-dimensional dynamic and static equilibrium rehabilitation modali-ty in the treatment of non-myelopathy type cervical spondylosis.Methods:Ninety-eight patients with non-myelopathy type cervical spondylo-sis enrolled in the study were randomly divided into three-dimensional rehabilitation group and traditional therapy group,49 cases in each group.The patients in three-dimensional rehabilitation group were treated with three-dimensional cervical vertebra rehabilitation cushion combined with three-dimensional neck muscle resistance isometric exercises,while the others in traditional therapy group were treated with jaw-occiput traction combined with drug therapy and neck-shoulder functional exercises.After 3-week treatment,the neck pain visual ana-logue scale(VAS)scores,neck disability index(NDI),horizontal distance between C2 and C7 plumb lines and clinical curative effects were compared between the 2 groups.Results:There was no statistical difference in neck pain VAS scores,NDI and horizontal distance between C2 and C7 plumb lines between the 2 groups before the treatment(5.16 +/-1.21 vs 5.21 +/-1.17 points,t =0.168,P =0.829;28.63 +/-5.07 vs 28.56 +/-5.11,t =0.131,P =0.896;7.15 +/-5.68 vs 7.08 +/-5.77 mm,t =0.156,P =0.863).The neck pain VAS scores and NDI were lower and the horizontal distance between C2 and C7 plumb lines was greater in the three-dimensional rehabilitation group compared to the traditional therapy group after 3-week treatment(2.53 +/-1.05 vs 3.79 +/-1.71 points,t =1.680, P =0.012;17.21 +/-4.75 vs 24.15 +/-5.82,t =1.132,P =0.023;9.83 +/-5.98 vs 7.69 +/-6.03 mm,t =-3.265,P =0.002).The neck pain VAS scores and NDI decreased while the horizontal distance between C2 and C7 plumb lines increased after 3-week treatment in three-dimensional rehabilitation group(t =2.946,P =0.004;t =2.685,P =0.013;t =-3.496,P =0.001).However,no statistical differ-ence was found between pretreatment and post

  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. Effect of lamina open angles in expansion of unilateral open-door laminoplasty on the clinical results in treating cervical myelopathy%颈椎单开门椎管扩大成形术椎板开门角度对脊髓型颈椎病疗效的影响

    Institute of Scientific and Technical Information of China (English)

    孙天威; 张杭; 卢守亮; 李辉南; 于斌; 张学利

    2012-01-01

    Objective:To evaluate and compare the relation between the efficacy and clinical results of expansion of open-door laminoplasty with different angles in lamina open- door.Method: 198 cases were select from July 2006 to January 2009 who underwent posterior cervical unilateral open-doorJaminoplasty and received treatment for more than 24 months follow-up of patients with cervical myelopathy.There were 115 male cases and 83 female case with the mean age of 49±5 years (range,29-72 years).There were 39 double-segment cases,including 11 C3-C5 cases and 28 C4-C6 cases;97 three-segment (C4-C7) cases and 62 four segment (C3-C7) cases.All of these cases iiad cervical spine anterior-posterior and lateral, oblique and double-bit excessive flexion and extension cervical spine X-ray,CT and MRI.Preoperative JOA scores were 4 to 9,an average of 6.3±2.9.By CT scan after 1 week in accordance with the measurement on the angle of the lamina to 30° for the open boundaries,the cases were divided into two groups,to compare operation time, blood loss,postoperative complications,C2-C7 Cobb angle,index of cervical lordosis,cervical movement and tovalues after the shift,and evaluate the neurological function at final follow-up and calculate improvement rate of nerve function.Result:Group A:a total of 76 cases had an opening angle change>30°.Group B: a total 122 cases had an opening angle change 15°-30°.In preoperative JOA scores,C2-C7 Cobb angle,index of cervical lordosis,cervical movement between the two groups showed no statistically significant difference (P>0.05).The surgical time and blood loss in group A were 110±13min and 250±80ml,and in group B respectively 120± 30min and 230±100ml,the difference was not statistically significant (P>0.05).In group A,51 patients after surgery(67.1%) had axial symptoms,8 patients(10.4%) with C5 nerve root palsy, 1 patient(1.32%) with mild cervical kyphosis.In group B,37 cases (10.5%) had axial symptoms,3 patients (2.4%) with C5 nerve root

  7. Short-and medium-term efficacy of artificial cervical disc replacement versus fusion for cervical spondylosis%人工颈椎间盘置换与融合治疗颈椎病:中短期疗效的比较

    Institute of Scientific and Technical Information of China (English)

    高明勇; 陶海鹰; 卫爱林; 贺斌

    2014-01-01

    BACKGROUND:Recently, non-fusion technology representing as artificial cervical disc replacement continues to improve. On the basis of reconstruction of disc structure and function of involved segments, cervical spine structure of surgery area segment is significantly close to dynamic and static load stress distribution required by natural physiological systems. It effects are apparent in protecting intervertebral facet joints of degenerated segment and structure and function of the cervical spine of adjacent segments and in maintaining cervical dynamic stability, which presented obvious methodological strengths compared with segmental fusion technology. OBJECTIVE:To evaluate the clinical outcomes of anterior cervical discectomy and fusion and Bryan artificial cervical disc replacement in the treatment of single-level cervical spondylotic myelopathy or radiculopathy. METHODS:A total of 43 middle and old age patients with single-level cervical spondylotic myelopathy or radiculopathy, who were treated from March 2010 to March 2012, were enrol ed in this study. They were randomly assigned to anterior cervical discectomy and fusion group (fusion group) and Bryan artificial cervical disc replacement group. Range-of-motion of cervical overal and adjacent intervertebral area near the intervertebral space was observed with radiography. During fol ow-up, postoperative recovery of neurological function was evaluated using Japanese Orthopaedic Association scale, visual analog scale and neck disability index. RESULTS AND CONCLUSION:None patients experienced complications of neurovascular injury during and after the surgery. Range-of-motion of postoperative overal cervical vertebra and adjacent joint was improved in the Bryan artificial cervical disc replacement group compared with the fusion group. Neurological function was apparently improved after surgery in each group. At 3 months after surgery, scores of Japanese Orthopaedic Association, visual analog scale and neck

  8. 探讨 ProDisc-C 人工颈椎间盘置换术与颈前路椎间盘切除融合治疗颈椎病的临床疗效%To evaluate clinical outcomes of ProDisc-C cervical disc replacement versus fusion for cervical spondylosis

    Institute of Scientific and Technical Information of China (English)

    郭卫春; 黄文俊; 汪光晔

    2015-01-01

    目的探讨ProDisc-C人工颈椎间盘置换术与颈前路椎间盘切除融合( ACDF)治疗单节段椎间盘退变引起的脊髓或神经根颈椎病的临床疗效。方法自2010年10月至2012年年8月武汉大学人民医院收治的46例颈椎病病例,随机进行分组,其中实验组:24例行ProDisc-C 置换术,对照组:22例行ACDF。评价指标主要如下:两组手术时间及术中出血量;两组术前、术后3、12月VAS评分,JOA评分,手术邻近节段活动度,颈椎活动度( ROM)以及术后并发症。结果46例患者全部获得平均12个月(8~18个月)随访。两组手术时间及术中出血量无统计学差异(P>0.05)。两组术后VAS评分,JOA评分均较术前明显提高( P <0.05),两组差异无统计学意义( P >0.05)。试验组整个下颈椎的活动度及邻近节段活动度各个随访时段与术前相比无变化(P>0.05);对照组在术后3个月整个下颈椎活动度较术前相比有统计学差异(P<0.05),术后12个月时逐渐恢复正常,术后12个月邻近节段活动度较术前有统计学差异(P<0.05)。其中对照组术后出现3例吞咽困难。结论  ProDisc-C人工颈椎间盘置换术与颈前路椎间盘切除融合( ACDF)治疗单节段椎间盘退变引起的脊髓或神经根颈椎病在中短期随访中临床效果满意,人工颈椎间盘置换术能有效保留颈椎活动度,减少临近节段的退变,并且术后吞咽困难发生率较低。%Objective To prospectively compare the clinical effects of ProDisc-C cervical disc replacement with those of anterior cervi-cal discectomy and fusion ( ACDF) in the treatment of single-level cervical spondylotic myelopathy or radiculopathy.Methods From the Department of Orthopaedics in Renmin Hospital of wuhan University within the period of October 2010 to August 2012,A total of 46 patients with single-level cervical spondylotic

  9. The clinical study on the application of calcium sulfate/Demineralized bone matrix (DBM) granule in the cervical interbody fusion%硫酸钙/脱钙骨基质颗粒在颈椎椎体间融合中的应用

    Institute of Scientific and Technical Information of China (English)

    谢幼专; 张蒲; 富灵杰; 李华; 赵杰

    2011-01-01

    Objective To investigate the clinical outcome of interbody fusion with calcium sulfate/demineralized bone matrix ( DBM ) granule in the cervical spine. Methods 35 patients had undergone anterior cervical discectomy and interbody fusion ( 59 segments )with the polyetheretherketone (PEEK )cages filled with calcium sulfate/DBM granule. There were 19 male and 16 female. The mean age was 53.2 years old (range, 32-65 1 The fusion was agumented with anterior cervical plate. There were 12 cases of cervical spondylotic radiculopathy, 15 cases of cervical spondylotic myelopathy and 8 cases of combined cervical spondylosis. The JOA score, cervical curvature and the fusion status were evaluated after the operation. Results All the patients were followed up consecutively for 24 months. The preoperative JOA score was 7.7± 2.1. At final follow-up, the score was 14.2±2.9 (P < 0.01 I The recovery rate was 69.9%. There was no breakage, looseness or migration of the implants. The fusion rate was 100%. Conclusion It is feasible to achieve the cervical interbody fusion with the PEEK cage filled with calcium sulfate/DBM granule.%目的 观察应用硫酸钙/脱钙骨基质颗粒作为植骨替代材料促进颈椎椎体间融合的效果.方法 对35例患者(59个节段)行颈椎前路间隙减压植骨融合钛板固定术,椎体间植骨采用填充硫酸钙/脱钙骨基质颗粒的聚醚醚酮(PEEK)融合器.其中男19例,女16例,年龄32~65岁,平均53.2±12.5岁.其中神经根型颈椎病12例,脊髓型颈椎病15例,混合型颈椎病8例.术后观察JOA评分、颈椎曲度、椎体间融合情况.结果 35例均获随访,随访时间24个月.JOA评分术前为7.7±2.1,随访终止时为14.2±2.9(P<0.01),恢复率为69.9%.术后无钛板、螺钉断裂或松动,无融合器移位现象发生.所有融合节段均融合.结论 颈椎前路减压融合术中使用填充硫酸钙/脱钙骨基质颗粒的PEEK椎体间融合器能够获得满意的椎体间融合.

  10. Cervical spondylosis anatomy: pathophysiology and biomechanics.

    Science.gov (United States)

    Shedid, Daniel; Benzel, Edward C

    2007-01-01

    Cervical spondylosis is the most common progressive disorder in the aging cervical spine. It results from the process of degeneration of the intervertebral discs and facet joints of the cervical spine. Biomechanically, the disc and the facets are the connecting structures between the vertebrae for the transmission of external forces. They also facilitate cervical spine mobility. Symptoms related to myelopathy and radiculopathy are caused by the formation of osteophytes, which compromise the diameter of the spinal canal. This compromise may also be partially developmental. The developmental process, together with the degenerative process, may cause mechanical pressure on the spinal cord at one or multiple levels. This pressure may produce direct neurological damage or ischemic changes and, thus, lead to spinal cord disturbances. A thorough understanding of the biomechanics, the pathology, the clinical presentation, the radiological evaluation, as well as the surgical indications of cervical spondylosis, is essential for the management of patients with cervical spondylosis.

  11. 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

  12. A Case of Delayed Myelopathy Caused by Atlantoaxial Subluxation without Fracture

    Directory of Open Access Journals (Sweden)

    Ryo Takamatsu

    2013-01-01

    Full Text Available We report a case of delayed myelopathy caused by atlantoaxial subluxation without fracture. The patient was a 38-year-old male who became aware of weakness in extremities. The patient had a history of hitting his head severely while diving into a swimming pool at the age of 14 years old. At that time, cervical spine plain X-ray images showed no fracture, and the cervical pain disappeared after use of a collar for several weeks. At his first visit to our department, X-ray images showed an unstable atlantoaxial joint. After surgery, weakness of the extremities gradually improved. At 6 months after surgery, bone union was completed and the symptoms disappeared. This case shows that atlantoaxial ligament injuries are difficult to diagnose and may easily be missed. A high level of suspicion is important in such cases, since neurological compromise or deterioration may occur many years after the injury.

  13. 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

  14. [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.

  15. 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.

  16. 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)

  17. 颈椎间盘突出程度与颈椎X线片相关指标测量值的相关性研究%The correlation analysis of the degree of cervical intervertebral disc herniation associated with cervical X-ray radiography index

    Institute of Scientific and Technical Information of China (English)

    蒋维利; 申才良; 董福龙; 章仁杰; 汪军; 朱晓红; 张华庆

    2015-01-01

    Objective To investigate the relationship of the related parameters of X-ray and the severity of cervical spinal cord compression caused by disc herniation in patients with single segment spondylotic myelopathy. Methods Clinical data of sixty paitents with single segment spondylotic myelopathy in the First Affiliated Hospital of Anhui Medical University from August 2012 to March 2014 were retrospectively analyzed. All the patients, aged from 42 to 65 (58. 4±9. 3), were male. According to the compression ratio ( E value) of cervical spinal cord in sagittal MRI images, all the patients were firstly divided into group Ⅰ, II and Ⅲ. The ratio of cervical spinal crosscutting area ( S1 ) to effective cervical canal crosscutting area ( S0 ) in cross-sectional imagings of cervical spine MRI was then calculated to reflect the degree of intervertebral disc herniation. Furthermore, the following indicators in cervical X-ray in different postures were measured for each case: the range of motion of the responsibility of intervertebral space ( B value) , the height of the anterior of intervertebral space ( D value) , Cobb angle of C2-7 , and the area of intervertebral foramen ( M value) . Linear correlation regression was used to study the relationship of the severity of cervical spinal cord compression and the above observation indexes. Results There were significant differences in the ratio of S1/S0 , E value, B value, D value, M value and Cobb angle of C2-7 among three groups (F values were 44. 187, 112. 789, 7. 232, 3. 778, 3. 232 and 15. 813, respectively. all P values<0. 05). E value, B value, D value, M value and Cobb angle of C2-7 decreased with the increase of the ratio of S1/S0 . These indicated that E value, B value, D value, M value and Cobb angle of C2-7 were negatively correlated with the ratio of S1/ S0 ( R values were-0. 821, -0. 581, -0. 378, -0. 419 and-0. 576, respectively, all P values<0. 05). The multiple linear regression results showed that B value, D

  18. 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

  19. 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

  20. 单开门侧块螺钉悬吊联合微型钛板椎管扩大成形术治疗多节段脊髓型颈椎病疗效分析%Treatment of Multiple Segmental Cervical Spondylopathy in Single Door Laminoplasty:Using an Anchor System and Titanium Plate

    Institute of Scientific and Technical Information of China (English)

    桑平; 李高峰; 张季铠

    2015-01-01

    目的:探讨经改良后路单开门侧块螺钉悬吊技术联合微型钛板固定治疗多节段脊髓型颈椎病的临床疗效。方法对58例颈椎病患者常规行后正中入路单开门椎管扩大成形术,门轴一侧3、5、7侧块采用Magerl方法置入直径3.2 mm、长度12 mm施乐辉带线锚钉,螺钉置入侧块后一端经棘突根部的预穿孔穿过,开门后拉紧丝线并打结,使椎板保持开门状态,同时4、6采用施乐辉微型钛板固定,术后颈部围领保护2周。结果平均随访15个月(7~19个月),术前JOA评分7.8分,40分法14.6分,术后平均评分15分,40分法35.4分。术后2个月颈部僵痛和后动受限者:轻度30例,中重度20例,术后6个月仅13例患者仍有轻度颈部疼痛、僵硬及活动受限,未见固定松动和再关门现象。结论改良后路单开门侧块螺钉悬吊技术联合微型钛板固定单开门椎管扩大成形术操作简单,安全有效,维持开门确实。术后患者颈部症状缓解明显,早期效果满意。%Objective To evaluate the clinical outcome of modified open door laminoplasty using an anchor system and titanium plate. Methods The clinical data of 58 patients with single door treatment of multiple segmental cervical spondylotic myelopathy using an anchor system and titanium plate ifxation remain the door in the opening position. Soft collar protection was applied for two weeks after operation.Results 58 cases of cervical spondylotic myelopathy were included in the study. The mean follow up was 15 months (7 to 19 months).the average pre-OP JOA score was 7.8 and 40 score was 14.6, post-OP JOA score was 15 and 40 score was 35.4.13cases had slingt axial symptom like neck pain, stiffness and restriction of neck movement tow months after operation. There was no cases of ifxation loosening and door reclosure.ConclusionThis modiifed open door laminoplasty using anchor system and titanium plate fixation method has the

  1. Cervical spondylosis: recognition, differential diagnosis, and management.

    Science.gov (United States)

    Voorhies, R M

    2001-04-01

    In contemporary clinical practice, the prevalence of neck pain in the general population is approximately 15%. The challenge for the primary care specialist is to be able to recognize the more serious disorders that require early referral. Additionally, it is important to have the confidence to institute specific treatment for nonurgent conditions in order to avoid unnecessary referral of patients with generally self-limiting conditions.CERVICAL SPONDYLOSIS IS A GENERAL AND NONSPECIFIC TERM THAT ENCOMPASSES A BROAD SPECTRUM OF AFFLICTIONS BUT, FOR PURPOSES OF CLARITY, CAN BE ORGANIZED INTO THREE CLINICAL SYNDROMES: Type I Syndrome (Cervical Radiculopathy); Type II Syndrome (Cervical Myelopathy); and Type III Syndrome (Axial Joint Pain). It is important to remember that shoulder problems can masquerade as cervical problems, and vice versa (e.g. adhesive capsulitis, recurrent anterior subluxation, impingement syndrome, rotator cuff tear, etc.). A number of management options, including pharmaceutical, physical therapy, and psychological therapies, are available once a diagnosis has been made.

