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1

Surgical Management of Cervical Spondylotic Myelopathy  

PubMed Central

Cervical spondylosis is a common degenerative condition that is a significant cause of morbidity. This review discusses the pathophysiology and natural history of cervical spondylotic myelopathy and focuses on the current literature evaluating the clinical management of these patients.

Hsu, Wesley; Dorsi, Michael J.; Witham, Timothy F.

2010-01-01

2

Anterior approach for complex cervical spondylotic myelopathy.  

PubMed

Cervical spondylotic myelopathy (CSM) is a slowly progressive disease resulting from age-related degenerative changes in the spine that can lead to spinal cord dysfunction and significant functional disability. The degenerative changes and abnormal motion lead to vertebral body subluxation, osteophyte formation, ligamentum flavum hypertrophy, and spinal canal narrowing. Repetitive movement during normal cervical motion may result in microtrauma to the spinal cord. Disease extent and location dictate the choice of surgical approach. Anterior spinal decompression and instrumented fusion is successful in preventing CSM progression and has been shown to result in functional improvement in most patients. PMID:22082628

Siemionow, Krzysztof B; Neckrysh, Sergey

2012-01-01

3

Posterior column dysfunction in cervical spondylotic myelopathy.  

PubMed

Five patients had cervical spondylotic myelopathy (CSM) with severe prorioceptive sensory loss in the upper and lower limbs. Despite an advanced age, each recovered considerable function following cervical laminectomy, in follow-up periods of 10 to 40 months. The role of newer methods of investigation including CT scanning, somatosensory evoked responses and nuclear magnetic resonance is discussed. The cause of the proprioceptive sensory loss in these patients cannot be definitively determined, but various ischemic and compressive lesions are discussed as possible pathogenetic mechanisms. PMID:6467087

MacFadyen, D J

1984-08-01

4

Effects of surgery on cervical spondylotic myelopathy.  

PubMed

The results of surgery for treatment of cervical spondylotic myelopathy (CSM) were assessed 3 months (early results) and 2-8 years (late results) postoperatively in 99 patients. Extensive laminectomy as well as anterior decompression and fusion, or the two procedures at staged intervals, were used. Immediate postoperative deterioration was never seen after laminectomy performed under local anaesthesia (84 patients), while transient deterioration occurred after anterior surgery in 2 of 28 patients. Cervical spondylotic radiculopathy (CSR) was found in 73% of the patients. Operative treatment for CSM also improved root symptoms, anterior surgery to a larger extent than posterior decompression. Only 10% of the patients treated with extensive laminectomy needed a second anterior operation for radiculopathy. The progression of myelopathy was arrested in 95% of the patients after surgery. Improvement was obtained in 80% both in the early and late follow-up review when compared to the preoperative functional status. The evaluation disclosed a tendency of rapid improvement during the first 3 months, subsequently followed by slow improvement in 50% and slight deterioration in 15% of the patients. The degree of improvement was in many patients not sufficient to raise the functional capability to a higher level in the employed grading system. In our opinion it is therefore important to operate patients with CSM as early as possible before neurological deficits are too pronounced. PMID:3529837

Wiberg, J

1986-01-01

5

The natural history of cervical spondylotic myelopathy.  

PubMed Central

This is a retrospective study of twenty-two patients with cervical spondylotic myelopathy who were admitted to the hospital for surgical treatment of their neurological condition. The purpose of the study was to evaluate the presenting symptoms, factors affecting the diagnosis and the course of the disease prior to surgical intervention. The earliest consistent symptom in all of our patients was a gait abnormality. The course of the disease was one of progressive deterioration. Spontaneous regression did not occur in any of the cases. The vagueness of the initial complaints led to considerable delay in the diagnosis (average of 6.3 years). Magnetic Resonance Imaging (MRI) was the most useful test in confirming the diagnosis.

Sadasivan, K. K.; Reddy, R. P.; Albright, J. A.

1993-01-01

6

The Natural History and Clinical Presentation of Cervical Spondylotic Myelopathy  

PubMed Central

Cervical spondylotic myelopathy (CSM) refers to impaired function of the spinal cord caused by degenerative changes of the cervical spine resulting in spinal cord compression. It is the most common disorder in the United States causing dysfunction of the spinal cord. A literature review of the natural history of mild cervical myelopathy is undertaken. Clinical presentation and current concepts of pathophysiology are also discussed. While many patients with mild signs of CSM will stabilize or improve over time with conservative treatment, the clinical course of a specific individual patient cannot be predicted. Asymptomatic patients with cervical stenosis and abnormalities on electrophysiologic studies may be at higher risk for developing myelopathy.

Yarbrough, Chester K.; Murphy, Rory K. J.; Ray, Wilson Z.; Stewart, Todd J.

2012-01-01

7

MRI in the management of suspected cervical spondylotic myelopathy.  

PubMed Central

One hundred and two patients with suspected cervical spondylotic myelopathy were prospectively investigated using MRI as the initial imaging technique. The aim was to discover if clinicians could manage patients with MRI alone, or if they would find a second investigation necessary. Eighty two patients were managed using MRI alone, 34 of whom were treated surgically. Twenty patients had a second investigation: a myelogram in 18 and a CT myelogram in two. This was performed in nine patients to exclude structural pathology in the thoracic or lumbar region (which was not examined with MRI), and in 11 to obtain more specific information about the cervical region. Only five of these 20 patients had surgical treatment. The diagnosis changed after the second investigation in four patients, but management was not influenced in any of these. MRI is a satisfactory alternative to myelography for most patients with suspected cervical spondylotic myelopathy. Images

Statham, P F; Hadley, D M; Macpherson, P; Johnston, R A; Bone, I; Teasdale, G M

1991-01-01

8

Evidence of an Inherited Predisposition for Cervical Spondylotic Myelopathy  

PubMed Central

Study Design A retrospective population based study cross referencing a genealogic database of over 2 million Utah residents with 10 years of clinical diagnosis data from a large tertiary hospital. Objective The objective of this study is to determine the presence or absence of an inherited predisposition to the development of cervical spondylotic myelopathy (CSM). Summary of Background Data A genetic predisposition for the development of cervical spondylosis has been discussed in the literature with low quality evidence. Families with a high incidence of disease or early onset disease in monozygotic twins have both been reported. However, these suggestions of an inherited predisposition for disease have never been rigorously studied. The purpose of this study is to determine a genetic predisposition among patients diagnosed with cervical spondylotic myelopathy. Methods The Utah Population Database (UPDB) combines health and genealogic data on over 2 million Utah residents. ICD-9 codes were used to identify 486 patients in the database with a diagnosis of cervical spondylosis with myelopathy (ICD9 code 721.1). The hypothesis of excessive familial clustering was tested using the Genealogical Index of Familiality (GIF) and Relative risks (RR) in relatives were estimated by comparing rates of disease in relatives with rates estimated in the relatives of 5 matched controls for each case. This methodology has been previously reported and validated for other disease conditions but not for cervical spondylotic myelopathy. Results The GIF analysis for patients with CSM showed significant excess relatedness for disease (p<0.001). Relative risks were significantly elevated in both first- (RR=5.21, CI=2.1-13.2, p<0.001) and third-degree relatives (RR=1.95, CI=1.04-3.7, p<0.05). Conclusions Excess relatedness of cases and significantly elevated relative risks to both close and distant relatives supports an inherited predisposition to cervical spondylosis with myelopathy. Level of Evidence III

Patel, Alpesh A.; Spiker, William Ryan; Daubs, Michael; Brodke, Darrel S.; Cannon-Albright, Lisa A.

2011-01-01

9

Cervical Spondylotic Myelopathy: Factors in Choosing the Surgical Approach  

PubMed Central

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

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

2012-01-01

10

Cervical spondylotic myelopathy: a review of the evidence.  

PubMed

Cervical spondylotic myelopathy (CSM) is the most common progressive spinal cord disorder in patients more than 55 years old. This disease is also the most common cause of acquired spasticity in later life and may lead to progressive spasticity and neurologic decline. This article explores some of the controversies about CSM and reviews pertinent articles, specifically prospective and randomized clinical trials when possible, to obtain the cleanest and least biased data. The 4 current controversial topics that surround CSM are: (1) natural history of mild CSM; (2) surgical approach: anterior versus posterior; (3) laminoplasty or laminectomy; and (4) cervical arthroplasty for CSM. PMID:20399358

Klineberg, Eric

2010-04-01

11

Cervical Spondylotic Myelopathy: Pathophysiology, Diagnosis, and Surgical Techniques  

PubMed Central

Cervical spondylotic myelopathy is a degenerative spinal disease which may lead to significant clinical morbidity. The onset of symptoms is usually insidious, with long periods of fixed disability and episodic worsening events. Regarding the pathophysiology of CSM, the repeated injuries to the spinal cord are caused by both static and dynamic mechanical factors. The combination of these factors affects the spinal cord basically through both direct trauma and ischemia. Regarding the diagnosis, both static and dynamics X-rays, as well as magnetic resonance imaging are important for preoperative evaluation as well as individualizing surgical planning. The choice of the most appropriate technique is affected by patient's clinical condition radiologic findings, as well as surgeon's experience. In opposition to the old belief that patients presenting mild myelopathy should be treated conservatively, there has progressively been amount of evidence indicating that the clinical course of this disease is progressive deterioration and that early surgical intervention improves long-term functional recovery and neurological prognosis.

Mattei, Tobias A.; Goulart, Carlos R.; Milano, Jeronimo B.; Dutra, Luis Paulo F.; Fasset, Daniel R.

2011-01-01

12

Human neuropathological and animal model evidence supporting a role for Fas-mediated apoptosis and inflammation in cervical spondylotic myelopathy.  

PubMed

Although cervical spondylotic myelopathy is a common cause of chronic spinal cord dysfunction in humans, little is known about the molecular mechanisms underlying the progressive neural degeneration characterized by this condition. Based on animal models of cervical spondylotic myelopathy and traumatic spinal cord injury, we hypothesized that Fas-mediated apoptosis and inflammation may play an important role in the pathobiology of human cervical spondylotic myelopathy. We further hypothesized that neutralization of the Fas ligand using a function-blocking antibody would reduce cell death, attenuate inflammation, promote axonal repair and enhance functional neurological outcomes in animal models of cervical spondylotic myelopathy. We examined molecular changes in post-mortem human spinal cord tissue from eight patients with cervical spondylotic myelopathy and four control cases. Complementary studies were conducted using a mouse model of cervical spondylotic myelopathy (twy/twy mice that develop spontaneous cord compression at C2-C3). We observed Fas-mediated apoptosis of neurons and oligodendrocytes and an increase in inflammatory cells in the compressed spinal cords of patients with cervical spondylotic myelopathy. Furthermore, neutralization of Fas ligand with a function-blocking antibody in twy/twy mice reduced neural inflammation at the lesion mediated by macrophages and activated microglia, glial scar formation and caspase-9 activation. It was also associated with increased expression of Bcl-2 and promoted dramatic functional neurological recovery. Our data demonstrate, for the first time in humans, the potential contribution of Fas-mediated cell death and inflammation to the pathobiology of cervical spondylotic myelopathy. Complementary data in a murine model of cervical spondylotic myelopathy further suggest that targeting the Fas death receptor pathway is a viable neuroprotective strategy to attenuate neural degeneration and optimize neurological recovery in cervical spondylotic myelopathy. Our findings highlight the possibility of medical treatments for cervical spondylotic myelopathy that are complementary to surgical decompression. PMID:21490053

Yu, Wen Ru; Liu, Tianyi; Kiehl, Tim-Rasmus; Fehlings, Michael G

2011-05-01

13

Risk factors for development of myelopathy in patients with cervical spondylotic cord compression.  