  2. 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

  3. St Anne's Private Nursing Home, Sonnagh, Charlestown, Mayo.

    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.

  4. 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.

  5. 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

  6. From less to maximally invasiveness in cervical spine surgery

    Science.gov (United States)

    Visocchi, M.; Conforti, G.; Roselli, R.; La Rocca, G.; Spallone, A.

    2015-01-01

    Introduction Multilevel cervical myelopathy without surgical treatment is generally poor in the neurological deficit without surgical decompression. The two main surgical strategies used for the treatment of multilevel cervical myelopathy are anterior decompression via anterior corpectomy or posterior decompression via laminctomy/laminoplasty. Presentation of case We present the case of a 62 year-old lady, harboring rheumatoid artritis (RA) with gait disturbances, pain, and weakness in both arms. A C5 and C6 somatectomy, C4–C7 discectomy and, instrumentation and fusion with telescopic distractor “piston like”, anterior plate and expandable screws were performed. Two days later the patient complained dysfagia, and a cervical X-ray showed hardware dislocation. So a C4 somatectomy, telescopic extension of the construct up to C3 with expandible screws was performed. After one week the patient complained again soft dysfagia. New cervical X-ray showed the pull out of the cranial screws (C3). So the third surgery “one stage combined” an anterior decompression with fusion along with posterior instrumentation, and fusion was performed. Discussion There is a considerable controversy over which surgical approach will receive the best clinical outcome for the minimum cost in the compressive cervical myelopathy. However, the most important factors in patient selection for a particular procedure are the clinical symptoms and the radiographic alignment of the spine. the goals of surgery for cervical multilevel stenosis include the restoration of height, alignment, and stability. Conclusion We stress the importance of a careful patients selection, and invocated still the importance for 360° cervical fixation. PMID:25734320

  7. 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

  8. 颈椎人工椎间盘置换术与颈前路减压融合内固定术手术疗效比较%Comparing the effects of Bryan cervical Disc arthroplasty with anterior cervical decompres-sion and fusion

    Institute of Scientific and Technical Information of China (English)

    张涛; 王弘; 徐宏光; 李从明

    2016-01-01

    目的:比较颈椎人工椎间盘置换术( cervical disc arthroplasty ,CDA)与颈前路减压融合内固定术( anterior cervical de-compression and fusion ,ACDF)的手术疗效。方法:回顾分析2012年8月~2015年1月收治的退变性颈椎病50例,随机给予CDA(n=23),或者ACDF(n=27)治疗,术后12个月门诊随访。结果:两组术前性别、年龄、手术节段活动度(range of motion, ROM)、VAS( visual analogue scale )及JOA( Japanese orthopaedic association )无统计学差异,CDA组比ACDF组手术时间短,出血量少,具有明显统计学差异( P<0.01),两组住院时间无明显统计学差异。术后12个月,两组手术节段ROM差异具有统计学意义( P<0.01),CDA组ROM较术前得以维持,ACDF组降低。两组JOA及VAS无统计学差异。结论:CDA较ACDF能维持手术节段的活动度,CDA有望取代ACDF。%Objective:To compare curative effects of Bryan cervical disc arthroplasty ( CDA) with those of anterior cervical decompression and fusion ( AC-DF).Methods:A total of 50 patients with cervical spondylotic myelopathy treated in our hospital between August 2012 and January 2015 were randomly as-signed to two groups.One group were treated with CDA (n=23) and another with ACDF(n=27).Two groups of patients were postoperatively followed on outpatient basis for 12 months.Results:The two groups were not significantly different regarding the gender,ages,range of cervical motion(ROM) and sco-ring on visual analogue scale(VAS) and Japanese Orthopedic Association(JOA).CDA group had shorter operative time and intraoperative blood loss than ACDF group,the difference was significant( P<0.01) .The length of hospital stay remained similar for the two groups ,yet the two groups were different con-cerning the ROM 12 month after operation(P<0.01).Postoperative ROM was maintained in patients in CDA group,whereas was decreased in ACDF group. There was no

  9. 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.

  10. 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.

  11. 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

  12. 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.

  13. Relapsing hypocupraemic myelopathy requiring high‐dose oral copper replacement

    OpenAIRE

    Prodan, C.I.; Bottomley, S S; Holland, N R; Lind, S. E.

    2006-01-01

    Adult‐onset copper deficiency with neurological manifestations is a newly recognised syndrome. Long‐term oral copper replacement therapy has been the mainstay of treatment in the literature. A case of relapsing hypocupraemic myelopathy responsive to increased doses of copper replacement is reported. Standard doses of copper may not be sufficient for all patients.

  14. Acute myelopathy with sudden paraplegia as the sole manifestation of meningococcal meningitis

    Directory of Open Access Journals (Sweden)

    Wanis H. Ibrahim

    2010-02-01

    Full Text Available Acute myelopathy with sudden paraplegia is a very rare manifestation of meningococcal meningitis, with only a few cases reported in the literature. In almost all previously reported cases, other clinical manifestations of meningitis, such as fever, headache, and neck stiffness preceded acute myelopathy. In this paper, we report a case of acute myelopathy with sudden paraplegia as the sole manifestation of meningococcal meningitis, in the absence of other clinical manifestations of meningitis.

  15. 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.

  16. RESULTS OF TREATMENT OF CERVICAL DISCOPATHY WITH PEEK INTERBODY CAGES AT THREE LEVELS WITHOUT PLATE FIXATION

    Directory of Open Access Journals (Sweden)

    Amado González Moga

    Full Text Available ABSTRACT Objective: To present the results of treatment of patients with cervical discopathy by anterior cervical approach, discectomy and placement of a PEEK interbody cage without anterior plate fixation. Methods: Retrospective, cross-sectional study from March 2013 to March 2015. Sixteen patients with radiculopathy or clinical signs of myelopathy were included; all patients underwent cervical surgery through anterior approach, discectomy, and placement of PEEK cages on three levels. Decompression levels were determined according to the correlation between preoperative radiological and clinical findings. Results: Sixteen patients predominantly male were included, with mean age of 50 years at the onset of the condition. Ten patients had involvement of C4-C5, C5-C6, C6-C7 levels, and six patients C3-C4, C4-C5 and C5-C6. Fourteen patients had cervicobrachialgia and two myelopathy. The preoperative visual analog scale average was 8/10 and the average postoperative value at 6 months was 3/10. At 6 months, there was no radiological evidence of recurrence. One patient had non-fatal complications. Conclusions: The treatment of cervical discopathy by anterior approach with interbody fusion with PEEK cage on three levels, with no plate fixation seemed to be safe and effective with better long-term results in terms of pain and myelopathy. The clinical results compare favorably with other similar series and, most importantly, the complications associated with anterior fixation plate are avoided.

  17. 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.

  18. 老年颈椎病患者围手术期护理%Perioperation care in elder patients with spondylotic myelopathy

    Institute of Scientific and Technical Information of China (English)

    刘慧卿

    2008-01-01

    目的:探讨老年颈椎病患者围手术期护理.方法:对60例颈椎病患者加强术前、术后康复训练.结果:odons临床疗效评级49例优,9例良,60例中58例得到随访,疗效优良率达96.67%,无1例并发症发生.结论:围手术期康复护理在颈椎病的恢复和功能重建中至关重要.

  19. Improved MR imaging of the cervical spine, 2; Study of disk protrusion in the cervical spine in flexion-versus-extension views

    Energy Technology Data Exchange (ETDEWEB)

    Tanno, Munehiko; Kyomasu, Yoshinori; Nakayama, Masafumi (Tokyo Metropolitan Geriatric Hospital, Tokyo (Japan)) (and others)

    1990-12-01

    Comparative study of incidence of disk protrusion was performed on the basis of MR imaging in a state of flexion versus extension. The results showed that the incidnece of disk protrusion at each disk level was generally higher on the extension images than on the flexion images at the corresponding levels. The degree of difference in the incidence of the disk protrusion on flexion and extension was the greatest at the mid-cervical level spine. Based on the results with respect to features of the cervical spine in extension and flexion, it appears that the difference in incidence of disk protrusion is probably caused by movement in response to bending of the cervical spine. These results may provide information concerning the dynamic of cervical disks and may partly explain cases in which patients have symptoms of cervical myelopathy and/or radiculopathy but have no disk protrusion on images in the neutral position. (author).

  20. A Brazilian Portuguese cross-cultural adaptation of the modified JOA scale for myelopathy

    Science.gov (United States)

    Pratali, Raphael R.; Smith, Justin S.; Motta, Rodrigo L.N.; Martins, Samuel M.; Motta, Marcel M.; Rocha, Ricardo D.; Herrero, Carlos Fernando P.S.

    2017-01-01

    OBJECTIVES: To develop a version of the modified Japanese Orthopaedic Association (mJOA) scale that had been translated into Portuguese and cross-culturally adapted for the Brazilian population. METHODS: The well-established process of forward-backward translation was employed along with cross-cultural adaptation. RESULTS: Three bilingual translators (English and native Portuguese) performed the forward translation of the mJOA scale from English to Portuguese based on iterative discussions used to reach a consensus translation. The translated version of the mJOA scale was then back-translated into English by a native English-speaking translator unaware of the concepts involved with the mJOA scale. The original mJOA scale and the back-translated version were compared by a native North American neurosurgeon, and as they were considered equivalent, the final version of the mJOA scale that had been translated into Portuguese and cross-culturally adapted was defined. CONCLUSION: To facilitate global and cross-cultural comparisons of the severity of cervical myelopathy, this study presents a version of the mJOA scale that was translated into Portuguese and cross-culturally adapted for the Brazilian population.

  1. 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.)

  2. 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.

  3. Non-compressive myelopathy : clinical and radiological study.

    Directory of Open Access Journals (Sweden)

    Prabhakar S

    1999-10-01

    Full Text Available Fifty seven patients (42 males and 15 females with non-compressive myelopathy were studied from 1997 to 1999. Acute transverse myelitis (ATM was the commonest (31 followed by Vit B12 deficiency myelopathy (8, primary progressive multiple sclerosis (5, hereditary spastic paraplegia (3, tropical spastic paraplegia (2, subacute necrotising myelitis (1, radiation myelitis (1, syphilitic myelitis (1 and herpes zoster myelitis (1. 4 cases remained unclassified. In the ATM group, mean age was 30.35 years, antecedent event was observed in 41.9% case, 25 cases had symmetrical involvement and most of the cases had severe deficit at onset. CSF study carried out in 23 patients of ATM revealed rise in proteins (mean 147.95mg%, range 20-1200 mg/dL and pleocytosis (mean 20.78/cumm, range 0-200 mm3. Oligoclonal band (OCB was present in 28% of cases of ATM. The most common abnormality detected was a multisegment hyperintense lesion on T2W images, that occupied the central area on cross section. In 6 patients hyperintense signal was eccentric in location. MRI was normal in 4 cases of ATM. Thus ATM is the leading cause of non-compressive myelopathy. Clinical features combined with MRI findings are helpful in defining the cause of ATM.

  4. 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

  5. Cervical Cancer

    Science.gov (United States)

    ... the place where a baby grows during pregnancy. Cervical cancer is caused by a virus called HPV. The ... for a long time, or have HIV infection. Cervical cancer may not cause any symptoms at first. Later, ...

  6. 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.

  7. 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

  8. 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.

  9. 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

  10. Syringomyelia and cervical spondylosis: A clinicoradiological investigation

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Y.L.; Moseley, I.F.

    1987-03-01

    Eight eight patients with proven syringomyelia have been studied retrospectively to explore the relationship between syringomyelia and spondylotic degeneration of the cervical spine. When compared with age and sex matched control subjects, they showed no significant increase in incidence or severity of spondylosis or of vertebral subluxation. Duration of symptoms, degree of disablity, and the pattern of analgesia or lower motor neurone lesions in the arms did not appear to be related to the development of spondylosis. The onset of moderate spondylosis, was however, earlier than in the controls, and individual cases with a remarkably early onset or unusual site and/or severity of spondylosis and subluxation were encountered, particularly following laminectomy. It was also noted that in a small number of patients the concomitant development of spondylosis contributed to clinical deterioration. It is concluded that while syringomyelia does not have a consistent, major role in the development of cervical spondylosis or vertebral luxation, it may contribute to progression of spinal degenerative disease in some patients.

  11. Office evaluation of spine and limb pain: spondylotic radiculopathy and other nonstructural mimickers.

    Science.gov (United States)

    Watson, James

    2011-02-01

    Low back and neck pain, with or without radiculopathy, are one of the most common reasons for referral to an outpatient neurology practice. Determining appropriate treatment relies on establishing an accurate diagnosis of the etiology of the spine or limb pain. The author reviews structural radiculopathies as a result of diskogenic and spondylotic etiologies with an emphasis on the clinical approach and evaluation of these patients (including imaging and electrodiagnostics), identifying management altering neurogenic mimickers of structural radiculopathies (such as infectious, inflammatory, and neoplastic myeloradiculitis and radiculoplexopathies), and stratifying patients for treatment.

  12. Myelopathy following hyperfractionated accelerated radiotherapy for anaplastic thyroid carcinoma.

    Science.gov (United States)

    Wong, C S; Van Dyk, J; Simpson, W J

    1991-01-01

    From 1975 to 1982, 32 patients with a diagnosis of anaplastic carcinoma of the thyroid were entered into a protocol of hyperfractionated accelerated radiotherapy. The tumor dose was 30-45 Gy at 1 Gy per fraction given 4 times a day at 3-h intervals. The results were disappointing with a median survival of less than 6 months. Two patients developed radiation myelopathy at 8 and 13 months, total spinal cord dose being 39.9 and 48.3 Gy, respectively. The risk of spinal cord damage was much higher than expected. The possible radiobiological causes and clinical implications are discussed.

  13. 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.

  14. Cervical Angina

    Science.gov (United States)

    Sussman, Walter I.; Makovitch, Steven A.; Merchant, Shabbir Hussain I.

    2015-01-01

    Cervical angina has been widely reported as a cause of chest pain but remains underrecognized. This series demonstrates the varied clinical presentation of patients with cervical angina, the delay in diagnosis, and the extensive cardiac examinations patients with this condition typically undergo prior to a definitive diagnosis. Recognition of this condition in patients with acute chest pain requires a high index of suspicion and an awareness of the common presenting features and clinical findings of cervical angina. PMID:25553225

  15. 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.

  16. Titanium cages subsidence following anterior cervical decompression and fusion%颈椎前路减压融合术后钛笼下沉临床分析

    Institute of Scientific and Technical Information of China (English)

    马永刚; 刘世清; 李亚明; 周小锐

    2011-01-01

    目的:探讨颈椎前路减压融合术治疗脊髓型颈椎病术后影响钛笼下沉的相关因素.方法:回顾性分析2005年6月~2009年6月我院收治的104例行颈椎融合钛笼植骨患者的颈椎平片和手术资料,分析撑开程度、钛笼直径和安放部位与钛笼下沉的相关性.结果:104例手术患者中,术后6个月复查时发现16例(15.4%)钛笼发生下沉.46例钛笼直径10mm者中9例发生下沉(19.6%),而58例直径12mm者中7例发生下沉(12.1%),差异有显著性(P<0.05).钛笼前缘与椎体前缘距离在1mm以内者89例,距离大于1mm者15例,发生下沉例数分别为13例和3例,差异有显著性(P<0.05).开槽节段相邻椎体终板延长线成角,其中角度在20°~30°者82例,成角大于30°者22例,两组发生下沉例数分别为11例和5例,发生率有显著性差异(P<0.05).结论:椎间撑开程度、钛笼直径和安放部位可能是影响钛笼下沉的重要因素.%Objective:To investigate the factors of titanium cage subsidence following anterior cervical decompression and fusion (ACDF) in patients with cervical spondylotic myelopathy (CSM).Method: 104 patients with CSM underwent ACDF from June 2005 to June 2009.All patients were followed up for 6 months. The subsidence associated factors,including space dsitraction,position and the diameter of cage,were reviewed retrospectively.Result:Titanium cage subsidence was noted in 16(15.4%) patients 6 months after surgery. Of 46 cases with cage diameter less than l0mm,9 suffered subsidence,while of 58 cases with cage diameter over 12mm,7 suffered subsidence,which showed significant difference (P<0.05).Of 89 cases with the distance between anterior edge of cage and anterior edge of vertebral body less than lmm,13 had cage subsidence;while of 15 cases with the distance over lmm,3 had cage subsidence which showed significant difference(P< 0.05).Of 82 cases with intervertebral distract angle between 20°and 30°and 22 cases with the angle

  17. 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.

  18. Atlantoaxial subluxation. Radiography and magnetic resonance imaging correlated to myelopathy

    Energy Technology Data Exchange (ETDEWEB)

    Yamashita, Y.; Takahashi, M.; Sakamoto, Y.; Kojima, R.

    Twenty-nine patients with atlantoaxial subluxation (18 with rheumatoid arthritis, 2 due to trauma, 4 with os odontoideum, and one each with polyarteritis nodosa, rheumatic fever, Klippel-Feil syndrome, achondroplasia, and cause unknown) were evaluated using a 0.22 tesla resistive MRI unit. Cord compression was classified into four grades according to the degree on magnetic resonance imaging. There were 7 patients with no thecal sac compression (grade 0), 10 with a minimal degree of subarachnoid space compression without cord compression (grade 1), 7 with mild cord compression (grade 2), and 5 with severe cord compression or cord atrophy (grade 3). Although the severity of myelopathy showed poor correlation with the atlantodental interval on conventional radiography, high correlation was observed between MR grading and the degree of myelopathy. The high signal intensity foci were observed in 7 or 12 patients with cord compression (grades 2 and 3) on T2 weighted images. Other frequently observed findings in rheumatoid arthritis included soft tissue masses of low to intermediate signal intensity in the paraodontoid space, erosions of the odontoid processes, and atlanto-axial impaction on T1 and T2 weighted images.

  19. 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.

  20. 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

  1. 锚定式颈椎椎间融合器临床应用中期随访报告%A retrospective mid-term study on the application of anchoring cervical intervertebral fusion cage

    Institute of Scientific and Technical Information of China (English)

    鲍达; 马远征; 陈兴; 李宏伟; 高天君; 罗小波

    2012-01-01

    reviewed retrospectively.There were 22 males and 20 females with the age of 25-69 years old (mean,48.2 years old).Of the 31 cases,there were 14 with cervical spondylotic myelopathy,9 with cervical spondylotic radiculopathy,and 8 with mixed type of cervical spondylosis.4 cases suffered from lower cervical instability, 5 cases from acute cervical disc herniation and 2 cases from Klippel- Feil syndrome.All cases underwent anterior discectomy, ACIFC fusion.The fusion segments included 27 single-segment, 14 two-segments and 1 three-segments.A total of 58 cages were implanted, which included 11 C3/4; 13 C4/5;18 C5/6;14 C6/7 and 12 C7/Tl.There were 40 primary and 2 revision surgeries.Radiographs were taken routinely to determine the fusion and adjacent segment degeneration (ASD).The neurofunction and life quality at preoperation and follow-up were evaluated by Chinese Orthopaedic Association (CO A) 40 score and neck disability index (NDI).Result:5 patients were complicated with pharyngis pain in 24 hours after operation, and relieved 7 days later after corresponding intervention.Axial symptoms (AS) were found in 2 patients (3.4%) in 48 hours after operation,and relieved 7 days later.All patients were followed up for an average of 4 years (range, 3-4.5 years).Bony union was achieved in all cases with the mean of 3.5 months(range 2.5-6 months).significant difference was noted on COA sscore between preoperation (30.21±2.69) and final follow-up (37.18±1.20)(P<0.05).The mean improve rate was 71.2%.And there were significant differences on NDI between preoperation (40.03±3.92) and final follow-up (29.95±4.51)(P<0.05).5 cases (11.9%) were complicated with ASD in 3.5-4.5 years (mean,4 years) follow-up,which included 3 caudal and 2 distal.Conclusion:A satisfactory mid-term outcome for cervical spinal disease can be obtsined by using ACIFC in operation of anterior cervical discectomy with fusion.And the higher fusion rate and lower AS or ASD can be also obtained.

  2. Atlanto-axial approach for cervical myelography in a Thoroughbred horse with complete fusion of the atlanto-occipital bones.

    Science.gov (United States)

    Aleman, Monica; Dimock, Abigail N; Wisner, Erik R; Prutton, Jamie W; Madigan, John E

    2014-11-01

    A 2-year-old Thoroughbred gelding with clinical signs localized to the first 6 spinal cord segments (C1 to C6) had complete fusion of the atlanto-occipital bones which precluded performing a routine myelogram. An ultrasound-assisted myelogram at the intervertebral space between the atlas and axis was successfully done and identified a marked extradural compressive myelopathy at the level of the atlas and axis, and axis and third cervical vertebrae.

  3. Dwarf with dual spinal kyphotic deformity at the cervical and dorsal spine unassociated with odontoid hypoplasia: Surgical management

    Directory of Open Access Journals (Sweden)

    Guru Dutta Satyarthee

    2016-01-01

    Full Text Available Morquio's syndrome is associated with systemic skeletal hypoplasia leading to generalized skeletal deformation. The hypoplasia of odontoid process is frequent association, which is responsible for atlantoaxial dislocation causing compressive myelopathy. However, development of sub-axial cervical kyphotic deformity unassociated with odontoid hypoplasia is extremely rare, and coexistence of dorsal kyphotic deformity is not reported in the western literature till date and represents first case. Current case is 16-year-old boy, who presented with severe kyphotic deformity of cervical spine with spastic quadriparesis. Interestingly, he also had additional asymptomatic kyphotic deformity of dorsal spine; however, odontoid proves hypoplasia was not observed. He was only symptomatic for cervical compression, accordingly surgery was planned. The patient was planned for correction of cervical kyphotic deformity under general anesthesia, underwent fourth cervical corpectomy with resection of posterior longitudinal ligament and fusion with autologous bone graft derived from right fibula, which was refashioned approximating to the width of the corpectomy size after harvesting and fixed between C3 and C5 vertebral bodies and further secured with anterior cervical plating. He tolerated surgical procedure well with improvement in power with significant reduction in spasticity. Postoperative X-ray, cervical spine revealed complete correction of kyphotic deformity cervical spine. At follow-up 6 months following surgery, he is doing well. Successful surgical correction of symptomatic cervical kyphotic deformity can be achieved utilizing anterior cervical corpectomy, autologous fibular bone graft, and anterior cervical plating.

  4. Cervical dysplasia - series (image)

    Science.gov (United States)

    ... to detect cervical cancer. Limited or early cervical cancer (carcinoma in situ, or cervical intraepithelial neoplasia, or dysplasia) requires treatment with ablation therapy, usually in the form of ...

  5. Etiological profile of noncompressive myelopathies in a tertiary care hospital of Northeast India

    OpenAIRE

    Ashok Kumar Kayal; Munindra Goswami; Marami Das; Lakhshya Jyoti Basumatary; Suvorit Subhas Bhowmick; Baiakmenlang Synmon

    2017-01-01

    Background: The discovery of antibodies against aquaporin-4 and evolving concepts of noncompressive myelopathies in the 21st century have made a major impact on the etiological profile of these diseases, with few cases turning out to be idiopathic. Objective: To find causes of noncompressive myelopathy in a tertiary care hospital of Northeast India. Materials and Methods: An observational study was carried out in the Neurology Department of Gauhati Medical College, Guwahati, from September 20...

  6. 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

  7. 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

  8. Cervical Laminoplasty

    Science.gov (United States)

    ... spine showing extension of the spine following a cervical laminoplasty. B) Post-operative lateral x-rays of the same patient showing flexion. Note that the range of motion is maintained after the laminoplasty and that no ...

  9. Cervical spondylosis

    Science.gov (United States)

    Cervical osteoarthritis; Arthritis - neck; Neck arthritis; Chronic neck pain; Degenerative disk disease ... therapist). Sometimes, a few visits will help with neck pain. Cold packs and heat therapy may help your ...

  10. Related factors to dysphagia after anterior cervical spine surgery%颈椎前路术后吞咽困难的相关因素分析

    Institute of Scientific and Technical Information of China (English)

    陈智; 黄轩; 李凤宁; 张帆; 何平; 綦珂; 侯铁胜; 沈洪兴

    2012-01-01

    Objectives: To evaluate the related factors of dysphagia following anterior cervical spine surgery. Methods: 135 cases undergoing anterior cervical spine surgery from August 2008 to July 2010 were followed up. There were 82 males and 53 females, with a mean age of 58.2 years (range, 32 to 80 years). Of these 135 patients, 58 had cervical spondylotic myelopathy(CSM), 32 had cervical radiculopathy, 18 had cervical myeloradiculopathy, 27 had ossification posterior longitudinal ligament (OPLL). All cases were treated by the same surgical group including anterior cervical discectomy and fusion(ACDF), and/or anterior cervical compec-tomy and fusion(ACCF), and total disc replacement(TDR). 135 patients were reviewed retrospectively on their postoperative dysphagia. All cases with dysphgia accepted Methylprednisolone intravenously and correspondant therapy. Results: 135 cases were followed up, and 36(26.7%) of them had postoperative dysphagia, including 11 males and 25 females. The age of patients with dysphagia ranged from 42 to 80 years, average age was 59.6. The rest age ranged from 32 to 76, the average age was 52.3, which was more significant compared to the former(P0.05). There was no statistical significance in the surgical time, blood loss or hospital day(P>0.05). After 6 month follow-up, 35 cases (97.2%) had dysphagia cured or improved. While 1 case had improvement at 1 year follow-up. Conclusions: Female, elder, titanium plating and multiple surgical level numbers may be associated with postoperative dysphagia. As a result, clinicians should pay more attention to this complication and make proper intervention.%目的:探讨颈椎前路手术后发生吞咽困难的相关因素.方法:随访2008年8月~2010年7月收治的颈椎前路手术患者135例,其中男82例,女53例;年龄32~80岁,平均58.2岁;诊断为脊髓型颈椎病58例,神经根型颈椎病32例,混合型颈椎病18例,后纵韧带骨化症27例.入院后均由同一组医师治疗,手术方

  11. Short-term Efficacy of Cervical Laminoplasty Preserving the Unilateral Ligament with Muscle Complex:Comparative Study%保留单侧肌肉韧带复合体颈椎椎板成形术近期疗效的比较研究

    Institute of Scientific and Technical Information of China (English)

    于淼; 孙宇; 刘忠军; 潘胜发; 张凤山

    2011-01-01

    Objective To compare the short-term efficacies of traditional open-door cervical laminoplasty and cervical laminoplasty with unilateral preservation of the muscular-ligament complex and reconstruction of the insertion of cervical extensive muscle. Methods From November 2006 to November 2008, 82 patients with cervical spondylotic myelopathy received cervical laminoplasty in our hospital; among them, traditional open-door cervical laminoplasty was performed on 36 cases (anchor group), and cervical laminoplasty preserving the unilateral ligament and muscle complex was carried out in 46 patients ( preservation group). The pre-operative, and 3- and 12-month postoperative JOA, VAS, and NDI, as well as maximum cervical flexion/extension angles and range of motions were compared between the two groups. During follow-up, the union of the lamina hinge and that of spinous processlamina in the preservation group were observed by CT scanning. Results In both the groups, thc JOA, VAS, and maximum cervical flexion/extension angles and motion range were improved significantly after the treatments (P = 0.00, 0.00, 0.03, 0.00, and 0.00 respectively). Furthermore, the 3- and 12-month postoperative VAS, maximum cervical flexion/extension of the preservation group were superior to those in the anchor group ( P = 0.00, 0.03, 0.0l ,and 0.00 respectively). Whereas, the postoperative union of the lamina hinge in the anchor group was superior to that in the preservation group ( P = 0.00 ). In the preservation group, the rate of spinous process-lamina union was related with the rate of lamina hinge union ( Spearman R = 0. 254, P = 0.00). Conclusions By cervical laminoplasty preserving the unilateral ligament and muscle complex, both spinal and axial symptoms can be alleviated while maintaining the cervical kinetic functions. The lamina hinge union rate of the procedure is lower than that of the traditional open-door technique.%目的 比较颈后路传统单开门(锚定组)和保留单侧

  12. 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

  13. Etiological profile of noncompressive myelopathies in a tertiary care hospital of Northeast India

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    Ashok Kumar Kayal

    2017-01-01

    Full Text Available Background: The discovery of antibodies against aquaporin-4 and evolving concepts of noncompressive myelopathies in the 21st century have made a major impact on the etiological profile of these diseases, with few cases turning out to be idiopathic. Objective: To find causes of noncompressive myelopathy in a tertiary care hospital of Northeast India. Materials and Methods: An observational study was carried out in the Neurology Department of Gauhati Medical College, Guwahati, from September 2013 to February 2016. Patients of noncompressive myelopathies who underwent magnetic resonance imaging (MRI of the spine were segregated into two categories: acute-to-subacute myelopathy (ASM and chronic myelopathy (CM. In addition to routine blood tests, chest X-ray, urinalysis, and visual evoked potentials, investigations included MRI of the brain, cerebrospinal fluid analysis, and immunological, infectious, and metabolic profile based on the pattern of involvement. Results: The study had 151 patients (96 ASM and 55 CM with a median age of 35 years and male: female ratio 1.4:1. The causes of ASM were neuromyelitis optica spectrum disorder (23, multiple sclerosis (MS (8, systemic lupus erythematosus (1, Hashimoto's disease (1, postinfectious acute disseminated encephalomyelitis (6, postinfectious myelitis (8, infections (9, spinal cord infarct (5, and electrocution (1. The causes of CM were MS (1, probable or possible sarcoidosis (7, mixed connective tissue disease (1, Hashimoto's disease (2, infections (9, Vitamin B12deficiency (4, folate deficiency (2, hepatic myelopathy (2, radiation (11, and paraneoplastic (1. No etiology could be found in 48 (31.8% patients (34 ASM and 14 CM. In 21/96 (21.9% patients of ASM, acute transverse myelitis was idiopathic based on current diagnostic criteria. Conclusion: Underlying etiology (demyelinating, autoimmune, infectious, vascular, metabolic disorder, or physical agent was found in 68% patients of noncompressive

  14. Etiological profile of noncompressive myelopathies in a tertiary care hospital of Northeast India

    Science.gov (United States)

    Kayal, Ashok Kumar; Goswami, Munindra; Das, Marami; Basumatary, Lakhshya Jyoti; Bhowmick, Suvorit Subhas; Synmon, Baiakmenlang