PubMed

PURPOSE: To clarify risk factors for the development of myelopathy in patients with cervical spondylotic cord compression. METHOD: The authors reviewed articles in which risk factors for the development of myelopathy in patients with cervical spondylotic cord compression were discussed. Ossification of the posterior longitudinal ligament (OPLL) was also reviewed as a disease which causes cervical cord compression to clarify pathomechanism of the development of myelopathy. RESULTS: Cervical motion segment disorders are considered to be multifactorial, and developmental size of the canal and foramina, pathological encroachment, biomechanical effects, and circulatory deficiencies are always present to some degree. Static and dynamic factors should be considered for the development of myelopathy. To clarify the pathomechanism of the development of myelopathy in patients with cervical spondylotic spinal cord compression, the exact natural history of CSM should be understood. CONCLUSION: Several predictable risk factors for the development of myelopathy have been proposed in CSM or OPLL studies, but they were not definitive. Further prospective population-based study is needed to clarify the mechanism. PMID:23700231

Matsunaga, Shunji; Komiya, Setsuro; Toyama, Yoshiaki

2013-05-23

14

Comparisons of three anterior cervical surgeries in treating cervical spondylotic myelopathy  

PubMed Central

Background Anterior cervical discectomy and fusion (ACDF) was one of the preferred treatments for degenerative cervical spondylosis. However, the motion of adjacent segment was significantly increased after operation. So cervical disc arthroplasty have been suggested to keep the motion of adjacent segment. A new implant named dynamic cervical implant (DCI) has been developed to keep the motion of adjacent segment. Methods We retrospectively reviewed 91 patients treated for single level cervical spondylotic myelopathy with anterior cervical discectomy and fusion (ACDF), dynamic cervical implant (DCI) and cervical total disc replacement (CTDR) between sep 2009 and Mar 2011 in our hospital. They were divided into three groups by surgical methods: ACDF group (group A, 34 cases), DCI group (group B, 25 cases), CTDR group (group C, 32 cases). Operation time, intraoperative blood loss, preoperative and postoperative JOA score and JOA recovery rate were compared among the three groups. Pre-and postoperative hyperextension and hyperflexion radiograms were observed to measure range of motion (ROM) of C2–7, operative and adjacent levels. Results There was no statistical difference in operative time, intraoperative blood loss, and JOA recovery rate (P?>?0.05) among three groups. But the differences of their postoperative JOA scores and preoperative JOA scores were of statistical significance (P??0.05). There was no statistically significant difference between preoperative ROM and postoperative ROM of upper and lower levels in group B (P?>?0.05), but had statistically significance of C2–7 and operative levels (P?cervical spondylotic myelopathy. But each group has respective advantages and disadvantages.

2014-01-01

15

Two Types of Laminoplasty for Cervical Spondylotic Myelopathy at Multiple Levels  

PubMed Central

Based on the results from pathological analysis and computer simulations by means of finite element analysis that were reported before, the pathological changes of cervical spondylotic myelopathy (CSM) seem to begin at the posterolateral parts of the spinal cord, because the mechanical stress is mainly concentrated in these parts. With progression of the compression, the pathological changes become distributed to a wider area of the spinal cord. In patients with spinal canal stenosis, these changes spread to multiple levels of the cervical spine. Therefore, posterior decompression surgery at multiple levels such as cervical laminoplasty is thought to be reasonable.

Hirabayashi, Shigeru; Matsushita, Takashi

2011-01-01

16

Computed tomographic evaluation of C5 root exit foramen in patients with cervical spondylotic myelopathy  

PubMed Central

Background: Narrowing of the intervertebral foramen for C5 root and a larger superior articular process in myelopathic patients with postlaminoplasty motor dominant C5 radiculopathy has been reported. We investigated whether the C4-5 foraminal dimensions and surface area in patients with cervical spondylotic myelopathy are universally smaller than the intervertebral foramina at other cervical levels. Methods: The study population consisted of 44 consecutive patients (sex: 24 males and 20 females), averaging 55.7 years of age (range 42-84) years who presented with clinical features suggestive of cervical spondylotic myelopathy. Using computed tomography (CT) imaging, we prospectively compared height, transverse diameter, and surface area of the C4-5 foramen to those of C3-4, C5-6 and C6-7 foramina of the same side in the whole study population as well as in male and female patients. Results: In the whole study population at C4-5 intervertebral foramen the mean foraminal height was 8.37 ± 1.3 mm on the right and 8.85 ± 1.16 mm on the left; and the mean foraminal transverse diameter on the right was 4.97 ± 1.35 mm and 5.14 ± 1.16 mm on the left. No statistically significant difference was found between the measurements in the whole study population at various levels, between or within male and female patient groups. Conclusion: C4-5 intervertebral foramen is not uniformly smaller in patients with cervical spondylotic myelopathy.

Hegazy, Rania M.; Abdelrahman, Ahmed Y.; Azab, Waleed A.

2014-01-01

17

Amyotrophic lateral sclerosis and severe cervical spondylotic myelopathy in a patient with a posterior fossa arachnoid cyst: diagnostic dilemma.  

PubMed

Distinguishing between cervical spondylotic myelopathy and ALS can be difficult, as illustrated by this report of a patient who had both disorders, as well as a relatively rare arachnoid cyst of the posterior fossa. Attempts to differentiate between ALS and cervical spondylotic myelopathy must persist until diagnosis of one (or both) of the disorders is made, since both the prognosis and treatment of the two are different. Careful neurologic examination with attention to clinical details, muscle biopsy in some patients, and routine EMG will usually lead to the proper diagnosis. PMID:3423904

Lee, K S; Kelly, D L

1987-12-01

18

Cervical disc arthroplasty for the treatment of spondylotic myelopathy and radiculopathy.  

PubMed

The concept of cervical disc arthroplasty (CDA) for the anterior treatment of cervical pathology has existed for approximately half a decade. In this time, multiple devices have been developed for this purpose, with the ultimate aim to provide an alternative to fusion. Fifty-five patients with cervical spondylotic radiculopathy and myelopathy underwent CDA over a 5 year period. Data was collected on 46 patients, which included Visual Analogue Scale scores for neck pain and arm pain, Neck Disability Index scores, Short Form-36 v2 (SF-36) and Nurick grades for myelopathy patients. Preoperative data and data obtained at the latest clinical follow-up (median 48 months, range, 10-76 months) were analysed to assess the intermediate term efficacy of the procedure. In patients with radiculopathy, arm pain improved by 88% (p<0.001). In those presenting with myelopathy, the Nurick grades improved from a median of 1 to 0 (p<0.001). In both groups of patients, improvements in pain and neurologic deficit were accompanied by significant improvements in multiple domains of the SF-36. Using a composite system which considered neck pain, arm pain, function and myelopathy, we arrived at an overall success rate of 73%. We concluded that CDA is an effective intervention for improving neurologic deficit, arm pain and local neck symptoms that translated into improvements in physical and social functioning in the intermediate term. PMID:23871454

Khong, Peter; Bogduk, Nikolai; Ghahreman, Ali; Davies, Mark

2013-10-01

19

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

PubMed

The purpose of this study was to compare the results of 2 surgical strategies for 4-level cervical spondylotic myelopathy: a hybrid procedure using anterior cervical diskectomy and fusion (ACDF) combined with segmental corpectomy versus posterior laminectomy and fixation. Between 2002 and 2010, fifty-one patients with consecutive 4-level cervical spondylotic myelopathy were treated surgically, with 27 patients undergoing the hybrid procedure and 24 undergoing posterior laminectomy and fixation. Radiologic data were compared between the 2 groups, including cervical curvature and cervical range of motion (ROM) in the sagittal plane. Pre- and postoperative neurological status was evaluated using the Japanese Orthopaedic Association (JOA) scoring system and the Nurick grading system. Mean ROM at last follow-up was not significantly different between the 2 groups (P>.05). In the hybrid group, mean JOA score and Nurick grade improved from 9.6±1.4 and 2.74±0.45 respectively, preoperatively, to 13.9±1.3 and 0.86±0.38 respectively, postoperatively. In the fixation group, mean JOA score and Nurick grade improved from 9.4±1.2 and 2.81±0.42 respectively, preoperatively, to 13.1±1.5 and 1.32±0.36 respectively, postoperatively. The JOA scores and Nurick grades at last follow-up were significantly different between the 2 groups (P<.05). In patients with preoperative cervical kyphosis, preoperative JOA score and Nurick grade were not significantly different between the 2 groups (P>.05); however, JOA scores and Nurick grades at last follow-up showed better improvement in the hybrid group than in the fixation group (P<.01). In patients with preoperative cervical lordosis, the preoperative and last follow-up JOA score and Nurick grade were not significantly different between the 2 groups (P>.05). PMID:24200449

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

2013-11-01

20

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

PubMed

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. PMID:24815593

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

2014-08-01

21

Cervical Pedicle Screw Fixation Combined with Laminoplasty for Cervical Spondylotic Myelopathy with Instability  

PubMed Central

Study Design A retrospective study. Purpose To evaluate the surgical results of cervical pedicle screw (CPS) fixation combined with laminoplasty for treating cervical spondylotic myelopathy (CSM) with instability. Overview of Literature Cervical fixation and spinal cord decompression are required for CSM patients with instability. However, only a few studies have reported on CPS fixation combined with posterior decompression for unstable CSM patients. Methods Thirteen patients that underwent CPS fixation combined with laminoplasty for CSM with instability were evaluated in this study. We assessed the clinical and radiological results of the surgical procedures. The Japanese Orthopedic Association (JOA) scoring system was used to evaluate the clinical results. The percentages of sli p, difference in sli p angle between maximum flexion and maximum extension of unstable intervertebrae, and perforation rate of CPS were evaluated. Results The mean JOA scores before surgery, immediately after surgery, and at final follow-up were 9.1, 13.3, and 12.6, respectively. The mean percentages of sli p before surgery, immediately after surgery, and at final follow-up were 9.1%, 3.2%, and 3.5%, respectively; there were significant improvements immediately after surgery and at final follow-up. The difference in sli p angle between the maximum flexion and maximum extension of the unstable intervertebrae changed from 9.0° before surgery to 1.6° at the final follow-up. The perforation rate of CPS was 10.9%. Conclusions The results suggest that CPS fixation combined with laminoplasty is an effective surgical procedure for treating CSM with instability.