    2017-01-01

    Background: The discovery of antibodies against aquaporin-4 and evolving concepts of noncompressive myelopathies in the 21st century have made a major impact on the etiological profile of these diseases, with few cases turning out to be idiopathic. Objective: To find causes of noncompressive myelopathy in a tertiary care hospital of Northeast India. Materials and Methods: An observational study was carried out in the Neurology Department of Gauhati Medical College, Guwahati, from September 2013 to February 2016. Patients of noncompressive myelopathies who underwent magnetic resonance imaging (MRI) of the spine were segregated into two categories: acute-to-subacute myelopathy (ASM) and chronic myelopathy (CM). In addition to routine blood tests, chest X-ray, urinalysis, and visual evoked potentials, investigations included MRI of the brain, cerebrospinal fluid analysis, and immunological, infectious, and metabolic profile based on the pattern of involvement. Results: The study had 151 patients (96 ASM and 55 CM) with a median age of 35 years and male: female ratio 1.4:1. The causes of ASM were neuromyelitis optica spectrum disorder (23), multiple sclerosis (MS) (8), systemic lupus erythematosus (1), Hashimoto's disease (1), postinfectious acute disseminated encephalomyelitis (6), postinfectious myelitis (8), infections (9), spinal cord infarct (5), and electrocution (1). The causes of CM were MS (1), probable or possible sarcoidosis (7), mixed connective tissue disease (1), Hashimoto's disease (2), infections (9), Vitamin B12 deficiency (4), folate deficiency (2), hepatic myelopathy (2), radiation (11), and paraneoplastic (1). No etiology could be found in 48 (31.8%) patients (34 ASM and 14 CM). In 21/96 (21.9%) patients of ASM, acute transverse myelitis was idiopathic based on current diagnostic criteria. Conclusion: Underlying etiology (demyelinating, autoimmune, infectious, vascular, metabolic disorder, or physical agent) was found in 68% patients of

  15. Application of anatomical measurement to anterior cervical decompression surgery%解剖学测量在颈椎前路减压手术中的应用

    Institute of Scientific and Technical Information of China (English)

    胡明华; 陈傲; 唐顺胜; 陈世杰; 袁宪宇

    2015-01-01

    Objective To explore the value of anatomic measurement applied to anterior cervical decompression surgery.Methods One hundred and twenty patients with cervical spondylotic myelopathy were divided into research group and control group based on random number table,with 60 cases in each group.Eighteen specimens of adult vertebrae cervicales were measured and the related data of C3 -C7 were collected before the surgery.The data included the distance between the adjacent transverse foramina,the distance between adjacent tips of uncus of vertebral body,the distance between bilateral posterior margins of uncus of vertebral body,the distance between bilateral anterior margins of uncus of vertebral body,the anteroposterior diameter of uncus of vertebral body,spinal canal transverse diameter and vertebral sagittal diameter.The anterior cervical decompression surgery was performed in the research group according to the measurement results, while the routine anterior cervical decompression surgery was performed in the control group.The surgical efficacy,operative duration and intraoperative blood loss were compared between two groups.Results There was no significant difference in the distance between bilateral posterior margins of uncus of vertebral body among C3 -C7(P>0.05).There was significant difference in the distance between bilateral anterior margins of uncus of vertebral body and the maximum spinal canal diameter among C3 -C7(P0.05).The JOA score of research group was significantly higher than that of control group 6 months after surgery(P<0.05).Conclusion The efficacy of anterior cervical decompression surgery is better when the data of cervical anatomical measurement are applied to the surgery.%目的:探讨颈椎解剖学测量在颈椎前路减压手术中的应用价值。方法120例脊髓颈椎病患者,按随机数字表法分为研究组和对照组,每组60例。术前测量18具成年人颈椎标本C3~C7相关数据:横突孔间距离、钩突尖

  16. 前路减压植骨可吸收螺钉内固定治疗颈椎病%The anterior decompression and bone grafting with bio-absorbable screw fixation for cervical spondylosis

    Institute of Scientific and Technical Information of China (English)

    王栋; 贺西京; 李浩鹏; 张健; 徐思越; 杨平林; 王国毓

    2009-01-01

    Objective:To observe the early clinical effect of the cervical spendylosis treated by the fixation with bio-absorbable screw after cervical anterior decompression and bone grafting.Method:26 cases suffered from cervical spondylosis who were treated by anterior compression,bone grafting and fixating with 2 bio-ab-serbable screws from Mar. 2007 to Sep. 2008,including 16 males and 10 females with an average age of 49.4 years (38-70 years ).There were 11 cases with cervical spondylotic myelopathy,5 with cervical spendylofic radieulopathy and 10 with mixed type of cervical spondylosis.Clinical data of these patients was analyzed ret-rospectively.One intervertebral space involvement was in 8 cases,and two spaces involvement in 18 cases.All patients underwent anterior decompression and bone grafting,in which the grafted bone was fixated by 2 bio-absorptive screws (PLLA,diameter:2.7mm) from the midline of graft bone to the bone surface of upper and lower vertebrae in 45°.Cervical collar was commonly used for 4-6 weeks after operation.All cases were fol-lowed-up every month in outpatient department to observe the improvement of symptoms and evaluate the fu-sion of bone graft.Neurological function recovery was observed by JOA score.Result:Operations of all cases were finished and screws were placed successfully.The operative incisions healed well.The excellent and good rate of symptom improvement was 84.2%,the graft fusion time was 3.3±0.6 months (range,3.2-4.6 months).No obvious complications were found.Conclusion:The cervical spendylosis with one or two-level involvement can be effectively treated by anterior decompression and bone grafting with bio-absorbable screw fixation.This operative method is safe and can avoid the complications induced by metal implants.%目的:观察颈椎前路减压植骨可吸收螺钉内同定治疗颈椎病的初步临床疗效.方法:2007年3月~2008年9月我院应用颈椎前路减压植骨可吸收螺钉

  17. 术前颈椎曲度与椎管扩大成形术后脊髓后移程度及疗效的相关性%Correlation between cervical curvature and spinal cord shift, surgical outcome after expansive open-door laminoplasty

    Institute of Scientific and Technical Information of China (English)

    朱继超; 刘晓光; 刘忠军; 姜亮; 韦峰; 于淼; 吴奉梁

    2013-01-01

    cervical curvature after expansive open-door laminoplasty for cervical myelopathy,and to investigate the relationship between cervical curvature and spinal cord shift.Methods:63 cases of cervical myelopathy undergoing traditional expansive open-door laminoplasty between January 2005 and December 2011 were reviewed retrospectively,the pathogenesis included cervical spondylotic myelopathy(26 cases),ossification of posterior longitudinal ligament(OPLL,20 cases) and developmental cervical spinal stenosis(17 cases).Traditional expansive open-door laminoplasty was performed because of multisegmental disc disease,multilevel OPLL or developmental cervical stenosis.All cases were divided into three groups according to the cervical curvature:the kyphosis group(n=16),the straight group(n=18) and the normal alignment group(n=29).The posterior shift of center of spinal cord(PCS) at each level of laminoplasty(C3-C7) was measured and calculated through the midsagittal images of MRI T2-weighted before and after surgery.Statistic analysis was performed to analyze the difference of PCS at each level (C3-C7) among three groups.The neurofunction for each patient was estimated by using the Japanese Orthopedic Association(JOA) score before surgery and at final follow-up,and the JOA recovery rate was calculated.Statistic analysis was performed to analyze the difference of the JOA recovery rate at final follow-up among three groups.Results:There was no statistical difference in the age,sex ratio,duration of symptoms,entity,follow-up time or the preoperative JOA score(P>0.05).Posterior migration of spinal cord was observed in all three groups,and there was no significant difference with respect to the mean PCS at C3-C7 level among three groups(P>0.05).The mean follow-up was 47±24(range 15-90) months,and the mean JOA recovery rate at final follow-up of each group was 59.81%,69.25% and 54.44% respectively,which showed no statistical difference(P>0.05).No linear correlation was found

  18. 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.

  19. Myelopathy in adult aortic coarctation: Causes and caveats of an atypical presentation

    Directory of Open Access Journals (Sweden)

    Chandan Mourya

    2016-01-01

    Full Text Available A 57-year-old female presenting with acute-onset paraplegia was referred for magnetic resonance imaging (MRI of cervico-dorsal spine. On MRI, multiple tortuous dilated vessels were noted in the epidural space with long segment cord compression and imaging features of compressive myelopathy. Associated small acute cervico-dorsal epidural hematoma was also noted in the same region. Computed tomography (CT angiography was performed subsequently which revealed post-ductal coarctation of aorta with multiple arterial collaterals in the chest wall and spinal canal. An extensive review of English language literature pertaining to the clinical presentations of adult aortic coarctation revealed only few reports of acute compressive myelopathy due to spinal epidural collateral vessels. Further, presentation at such a late age has not been reported before. In the present case, apart from a hypertrophied anterior spinal artery and perispinal collaterals, an anterior epidural hematoma was an additional important factor in the causation of myelopathy.

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

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    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

  1. A case of chronic progressive radiation myelopathy treated with long-time corticosteroid administration

    Energy Technology Data Exchange (ETDEWEB)

    Hirota, Saeko; Soejima, Toshinori; Higashino, Takanori; Obayashi, Kayoko; Takada, Yoshiki [Hyogo Medical Center for Adults, Akashi (Japan); Hishikawa, Yoshio

    1998-05-01

    This is a report of one patient who developed chronic progressive radiation myelopathy at a gap of two portals 31 months after 40 Gy irradiation. He presented an unusual clinical course with over 5 years and 6 months administration of oral corticosteroid, very slow progression and long-lasting presentation of Gd-DTPA enhanced area in the suffered cord by MRI. It is suggested that corticosteroid administration from initial onset for a long period may change the natural course of radiation myelopathy, that is, may delay progress of it. (author)

  2. Myelopathy secondary to copper deficiency as a complication of treatment of Wilson's disease.

    Science.gov (United States)

    Lozano Herrero, Jesús; Muñoz Bertrán, Eduardo; Ortega González, Isabel; Gómez Espín, Rosa; López Espín, María Isabel

    2012-12-01

    Wilson's Disease (WD) is an autosomal recessive disorder of copper metabolism resulting in a pathological accumulation of this metal, initially in the liver and later in other organs, mainly brain. Treatment with copper chelating agents and zinc salts results in a depletion of copper deposits and prevents or reverses the clinical manifestations. Copper deficiency may cause haematological and neurological changes, the latter principally being polyneuropathy and myelopathy. We report a patient with WD who developed a myelopathy associated with a deficiency of copper following prolonged treatment with D-penicillamine and zinc salts.

  3. Cervical Cancer Stage IVA

    Science.gov (United States)

    ... historical Searches are case-insensitive Cervical Cancer Stage IVA Add to My Pictures View /Download : Small: 756x576 ... Large: 3150x2400 View Download Title: Cervical Cancer Stage IVA Description: Stage IVA cervical cancer; drawing and inset ...

  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. 下段颈椎脊椎功能单位活动度与椎管狭窄程度间相关性分析%To investigate the correlation between the segmental activity of the functional units and extent of the vertebral canal stenosis in the lower cervical spine

    Institute of Scientific and Technical Information of China (English)

    张晓光; 王淑丽; 张晓林; 潘涛; 崔壮

    2012-01-01

    Objective: To investigate relationships between the degree of the cervical spinal canal stenosis and lower cervical segmental stability in patients with cervical spondylotic myelopathy(CSM). Methods: Sixty-two patients with CSM for prepared surgery were examined with the lateral dynamic radiographs (flexion-extension) and MR scanner. Radiographic evaluation included the C2~C7 Cobb angle and FSU-Cobb angle at C3~C4, C4~C5, and C5~C6. Cervical spinal stenosis was classified by means of the T2-weighted MR images into four grades. Radiological change was analyzed according to the degree of the spinal stenosis during flexion-extension motion. Results: The segmental activity of the C4-~C5, C5~C6 was greater than that at the C3~ C4 in Grade I spinal stenosis, and statistical difference was observed between the C4~C5 and the C3~C4. The segmental activity at the C4~C5 decreased significantly in Grade III compared with Grade I and Grade II spinal stenosis, and implied the segmental units at the C4~C5 contributed the majority of the mobility on the cervical spine and motion decreased in the severe spinal stenosis. There was no statistical difference on the range of the motion of the overall cervical spine between grade 0~ II and grade IH groups. Conclusion: The functional spinal unit(FSU) is the smallest functional unit of the cervical spine and exhibits the generic characteristics of the spine. The mobility of the FSU was significantly reduced in the severe cervical spinal stenosis, from an unstable phase to an ankylosed stage, with the progression of the degenerative change. Hence, combined application of the common lateral dynamic radiographs and MRI in judging the activity of the cervical spine and spinal canal stenosis plays an important role in the clinical practice.%目的:探讨退变性下段颈椎的脊椎功能单位(FSU)活动度与相应节段椎管狭窄程度间相关性.资料与方法:随机选取拟行手术治疗的脊髓型颈椎病病人62例.全部拍

  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. Further studies on HTLV-I associated myelopathy in Argentina.

    Science.gov (United States)

    Gonzalez, L A; Villa, A M; Kohler, G; Garcea, O; Kremenchutzky, M; Caceres, F; Sanz, O P; Sica, R E

    1998-01-01

    We report 10 HTLV-I virus seropositive subjects, eight of them with HTLV-I associated myelopathy (HAM), two of them also infected with HIV as well as two asymptomatic HTLV-I+ relatives of two unrelated patients. HTLV-I is endemic in several tropical areas, where it causes different neurological diseases. Only few patients have been reported in our country since 1994. We studied 8 patients, who fulfilled the clinical criteria for chronic spastic paraplegia, and 2 other non-symptomatic HTLV-I seropositive relatives, with electromyography (EMG), motor and sensory conduction velocities (NCV), somatosensory, visual and brainstem auditory evoked potentials (SSEP, VEP and BAEP), Magnetic Resonance Images (MRI) and cerobrospinal fluid (CSF) analysis. The latter was carried out only in seven symptomatic patients. In every case positive ELISA tests for HTLV-I/II were confirmed by Western Blot. The two asymptomatic persons were clinically and electromyographically assessed, one of them was also submitted to SSEPs studies. Three patients were males. Patient's ages ranged from 5 to 65 years old. All symptomatic patients showed muscular weakness, spasticity with pyramidal signs and sphincter disturbances. Five of them had paresthesias and 2 had burning pain on their feet. The EMGs and the NCVs were normal in 7 patients and in the 2 asymptomatic ones. SSEPs, obtained by stimulating the posterior tibial nerves, were impaired in 7 patients and in the asymptomatic person who received the procedure. The 7 symptomatic patients who underwent lumbar puncture had positive tests for HTLV-I in CSF, 3 out of these 7 patients had also high protein levels and 4 had increased number of lymphocytes. In 2 patients intrathecal IgG production could also be demonstrated. MRI were normal in 7 patients and in the 2 asymptomatics, the exception being a female who had bilateral hyperintense lesions in cerebral white matter in T2. In conclusion, tropical spastic paraparesis is apparently a rare disorder

  9. Ossification of the posterior longitudinal ligament (OPLL) in the cervical spine. Clinical, neuroradiological and neurophysiological study on 9 cases.

    Science.gov (United States)

    Del Conte, L; Tassinari, T; Trucco, M; Serrato, O; Badino, R

    1992-12-01

    Ossification of the posterior longitudinal ligament (OPLL) in the cervical spine is considered to be uncommon in western countries, although widely known and studied in Japan. We report on 9 cases of OPLL cervical myelopathy investigated by x-ray films and cervical CT and by somatosensory evoked potentials. The patients reported spastic tetraparesis, sensory disorders of the limbs and, in one case, sphincter incontinence. Neuroradiological examinations showed that the posterior columns of the spinal cord were more affected than the roots. Our data suggest that OPLL is more frequent in the West than has so far been reported and that combined radiological and neurophysiological investigation ensures correct diagnosis and accurate assessment of the cord impairment.

  10. 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

  11. Cervical cancer - screening and prevention

    Science.gov (United States)

    Cancer cervix - screening; HPV - cervical cancer screening; Dysplasia - cervical cancer screening; Cervical cancer - HPV vaccine ... Almost all cervical cancers are caused by HPV (human papilloma virus). HPV is a common virus that spreads through sexual contact. Certain ...

  12. 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.

  13. Cervical surgery for ossification of the posterior longitudinal ligament: One spine surgeon′s perspective

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    Nancy E Epstein

    2014-01-01

    Full Text Available Background: The selection, neurodiagnostic evaluation, and surgical management of patients with cervical ossification of the posterior longitudinal ligament (OPLL remain controversial. Whether for prophylaxis or treatment, the decision to perform anterior vs. posterior vs. circumferential cervical OPLL surgery is complex. MR and CT Documentation of OPLL: Together, MR and CT cervical studies best document the full extent of OPLL. While MR provides the optimal soft-tissue overview (e.g. hyperintense signals reflecting edema/myelomalacia in the cord, CT′s directly demonstrate the ossification of OPLL often "missed" by MR (e.g. documents the single or double layer signs of dural penetration. Patient Selection: Patients with mild myelopathy/cord compression rarely require surgery, while those with moderate/severe myelopathy/cord compression often warrant anterior, posterior, or circumferential approaches. Operative Approaches: Anterior corpectomies/fusions, warranted in patients with OPLL and kyphosis/loss of lordosis, also increase the risks of cerebrospinal fluid (CSF leaks (e.g. single/double layer sign, and vascular injuries (e.g. carotid, vertebral. Alternatively, with an adequate lordosis, posterior procedures (e.g. often with fusions, may provide adequate multilevel decompression while minimizing risk of anterior surgery. Occasionally, combined pathologies may warrant circumferential approaches. Anesthetic and Intraoperative Monitoring Protocols: The utility of awake nasotracheal fiberoptic intubation/awake positioning, intraoperative somatosensory/motor evoked potential, and electromyographic monitoring, and the requirement for total intravenous anesthesia (TIVA for OPLL surgery is also discussed. Conclusion: Anterior, posterior, or circumferential surgery may be warranted to treat patients with cervical OPLL, and must be based on careful patient selection, and both MR and CT documentation of the full extent of OPLL.

  14. Neurophysiological evaluation of patients with degenerative diseases of the cervical spine

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    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. Myelopathy and sciatica induced by an extradural S1 root haemangioblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Hermier, M.; Cotton, F.; Froment, J.C. [Department of Radiology, Hopital Neurologique et Neurochirurgical, Lyon (France); Saint-Pierre, G.; Jouvet, A. [Department of Neuropathology, Hopital Neurologique et Neurochirurgical, Lyon (France); Ongolo-Zogo, P. [Department of Radiology, Hopital Neurologique et Neurochirurgical, Lyon (France); Department of Radiology, Hopital Central, Yaounde (Cameroon); Fischer, G. [Department of Neurosurgery, Hopital Neurologique et Neurochirurgical, Lyon (France)

    2002-06-01

    Haemangioblastomas are vascular tumours which mainly involve the central nervous system and retina, often in the setting of von Hippel-Lindau disease. Haemangioblastomas occurring outside the central nervous system are uncommon. Wherever it is, recognising this tumour prior to surgery is desirable, as preoperative embolisation may be considered. We report the clinical, imaging and pathological features of a sporadic sacral root haemangioblastoma in a 58-year-old man with chronic sciatica and myelopathy. The diagnosis was questioned preoperatively because an enlarged sacral foramen, seen to be filled by a highly vascular, enhancing mass and dilated vessels. Myelopathy was attributed to the presumed high venous pressure resulting from increased flow in veins draining the vascular tumour. Microneurosurgical excision was performed after endovascular embolisation and led to persistent clinical improvement. (orig.)

  16. Two-level cervical disc replacement: perspectives and patient selection

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    Narain AS

    2017-02-01

    Full Text Available Ankur S Narain, Fady Y Hijji, Daniel D Bohl, Kelly H Yom, Krishna T Kudaravalli, Kern Singh Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA Introduction: Cervical disc replacement (CDR is an emerging treatment option for cervical degenerative disease. Postulated benefits of cervical disc replacement compared to anterior cervical discectomy and fusion include preserved motion at the operative segments and decreased motion at adjacent levels. Multiple studies have been performed investigating the outcomes of CDR in single-level pathology. The investigation of the use of CDR in two-level pathology is an emerging topic within the literature.Purpose: To critically evaluate the literature regarding two-level CDR in order to determine its utility compared to two-level cervical arthrodesis. Patient selection factors including indications and contraindications will also be explored.Methods: The PubMed database was searched for all articles published on the subject of two-level CDR up until October 2016. Studies were classified by publication year, study design, sample size, follow-up interval, and conflict of interest. Outcomes were recorded from each study, and included data on patient-reported outcomes, radiographic measurements, range of motion, peri- and postoperative complications, heterotopic ossification, adjacent segment disease, reoperation rate, and total intervention cost. Results: Fourteen studies were included in this review. All studies demonstrated at least noninferiority of two-level CDR compared to both two-level arthrodesis and single-level CDR. Patient selection in two-level CDR is driven by the inclusion and exclusion criteria presented in prospective, randomized controlled trials. The most common indication is subaxial degenerative disc disease over two contiguous levels presenting with radiculopathy or myelopathy. Furthermore, costs analyses trended toward at least noninferiority of two

  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. Danazol a new perspective in the treatment of htlv-l associated myelopathy (preliminary report

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    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.

  19. Hepatic Myelopathy in a Patient with Decompensated Alcoholic Cirrhosis and Portal Colopathy

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    Madhumita Premkumar

    2012-01-01

    Full Text Available Cirrhotic or hepatic myelopathy is a rare neurological complication of chronic liver disease usually seen in adults and presents as a progressive pure motor spastic paraparesis which is usually associated with overt liver failure and a surgical or spontaneous systemic portocaval shunt. We describe the development of progressive spastic paraparesis, in a patient with alcoholic cirrhosis with portal hypertension and portal colopathy who presented with the first episode of hepatic encephalopathy. The patient had not undergone any shunt procedure.

  20. Myelopathy due to Spinal Extramedullary Hematopoiesis in a Patient with Polycythemia Vera

    Science.gov (United States)

    Ito, Shuhei; Hosogane, Naobumi; Nagoshi, Narihito; Yagi, Mitsuru; Iwanami, Akio; Watanabe, Kota; Tsuji, Takashi; Nakamura, Masaya; Matsumoto, Morio; Ishii, Ken

    2017-01-01

    Extramedullary hematopoiesis (EMH) occasionally occurs in patients exhibiting hematological disorders with decreased hematopoietic efficacy. EMH is rarely observed in the spinal epidural space and patients are usually asymptomatic. In particular, in the patients with polycythemia vera, spinal cord compression due to EMH is extremely rare. We report a case of polycythemia vera, in which operative therapy proved to be an effective treatment for myelopathy caused by spinal EMH. PMID:28133558

  1. Orion锁定型颈椎前路钢板系统的临床应用%Clinical application of Orion anterior cervical locking plate system

    Institute of Scientific and Technical Information of China (English)

    郭澄水; 蒋学金; 陈新良; 韩国华; 孔祥飞

    2001-01-01

    Objective To evaluate the clinical application of Orion anterior cervical locking plate system in cervical injuries and cervical spondylous myelopathy. Methods 3 cervical spinal fractures and 2 cervical spondylous myelopathy were treated by anterior decompression, autografting and Orion plate fixation. Results 5 cases were followed up for 4~12 months. Bone graft was completely fused without complications of broken plate or loosening screw. Conclusion Orion plate can offer cervical stability after anterior decompression and bone grafting. It is easy to apply and suitable for the treatment of cervical fractures with spinal cord injuries.%目的探讨Orion锁定型颈椎前路钢板系统对颈椎骨折和脊髓型颈椎病手术固定的效果。方法对3例颈椎骨折合并高位截瘫和2例脊髓型颈椎病患者施行颈椎前路减压植骨融合及Orion钢板内固定。结果术后随访4~12个月,植骨已完全融合,无钢板断裂、螺钉松动等情况发生。结论 Orion锁定型颈椎前路钢板系统方法简单、容易掌握,内固定牢固,尤其适用于颈椎骨折伴高位截瘫患者的内固定治疗。

  2. 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

  3. DYNAMIC MAGNETIC RESONANCE IMAGING: PRELIMINARY PRESENTATION OF A TECHNIQUE

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    BRUNO DA COSTA ANCHESCHI

    Full Text Available ABSTRACT Objective: To evaluate morphometric variations of the cervical spine in patients with cervical spondylotic myelopathy (CSM using dynamic magnetic resonance imaging (MRI in neutral, flexion and extension positions. Methods: This is a prospective study of patients with CSM secondary to degenerative disease of the cervical spine. The morphometric parameters were evaluated using T2-weighted MRI sequences in the sagittal plane in neutral, flexion and extension position of the neck. The parameters studied were the anterior length of the spinal cord (ALSC, the posterior length of the spinal cord (PLSC, the diameter of the vertebral canal (DVC and the diameter of the spinal cord (DSC. Results: The ALSC and PLSC were longer in flexion than in extension and neutral position, with statistically significant difference between the flexion and extension position. The DVC and the DSC were greater in flexion than in extension and neutral position, however, there was no statistically significant difference when they were compared in the neutral, flexion and extension positions. Conclusion: Dynamic MRI allows to evaluate morphometric variations in the cervical spinal canal in patients with cervical spondylotic myelopathy.

  4. Cervical Cancer Screening

    Science.gov (United States)

    ... 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 ...

  5. Cervical Cancer Screening

    Science.gov (United States)

    ... are at increased risk for HPV infections. Other risk factors for cervical cancer include: Giving birth to many children. Smoking cigarettes. Using oral contraceptives ("the Pill"). Having a weakened immune system . Cervical Cancer Screening ...

  6. Cervical Cancer Stage IVB

    Science.gov (United States)

    ... of the body, such as the lymph nodes, lung, liver, intestine, or bone. Stage IVB cervical cancer. Topics/Categories: Anatomy -- Gynecologic Cancer Types -- Cervical Cancer Staging Type: Color, ...

  7. Anterior cervical plating

    Directory of Open Access Journals (Sweden)

    Gonugunta V

    2005-01-01

    Full Text Available Although anterior cervical instrumentation was initially used in cervical trauma, because of obvious benefits, indications for its use have been expanded over time to degenerative cases as well as tumor and infection of the cervical spine. Along with a threefold increase in incidence of cervical fusion surgery, implant designs have evolved over the last three decades. Observation of graft subsidence and phenomenon of stress shielding led to the development of the new generation dynamic anterior cervical plating systems. Anterior cervical plating does not conclusively improve clinical outcome of the patients, but certainly enhances the efficacy of autograft and allograft fusion and lessens the rate of pseudoarthrosis and kyphosis after multilevel discectomy and fusions. A review of biomechanics, surgical technique, indications, complications and results of various anterior cervical plating systems is presented here to enable clinicians to select the appropriate construct design.

  8. Cervical spinal cord injury without radiological abnormality in adults.

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    Bhatoe H

    2000-07-01

    Full Text Available Spinal cord injury occurring without concomitant radiologically demonstrable trauma to the skeletal elements of the spinal canal rim, or compromise of the spinal canal rim without fracture, is a rare event. Though documented in children, the injury is not very well reported in adults. We present seventeen adult patients with spinal cord injury without accompanying fracture of the spinal canal rim, or vertebral dislocation, seen over seven years. None had preexisting spinal canal stenosis or cervical spondylosis. Following trauma, these patients had weakness of all four limbs. They were evaluated by MRI (CT scan in one patient, which showed hypo / isointense lesion in the cord on T1 weighted images, and hyperintensity on T2 weighted images, suggesting cord contusion or oedema. MRI was normal in two patients. With conservative management, fifteen patients showed neurological improvement, one remained quadriplegic and one died. With increasing use of MRI in the evaluation of traumatic myelopathy, such injuries will be diagnosed more often. The mechanism of injury is probably acute stretching of the cord as in flexion and torsional strain. Management is essentially conservative and prognosis is better than that seen in patients with fracture or dislocation of cervical spine.

  9. Cervical insufficiency and cervical cerclage.

    Science.gov (United States)

    Brown, Richard; Gagnon, Robert; Delisle, Marie-France; Gagnon, Robert; Bujold, Emmanuel; Basso, Melanie; Bos, Hayley; Brown, Richard; Cooper, Stephanie; Crane, Joan; Davies, Gregory; Gouin, Katy; Menticoglou, Savas; Mundle, William; Pylypjuk, Christy; Roggensack, Anne; Sanderson, Frank; Senikas, Vyta

    2013-12-01

    Objectif : La présente directive clinique a pour but de fournir un cadre de référence que les cliniciens pourront utiliser pour identifier les femmes qui sont exposées aux plus grands risques de connaître une insuffisance cervicale, ainsi que pour déterminer les circonstances en présence desquelles la mise en place d’un cerclage pourrait s’avérer souhaitable. Résultats : La littérature publiée a été récupérée par l’intermédiaire de recherches menées dans PubMed ou MEDLINE, CINAHL et The Cochrane Library en 2012 au moyen d’un vocabulaire contrôlé (p. ex. « uterine cervical incompetence ») et de mots clés appropriés (p. ex. « cervical insufficiency », « cerclage », « Shirodkar », « cerclage », « MacDonald », « cerclage », « abdominal », « cervical length », « mid-trimester pregnancy loss »). Les résultats ont été restreints aux analyses systématiques, aux essais comparatifs randomisés / essais cliniques comparatifs et aux études observationnelles. Aucune restriction n’a été appliquée en matière de date ou de langue. Les recherches ont été mises à jour de façon régulière et intégrées à la directive clinique jusqu’en janvier 2011. La littérature grise (non publiée) a été identifiée par l’intermédiaire de recherches menées dans les sites Web d’organismes s’intéressant à l’évaluation des technologies dans le domaine de la santé et d’organismes connexes, dans des collections de directives cliniques, dans des registres d’essais cliniques et auprès de sociétés de spécialité médicale nationales et internationales. Valeurs : La qualité des résultats est évaluée au moyen des critères décrits dans le rapport du Groupe d’étude canadien sur les soins de santé préventifs (Tableau). Recommandations 1. Les femmes qui sont enceintes ou qui planifient connaître une grossesse devraient faire l’objet d’une évaluation visant les facteurs de

  10. Ossificação do ligamento longitudinal posterior na coluna cervical: relato de caso Ossification of the posterior longitudinal ligament in the cervical spine: case report

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    ROSANA HERMINIA SCOLA

    1998-09-01

    Full Text Available A ossificação do ligamento longitudinal posterior (OLLP é causa incomum de mielopatia compressiva na população caucasiana. É relatado o caso de um paciente do sexo masculino com um quadro de paraparesia espástica, cuja investigação radiológica mostrou OLLP. O raio-X de coluna cervical mostrou imagem laminar, vertical, com densidade óssea, posterior aos corpos vertebrais, que se estendia de C2 a T1. A tomografia computadorizada (TC e a mielotomografia mostravam OLLP causando compressão medular ântero-posterior no segmento descrito. Na ressonância magnética, observou-se área de hiperintensidade em T2 no segmento C7-T1, compatível com mielomalácia. O paciente foi submetido a laminoplastia tipo "open-door", com melhora do quadro parético dos membros inferiores. A OLLP deve entrar no diagnóstico diferencial das mielopatias cervicais, sendo facilmente diagnosticada através de radiografias e TC da coluna cervical. São revisados os aspectos clínicos e radiológicos e o tratamento da OLLP.Ossification of the posterior longitudinal ligament (OPLL is an uncommon cause of compressive myelopathy in the Caucasian population. A case of spastic paraparesis in a Caucasian man whose radiological investigation showed OPLL is presented. The radiographs of the cervical spine showed a strip of bony density posterior to the vertebral bodies, extending from C2 to T1. Computerized tomography (CT and CT myelography showed OPLL at the same level. Magnetic resonance showed an area of increased signal on T2-weighted sequences at C7-T1 level suggestive of myelomalacia. The patient underwent an open-door laminoplasty (C2 to C7 with improvement of the paraparesis. OPLL should be included in the differential diagnosis of cervical myelopathy. It can be easily detected by plain radiographs and CT of the cervical spine. A review of the clinical and radiological features and the treatment of OPLL is presented.

  11. 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.

  12. 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 ...

  13. Diagnosis of amyotrophic lateral sclerosis.

    Science.gov (United States)

    Rowland, L P

    1998-10-01

    This review of the differential diagnosis of amyotrophic lateral sclerosis focuses on two themes. The first is practical, how to establish the diagnosis based primarily on clinical findings buttressed by electrodiagnosis. The main considerations are multifocal motor neuropathy and cervical spondylotic myelopathy. The second theme is the relationship of motor neuron disease to other conditions, including benign fasciculation (Denny-Brown, Foley syndrome), paraneoplastic syndromes, lymphoproliferative disease, radiation damage, monomelic amyotrophy (Hirayama syndrome), as well as an association with parkinsonism, dementia and multisystem disorders of the central nervous system.

  14. 运动神经元病并发脊髓型颈椎病11例分析

    Institute of Scientific and Technical Information of China (English)

    侯玉堂

    2009-01-01

    @@ 运动神经元病(motor neuron disease,MND)与脊髓型颈椎病(cervical spondylotic myelopathy,CSM)临床表现有时极为相似,容易相互混淆,且以将GSM误诊为MND居多,目前,急诊多认为非此即彼.但我们发现临床上两个独立的疾病可以并存,现将于2007~2008年间发现的11例MND与CSM合病的病例报告并分析如下

  15. 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...