Uehara, Masashi; Ogihara, Nobuhide; Hirabayashi, Hiroki; Hashidate, Hiroyuki; Mukaiyama, Keijiro; Shimizu, Masayuki; Kato, Hiroyuki

2012-01-01

22

Degenerative spondylolisthesis does not influence surgical results of laminoplasty in elderly cervical spondylotic myelopathy patients  

PubMed Central

The objective of the study was to investigate the comorbidity of degenerative spondylolisthesis (DS), in elderly cervical spondylotic myelopathy (CSM) patients in our hospital, and the correlation between surgical results and preoperative DS. There are few studies on the outcome of laminoplasty for CSM with DS. A total of 49 elderly patients (>65 years old) who eventually had surgical treatment for CSM were evaluated. A slippage displacement of more than 2.5 mm at least at one level was classified to have a positive DS on flexion/extension radiographs (DS group). A slippage displacement less than 1.0 mm was considered a negative DS (non-DS group). Seventeen patients who had slippage of 1.0–2.5 mm were excluded from the study. The DS group (n = 15) included cases with DS at preoperation, while the remaining cases (n = 17) belonged to the non-DS group. The flexion/extension radiographs of the two groups were compared for range of motion and clinical results at 3 years after the operation. Of all elderly patients, 30.6% had DS. There was no significant difference between the two groups based on the clinical results. The range of motion of all cervical spines (DS group and non-DS group) was significantly limited. However, there was no significant difference between the two groups. New postoperative DS appeared in four patients, of which two were from the DS group and two from the non-DS group. These data suggest that degenerative spondylolisthesis does not influence surgical results in elderly cervical spondylotic myelopathy patients.

2010-01-01

23

Postmortem findings in a woman with history of laminoplasty for severe cervical spondylotic myelopathy  

PubMed Central

Context We report the autopsy of a 65-year-old woman who underwent a C3–C7 laminoplasty 4 years after the diagnosis of cervical spondylotic myelopathy (CSM). Her sensory disturbance, spasticity, and vesicorectal disturbance, which corresponded to long tract sign, had improved after surgery. Findings Cross sections at the C4–C5 level showed a triangular shape because of atrophied ventral gray matter. Moreover, despite the scarce glial scar formation around the cystic cavity, regeneration of gray matter had not occurred. In the white matter, the posterior and lateral funiculi were shrunken including three to four segments. Conclusion Pathological change of white matter did not coincide with relief of clinical symptoms in this case. These findings indicate that it may be better to operate earlier in cases of CSM, because delay may lead to irreversible histological change.

Someya, Yukio; Koda, Masao; Hashimoto, Masayuki; Okawa, Akihiko; Masaki, Yutaka; Yamazaki, Masashi

2011-01-01

24

Evaluation of conservative treatment and timing of surgical intervention for mild forms of cervical spondylotic myelopathy  

PubMed Central

The optimal management approach for patients with mild forms of cervical spondylotic myelopathy (MCSM) has not been well established. The aim of the present study was to investigate the outcome of conservative treatment, identify prognostic factors and provide evidence for the timing of surgical intervention. A total of 90 patients with MCSM attending hospital between February 2007 and January 2009 were prospectively enrolled. Initially, all patients received conservative treatment and were followed up periodically. When a deterioration in myelopathy was clearly identified, surgical treatment was conducted. Clinical and radiological factors correlating with the deterioration were examined, and final clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) score. At the end of January 2012, follow-ups of >3 years were completed. Seventy-eight patients were available for data analysis. Only 21 patients (26.9%) deteriorated and underwent surgery thereafter (group A), while the remaining 57 patients (73.1%) were treated conservatively throughout (group B). Statistical analysis revealed that segmental instability and cervical spinal stenosis were adverse factors for the prognosis of conservative treatment. Although the JOA scores of the patients in group A declined initially, following surgical intervention, no significant differences were identified in JOA scores between the two groups at the time of the final follow-up (P=0.46). In summary, conservative treatment is effective in MCSM patients. Patients with segmental instability and cervical spinal stenosis have a tendency to deteriorate, but conservative treatment remains the recommendation for the first action. If the myelopathy deteriorates during conservative treatment, timely surgical intervention is effective.

KONG, LING-DE; MENG, LING-CHEN; WANG, LIN-FENG; SHEN, YONG; WANG, PAN; SHANG, ZI-KUN

2013-01-01

25

Is there a benefit to operating on patients (bedridden or in wheelchairs) with advanced stage cervical spondylotic myelopathy?  

Microsoft Academic Search

Surgical treatment of cervical spondylotic myelopathy (CSM) aims to prevent or delay the progression of the disease. Many\\u000a patients are diagnosed in advanced stages of the disease, presenting severe functional disability and extensive radiologic\\u000a changes, which suggests clinical irreversibility. There are doubts about the real benefit of surgery in patients who are seriously\\u000a ill, bedridden or in a wheelchair. The

Fabrizio Borges Scardino; Leonardo Poubel Rocha; Alécio Cristino Evangelista Santos Barcelos; José Marcus Rotta; Ricardo Vieira Botelho

2010-01-01

26

Cervical spondylotic myelopathy with vitamin B12 deficiency: Two case reports  

PubMed Central

Although it has been observed that a vitamin B12 (VB12) deficiency may lead to defects in the nervous system, there is a lack of studies elucidating whether VB12 has a role in the pathogenesis of cervical spondylotic myelopathy (CSM). The present study describes two cases of CSM observed in the clinic, where the patients presented with common characteristics of the typical clinical symptoms; however, T2-weighted magnetic resonance imaging examinations revealed that although the degree of spinal cord compression was not serious, the spinal cord exhibited significant high signal changes. At the same time, the serum VB12 levels of the two patients were lower compared with those of normal controls. The symptoms of the patients improved following anterior cervical decompression surgery and VB12 replacement therapy. The incidence of CSM in the two patients may have been correlated with a lack of VB12. Therefore, it is recommended that the serum VB12 levels are checked in cases of CSM where the standard imaging and clinical manifestations do not fully match.

XU, YAO; CHEN, WENJUN; JIANG, JIANYUAN

2013-01-01

27

Risk factors for development of cervical spondylotic myelopathy: results of a systematic review.  

PubMed

Study design: ?Systematic review. Study rationale: ?Cervical spondylotic myelopathy (CSM) is a common cause of spinal cord dysfunction that may be asymptomatic or may present with severe symptoms. Since CSM has an insidious manifestation, identification of risk factors associated with this condition may aid clinicians in monitoring high-risk patients and implementing appropriate management strategies. Objective: ?To assess sociodemographic, clinical, radiographic, and genetic risk factors associated with presence of CSM in patients 18 years or older. Methods: ?A systematic review of the literature was performed using PubMed, the National Guideline Clearinghouse Databases, and bibliographies of key articles to assess risk factors associated with CSM. Articles were reviewed by two independent reviewers based on predetermined inclusion and exclusion criteria. Each article was evaluated using a predefined quality-rating scheme. Results: ?From 486 citations, eight articles met all inclusion and exclusion criteria. Larger vertebral body and smaller spinal canal and Torg/Pavlov ratio were associated with CSM diagnosis, while gender was not associated with a CSM diagnosis across multiple studies. There were inconsistent reports with respect to increased age as a risk factor for CSM diagnosis. Conclusion: ?The limited data available suggests that inherent anatomical features that may contribute to congenital cervical stenosis may be associated with CSM. This systematic review is limited by the small number of high-quality studies evaluating prognostic factors for CSM. The overall strength of evidence for all risk factors evaluated is low. PMID:23526904

Singh, Anoushka; Tetreault, Lindsay; Fehlings, Michael G; Fischer, Dena J; Skelly, Andrea C

2012-08-01

28

Long Term Results of Anterior Corpectomy and Fusion for Cervical Spondylotic Myelopathy  

PubMed Central

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.

Chen, Huajiang; Liu, Yang; Liang, Lei; Yuan, Wen

2012-01-01

29

Riluzole attenuates neuropathic pain and enhances functional recovery in a rodent model of cervical spondylotic myelopathy.  

PubMed

Cervical spondylotic myelopathy (CSM) is the commonest cause of spinal cord impairment worldwide and despite surgical treatment, it is commonly associated with chronic neuropathic pain and neurological impairment. Based on data suggesting a key role of sodium and glutamate mediated cellular injury in models of spinal cord compression, we examined whether riluzole, a sodium channel/glutamate blocker, could improve neurobehavioral outcomes in a rat model of CSM. To produce chronic progressive compression of the cervical spinal cord, we used an established model of graded mechanical cord compromise developed in our laboratory. The chronic (8weeks) mechanical compression of the cervical spinal cord resulted in persistent mechanical allodynia and thermal hyperalgesia at 8weeks. Moreover, we found increased expression of phosphorylated NR1 and NR2B in the dorsal horns as well as astrogliosis and increased microglia expression in the dorsal horns after mechanical compression. Following daily systemic administration for 7weeks after the induction of compression, riluzole (8mg/kg) significantly attenuated forelimb and hindlimb mechanical allodynia and alleviated thermal hyperalgesia in the tail. Importantly, riluzole led to a decrease in swing phase duration, an increase in hind leg swing speed and an increase paw intensity in gait analysis. Riluzole also decreased the number of phosphorylated NR1 and phosphorylated NR2B positive cells in the dorsal horns and the microglia activation in the dorsal horns. Together, our results indicate that systemic riluzole administration during chronic cervical spinal cord compression is effective at protecting spinal cord tissue, preserving neurobehavioral function and alleviating neuropathic pain, possibly by decreasing NMDA receptor phosphorylation in astrocytes and by eliminating microglia activation. As such, riluzole represents a promising clinical treatment for CSM. PMID:24184328

Moon, Eun Su; Karadimas, Spyridon K; Yu, Wen-Ru; Austin, James W; Fehlings, Michael G

2014-02-01

30

Clinical predictors of surgical outcome in cervical spondylotic myelopathy: an analysis of 248 patients.  

PubMed

The purpose of this study was to investigate the clinical predictors of surgical outcome in patients with cervical spondylotic myelopathy (CSM). We reviewed a consecutive series of 248 patients (71 women and 177 men) with CSM who had undergone surgery at our institution between January 2000 and October 2010. Their mean age was 59.0 years (16 to 86). Medical records, office notes, and operative reports were reviewed for data collection. Special attention was focused on pre-operative duration and severity as well as post-operative persistence of myelopathic symptoms. Disease severity was graded according to the Nurick classification. Our multivariate logistic regression model indicated that Nurick grade 2 CSM patients have the highest chance of complete symptom resolution (p < 0.001) and improvement to normal gait (p = 0.004) following surgery. Patients who did not improve after surgery had longer duration of myelopathic symptoms than those who did improve post-operatively (17.85 months (1 to 101) vs 11.21 months (1 to 69); p = 0.002). More advanced Nurick grades were not associated with a longer duration of symptoms (p = 0.906). Our data suggest that patients with Nurick grade 2 CSM are most likely to improve from surgery. The duration of myelopathic symptoms does not have an association with disease severity but is an independent prognostic indicator of surgical outcome. PMID:23814251

Pumberger, M; Froemel, D; Aichmair, A; Hughes, A P; Sama, A A; Cammisa, F P; Girardi, F P

2013-07-01

31

The role of oligodendrocytes in the molecular pathobiology and potential molecular treatment of cervical spondylotic myelopathy.  