  16. Acupoints for cervical spondylosis

    OpenAIRE

    Zhu, Jihe; Arsovska, Blagica; Vasileva, Dance; Petkovska, Sofija; Kozovska, Kristina

    2015-01-01

    Cervical spondylosis is a chronic degenerative condition of the cervical spine that affects the vertebral bodies and intervertebral disks of the neck, as well as the contents of the spinal canal. This is one of the most common degenerative disorders of the spine. The disease can be symptomatic and asymptomatic. Symptoms that are distinctive for cervical spondylosis are: tingling, numbness and weakness in the limbs, lack of coordination, stiff neck, shoulder pain, occipital pain, vertigo, poor...

  17. 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

  18. 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.

  19. 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.

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

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    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.

  1. HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP): still an obscure disease.

    Science.gov (United States)

    Pillat, Micheli Mainardi; Bauer, Moisés Evandro; de Oliveira, Augusto Cesar Penalva; Ulrich, Henning; Casseb, Jorge

    2011-12-01

    Human T-cell leukemia virus type 1 (HTLV-1) is the ethiologic agent of the neurological disorder HTLV-1- associated myelopathy/tropical spastic paraparesis (HAM/TSP). Although the majority of HTLV-1-infected individuals remain asymptomatic during their lifetime, approximately one percent of this population develops a myelopathy consisting of a chronic inflammation of the white and gray matter of the spinal cord. Glucocorticoids are widely used for treatment because of their anti-inflammatory properties, improving symptoms mainly in those patients with only a few years from onset of the disease, when inflammation is more prominent. Interferon-alpha and vitamin C are other therapies presenting some benefits in clinical practice, probably due to their anti-viral and immunomodulatory activities observed ex vivo. Furthermore, inhibitors of histone deacetylase, which increase virus expression but result in a substantial decline in the proviral load, have also been proposed. This review is intended to bridge the gap between clinical and basic science by presenting recent findings on HAM/TSP disease, mechanisms of drug action, and benefits of these therapies in HAM/TSP patients.

  2. [Necrotic myelopathies and neoplastic pathologie. Three clinico-pathological cases (author's transl)].

    Science.gov (United States)

    Gray, F; Hauw, J J; Escourolle, R; Castaigne, P

    1980-01-01

    Three clinico-pathological cases of necrotic myelopathies with a distant malignancy are presented. Two cases had a lymphosarcoma and one case a prostatic carcinoma. They were compared to 13 well studied other cases collected in the literature. These myelopathies were related to solid visceral tumours in 8 cases and to lymphomas in 5 cases. The disease could be individualized on clinical grounds (flaccid paraplegia with bladder and bowell incontinence and sensory loss without clear-cut upper boundary developing over a few weeks with normal CSF and fast impairement of general condition), and, on pathological features. It is characterized by one or several spinal cord necrosis areas, often asymetrical, involving mostly white matter, without any vascular topography. Axons are involved as well as myelin sheats. There is mild inflammation and no specific vascular alteration. There is no metastases in the cord, meninges, vertebral column or nerve root. No vascular occlusion is found. The mechanism of the disease is unknown. The frequent occurence of lymphomas could suggest the presence of immunopathological factors.

  3. [Intact cervical pregnancy].

    Science.gov (United States)

    Habek, D; Bobic, M V; Dosen, L

    2003-01-01

    The authors describe a case of intact cervical pregnancy in a 24-year-old secundigravida. The patient was treated successfully with Methotrexate. Conservative treatment is the first choice in the therapy of uncomplicated cervical pregnancy. Conservative and operative therapeutic procedures are discussed.

  4. 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

  5. Cervical disc herniation. Follow-up studies on morphological changes seen by MRI

    Energy Technology Data Exchange (ETDEWEB)

    Nagata, Kensei; Ohashi, Teruaki; Ishibashi, Kazumasa; Abe, Jun; Morita, Masakazu; Hirohashi, Akiyuki; Satou, Kimiaki; Ishida, Hyota; Inoue, Akio [Kurume Univ., Fukuoka (Japan). School of Medicine

    1996-03-01

    In recent years, many authors have reported that an extruded lumbar intervertebral disc was absorbed through phagocytosis and dehydration. However, absorption of an extruded cervical intervertebral disc has rarely been reported. We have investigated the follow-up MRI of all 24 patients with cervical disc herniation seen between 1991 and 1995. Of these, 8 patients with radiculopathy and 7 with myelopathy had been treated nonoperatively, and a further 9 patients with severe myelopathy had undergone expansive laminoplasty. In follow-up MRI, a reduction in the size of the extruded disc was seen in 5 of the 15 nonoperative patients and in 8 of the 9 operative patients. The 9 operative patients showed a mean recovery rate of 68.4{+-}15.2% (range from 44 to 90%) according to their JOA score. In the nonoperative group, recovery of symptoms was seen in all 5 patients with reduction, and in only 4 of 10 patients with nonreduction. The initial MRI of the 5 patients with reduction was taken between 2 and 7 weeks (mean 4 weeks) after onset, and between 1 month and 14 years (mean 13 months, not including the one at 14 years) after onset in the 10 patients with nonreduction. The initial MRI of the 9 operative patients was taken between 1 month and 6 years (mean 14 months after onset). The pathomechanism for disc reduction was concluded to have been the same as for lumbar disc herniation in the nonoperative patients. However, the pathomechanism in the operative patients was inconclusive and was likely to be different from that in the nonoperative patients. (author).

  6. Hematoma in the cervical ligamentum flavum. Report of a case and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Tamura, Tatsuya; Sakai, Toshinori; Sairyo, Koichi; Katoh, Shinsuke; Yasui, Natsuo [The University of Tokushima Graduate School, Department of Orthopedics, Institute of Health Biosciences, Tokushima (Japan); Takao, Shoichiro [The University of Tokushima Graduate School, Department of Radiology, Institute of Health Biosciences, Tokushima (Japan); Kagawa, Seiko [The University of Tokushima Graduate School, Department of Human Pathology, Institute of Health Biosciences, Tokushima (Japan)

    2010-03-15

    Hematoma of the cervical ligamentum flavum is very rare, and its pathogenesis is unknown. We describe a case of ligamentum flavum hematoma in the cervical spine causing severe myelopathy. Postoperative histological examination suggested it was the result of the rupture of a hemangioma or of an arteriovenous malformation in the ligamentum flavum. After removal of the lesion, the patient's condition immediately improved. Review of all three reported cases, including this one, showed that complete resection of the mass resulted in immediate relief of symptoms of incomplete paraplegia. The findings of magnetic resonance imaging (MRI) of the hematoma may vary with time, and they may show no characteristic intensity. However, MRI of this case revealed that the tissues surrounding the mass were enhanced with gadolinium diethylene triamine penta-acetic acid, and an area of homogeneous iso-intensity was clearly surrounded by a low-intensity area (flavum) on T2-weighed short-tau inversion recovery images. These findings could be characteristic of the ligamentum flavum hematoma and might help in the differentiation from a cervical epidural hematoma. (orig.)

  7. Changes of sagittal balance of cervical spine after open-door expansive laminoplasty%颈后路单开门椎管扩大椎板成形术后颈椎矢状面平衡的变化

    Institute of Scientific and Technical Information of China (English)

    林圣荣; 周非非; 孙宇; 陈仲强; 张凤山; 潘胜发

    2014-01-01

    Objective To explore the changes of sagittal balance of cervical spine after open-door expansive laminoplasty.Methods The clinical and radiological data were analyzed retrospectively for 90 patients undergoing open-door expansive laminoplasty due to cervical spondylotic myelopathy.The Japanese Orthopedic Association (JOA) score and 3 cervical sagittal parameters including C2-C7 SVA,C0-2 Cobb angle and T1-Slope on lateral view radiographs were recorded before operation and at the final follow-up.Results The average follow-up period was 16.7 (3-40) months.The post-operative JOA score rose to 14.6 ±0.2 from pre-operative 12.2 ±0.3 with 43.5% ±4.2% recovery rate.The post-operative values of C2-C7 SVA,C0-2 Cobb angle and T1-Slope were significantly different from pre-operative ones (P =0.022,P <0.001,P =0.002).C2-C7 SVA increased to (23.0 ± 1.2) mm from pre-operative (20.7 ± 1.1) mm.C0-2 Cobb angle increased (23.1 ± 0.8) ° from pre-operative (19.9 ± 0.8) ° ; T1-Slope increased to (26.2 ± 0.7) ° from pre-operative (25.1 ± 0.7) °.The changes of C0-2 Cobb angle and T1-Slope were correlated with that of C2-C7 SVA respectively (Pearson =0.469,P < 0.001) (Pearson =0.303,P =0.004).Patients with higher preoperative T1-Slope had less JOA improvement(31.5% vs 53.7%,P =0.019)than those with lower preoperative T1-Slope after laminoplasty.Conclusion The sagittal balance of cervical spine significantly changes after open-door expansive laminoplasty with forward tilting of cervical vertebra.And compensation occurs by excessive high-strength contraction of posterior muscles to maintain lordosis in upper cervical spine.A higher pre-OP T1-Slope affects the outcomes of open-door expansive laminoplasty.%目的 探索颈后路椎管扩大椎板成形术后颈椎矢状位平衡变化.方法 2008年1月至2011年7月北京大学第三医院骨科对90例因脊髓型颈椎病接受C3-C7颈后路单开门椎管扩大椎板成形术患者的临床和影像学资料进

  8. 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.

  9. Mini-plate fixation versus suture suspensory fixation in cervical laminoplasty

    Science.gov (United States)

    Liu, Feng-Yu; Ma, Lei; Huo, Li-Shuang; Cao, Yan-Xiang; Yang, Da-Long; Wang, Hui; Yang, Si-Dong; Ding, Wen-Yuan

    2017-01-01

    Abstract Background: Both the mini-plate fixation and suture suspensory fixation techniques are extensively applied in cervical laminoplasty, but which technique is superior has not been ascertained. The purpose of this meta-analysis is to compare the results between mini-plate fixation and suture suspensory fixation in cervical laminoplasty for the patients with multilevel cervical compressive myelopathy. Methods: PubMed, Embase, the Cochrane library, CNKI, and WANFANG were searched for studies that compared mini-plate fixation and suture suspensory fixation in cervical laminoplasty up to November 1, 2016. We calculated odds ratio (OR) with 95% confidence interval (CI) for dichotomous outcomes and mean difference (MD) with 95% CI for continuous outcomes. Review Manager 5.3 was used for the statistical analyses. Results: A total of 25 studies, involving 1603 participants, were included in this review. The results of this meta-analysis indicated that there were statistically significant differences in postoperative Japanese Orthopedic Association (JOA) scores (MD = 0.67, 95% CI: 0.34–0.99, P statistically significant difference in C5 palsy (OR = 0.82, 95% CI: 0.37–1.84, P = 0.63). Conclusions: As compared with suture suspensory fixation, mini-plate fixation in cervical laminoplasty appears to achieve better clinical and radiographic outcomes with fewer surgical complications. However, mini-plate fixation is associated with bigger surgical trauma. This conclusion should be interpreted cautiously and more high-quality, randomized controlled trials are needed in the future. PMID:28151906

  10. Immunohistochemical screening for viral agents in cheetahs (Acinonyx jubatus) with myelopathy.

    Science.gov (United States)

    Shibly, S; Schmidt, P; Robert, N; Walzer, C; Url, A

    2006-10-21

    Numerous cases of acute-onset progressive ataxia, hindlimb paresis and paralysis of unknown aetiology occurred during 1993 to 2003 in cheetahs (Acinonyx jubatus) within the European Endangered Species Programme (eep). This study describes the immunohistochemical investigation of a possible viral aetiology of the "cheetah myelopathy". Antibodies to feline herpesvirus type 1, canine distemper virus, canine parvovirus and Borna disease virus were applied to formalin-fixed and paraffin-embedded brain and spinal cord sections from 25 affected cheetahs aged between three-and-a-half months and 13 years. Using the avidin-biotin complex technique, none of the antibodies gave positive immunosignals in either the brain or the spinal cord tissue.

  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 spine CT scan

    Science.gov (United States)

    ... defects of the cervical spine Bone problems Fracture Osteoarthritis Disc herniation Risks Risks of CT scans include: ... Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, ...

  14. Cervical Radiculopathy (Pinched Nerve)

    Science.gov (United States)

    ... help relieve pain, strengthen neck muscles, and improve range of motion. In some cases, traction can be used to ... Learn more about surgery for radiculopathy online at Cervical ... a wide range of musculoskeletal conditions and injuries. All articles are ...

  15. 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.

  16. Dolor cervical incoercible

    Directory of Open Access Journals (Sweden)

    Adrián F Narváez-Muñoz

    2014-03-01

    Astrocytomas are relatively common glial neoplasm of the central nervous system, but only a small percentage of them are located in the spinal cord, with a predilection for the cervical and dorsal regions. In most cases, extend longitudinally, affecting several cord segments. Pain is a frequent symptom of local character bone segments involving the tumor, associated with sensory deficit and / or motor. The following is the case of a 60 year old woman with cervical cord astrocytoma extended to the brainstem.

  17. 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.

  18. 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.

  19. 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

  20. Dynamic' MR imaging of the cervical cord in patients with cervical spondylosis and ossification of the posterior longitudinal ligament; Significance of dynamic cord compression

    Energy Technology Data Exchange (ETDEWEB)

    Ando, Tetsuo; Itoh, Takayuki; Takahashi, Akira (Nagoya Univ. (Japan). Faculty of Medicine); Yanagi, Tsutomu; Yamamura, Akiko

    1992-01-01

    This investigation was designed to assess the influence of dynamic cord compression on severity and course of myelopathy. Sixty-seven patients consisted of 54 cases of cervical spondylosis and 13 cases of ossification of posterior longitudinal ligament. These patients underwent 'dynamic' MRI imaging of the cervical spine. MR images in the sagittal view were obtained in three different neck positions: flexion, neutral, and extension. MR imaging was performed with a 0.15 T resistive unit. For technical reasons, the body coil was used. The pulse sequence was 500/30 (Tr msec/echo time msec) for T1 images. The spinal cord compression was accelerated in 32 cases when extended, in 2 cases when flexsed, and in 4 cases when both extended and flexed. In 21 cases, we compared myelograms with MR images in the same neck position. Findings of myelograms well corresponded with those of MR images on 83 percent of intervertebral levels. The patients with dynamic cord compression were proved to have severer long tract signs, and their disability was regressive or progressive case by case for an average of 21-month follow-up. The 'dynamic' MR imaging can provide dynamic nature of spinal cord compression, and prognostic clues. (author).

  1. Biomechanical evaluation of DTRAX® posterior cervical cage stabilization with and without lateral mass fixation

    Directory of Open Access Journals (Sweden)

    Voronov LI

    2016-08-01

    Full Text Available Leonard I Voronov,1,2 Krzysztof B Siemionow,3 Robert M Havey,1,2 Gerard Carandang,2 Avinash G Patwardhan1,2 1Department of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago, Maywood, 2Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. VA Hospital, Hines, 3Department of Orthopaedics, University of Illinois College of Medicine at Chicago, Chicago, IL, USA 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: Seven 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

  2. Cervical perineural cyst masquerading as a cervical spinal tumor.

    Science.gov (United States)

    Joshi, Vijay P; Zanwar, Atul; Karande, Anuradha; Agrawal, Amit

    2014-04-01

    Tarlov (perineural) cysts of the nerve roots are common and usually incidental findings during magnetic resonance imaging of the lumbosacral spine. There are only a few case reports where cervical symptomatic perineural cysts have been described in the literature. We report such a case where a high cervical perineural cyst was masquerading as a cervical spinal tumor.

  3. Risks of Cervical Cancer Screening

    Science.gov (United States)

    ... are at increased risk for HPV infections. Other risk factors for cervical cancer include: Giving birth to many children. Smoking cigarettes. Using oral contraceptives ("the Pill"). Having a weakened immune system . Cervical Cancer Screening ...

  4. Invasive cervical resorption: treatment challenges

    OpenAIRE

    2012-01-01

    Invasive cervical resorption is a relatively uncommon form of external root resorption. It is characterized by invasion of cervical region of the root by fibrovascular tissue derived from the periodontal ligament. This case presents an invasive cervical resorption occurring in maxillary lateral incisor, following damage in cervical cementum from avulsion and intracoronal bleaching procedure. Flap reflection, debridement and restoration with glass ionomer cement were performed in an attempt to...

  5. 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.

  6. Prognostic factors in cervical cancer

    NARCIS (Netherlands)

    Biewenga, P.

    2015-01-01

    Surgery is the standard of care for women with early stage cervical cancer; radiotherapy is the cornerstone in patients with advanced stages of disease. Recent changes in the treatment of cervical cancer involve less radical surgery in early stage cervical cancer, concomitant chemo- and radiotherapy

  7. Cervical deciduosis imitating dysplasia.

    Science.gov (United States)

    van Diepen, Diederik Anthony; Hellebrekers, Bart; van Haaften, Anne-Marie; Natté, Remco

    2015-09-22

    Ectopic cervical deciduosis is generally an accidental finding during pregnancy, and usually presents without any symptoms or need for therapeutic intervention. However, it can sometimes imitate dysplasia or carcinoma. We report a case of a 34-year-old G2P0, with a history of cervical dysplasia, presenting at 11 weeks of gestation, with vaginal blood loss. During examination, lesions mimicking dysplasia were found on the cervix. Histological examination reported cervical deciduosis. Deciduosis is a benign change during pregnancy and will resolve spontaneously. With the increasing use of cytology and colposcopy, the reported incidence is growing. When it is hard to differentiate between dysplasia and deciduosis, histological confirmation should be considered.

  8. Etanercept-Induced Myelopathy in a Pediatric Case of Blau Syndrome

    Directory of Open Access Journals (Sweden)

    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. Possible etiologies for tropical spastic paraparesis and human T lymphotropic virus I-associated myelopathy

    Directory of Open Access Journals (Sweden)

    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.

  10. Proprioceptive neuromuscular facilitation in HTLV-I-associated myelopathy/tropical spastic paraparesis

    Directory of Open Access Journals (Sweden)

    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.

  11. A 66-Year-Old Woman with a Progressive, Longitudinally Extensive, Tract Specific, Myelopathy

    Directory of Open Access Journals (Sweden)

    Elizabeth O’Keefe

    2016-01-01

    Full Text Available A 66-year-old woman presented with progressive lancinating pain and sensory deficits attributable to a myelopathy of unclear etiology. Spinal cord magnetic resonance imaging showed a longitudinally extensive T2-hyperintense lesion of the dorsal columns. Comprehensive serum, urine, and cerebrospinal fluid analyses failed to identify an etiology. Empiric intravenous methylprednisolone and intravenous immunoglobulin were of no benefit and serial screens for an occult malignancy were negative. She developed dysesthesias and allodynia affecting her entire body and lost the use of her arms and legs due to severe sensory ataxia that was steadily progressive from onset. She opted against additional aggressive medical management of her condition and passed away on hospice eleven months after symptom onset. Autopsy revealed findings most consistent with polyphasic spinal cord ischemia affecting the dorsal and lateral white matter tracts and, to a lesser extent, adjacent gray matter. The underlying etiology for the progressive vasculopathy remains unknown. Spinal cord ischemia affecting the posterior spinal cord is rare and to our knowledge this case represents the only instance of a progressive spinal cord tractopathy attributable to chronic spinal cord ischemia.

  12. [Central nervous system leukemia mimicking rapidly progressive HTLV-1 associated myelopathy].

    Science.gov (United States)

    Haruki, Hiroyo; Tanaka, Shinichiro; Koga, Michiaki; Kawai, Motoharu; Negoro, Kiyoshi; Kanda, Takashi

    2009-03-01

    A 79-year-old woman was suffered from rapidly progressive paresthesia of lower limbs and gait disturbance. After one month, she showed flaccid paraplegia and hyperreflexia in the lower limbs with positive Babinski signs. Anti-HTLV-1 antibody titer was elevated in the serum, but negative in the cerebrospinal fluid (CSF). CSF examination showed mild pleocytosis, elevated protein, and normal glucose content. Adult T cell lymphoma (ATL)-like cells were seen in the CSF. MRI showed no abnormal intensity in the spinal cord and brain. Two months later, she showed rapid worsening of the paraplegia and she became unable to stand. A tentative diagnosis of rapidly progressive HTLV-1 associated myelopathy (HAM) was given, but intravenous methylprednisolone was ineffective. Six months later, she developed pneumonia, and abundant ATL cells were seen in the peripheral blood, suggesting a diagnosis of ATL. Direct infiltration of ATL cells to central nervous system was therefore suggested to have caused neurological abnormalities in this case. One may consider central nervous system leukemia when rapidly progressive HAM-like symptoms and signs are recognized, especially without positive anti-HTLV-1 antibody in the CSF.

  13. Cervical Cancer Prevention

    Science.gov (United States)

    ... infected with HPV, those who have used oral contraceptives ("the Pill") for 5 to 9 years have a risk of cervical cancer that is 3 times greater than that of women who have never used oral contraceptives. The risk is 4 times greater after 10 ...

  14. 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.

  15. 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

  16. 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

  17. Flexion/extension cervical spine views in blunt cervical

    OpenAIRE

    Nasir Sadaf; Hussain Manzar; Mahmud Roomi

    2012-01-01

    【Abstract】Objective: To examine the contribution of flexion and extension radiographs in the evaluation of ligamentous injury in awake adults with acute blunt cervical spine trauma, who show loss of cervical lordosis and neck pain. Methods: All patients who presented to our emer-gency department following blunt trauma were enrolled in this study, except those with schiwora, neurological defi-cits or fracture demonstrated on cross-table cervical spine X-rays, and tho...

  18. Solitary extramedullary plasmacytoma of thoracic epidural space presenting with dorsal compressive myelopathy: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Amandeep Kumar

    2015-01-01

    Full Text Available Plasma Cell neoplasms result from monoclonal proliferation of plasma cells. Solitary extramedullary plasmacytomas (SEMPs are rare and constitute 5% of all plasma cell disorders. SEMPs most commonly involve upper aerodigestive tract. Isolated spinal epidural space involvement by SEMPs is extremely rare and to best of our knowledge only 7 such cases have been reported previously in available English literature. We hereby present a rare case of thoracic epidural SEMP in a 32-year-old female who presented with thoracic compressive myelopathy and discuss the pertinent literature.

  19. Subacute post-traumatic ascending myelopathy (SPAM: Two cases of SPAM following surgical treatment of thoracolumbar fractures

    Directory of Open Access Journals (Sweden)

    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.

  20. The Biomechanics of Cervical Spondylosis

    OpenAIRE

    Ferrara, Lisa A.

    2012-01-01

    Aging is the major risk factor that contributes to the onset of cervical spondylosis. Several acute and chronic symptoms can occur that start with neck pain and may progress into cervical radiculopathy. Eventually, the degenerative cascade causes desiccation of the intervertebral disc resulting in height loss along the ventral margin of the cervical spine. This causes ventral angulation and eventual loss of lordosis, with compression of the neural and vascular structures. The altered posture ...

  1. Os Odontoideum: Rare Cervical Lesion

    Science.gov (United States)

    2011-11-01

    the articulation between C1 and the os odontoideum on flexion imaging. The remainder of his cervical vertebral bodies had normal alignment with no...appears normal. Figure 3. Flexion view of plain cervical spine. This image shows abnormal translation of the articulation between C1 and the C2 os...worldwide. Peer Reviewed Title: Os Odontoideum: Rare Cervical Lesion Journal Issue: Western Journal of Emergency Medicine, 12(4) Author: Robson

  2. Chronic Pseudomonas aeruginosa cervical osteomyelitis

    Directory of Open Access Journals (Sweden)

    Sujeet Kumar Meher

    2016-01-01

    Full Text Available Pseudomonas aeruginosa is a rare cause of osteomyelitis of the cervical spine and is usually seen in the background of intravenous drug use and immunocompromised state. Very few cases of osteomyelitis of the cervical spine caused by pseudomonas aeruginosa have been reported in otherwise healthy patients. This is a case presentation of a young female, who in the absence of known risk factors for cervical osteomyelitis presented with progressively worsening neurological signs and symptoms.

  3. Mucopurulent cervicitis: a clinical entity?

    OpenAIRE

    Willmott, F E

    1988-01-01

    Of 297 women attending a sexually transmitted disease clinic who were examined for the presence of mucopurulent cervicitis, 96 (32%) satisfied the diagnostic criteria. Mucopurulent cervicitis was strongly associated with the isolation of Chlamydia trachomatis and Neisseria gonorrhoeae. It was also associated with bacterial vaginosis, the use of oral contraceptives, and sexual contact with men who had non-gonococcal urethritis. Conversely, the presence of opaque cervical secretions did not sho...

  4. Genetic testing of canine degenerative myelopathy in the South African Boxer dog population

    Directory of Open Access Journals (Sweden)

    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. Urodynamic profile of patients with neurogenic bladder following non-traumatic myelopathies

    Directory of Open Access Journals (Sweden)

    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.

  6. An occult cervical spine fracture.

    Science.gov (United States)

    Khosla, R

    1997-12-01

    A 16-year-old athlete developed neck pain after being dropped on his head with his neck flexed while recreationally wrestling. Initial cervical spine radiographs were negative, but he continued to have neck and arm pain, especially after heading a wet soccer ball. Two months after the initial injury, he had a positive Spurling test; cervical spine CT then revealed a parasagittal linear fracture through the body of C-7. The patient avoided contact and collision activities and had no further physical problems. For patients who suffer cervical spine trauma, adequate visualization of the cervical spine can help prevent catastrophic outcomes.

  7. Drugs Approved for Cervical Cancer

    Science.gov (United States)

    ... Human Papillomavirus (HPV) Nonavalent Vaccine Recombinant Human Papillomavirus (HPV) Quadrivalent Vaccine Drugs Approved to Treat Cervical Cancer Avastin (Bevacizumab) Bevacizumab Blenoxane (Bleomycin) Bleomycin Hycamtin (Topotecan ...

  8. 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.

  9. 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.

  10. SUPERFICIAL CERVICAL PLEXUS BLOCK

    Directory of Open Access Journals (Sweden)

    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.

  11. Preinduction cervical ripening.

    Science.gov (United States)

    Thiery, M

    1983-01-01

    This work reviews the evolution of cervical ripening procedures and discusses the most effective current techniques. Current knowledge of the process of spontaneous ripening of the cervix is briefly assessed, but the review concentrates on methodological aspects and the clinical results of preinduction cervical ripening. The historical development of mechanical and pharmacologic ripening procedures is examined, including enzymes, oxytocin, relaxin, corticosteriods, estrogens administered parenterally or locally, and prostaglandins (PGs) administered intravenously, orally, locally, and intravaginally. 3 effective procedures for preinduction cervical ripening are identified and described in greater detail: the catheter technique and local and vaginal administration of PGs. The extraamniotic catheter technique is simple, effective, and safe and is recommended for patients with not totally unripe cervixes and for whom PGs are unavailable or contraindicated. Single-dose extraamniotic instillation of PGE2 in Tylose gel was found to be highly effective for priming the unfavorable cervix before conventional labor induction. In some patients the procedure induces labor. The technique is easy to use, well accepted by the woman, and safe when applied appropriately to carefully selected patients. PGF2alpha gel has been less thoroughly studied. Electronic monitoring at the ripening stage is recommended for patients at risk, and even in low-risk cases much larger series will require study before conclusions can be reached about safety. Injection of PG gel into the cervical canal is less invasive than extraamniotic instillation, but no definite conclusions about its safety are possible due to small series and dissimilar clinical protocols. Pericervical administration of PGE2 and PGF2 alpha and intracervical and intraamniotic tablets of PGE2 are briefly assessed. Adoption of the intravaginal route has been a major step in the development of ripening techniques. 3 types of media

  12. [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.

  13. Cervical spinal canal narrowing and cervical neurologi-cal injuries

    Directory of Open Access Journals (Sweden)

    ZHANG Ling

    2012-04-01

    Full Text Available 【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, the mean transverse diameter at the same levels ranges from 24.45 mm to 27.00 mm and the mean value of Torg ratio is 0.96. With respect to narrow cervical spinal canal, the following charaterstics are found: firstly, extension of the cervical spine results in statistically significant stenosis as compared with the flexed or neutral positions; secondly, females sustain cervical spinal canal narrowing more easily than males; finally, the consistent narrowest cervical canal level is at C 4 for all ethnicity, but there is a slight variation in the sagittal diameter of cervical spinal stenosis (≤14 mm in Whites, ≤ 12 mm in Japanese, ≤13.7 mm in Chinese. Narrow sagittal cervical canal diameter brings about an increased risk of neurological injuries in traumatic, degenerative and inflam-matory conditions and is related with extension of cervical spine, gender, as well as ethnicity. It is hoped that this re-view will be helpful in diagnosing spinal cord and neuro-logical injuries with the geometric parameters of cervical spine in the future. Key words: Spinal cord injuries; Spinal stenosis; Trauma, nervous system

  14. Cervical spinal canal narrowing and cervical neurological injuries

    Institute of Scientific and Technical Information of China (English)

    ZHANG Ling; CHEN Hai-bin; WANG Yi; ZHANG Li-ying; LIU Jing-cheng; WANG Zheng-guo

    2012-01-01

    Cervical spinal canal narrowing can lead to injury of the spinal cord and neurological symptoms including 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 C1 to C7 ranges from 15.33 mm to 20.46 mm,the mean transverse diameter at the same levels ranges from 24.45 mm to 27.00 mm and the mean value of Torg ratio is 0.96.With respect to narrow cervical spinal canal,the following charaterstics are found:firstly,extension of the cervical spine results in statistically significant stenosis as compared with the flexed or neutral positions; secondly,females sustain cervical spinal canal narrowing more easily than males;finally,the consistent narrowest cervical canal level is at C4 for all ethnicity,but there is a slight variation in the sagittal diameter of cervical spinal stenosis(≤ 14 mm in Whites,≤12 mm in Japanese,≤ 13.7 mm in Chinese).Narrow sagittal cervical canal diameter brings about an increased risk of neurological injuries in traumatic,degenerative and inflammatory conditions and is related with extension of cervical spine,gender,as well as ethnicity.It is hoped that this review will be helpful in diagnosing spinal cord and neurological injuries with the geometric parameters of cervical spine in the future.

  15. 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.

  16. Mielopatía Degenerativa canina: signos clínicos, diagnóstico y terapéutica (Canine degenerative myelopathy: clinical signs, diagnosis and therapy)

    OpenAIRE

    2011-01-01

    ResumenLa mielopatía degenerativa canina es una enfermedad neurológica progresiva autoinmune que afecta principalmente a caninos adultos de talla grande sin predilección de sexo.SummaryCanine degenerative myelopathy is a progressive neurological autoimmune disease that primarily affects large size adult dogs and no sex predilection.

  17. Mielopatía Degenerativa canina: signos clínicos, diagnóstico y terapéutica (Canine degenerative myelopathy: clinical signs, diagnosis and therapy

    Directory of Open Access Journals (Sweden)

    Suraniti, A.P

    2011-08-01

    Full Text Available ResumenLa mielopatía degenerativa canina es una enfermedad neurológica progresiva autoinmune que afecta principalmente a caninos adultos de talla grande sin predilección de sexo.SummaryCanine degenerative myelopathy is a progressive neurological autoimmune disease that primarily affects large size adult dogs and no sex predilection.