PubMed

Cervical spondylotic myelopathy (CSM) is a very common and debilitating disease; however, its underlying pathocellular process remains uncertain. Attempts have been made to reproduce CSM in experimental animal models in order to deepen the knowledge on the molecular pathobiology of this disease. The up-to-date observations have established the apoptosis of oligodendrocytes (OLGs) as the principal pathocellular process of CSM. Since favorable neurological recovery cannot be obtained in afflicted patients, even after the decompression surgery, elucidation of the apoptotic cascade in OLGs may unveil possible molecular treatments which could inhibit demyelination and ameliorate the neurological deficits. Moreover, additional therapeutic benefits may include improvement of myelin self-repair capability by stimulating OLG progenitor cells to become mature and finally, myelinating OLGs. This review focuses on the factors and mechanisms of crucial importance for developing antiapoptotic treatments. Critical evaluations of the role of OLGs in molecular pathobiology of CSM as well as strategies for potential remyelination of CSM are also provided. The analyses and evaluations of the experimental findings can possibly lead to treatment of CSM as well as to development of novel biopharmacenticals. PMID:20156160

Karadimas, S K; Gialeli, C H; Klironomos, G; Tzanakakis, G N; Panagiotopoulos, E; Karamanos, N K; Gatzounis, G

2010-01-01

32

Outcomes for combined anterior and posterior surgical approaches for patients with multisegmental cervical spondylotic myelopathy.  

PubMed

Corpectomy is widely used to treat cervical spondylotic myelopathy (CSM). However, when this technique alone is performed at 1 or 2 levels for a multisegmental involvement (3 or more vertebrae), the incidence of post-operative complications is high. The optimal treatment for multisegmental CSM is still debatable. The aim of this study was to assess clinical and radiological outcomes for patients with multisegmental CSM who underwent combined anterior and posterior (AP) surgical approaches. Forty adults (17 women and 23 men; age range, 41-76 y) treated at our center between 2004 and 2007 were reviewed retrospectively. Their neurological function was assessed at different times using the Nurick classification (Grades 0 [root symptoms only] to 5 [wheelchair- or bed-bound]). Patients' satisfaction with the surgery was evaluated using Odom's criteria (poor, fair, good, or excellent). Pre-operatively, 20% of patients were assessed as Nurick Grade 0, 60% as Grade 1, and 20% as Grade 2. At the 1-year follow-up, only 10% of patients were assessed as Grade 1. At 1 year after surgery, 85% of patients rated their satisfaction with the operation as "excellent" and 15% rated it as "good". These outcomes suggest that, when surgery is indicated and patients with multisegmental CSM are carefully selected, the combined AP approach yields symptom relief comparable to that of corpectomy alone and a lower incidence of post-operative complications. PMID:19153044

Konya, Deniz; Ozgen, Serdar; Gercek, Arzu; Pamir, M Necmettin

2009-03-01

33

Compensatory cerebral adaptations before and evolving changes after surgical decompression in cervical spondylotic myelopathy  

PubMed Central

Object The goal of this study was to compare cortical sensorimotor adaptations associated with neurological deterioration and then recovery following surgical decompression for cervical spondylotic myelopathy (CSM). Methods Eight patients with CSM underwent functional MR (fMR) imaging during wrist extension and the 3-finger pinch task, along with behavioral assessments before and 3 and 6 months after surgery. Six healthy control volunteers were scanned twice. Results Cervical spine MR imaging demonstrated successful cord decompression. The patients improved after surgery on the modified Japanese Orthopaedic Association score for the upper extremity, which correlated with the changes in task-associated activation in specific sensorimotor regions of interest. Pinch-related activation in sensorimotor cortex contralateral to the movement paradigm was reduced before surgery then increased toward the extent of healthy controls after surgery. Before surgery, patients showed broader activation in ipsilateral sensorimotor cortex during wrist extension than during pinch, but activations became similar to those of healthy controls after surgery. Pinch-related activation volume in the ipsilateral sensorimotor cortex and the magnitude of activation in the contralateral dorsal premotor cortex evolved linearly across time after surgery, along with wrist extension–related activation magnitude in the contralateral supplementary motor area. Conclusions Serial fMR imaging studies in CSM can capture the adaptations in specific sensorimotor cortices that accompany clinical deterioration and postsurgical improvement in sensorimotor function associated with damage and partial recovery of conduction in corticospinal pathways. These adaptive regions can be monitored by serial fMR imaging to detect a critical loss of supraspinal reserve in compensatory plasticity, which might augment clinical information about the need for surgical decompression.

Dong, Yun; Holly, Langston T.; Albistegui-Dubois, Richard; Yan, Xiaohong; Marehbian, Jonathan; Newton, Jennifer M.; Dobkin, Bruce H.

2014-01-01

34

Noncontiguous anterior decompression and fusion for multilevel cervical spondylotic myelopathy: a prospective randomized control clinical study  

PubMed Central

Anterior decompression and fusion is an established procedure in surgical treatment for multilevel cervical spondylotic myelopathy (MCSM). However, contiguous corpectomies and fusion (CCF) often induce postoperative complications such as nonunion, graft subsidence, and loss of lordotic alignment. As an alternative, noncontiguous corpectomies or one-level corpectomy plus adjacent-level discectomy with retention of an intervening body has been developed recently. In this study, we prospectively compared noncontiguous anterior decompression and fusion (NADF) and CCF for MCSM in terms of surgical invasiveness, clinical and radiographic outcomes, and complications. From January 2005 to June 2007, 105 patients with MCSM were randomized to NADF group (n = 55) and CCF group (n = 50), and followed up for average 31.5 months (range 24–48 months). Average operative time and blood loss decreased significantly in the NADF group as compared with those in the CCF group (p < 0.05 and <0.001, respectively). For VAS, within 3 months postoperatively, there was no significant difference between the two groups. But at 6 months after surgery and final follow-up, VAS improved significantly in NADF group than that in CCF group (p < 0.05). No significant difference of JOA score was observed between the two groups at every collection time. In NADF group, all 55 cases obtained fusion at 1 year after operation (average 5.1 months). In CCF group, 48 cases achieved fusion 1 year postoperatively, but the other 2 cases were performed posterior stabilization and achieved fusion 6 months later. The differences of cervical lordosis between two groups were insignificant at the same follow-up time. But the loss of lordosis and height of fusion segments in 6 months postoperatively and final follow-up were significantly more in CFF group than in NADF group (p < 0.001). Complications were similar in both groups. But in CCF group three cases needed reoperation, one case with extradural hematoma was immediately re-operated after anterior decompression and two cases mentioned above were performed posterior stabilization at 1 year postoperatively. In conclusion, in the patients with MCSM, without developmental stenosis and continuous or combined ossification of posterior longitudinal ligaments, NADF and CCF showed an identical effect of decompression. In terms of surgical time, blood loss, VAS, fusion rate and cervical alignment, NADF was superior compared with CCF.

Lian, Xiao-Feng; Zeng, Bing-Fang; Zhou, Wei; Kong, Wei-Qing; Hou, Tie-Sheng

2010-01-01

35

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

PubMed Central

Background: There are a number of surgical treatment options for cervical spondylotic myelopathy (CSM). In this study, the authors present their clinical results with cervical laminectomy and fusion for the treatment of patients with CSM. Methods: This retrospective study included 58 consecutive patients who underwent cervical laminectomy and fusion for CSM. There were 38 males and 20 females, with a mean age of 64 (range 42-92) years. The Japanese orthopedic association score (mJOA) scale was used as the functional outcome measurement. Both the absolute increase in mJOA and the neurological recovery rate of mJOA were analyzed. The mean clinical follow-up was 17 months (range 5-52 months). Results: There was a statistically significant improvement between mean preoperative (13.2, range 7-17) and postoperative (16.1, range 11-18) mJOA scores following surgery. The average improvement in mJOA score was 2.9 points. The mean neurological recovery rate was 56.6%. Overall 85.5% of patients improved with surgery (n = 51) and the remaining 14.5% of patients had no change in their mJOA score after surgery (n = 7). Fusion was documented in all 58 patients. There was a 10.3% overall complication rate (n = 6). The most common complications were C5 nerve palsies which occurred in 6.9% of the cohort (n = 4); all completely resolved. Conclusion: Cervical laminectomy and fusion is a safe and efficacious procedure for the treatment of CSM. The clinical outcomes appear to be quite reproducible, and this technique is an important part of a spine surgeon's armamentarium.

Chang, Victor; Lu, Daniel C.; Hoffman, Haydn; Buchanan, Colin; Holly, Langston T.

2014-01-01

36

Tandem spinal stenosis: a case of stenotic cauda equina syndrome following cervical decompression and fusion for spondylotic cervical myelopathy  

PubMed Central

Tandem spinal stenosis is a clinical phenomenon which may cause a functional loss related to neurologic compression in numerous areas of the spinal cord. In this phenomenon, the second area of symptomatic neurologic insult is not revealed until the primary symptomatic area has been treated. This case describes a 71-year-old male referred to physical therapy 4 weeks following a combined anterior/posterior C3/4 decompression and fusion for treatment of cervical spondylotic myelopathy. Approximately 8 weeks post-operatively (4 weeks after initiation of physical therapy), the patient began to complain of bilateral lower extremity weakness, primarily with climbing stairs. At 12 weeks post-operatively, the patient developed bowel incontinence and saddle paresthesia. Magnetic resonance imaging revealed multiple levels of critical stenosis of the lower thoracic and upper lumbar spine, which resulted in referral for surgical intervention. Following surgical decompression there was complete recovery of lower extremity strength, saddle area sensation and bowel function. This case highlights the need for the clinician to remain vigilant for concomitant pathology despite successful surgical intervention. A thorough knowledge of the presentation of various spinal disorders, as well as a thorough neurologic examination, is required to accurately recognize both candid and subtle red flags requiring immediate referral for surgical intervention.

Swanson, Brian T

2012-01-01

37

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

PubMed Central

In patients with os odontoideum and posterior atlantoaxial subluxation are extremely rare. No reports have described posterior atlantoaxial subluxation associated with os odontoideum combined with cervical spondylotic canal stenosis, both of which require surgical treatment. We report one case of a 75-year-old female who underwent arthrodesis between the occiput and C3 using a hook-and-rod system and also a double-door laminoplasty from levels C3 to C7. The claw mechanism was applied between the C2 lamina and the C3 inferior articular process. The posterior atlantoaxial subluxation was completely reduced by the method that the rod gradually pushed the posterior arch of C1 anteriorly during connection to the occiput. Twelve months after surgery, the patient showed improvement in preoperative clumsiness and gait disturbance, and the latest plain radiographs showed solid osseous fusion, with no loss of correction or instrumentation failure.