  18. Significance of cervical length and cervical gland area in cervical maturation

    Directory of Open Access Journals (Sweden)

    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

  19. Spondilitis Tuberkulosa Cervical

    Directory of Open Access Journals (Sweden)

    Roni Eka Saputra

    2015-05-01

    Full Text Available Abstrak Spondilitis tuberkulosa servikalis adalah penyakit yang cukup jarang dijumpai, hanya berkisar 2-3% dariseluruh kasus spondilitis tuberkulosa. Gambaran klinis sangat bervariasi, mulai dari gejala ringan dan tidak spesifikhingga komplikasi neurologis yang berat. Seorang wanita berusia 29 tahun datang dengan keluhan lemah keempatanggota gerak yang semakin memberat dalam 10 hari terakhir yang didahului oleh nyeri leher yang menjalar ke bahudan lengan sejak 6 bulan sebelumnya. Nyeri awalnya dirasakan sebagai keterbatasan gerakan leher saat menolehkesamping kiri dan kanan serta menundukkan kepala. Nyeri dirasakan semakin berat dengan pergerakan danberkurang jika istirahat. Pasien mengalami penurunan berat badan sejak 2 bulan terakhir. Tidak dijumpai riwayat batukatau nyeri dada. Pemeriksaan neurologis menunjukkan kelemahan  pada keempat ekstremitas. Hasil laboratoriumditemukan peningkatan Laju Endap Darah (LED. Rontgen foto toraks dalam batas normal. Roentgen foto cervicalmenunjukkan destruksi setinggi C5. MRI cervical menunjukkan destruksi pada korpus C5-6 dengan penyempitan padadiscus intervertebrae C5-6 disertai dengan  massa/abses paravertebral dengan penekanan ke posterior. MRI Thorakaltampak destruksi corpus verebre T4,5 dengan diskus intervertebralis yang menyempit. Sugestif suatu spondilitistuberkulosa. Pasien dilakukan tindakan pembedahan anterior corpectomi melalui microscopic surgery dengan graftdari iliac sinistra, serta insersi anterior plate 1 level. Hasil pemeriksaan patologi anatomi menunjukkan spodilitis TBCkaseosa. Pada spondilitis vertebre T4,5 dilakukan laminectomi, debridement costotrasversektomi, dan stabilisasidengan pedicle screw T2, T3, dan T5. Pasien diterapi dengan obat antituberkulosis. Keadaan pasien saat ini, pasiensudah bisa beraktifitas normal dengan motorik dan sensorik baik. Spondilitis tuberkulosa merupakan bentuktuberkulosa tulang yang paling sering dijumpai. Spondilitis tuberkulosa cervical berkisar 2

  20. Flexion/extension cervical spine views in blunt cervical

    Directory of Open Access Journals (Sweden)

    Nasir Sadaf

    2012-06-01

    Full Text Available 【Abstract】Objective: To examine the contribution of flexion and extension radiographs in the evaluation of ligamentous injury in awake adults with acute blunt cervical spine trauma, who show loss of cervical lordosis and neck pain. Methods: All patients who presented to our emer-gency department following blunt trauma were enrolled in this study, except those with schiwora, neurological defi-cits or fracture demonstrated on cross-table cervical spine X-rays, and those who were either obtunded or presented after cervical spine surgery. Adequacy of flexion and exten-sion views was checked by the neurosurgery and radiology team members. All these patients underwent cross-table cervical spine view followed by flexion/extension views based on the loss of lordosis on cross-table imaging and the presence of neck pain. Results: A total of 200 cases were reviewed, of whom 90 (45% underwent repeat X-rays because of either inadequate exposure or limited motion. None of the patients with loss of lordosis on cross-table view had positive flexion and extension views of cervical spine for instability. Conclusions: Our results show that in patients who underwent acute radiographic evaluation of blunt cervical spine trauma, flexion and extension views of the cervical spine are unlikely to yield positive results in the presence of axial neck pain and/or loss of cervical lordosis. We can also hypothesize that performing flexion and extension views will be more useful once the acute neck pain has settled. Key words: X-rays; Cervical vertebrae; Lordosis

  1. MRI and PET Imaging in Predicting Treatment Response in Patients With Stage IB-IVA Cervical Cancer

    Science.gov (United States)

    2017-02-08

    Cervical Adenocarcinoma; Cervical Adenosquamous Carcinoma; Cervical Squamous Cell Carcinoma, Not Otherwise Specified; Cervical Undifferentiated Carcinoma; Recurrent Cervical Carcinoma; Stage IB2 Cervical Cancer; Stage II Cervical Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage IIIA Cervical Cancer; Stage IIIB Cervical Cancer; Stage IVA Cervical Cancer

  2. [Anterior cervical hypertrichosis: case report].

    Science.gov (United States)

    Orozco-Gutiérrez, Mario H; Sánchez-Corona, José; García-Ortiz, José E; Castañeda-Cisneros, Gema; Dávalos-Rodríguez, Nory O; Corona-Rivera, Jorge R; García-Cruz, Diana

    2016-10-01

    The non-syndromic anterior cervical hypertrichosis (OMIM N° 600457) is a genetic disorder characterized by a patch of hair at the level of the laryngeal prominence. We present a 12-year-old boy with anterior cervical hypertrichosis and mild generalized hypertrichosis. He has no neurological, ophthalmological or skeletal anomalies. The clinical follow up is 10 years.

  3. Extreme cervical elongation after sacrohysteropexy

    NARCIS (Netherlands)

    Vierhout, M.E.; Futterer, J.J.

    2013-01-01

    We present a case of extreme cervical elongation with a cervix of 12 cm after an unusual operation in which the uterine corpus was directly fixed to the promontory, and which became symptomatic after 8 years. The possible pathophysiology of cervical elongation is discussed. Diagnosing a case of seve

  4. The Biomechanics of Cervical Spondylosis

    Directory of Open Access Journals (Sweden)

    Lisa A. Ferrara

    2012-01-01

    Full Text Available Aging is the major risk factor that contributes to the onset of cervical spondylosis. Several acute and chronic symptoms can occur that start with neck pain and may progress into cervical radiculopathy. Eventually, the degenerative cascade causes desiccation of the intervertebral disc resulting in height loss along the ventral margin of the cervical spine. This causes ventral angulation and eventual loss of lordosis, with compression of the neural and vascular structures. The altered posture of the cervical spine will progress into kyphosis and continue if the load balance and lordosis is not restored. The content of this paper will address the physiological and biomechanical pathways leading to cervical spondylosis and the biomechanical principles related to the surgical correction and treatment of kyphotic progression.

  5. The biomechanics of cervical spondylosis.

    Science.gov (United States)

    Ferrara, Lisa A

    2012-01-01

    Aging is the major risk factor that contributes to the onset of cervical spondylosis. Several acute and chronic symptoms can occur that start with neck pain and may progress into cervical radiculopathy. Eventually, the degenerative cascade causes desiccation of the intervertebral disc resulting in height loss along the ventral margin of the cervical spine. This causes ventral angulation and eventual loss of lordosis, with compression of the neural and vascular structures. The altered posture of the cervical spine will progress into kyphosis and continue if the load balance and lordosis is not restored. The content of this paper will address the physiological and biomechanical pathways leading to cervical spondylosis and the biomechanical principles related to the surgical correction and treatment of kyphotic progression.

  6. Fractures of the cervical spine

    Directory of Open Access Journals (Sweden)

    Raphael Martus Marcon

    2013-11-01

    Full Text Available OBJECTIVES: The aim of this study was to review the literature on cervical spine fractures. METHODS: The literature on the diagnosis, classification, and treatment of lower and upper cervical fractures and dislocations was reviewed. RESULTS: Fractures of the cervical spine may be present in polytraumatized patients and should be suspected in patients complaining of neck pain. These fractures are more common in men approximately 30 years of age and are most often caused by automobile accidents. The cervical spine is divided into the upper cervical spine (occiput-C2 and the lower cervical spine (C3-C7, according to anatomical differences. Fractures in the upper cervical spine include fractures of the occipital condyle and the atlas, atlanto-axial dislocations, fractures of the odontoid process, and hangman's fractures in the C2 segment. These fractures are characterized based on specific classifications. In the lower cervical spine, fractures follow the same pattern as in other segments of the spine; currently, the most widely used classification is the SLIC (Subaxial Injury Classification, which predicts the prognosis of an injury based on morphology, the integrity of the disc-ligamentous complex, and the patient's neurological status. It is important to correctly classify the fracture to ensure appropriate treatment. Nerve or spinal cord injuries, pseudarthrosis or malunion, and postoperative infection are the main complications of cervical spine fractures. CONCLUSIONS: Fractures of the cervical spine are potentially serious and devastating if not properly treated. Achieving the correct diagnosis and classification of a lesion is the first step toward identifying the most appropriate treatment, which can be either surgical or conservative.

  7. Aquaporin-4 antibodies are not related to HTLV-1 associated myelopathy.

    Directory of Open Access Journals (Sweden)

    Felipe von Glehn

    Full Text Available INTRODUCTION: The seroprevalence of human T-cell leukemia virus type 1 (HTLV-1 is very high among Brazilians (1:200. HTLV-1 associated myelopathy or tropical spastic paraparesis (HAM/TSP is the most common neurological complication of HTLV-1 infection. HAM/TSP can present with an acute/subacute form of longitudinally extensive myelitis, which can be confused with lesions seen in aquaporin-4 antibody (AQP4-Ab positive neuromyelitis optica spectrum disorders (NMOSD on MRI. Moreover, clinical attacks in patients with NMOSD have been shown to be preceded by viral infections in around 30% of cases. OBJECTIVE: To evaluate the frequency of AQP4-Ab in patients with HAM/TSP. To evaluate the frequency of HTLV-1 infection in patients with NMOSD. PATIENTS AND METHODS: 23 Brazilian patients with HAM/TSP, 20 asymptomatic HTLV-1+ serostatus patients, and 34 with NMOSD were tested for AQP4-Ab using a standardized recombinant cell based assay. In addition, all patients were tested for HTLV-1 by ELISA and Western blotting. RESULTS: 20/34 NMOSD patients were positive for AQP4-Ab but none of the HAM/TSP patients and none of the asymptomatic HTLV-1 infected individuals. Conversely, all AQP4-Ab-positive NMOSD patients were negative for HTLV-1 antibodies. One patient with HAM/TSP developed optic neuritis in addition to subacute LETM; this patient was AQP4-Ab negative as well. Patients were found to be predominantly female and of African descent both in the NMOSD and in the HAM/TSP group; Osame scale and expanded disability status scale scores did not differ significantly between the two groups. CONCLUSIONS: Our results argue both against a role of antibodies to AQP4 in the pathogenesis of HAM/TSP and against an association between HTLV-1 infection and the development of AQP4-Ab. Moreover, the absence of HTLV-1 in all patients with NMOSD suggests that HTLV-1 is not a common trigger of acute attacks in patients with AQP4-Ab positive NMOSD in populations with high HTLV-1

  8. CDC Vital Signs: Cervical Cancer is Preventable

    Science.gov (United States)

    ... HPV vaccine can reduce risk of cervical cancer. HPV causes most cervical cancers. Only 1 in 3 girls and 1 in ... Signs – Cervical Cancer [PSA - 0:60 seconds] Cervical Cancer Preteen and Teen Vaccines Human Papillomavirus (HPV)-Associated Cancers What Should I Know About ...

  9. X-Ray Exam: Cervical Spine

    Science.gov (United States)

    ... Old Feeding Your 1- to 2-Year-Old X-Ray Exam: Cervical Spine KidsHealth > For Parents > X-Ray Exam: Cervical Spine A A A What's ... columna cervical What It Is A cervical spine X-ray is a safe and painless test that ...

  10. 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.

  11. [Cervical spine instability in the surgical patient].

    Science.gov (United States)

    Barbeito, A; Guerri-Guttenberg, R A

    2014-03-01

    Many congenital and acquired diseases, including trauma, may result in cervical spine instability. Given that airway management is closely related to the movement of the cervical spine, it is important that the anesthesiologist has detailed knowledge of the anatomy, the mechanisms of cervical spine instability, and of the effects that the different airway maneuvers have on the cervical spine. We first review the normal anatomy and biomechanics of the cervical spine in the context of airway management and the concept of cervical spine instability. In the second part, we review the protocols for the management of cervical spine instability in trauma victims and some of the airway management options for these patients.

  12. Flexion/extension cervical spine views in blunt cervical trauma

    Institute of Scientific and Technical Information of China (English)

    Sadaf Nasir; Manzar Hussain; Roomi Mahmud

    2012-01-01

    Objective: To examine the contribution of flexion and extension radiographs in the evaluation of ligamentous injury in awake adults with acute blunt cervical spine trauma,who show loss of cervical lordosis and neck pain.Methods: All patients who presented to our emergency department following blunt trauma were enrolled in this study,except those with schiwora,neurological deficits or fracture demonstrated on cross-table cervical spine X-rays,and those who were either obtunded or presented after cervical spine surgery.Adequacy of flexion and extension views was checked by the neurosurgery and radiology team members.All these patients underwent cross-table cervical spine view followed by flexion/extension views based on the loss of lordosis on cross-table imaging and the presence of neck pain.Results: A total of 200 cases were reviewed,of whom 90 (45%) underwent repeat X-rays because of either inadequate exposure or limited motion.None of the patients with loss of lordosis on cross-table view had positive flexion and extension views of cervical spine for instability.Conclusions: Our results show that in patients who underwent acute radiographic evaluation of blunt cervical spine trauma,flexion and extension views of the cervical spine are unlikely to yield positive results in the presence of axial neck pain and/or loss of cervical lordosis.We can also hypothesize that performing flexion and extension views will be more useful once the acute neck pain has settled.

  13. Two cases of cervical disc disease with intramedullary pathological changes, which are responsible for their neurological syndromes, on delayed CT myelography

    Energy Technology Data Exchange (ETDEWEB)

    Isu, Toyohiko; Iwasaki, Yoshinobu; Abe, Hiroshi; Tashiro, Kunio; Murai, Hiroshi; Miyasaka, Kazuo

    1987-08-01

    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.

  14. Cervical extravasation of bevacizumab.

    Science.gov (United States)

    Dréanic, Johann; Coriat, Romain; Mir, Olivier; Perkins, Géraldine; Boudou-Rouquette, Pascaline; Brezault, Catherine; Dhooge, Marion; Goldwasser, François; Chaussade, Stanislas

    2013-04-01

    Monoclonal antibodies such as bevacizumab are widely used in medical oncology, either alone or in combination with chemotherapy. No specific recommendations on the management of monoclonal antibodies extravasation exist. Incidence rates vary considerably. Estimates of 0.5-6% have been reported in the literature. Also, patient-associated and procedure-associated risk factors of extravasation are multiple, such as bolus injections or poorly implanted central venous access. We report on an 86-year-old woman with colon cancer with liver metastasis who was treated with 5-fluorouracil, folinic acid, and bevacizumab. Extravasation occurred during chemotherapy infusion because of a catheter migration of the port outside of the superior vena cava, causing cervical pain without skin modifications. Diagnosis was confirmed with the appearance of clinical right cervical tumefaction and cervicothoracic computed tomography scan indicated a perijugular hypodense collection, corresponding to the extravasation. Conservative management was proposed. The patient recovered within 3 weeks from all symptoms. Physicians should be aware that in cases of bevacizumab extravasation, a nonsurgical approach might be effective.

  15. 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.

  16. Tuina treatment in cervical spondylosis

    Directory of Open Access Journals (Sweden)

    Florin Mihai Hinoveanu

    2010-12-01

    Full Text Available Cervical spondylosis is a common, chronic degenerative condition of the cervical spine that affects the vertebral bodies and intervertebral disks of the neck as well as the contents of the spinal canal. Common clinical syndromes associated with cervical spondylosis include cervical pain, cervical radiculopathy and/or mielopathy. This study show the main principles, indication and side effects of tuina in cervical spondylosis´ treatment; tuina is one of the external methods based on the principles of Traditional Chinese Medicine (TCM, especially suitable for use on the elderly population and on infants. While performing Tuina, the therapist concentrates his mind, regulates his breathing, and actuates the Qi and power of his entire body towards his hands. For a better result is recommended to try to combine acupuncture with tuina treatment. Tuina can help relieve the pain associated with spondylosis. After this kind of treatment, the symptomes produced by irritated nerves and sore muscles can find some relief. Tuina helps patients with cervical spondylosis regain muscle control, nerve function and flexibility, all through the restoration of the life force flow.

  17. Night blindness due to vitamin A deficiency associated with copper deficiency myelopathy secondary to bowel bypass surgery.

    Science.gov (United States)

    AlHassany, Ali Abdul Jabbar

    2014-04-29

    We present an interesting case of combined vitamin A and copper deficiency after a history of gastric bypass surgery where symptoms improved after parenteral copper and vitamin A treatment. Gastric bypass surgery as a cause of fat soluble vitamin deficiency is generally under-reported. Copper deficiency has been reported after gastric bypass surgery. Vitamin A deficiency after gastric bypass surgery has also been reported in the literature, but the reported cases again fall below the actual figures. B12 and folate deficiencies can produce a type of myelopathy similar to that produced by copper deficiency, and differentiation on the basis of laboratory tests, neurophysiology and improvement of symptoms after replacement therapy might be the hallmark of diagnosis. Combinations of vitamin deficiencies were previously reported, but no cases of combined vitamin A and copper deficiency could be found in the literature.

  18. 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

  19. Cervical cancer screening at crossroads

    DEFF Research Database (Denmark)

    Lynge, Elsebeth; Rygaard, Carsten; Baillet, Miguel Vazquez-Prada;

    2014-01-01

    Cervical screening has been one of the most successful public health prevention programmes. For 50 years, cytology formed the basis for screening, and detected cervical intraepithelial lesions (CIN) were treated surgically to prevent progression to cancer. In a high-risk country as Denmark......, screening decreased the incidence of cervical cancer from 34 to 11 per 100,000, age-standardized rate (World Standard Population). Screening is, however, also expensive; Denmark (population: 5.6 million) undertakes close to half a million tests per year,