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

2007-01-01

38

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

PubMed

In patients with os odontoideum and posterior atlantoaxial subluxation are extremely rare. No reports have described posterior atlantoaxial subluxation associated with os odontoideum combined with cervical spondylotic canal stenosis, both of which require surgical treatment. We report one case of a 75-year-old female who underwent arthrodesis between the occiput and C3 using a hook-and-rod system and also a double-door laminoplasty from levels C3 to C7. The claw mechanism was applied between the C2 lamina and the C3 inferior articular process. The posterior atlantoaxial subluxation was completely reduced by the method that the rod gradually pushed the posterior arch of C1 anteriorly during connection to the occiput. Twelve months after surgery, the patient showed improvement in preoperative clumsiness and gait disturbance, and the latest plain radiographs showed solid osseous fusion, with no loss of correction or instrumentation failure. PMID:18097691

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

2008-09-01

39

Measuring Surgical Outcomes in Cervical Spondylotic Myelopathy Patients Undergoing Anterior Cervical Discectomy and Fusion: Assessment of Minimum Clinically Important Difference  

PubMed Central

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.

Auffinger, Brenda M.; Lall, Rishi R.; Dahdaleh, Nader S.; Wong, Albert P.; Lam, Sandi K.; Koski, Tyler; Fessler, Richard G.; Smith, Zachary A.

2013-01-01

40

Laminoplasty and Laminectomy Hybrid Decompression for the Treatment of Cervical Spondylotic Myelopathy with Hypertrophic Ligamentum Flavum: A Retrospective Study  

PubMed Central

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 with HLF.

Ding, Huairong; Xue, Yuan; Tang, Yanming; He, Dong; Li, Zhiyang; Zhao, Ying; Zong, Yaqi; Wang, Yi; Wang, Pei

2014-01-01

41

Prognostic value of magnetic resonance imaging combined with electromyography in the surgical management of cervical spondylotic myelopathy  

PubMed Central

The present study aimed to evaluate the value of pre-operative magnetic resonance imaging (MRI) combined with electromyography (EMG) for predicting clinical outcome following surgical management of cervical spondylotic myelopathy (CSM). A total of 94 patients with cervical compressive myelopathy were prospectively enrolled and treated with anterior, posterior and posterior-anterior united decompression between October 2007 and February 2009. Prior to surgery 1.5-T MRI and EMG were performed in all patients. The patients were classified into four types based on the presence (+) or absence (?) of an increased signal intensity (ISI) on the T2-weighted magnetic resonance (MR) images and also based on the positive (+)/negative (?) results of the EMG. The four types were as follows: Type I, MRI/EMG (?/?); Type II, MRI/EMG (+/?); Type III, MRI/EMG (?/+); and Type IV, MRI/EMG (+/+). The clinical outcome was also graded according to a modified Japanese Orthopedic Association (JOA) scoring system. Furthermore, pre- and post-operative clinical data were statistically analyzed to explore the correlation between the factors. There were 36 cases (38%) of Type I, 16 (17%) of Type II, 13 (14%) of Type III and 29 (31%) of Type IV. According to the analysis of the clinical data between the four types, there were significant differences in the disability classifications, pre-operative JOA scores and disease duration (P<0.05), but there were no significant differences in gender, age or cord compression ratios (P>0.05). Until the final follow-up, there was a significant difference in the recovery ratio between the four study groups (Hc=27.46, P<0.05). Further comparison showed that the surgical outcome was best in Type I patients and worst in Type IV patients. In conclusion, there was a distinct correlation between classification and the rate of clinical improvement. Patients who had a negative EMG and those without an ISI on T2-weight images tended to suffer only mild symptoms, a short disease duration and, most significantly, experience a good surgical outcome.

LIU, FA-JING; SUN, YA-PENG; SHEN, YONG; DING, WEN-YUAN; WANG, LIN-FENG

2013-01-01

42

Clinical features and surgical outcomes of cervical spondylotic myelopathy in patients aged 80 years or older: a multi-center retrospective study  

PubMed Central

With the aging of the population in developed countries, spine surgeons have recently been more likely to encounter elderly patients in need of treatment. This study investigated whether decompression surgery for cervical spondylotic myelopathy (CSM) in elderly patients aged 80 years or older would likely be a reasonable treatment. We retrospectively reviewed 605 consecutive patients with cervical myelopathy who underwent decompression surgery between 2004 and 2008. Patients with other conditions that could affect functional status or compression factors other than spondylosis were excluded from this study. Of the remaining 189 patients, 161 with CSM whose condition could be evaluated 6 months after surgery were analyzed. The patients were divided into two age groups: 80 years or older (Group A, 37 patients) and younger than 80 years of age (Group B, 124 patients). We evaluated the differences in symptom duration, clinical data, involved levels, surgical outcome, comorbidities, and postoperative complications between the two groups. The symptom duration was significantly shorter in Group A. The average JOA scores preoperatively and 6 months postoperatively were significantly lower in Group A; however, there was no significant difference in the recovery ratio. There were no significant differences in the percentages of patients with comorbidities or those with postoperative complications. Elderly patients aged 80 years or older regained approximately 40% of their function postoperatively, and the incidence of postoperative complication was similar to that in younger patients. Since this age group shows a rapid deterioration after onset, prompt decompression surgery is required.

Dokai, Toshiyuki; Hashiguchi, Hirokazu; Ishii, Hiroyuki; Kameyama, Yasuhiro; Katae, Yuji; Morio, Yasuo; Morishita, Tsugutake; Murata, Masaaki; Nanjo, Yoshiro; Takahashi, Toshiaki; Tanida, Atsushi; Tanishima, Shinji; Yamane, Koji; Teshima, Ryota

2011-01-01

43

Texture-based characterization of pre- and post-operative T2-weighted magnetic resonance signals of the cervical spinal cord in cervical spondylotic myelopathy  

NASA Astrophysics Data System (ADS)

The utility of texture analysis regarding the provision of quantitative prognostic factors, potentially valuable to the prediction of the post-operative outcome of cervical spondylotic myelopathy (CSM) patients, is investigated. The clinical sample of the study comprised six subjects, who had undergone surgical therapeutic intervention for CSM. Following a specific imaging protocol, a pair of MR images of the cervical spine, corresponding to pre- and post-operative MR scans, was obtained for each of the patients. Accordingly, 12 sagittal T2-weighted magnetic resonance (MR) images were studied. Employing custom developed software, a Region Of Interest (ROI) within the spinal cord, corresponding to the region of the high-intensity CSM MR signal, was segmented on each image, according to the region growing method. Utilizing custom developed algorithms, the following sets of textural features were generated from the segmented ROIs: (i) gradient features, (ii) mean values of features from co-occurrence matrices (co-occurrence features) and (iii) range values of co-occurrence features. Utilizing each one of these sets of features, as well as the least-squares minimum distance and the quadratic classification algorithms, pattern recognition classification schemes were implemented for the discrimination between pre-operative and post-operative MR signals. Statistical analysis revealed the existence of statistically significant differences (p < 0.05) between textural features generated from pre-operative and post-operative high-intensity MR signals. The classification accuracies accomplished ranged from 75% to 100%. Textural features, descriptive of relevant properties of the high-intensity MR signal in CSM, may be considered as quantitative information of potential value for the prediction of the post-operative outcome of CSM patients.

Boniatis, Ioannis; Klironomos, George; Gatzounis, George; Panayiotakis, George

2009-10-01

44

Accuracy and reliability of MRI quantitative measurements to assess spinal cord compression in cervical spondylotic myelopathy: a prospective study  

PubMed Central

Study type:?Reliability study Introduction:?Cervical spondylotic myelopathy (CSM) is the most common spinal cord disorder in persons more than 55 years old. Despite multiple neuroimaging approaches proposed to quantify the spinal cord compromise in CSM patients, magnetic resonance imaging (MRI) remains the procedure of choice by providing helpful information for clinical decision making, determining optimal subpopulations for treatment, and selecting the optimal treatment strategies. However, the validity, reliability, and accuracy of the MRI quantitative measurements have not yet been addressed. Objective:?To assess the intra- and inter-observer reliability of MRI quantitative measurements of the spinal cord compromise in CSM patients. Methods:?Seventeen CSM patients (13 male) of mean age 54.5 years old were selected from the AOSpine North America database. The patients had different combinations of stenotic levels (1–4 levels) and the clinical severity (range mJOA baseline: 8–18). Asymptomatic or previous surgically treated CSM, active infection, neoplastic disease, rheumatoid arthritis, ankylosing spondylitis, trauma, or concomitant lumbar stenosis were excluded. The patients underwent preoperative MRI using 1.5T (15 patients) and 3T (two patients) scanner, including mid-sagittal T1-weighted, axial and mid-sagittal T2-weighted series. MRI data were analyzed (Mango 2.0 software; Multi-Image Analysis GUI) by four blind raters in three different sessions. Four measurements were analysed: transverse area (TA) (Figure 1), compression ratio (CR) (Figure 2), maximal canal compromise (MCC), and maximal spinal cord compression (MSCC) (Figure 3). The differences for each measurement were evaluated using mixed-effect ANOVA models (ratter, session, ratter x session). The intra- and inter-rater reliability was evaluated with intraclass correlation coefficients (ICC) (Figure 4). Figure 1 Transverse area (TA) Figure 2 Compression ratio (CR?=?AP/W) Figure 3 Maximal canal compromise (MCC), and maximal spinal cord compression (MSCC). MCC(%)?=?1?[Dx/(Da+Db)/2] × 100%; MSCC(%)?=?1?[dx/(da+db)/2] × 100% Figure 4 Intraclass correlation coefficients (ICC) Results:?The principal findings were: (i) for TA (71.48 ± 12.99mm2), the intra-rater agreement was 0.97 (95% CI, range 0.94–0.99) and the inter-rater agreement was 0.76 (95% CI, range 0.49–0.90); (ii) for CR (0.35 ± 0.04%), 0.94 (95% CI, range 0.88–0.98), and 0.79 (95% CI, range 0.57–0.91) respectively; (iii) for MCC (83.21 ± 2.08%), 0.95 (95% CI, range 0.89–0.98), and 0.64 (95% CI, range 0.28–0.85) respectively; and (iv) for MSCC (82.87 ± 1.52%), 0.93 (95% CI, range 0.86–0.97), and 0.84 (95% CI, range 0.65–0.93) respectively. Conclusions:?Our data suggest that three out of four measurements (TA, CR and MSCC) have acceptable intra- and interreliability coefficients (ICC > 0.75). However, for the maximal canal compromise measure, although the intrareliability was acceptable, the inter-rater reliability was not acceptable (0.64). Based on this study, we recommend that three MRI measures: transverse area, compression ratio and maximal spinal cord compression should be used in the imaging assessment of the spinal cord in CSM patients.

Karpova, Alina; Craciunas, Sorin; Chua, Soo-Yong; Rabin, Doron; Smith, Sean; Fehlings, Michael G.

2010-01-01

45

Accuracy and reliability of MRI quantitative measurements to assess spinal cord compression in cervical spondylotic myelopathy: a prospective study.  

PubMed

Study type: ?Reliability study Introduction: ?Cervical spondylotic myelopathy (CSM) is the most common spinal cord disorder in persons more than 55 years old. Despite multiple neuroimaging approaches proposed to quantify the spinal cord compromise in CSM patients, magnetic resonance imaging (MRI) remains the procedure of choice by providing helpful information for clinical decision making, determining optimal subpopulations for treatment, and selecting the optimal treatment strategies. However, the validity, reliability, and accuracy of the MRI quantitative measurements have not yet been addressed. Objective: ?To assess the intra- and inter-observer reliability of MRI quantitative measurements of the spinal cord compromise in CSM patients. Methods: ?Seventeen CSM patients (13 male) of mean age 54.5 years old were selected from the AOSpine North America database. The patients had different combinations of stenotic levels (1-4 levels) and the clinical severity (range mJOA baseline: 8-18). Asymptomatic or previous surgically treated CSM, active infection, neoplastic disease, rheumatoid arthritis, ankylosing spondylitis, trauma, or concomitant lumbar stenosis were excluded. The patients underwent preoperative MRI using 1.5T (15 patients) and 3T (two patients) scanner, including mid-sagittal T1-weighted, axial and mid-sagittal T2-weighted series. MRI data were analyzed (Mango 2.0 software; Multi-Image Analysis GUI) by four blind raters in three different sessions. Four measurements were analysed: transverse area (TA) (Figure 1), compression ratio (CR) (Figure 2), maximal canal compromise (MCC), and maximal spinal cord compression (MSCC) (Figure 3). The differences for each measurement were evaluated using mixed-effect ANOVA models (ratter, session, ratter x session). The intra- and inter-rater reliability was evaluated with intraclass correlation coefficients (ICC) (Figure 4). Figure 1 Transverse area (TA)Figure 2 Compression ratio (CR?=?AP/W)Figure 3 Maximal canal compromise (MCC), and maximal spinal cord compression (MSCC). MCC(%)?=?1-[Dx/(Da+Db)/2] × 100%; MSCC(%)?=?1-[dx/(da+db)/2] × 100%Figure 4 Intraclass correlation coefficients (ICC) Results: ?The principal findings were: (i) for TA (71.48 ± 12.99mm2), the intra-rater agreement was 0.97 (95% CI, range 0.94-0.99) and the inter-rater agreement was 0.76 (95% CI, range 0.49-0.90); (ii) for CR (0.35 ± 0.04%), 0.94 (95% CI, range 0.88-0.98), and 0.79 (95% CI, range 0.57-0.91) respectively; (iii) for MCC (83.21 ± 2.08%), 0.95 (95% CI, range 0.89-0.98), and 0.64 (95% CI, range 0.28-0.85) respectively; and (iv) for MSCC (82.87 ± 1.52%), 0.93 (95% CI, range 0.86-0.97), and 0.84 (95% CI, range 0.65-0.93) respectively. Conclusions: ?Our data suggest that three out of four measurements (TA, CR and MSCC) have acceptable intra- and interreliability coefficients (ICC > 0.75). However, for the maximal canal compromise measure, although the intrareliability was acceptable, the inter-rater reliability was not acceptable (0.64). Based on this study, we recommend that three MRI measures: transverse area, compression ratio and maximal spinal cord compression should be used in the imaging assessment of the spinal cord in CSM patients. PMID:23637669

Karpova, Alina; Craciunas, Sorin; Chua, Soo-Yong; Rabin, Doron; Smith, Sean; Fehlings, Michael G

2010-08-01

46

Development and characterization of a novel rat model of cervical spondylotic myelopathy: the impact of chronic cord compression on clinical, neuroanatomical, and neurophysiological outcomes.  

PubMed

Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord impairment worldwide and is a risk factor for traumatic central cord syndrome. Despite advances in surgery, there are no effective neuroprotective treatments for CSM, which reflects a limited understanding of its pathophysiology. In order to develop therapeutic strategies, we have developed a novel rat model of chronic progressive cervical spinal cord compression that mimics CSM. A titanium-screw-based chronic compression device (CCD) was designed to achieve progressive cord compression at the C6 level. The CCD was fixed to the C2 and T2 spinous processes and a threaded screw was turned to induce compression. Sprague-Dawley rats (n=75) were divided into three groups: (1) sham (no compression, n=6), (2) mild compression (1.4?mm stenosis, n=27), and (3) severe compression (2.6?mm stenosis, n=42). Compression was evaluated using micro-computed tomography (micro-CT). The area of spared white matter, extent of cord flattening ratio, and loss of neurons were assessed. Functional deficits were characterized using sensory-evoked potential (SEP) recordings, and with neurobehavioral tests: the Basso, Beattie, and Bresnahan (BBB) locomotor rating scale, inclined plane, paw grip strength, and assessment of mechanical and thermal allodynia. Micro-CT confirmed progressive canal stenosis. The loss of intact white matter and cord flattening were significantly greater in rats with severe cord compression, and the number of neurons was reduced at the epicenter of cord compression. With chronic cord compression there was a significant decline in locomotor function, forelimb function, trunk stability/coordination, an increase in mechanical allodynia, and impaired axonal conduction. The CCD model results in chronic and precise cervical cord compression. The compression is associated with mechanical allodynia and measurable neurobehavioral, neurophysiological, and neuropathological deficits. We anticipate that the CCD model will enable the investigation of translationally-relevant therapeutic strategies for CSM. PMID:21561323

Lee, JangBo; Satkunendrarajah, Kajana; Fehlings, Michael G

2012-03-20

47

Median corpectomy in cervical spondylotic multisegmental stenosis.  

PubMed

Cervical median corpectomy as an alternative to laminoplasty and laminectomy has been suggested as an effective treatment for cervical spondylotic myelopathy (CSM) in cases of multisegmental spondylotic stenosis. We report on our experience with this procedure with particular reference to neurological outcome and complications. Median corpectomy was performed in 17 cases (3 female, 14 male; mean age 59 yrs, (41-80 yrs.) with cervical myelopathy (CM) and radiologically diagnosed multisegmental spondylotic stenosis and spinal cord compression seen on MRI. The degree of stenosis was determined by means of the modified Pavlov's index (ratio between spinal canal width at the level of the intervertebral disc and the diameter of the vertebral body itself). 3/17 patients suffered from acute, 4/17 from subacute and 10/17 from chronic CM. Single level corpectomy was performed in 9 cases, one and a half vertebrae were removed in 2 cases and dual level corpectomy was performed in the remaining 6 cases. All patients received an autologous bone graft and AO - anterior plate stabilization or were stabilized as described by Morscher. Postoperative follow - up was possible in 16/17 cases over a mean time of 13.5 months. Myelopathy was graded according to Nurick's scale. Postoperatively, 12% with chronic CM improved by two grades, 38% (2 pts, with acute, 3 with subacute and 1 with chronic CM) improved by one grade. The other patients remained stable, none showed worsening of their myelopathy. Paresis improved in 92%, sensory deficits in 69%, spasticity in 73%, pain in 60%, and vegetative disturbances in 100% of all patients presenting these preoperative symptoms respectively. One patient died due to esophageal perforation and subsequent lethal mediastinitis caused by screw loosening 4 months following surgery and after initial neurological improvement. 4 other patients experienced screw loosening, three with acataposis, one remained clinically asymptomatic with concomitant graft displacement in two of these. One patient had to be re-operated due to a hematoma at the iliac crest and 2 suffered from a pelvic fracture of the spina iliaca at the site of graft removal. With respect to the neurological improvement, especially to the motor function and spasticity, median corpectomy can be regarded as an effective procedure in selected cases with cervical myelopathy, even when treatment related complications are taken into consideration. PMID:8779271

Burger, R; Tonn, J C; Vince, G H; Hofmann, E; Reiners, K; Roosen, K

1996-01-01

48

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

PubMed

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. PMID:20510612

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

2010-06-01

49

Skip laminectomy—a new treatment for cervical spondylotic myelopathy, preserving bilateral muscular attachments to the spinous processes  

Microsoft Academic Search

Background context: Techniques in current use for expansive laminoplasty operations (ELAP) on the cervical spine damage the extensor mechanisms, resulting in restriction of neck motion, loss of lordosis and persistent axial pains.Purpose: This article introduces a new surgical technique called skip laminectomy, which reduces morbidity after decompression of the cervical spinal canal. Study design\\/setting: A prospective study is presented of

Tateru Shiraishi

2002-01-01

50

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  

PubMed Central

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.

Zhang, Yuan; Quan, Zhengxue; Zhao, Zenghui; Luo, Xiaoji; Tang, Ke; Li, Jie; Zhou, Xu; Jiang, Dianming

2014-01-01

51

Cervical Myelopathy in Rheumatoid Arthritis  

PubMed Central

Involvement of the cervical spine is common in rheumatoid arthritis. Clinical presentation can be variable, and symptoms may be due to neck pain or compressive myeloradiculopathy. We discuss the pathology, grading systems, clinical presentation, indications for surgery and surgical management of cervical myelopathy related to rheumatoid arthritis in this paper. We describe our surgical technique and results. We recommend early consultation for surgical management when involvement of the cervical spine is suspected in rheumatoid arthritis. Even patients with advanced cervical myelopathy should be discussed for surgical treatment, since in our experience improvement in function after surgery is common.

Mukerji, N.; Todd, N. V.

2011-01-01

52

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

PubMed Central

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

Kotil, Kadir; Ozyuvaci, Emine

2011-01-01

53

Anterior Fusion Technique for Multilevel Cervical Spondylotic Myelopathy: A Retrospective Analysis of Surgical Outcome of Patients with Different Number of Levels Fused  

PubMed Central

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.

Yu, Shunzhi; Li, Fengning; Yan, Ning; Yuan, Chaoqun; He, Shisheng; Hou, Tiesheng

2014-01-01

54

Characteristics of Spondylotic Myelopathy on 3D Driven-Equilibrium Fast Spin Echo and 2D Fast Spin Echo Magnetic Resonance Imaging: A Retrospective Cross-Sectional Study  

PubMed Central

In patients with spinal stenosis, magnetic resonance imaging of the cervical spine can be improved by using 3D driven-equilibrium fast spin echo sequences to provide a high-resolution assessment of osseous and ligamentous structures. However, it is not yet clear whether 3D driven-equilibrium fast spin echo sequences adequately evaluate the spinal cord itself. As a result, they are generally supplemented by additional 2D fast spin echo sequences, adding time to the examination and potential discomfort to the patient. Here we investigate the hypothesis that in patients with spinal stenosis and spondylotic myelopathy, 3D driven-equilibrium fast spin echo sequences can characterize cord lesions equally well as 2D fast spin echo sequences. We performed a retrospective analysis of 30 adult patients with spondylotic myelopathy who had been examined with both 3D driven-equilibrium fast spin echo sequences and 2D fast spin echo sequences at the same scanning session. The two sequences were inspected separately for each patient, and visible cord lesions were manually traced. We found no significant differences between 3D driven-equilibrium fast spin echo and 2D fast spin echo sequences in the mean number, mean area, or mean transverse dimensions of spondylotic cord lesions. Nevertheless, the mean contrast-to-noise ratio of cord lesions was decreased on 3D driven-equilibrium fast spin echo sequences compared to 2D fast spin echo sequences. These findings suggest that 3D driven-equilibrium fast spin echo sequences do not need supplemental 2D fast spin echo sequences for the diagnosis of spondylotic myelopathy, but they may be less well suited for quantitative signal measurements in the spinal cord.

Abdulhadi, Mike A.; Perno, Joseph R.; Melhem, Elias R.; Nucifora, Paolo G. P.

2014-01-01

55

Conservative treatment with hyperbaric oxygen therapy for cervical spondylotic amyotrophy  

Microsoft Academic Search

Study design:Small case series of patients with cervical spondylotic amyotrophy (CSA) managed by conservative treatment with hyperbaric oxygen (HBO) therapy.Objective:To study the effects of conservative treatment with HBO therapy of CSA patients.Setting:Department of Orthopaedic Surgery, Imakiire General Hospital, Kagoshima, Japan.Methods:This study included 10 patients with CSA who underwent rehabilitation, including cervical traction and muscle exercise, for some period of time

K Tofuku; H Koga; K Yone; S Komiya

2011-01-01

56

The chiropractic management of two cases of cervical spondylotic radiculopathy  

PubMed Central

Cervical spondylotic radiculopathy (CSR) is one of the potential sources of radiculopathy, particularly in patients aged 40 to 60 years. The hallmark sign of cervical-brachial pain presents in the majority of the cases, however a definitive clinical diagnosis is often difficult in the absence of reliable and valid diagnostic tests. Two cases of presumed CSR illustrate the usefulness of applying a comprehensive mechanical assessment that guides the patient's rehabilitation regardless of the traditional anatomical diagnosis. A brief overview of the epidemiology, clinical presentation, and management of CSR is also presented.

Dufton, John A.; Giantomaso, Tony

2003-01-01

57

Operative Techniques for Cervical Radiculopathy and Myelopathy  

PubMed Central

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.

Moran, C.; Bolger, C.

2012-01-01

58

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

PubMed

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. PMID:2693979

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

1989-01-01

59

Hypertrophic Posterior Arch of Atlas Causing Cervical Myelopathy  

PubMed Central

Cervical stenosis, especially of the upper cervical spine, is quite rare which can be developmental or acquired. Clefts or aplasias of anterior and posterior arches of atlas, ossification of the transverse atlantal ligament, hypertrophy of the dens and os odontoideum are rare conditions causing cervical myelopathy reported either singly or in combination. Hypertrophy of the posterior arch of atlas in the absence of any ring hypoplasia as a cause of cervical myelopathy has not been reported earlier. The authors report a case of cervical myelopathy in a 26-year-old female due to hypertrophied posterior arch of atlas which was preoperatively diagnosed as a bony tumor. Being aware of such an entity may avoid diagnostic surprises and facilitate patient prognostication and management.

Traynelis, Vincent Charles

2012-01-01

60

Hypertrophic posterior arch of atlas causing cervical myelopathy.  

PubMed

Cervical stenosis, especially of the upper cervical spine, is quite rare which can be developmental or acquired. Clefts or aplasias of anterior and posterior arches of atlas, ossification of the transverse atlantal ligament, hypertrophy of the dens and os odontoideum are rare conditions causing cervical myelopathy reported either singly or in combination. Hypertrophy of the posterior arch of atlas in the absence of any ring hypoplasia as a cause of cervical myelopathy has not been reported earlier. The authors report a case of cervical myelopathy in a 26-year-old female due to hypertrophied posterior arch of atlas which was preoperatively diagnosed as a bony tumor. Being aware of such an entity may avoid diagnostic surprises and facilitate patient prognostication and management. PMID:23275813

Kasliwal, Manish Kumar; Traynelis, Vincent Charles

2012-12-01

61

Cervical Compressive Myelopathy due to Anomalous Bilateral Vertebral Artery  

PubMed Central

We report a very rare case of cervical compressive myelopathy by an anomalous bilateral vertebral artery (VA) entering the spinal canal at the C1 level and compressing the spinal cord. A 70-year-old woman had been suffering from progressive gait disturbance. Magnetic resonance imaging revealed that a bilateral VA at the V4 segment had abnormal courses and caused compression to the high cervical cord. VA repositioning was performed by anchoring a suture between the artery and around the arachnoid membrane and dentate ligament, and then, microvascular decompression using a Teflon sponge was done between the VA and the spinal cord. The weakness in the patient improved in the lower extremity after the operation. Anomalous VA could be one of the rare causes of cervical compressive myelopathy. Additionally, an anchoring suture and microvascular decompression around the VA could be a sufficient and safe method to indirectly decompress the spinal canal.

Ha, Eun Jin; Lee, Soo Eon; Kim, Hyun-Jib

2013-01-01

62

An Outcome Measure of Functionality and Quality of Life in Patients With Cervical Myelopathy  

PubMed Central

Background: Cervical spondylotic myelopathy (CSM) is a common cause of significant clinical morbidity. The Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) is a measure of health-related quality of life in these patients. Objectives: This study aimed to cross-culturally translate and validate the JOACMEQ in Iran. Patients and Methods: This study was a prospective clinical validation one. Forward-backward procedure was applied to translate the questionnaire from English into Persian. The translation and cross-cultural adaptation were performed in accordance with the published guidelines. A sample of patients with CSM was asked to respond to the questionnaire at two times: providing preoperative and postoperative assessments (6 months follow-up). To test the reliability, the internal consistency was assessed by Cronbach ? coefficient and the validity was assessed by convergent validity. Responsiveness to change was also assessed comparing patients’ preoperative and postoperative scores. Results: All 87 patients completed the questionnaire. The Cronbach ? coefficient for the JOACMEQ at preoperative and postoperative assessments ranged from 0.71 to 0.82 indicating a good internal consistency for the questionnaire. In addition, the correlation of each item with its hypothesized subscale of the JOACMEQ showed satisfactory results suggesting that the items had a substantial association with their own subscales. Further analysis also indicated that the questionnaire was responsive to change (P < 0.001). Conclusions: In general, the findings suggest that the Persian version of the JOACMEQ is a reliable and valid measure of functionality and quality of life evaluation among Iranian patients suffered from CSM.

Azimi, Parisa; Rezaei, Omidvar; Montazeri, Ali

2014-01-01

63

Operative Techniques for Cervical Radiculopathy and Myelopathy  

PubMed Central

Cervical spondylosis is a common problem encountered in modern orthopaedic practice. It is associated with significant patient morbidity related to the consequent radiculopathic and myelopathic symptoms. Operative intervention for this condition is generally indicated if conservative measures fail; however there are some circumstances in which urgent surgical intervention is necessary. Planning any surgical intervention must take into account a number of variables including, but not limited to, the nature, location and extent of the pathology, a history of previous operative interventions, and patient co-morbidities. There are many different surgical options and a multitude of different procedures have been described using both the anterior and posterior approaches to the cervical spine. The use of autograft to achieve cervical fusion is still the gold standard with allograft showing similar results; however fusion techniques are constantly evolving with novel synthetic bone graft substitutes now widely available.

Kavanagh, R. G.; Butler, J. S.; O'Byrne, J. M.; Poynton, A. R.

2012-01-01

64

Vertebral Arteriovenous Fistula Presenting as Cervical Myelopathy: A Rapid Recovery with Balloon Embolization  

SciTech Connect

A 24-year-old male presented with progressive cervical myelopathy of 2 months' duration. Magnetic resonance imaging of the cervical spine and angiography revealed a large arteriovenous fistula arising from the left vertebral artery. The present case highlights the clinical features and dramatic recovery following endovascular balloon occlusion of a giant cervical arteriovenous fistula.

Modi, Manish, E-mail: modim72@yahoo.co [PGIMER, Department of Neurology (India); Bapuraj, J. Rajiv [University Hospital, Department of Neuroradiology (United States); Lal, Anupam [PGIMER, Department of Radiodiagnosis (India); Prabhakar, S. [PGIMER, Department of Neurology (India); Khandelwal, N. [PGIMER, Department of Radiodiagnosis (India)

2010-12-15

65

Cervical myelopathy from calcium pyrophosphate dihydrate crystal deposition: a case report  

Microsoft Academic Search

Calcification of the ligamentum flavum secondary to calcium pyrophosphate dihydrate (CPPD) deposition may be a rare cause\\u000a of cervical myelopathy. We present a 56-year-old man with spinal stenosis secondary to CPPD disease and subacute cervical\\u000a myelopathy following minor trauma. The patient had no history of CPPD disease. Posterior C4-C6 decompression and instrumented\\u000a fusion were performed. Intraoperative findings were densely thickened

Andreas F. Mavrogenis; Panayiotis J. Papagelopoulos; Demetrios S. Korres; Spyridon Pneumaticos

2010-01-01

66

Abnormal subcortical somatosensory evoked potentials indicate high cervical myelopathy in achondroplasia  

Microsoft Academic Search

Children with achondroplasia may have high cervical myelopathy due to stenosis of the cranio-cervical junction resulting\\u000a in neurological disability and an increased rate of sudden death. To detect myelopathy we recorded somatosensory evoked potentials\\u000a (SEPs) after median nerve stimulation in 30 patients with achondroplasia aged 13 months to 18 years (mean 6 years). In addition\\u000a to the conventional technique of

R. Boor; G. Fricke; K. Brühl; J. Spranger

1999-01-01

67

Clinical Features and Surgical Results of Cervical Myelopathy Caused by Soft Disc Herniation  

PubMed Central

Objective There are many causes of cervical myelopathy including trauma, degenerative conditions, tumors and demyelinating disorders. However, myelopathy caused by soft disc herniation might be seen rarely than the spondylosis caused by hard disc. Here, authors retrospectively analyzed the clinical features and results of cervical myelopathy caused by soft disc herniation. Methods From March 2010 to December 2010, 134 patients with degenerative cervical spinal disease were treated with anterior cervical discectomy and interbody fusion. Among them, 21 patients with cervical myelopathy secondary to cervical soft disc herniation were analyzed. Their clinical features, preoperative and, postoperative clinical results were evaluated by Nurick Grade and Japanese Orthopaedic Association scale (JOA) retrospectively. Preoperative clinical features including duration of myelopathy, pain intensity and postoperative clinical results including improvement rate of myelopathy and radiculopathy were retrospectively analyzed by Nurick Grade and JOA scale. We also evaluated correlation between the duration of symptom, type of the disc herniation, pain intensity and clinical outcome. Results Mean age was 49.7 and male was predominant. Gait disturbance with mild to moderate pain was most common symptom in clinical features. Severe pain was shown in only 9 cases, and the other 12 cases experienced mild to moderate pain. Mean duration of myelopathy was 1.18 month. The mean JOA scores were 11.22 before surgery and 14.2 after surgery. The mean Nurick grades were 2.78 before treatment and 1.67 after treatment. Neurologic status of mild or moderate pain group on preoperative state is worse than that of severe pain group. The patients with duration of myelopathy symptom (<1 month) showed lower clinical improvement rate than the patients with myelopathy over 1 month. Patients with median type of disc herniation showed poorer neurological status than those with paramedian type of herniation in preoperative state. Conclusion Authors reviewed the clinical features and surgical outcome of the cervical myelopathy secondary to cervical soft disc herniation. We presumed that patients of more than one month of symptom duration, mild to moderate initial symptom would be related with better postoperative improvement rate.

Park, Sung Joo; Kim, Min Ki; Lee, Sung Ho; Oh, In Ho

2013-01-01

68

Correlation between the clinic and the index of cervical myelopathy Torg  

PubMed Central

Objective Cervical myelopathy is a spinal cord dysfunction related to degeneration typical of aging. Its primary pathology is related to ischemia and spinal cord compression. Patients with myelopathy present many clinical problems; more severe cases may lead to quadriplegia if not treated in a timely manner. Because the primary pathology of this disease is caused by compression, thus generating spinal cord ischemia, we believed there must be a correlation between the degree of compression and the clinical assessment of patients with cervical myelopathy, but we did not find any study in the literature that made this correlation. Because there is doubt the literature we aimed, in our study, to analyze the correlation between the degree of clinical impairment of patients with cervical myelopathy and the Torg index. Methods A prospective, descriptive study, evaluating 46 patients, in which radiographic measurements of the Torg index were performed, with clinical analysis through the Nurick and JOA scale. Results Of the 46 study patients included in the study, 100% presented a Torg score <0.8. The decrease in Torg values was directly proportional to clinical worsening on the Nurick and JOA scale. Conclusions The degree of clinical impairment in patients with cervical myelopathy is directly related to the degree of spinal canal stenosis. Level of Evidence I, Prognostic Studies - Investigating the effect of the characteristics of a patient on the outcome of the disease.

Lozorio, Agnaldo Rogerio; Borges, Mateus; Batista Junior, Jose Lucas; Chacob Junior, Charbel; Machado, Igor Cardoso; Rezende, Rodrigo

2012-01-01

69

Cervical vertebral canal endoscopy in a horse with cervical vertebral stenotic myelopathy.  

PubMed

A 3-year-old Thoroughbred gelding presented with a history of neurological signs, including incoordination in his hindlimbs, of about 7 months' duration. On initial examination, the horse exhibited ataxia and paresis in all limbs with more severe deficits in the hindlimbs. Cervical radiographs displayed severe osteoarthritis of the articular processes between C5 and C6. On subsequent cervical myelography the dorsal contrast column was reduced by 90% at the level of the intervertebral space between C5 and C6. Cervical vertebral canal endoscopy, including epidural (epiduroscopy) and subarachnoid endoscopy (myeloscopy), was performed under general anaesthesia. A substantial narrowing of the subarachnoid space at the level between C6 and C7 was seen during myeloscopy, while no compression was apparent between C5 and C6. Epiduroscopy showed no abnormalities. After completion of the procedure, the horse was subjected to euthanasia and the cervical spinal cord submitted for histopathological examination. Severe myelin and axon degeneration of the white matter was diagnosed at the level of the intervertebral space between C6 and C7, with Wallerian degeneration cranially and caudally, indicating chronic spinal cord compression at this site. Myeloscopy was successfully used to identify the site of spinal cord compression in a horse with cervical vertebral stenotic myelopathy, while myelography results were misleading. PMID:21696435

Prange, T; Carr, E A; Stick, J A; Garcia-Pereira, F L; Patterson, J S; Derksen, F J

2012-01-01

70

Cervical myelopathy due to atlantoaxial and subaxial subluxation in rheumatoid arthritis.  

PubMed

Four patients aged 41 to 73 years, who had had rheumatoid arthritis for eight to 25 years, had signs and symptoms of cervical myelopathy and radiculopathy due to either atlantoaxial dislocation with herniation of the odontoid through the foramen magnum, or subluxation of the middle to lower cervical vertebrae. Spastic paraparesis or quadriparesis, severe nuchal immobility and pain, and flaccid paresis of the upper limbs necessitated anterior medullary decompression and posterior cervical fusion. Postmortem examination disclosed old ischemic necrosis, atrophy, and gliosis in the low medulla and cervical cord. Anterior and posterior gray horns and contiguous posterior and lateral funiculi bore the brunt of the damage. Ascending and descending wallerian degeneration and atrophy of the cervical nerve root were evident. In three cases, anterior spinal or radicular arteries demonstrated intimal fibrosis with moderate stenosis; two cases depicted chronic phlebitis or subarachnoid vessels. Previous reports have infrequently provided evidence of a vasculopathy. PMID:6687427

Manz, H J; Luessenhop, A J; Robertson, D M

1983-02-01

71

Contribution of disc degeneration to osteophyte formation in the cervical spine: a biomechanical investigation  

Microsoft Academic Search

Cervical spine disorders such as spondylotic radiculopathy and myelopathy are often related to osteophyte formation. Bone remodeling experimental–analytical studies have correlated biomechanical responses such as stress and strain energy density to the formation of bony outgrowth. Using these responses of the spinal components, the present study was conducted to investigate the basis for the occurrence of disc-related pathological conditions. An

Srirangam Kumaresan; Narayan Yoganandan; Frank A. Pintar; Dennis J. Maiman; Vijay K. Goel

2001-01-01

72

Laminoplasty Techniques for the Treatment of Multilevel Cervical Stenosis  

PubMed Central

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

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

2012-01-01

73

Comparison of one-level microendoscopy laminoforaminotomy and cervical arthroplasty in cervical spondylotic radiculopathy: a minimum 2-year follow-up study  

PubMed Central

Background This study aims to compare the perioperative parameters and clinical results between microendoscopy laminoforaminotomy (MELF) and cervical arthroplasty (CA) in the treatment of one-level cervical spondylotic radiculopathy in a retrospective study. Methods From 2003 to 2007, a total of 97 patients with one-level cervical spondylotic radiculopathy were treated. Forty-five patients underwent CA. Fifty-two patients underwent MELF. Patient demographics and operative data were collected with a minimum 2-year follow-up. Perioperative parameters were compared. Clinical assessment in terms of neck disability index (NDI), short form (SF)-36, and visual analogue scale (VAS) of arm pain and neck pain was performed prior to surgery and at 1.5, 3, 6, 12, and 24 months after surgery. Results Fluoroscopy time (CA, 60.3 s; MELF, 12.1 s; P??0.05). Conclusions As alternatives of anterior cervical decompression and fusion (ACDF), both CA and MELF can produce satisfactory clinical outcomes. MELF has the additional benefits of less blood loss, less surgical time, less X-ray time, and shorter hospital stay.

2013-01-01

74

[Combined anterior-posterior arthrodesis en patient with athetoid cerebral palsy who developed spondylotic cervical mielopathy. Case report and review of literature].  

PubMed

Spondylotic cervical mielopathy is a common complication in young patients with Cerebral Child Palsy with an important dystonic and athetoid component. Its surgical treatment is a challenge, due to elevate incidence of early faliure of the arthrodesis, both in anterior and posterior approaches. We report an historical review about the treatment of cervical mielopathy in this subgroup of patients and a clinical case in which we decided to realize decompression and arthtrodesis by a combined anterior and posterior approach, with lateral-mass screw placement, using botulinium toxin injections in the postoperative period, achieving a good clinical outcome. PMID:21743945

Pancucci, G; Miranda-Lloret, P; Plaza-Ramírez, M E; López-González, A; Rovira-Lillo, V; Beltrán-Giner, A

2011-06-01

75

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

Microsoft Academic Search

OBJECTIVETo report the efficacy of conservative treatment with cervical traction and immobilisation with a Halo vest, in two consecutive rheumatoid arthritis patients with progressive cervical myelopathy caused by subaxial subluxation.METHODSDescription of neurological symptoms and signs and findings in plain radiography (PR) and magnetic resonance imaging (MRI) of the cervical spine before and after treatment of the subaxial subluxation by traction

Johanna C M Oostveen; Martin A F J van de Laar; Jan A G Geelen; Ron de Graaff

1999-01-01

76

Concomitant Occurrence of Cervical Myelopathy, Cerebral Infarction, and Peripheral Neuropathy in Systemic Lupus Erythematosus: A Case Report  

PubMed Central

Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disease characterized by multiorgan involvement with diverse clinical presentations. Central nervous system involvement in neuropsychiatric syndromes of SLE (NPSLE), such as cerebrovascular disease and myelopathy, is a major cause of morbidity and mortality in SLE patients. The concomitant occurrence of myelopathy, cerebrovascular disease, and peripheral neuropathy in a patient with SLE has not yet been reported. We report on a 41-year-old woman with SLE who showed motor and sensory impairment with urinary retention and was diagnosed with cervical myelopathy and acute cerebral infarction by spine and brain magnetic resonance imaging and peripheral neuropathy by electrodiagnostic examination. Even though pathogenesis of NPSLE is not well elucidated, we assume that increased antibodies of anti-double stranded DNA (anti-dsDNA), presence of lupus anticoagulant and hypertension are risk factors that have caused neuropsychiatric lupus in this patient.

Kim, So-Yeon; Suh, Jee-Hyun

2014-01-01

77

Correlation between spinal cord compression and abnormal patterns of median nerve somatosensory evoked potentials in compressive cervical myelopathy: Comparison of surface and epidurally recorded responses  

Microsoft Academic Search

To investigate the correlation between the level of spinal cord lesion and the abnormal pattern of median nerve somatosensory evoked potentials (SSEPs), evoked spinal cord potentials (ESCPs) were also recorded from the posterior epidural space intraoperatively in 18 patients with compressive cervical myelopathy. Levels of symptomatic spinal cord compression were determined by ESCP findings. Spinal N13 potential of the SSEPs

Kazuo Kaneko; Shinya Kawai; Toshihiko Taguchi; Yasunori Fuchigami; Takashi Ito; Hideki Morita

1998-01-01

78

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

PubMed

Atlanto-occipital assimilation is one of the most common osseous anomalies observed at the craniocervical junction. Most patients with atlas assimilation show no symptom, but some have neurological problems such as myelopathy that may require surgical treatment. Occipitocervical fusion may be required if atlato-occipital assimilation is accompanied by occipito-axial instability. However, in cases of symptomatic atlas assimilation with minor cord compression without instability, simple decompressive surgery may be the treatment modality. This report describes a case of successful treatment of a patient with myelopathy secondary to atlanto-occipital assimilation without instability, using posterior simple decompressive surgery. PMID:24757486

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

2013-09-01

79

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

PubMed Central

Atlanto-occipital assimilation is one of the most common osseous anomalies observed at the craniocervical junction. Most patients with atlas assimilation show no symptom, but some have neurological problems such as myelopathy that may require surgical treatment. Occipitocervical fusion may be required if atlato-occipital assimilation is accompanied by occipito-axial instability. However, in cases of symptomatic atlas assimilation with minor cord compression without instability, simple decompressive surgery may be the treatment modality. This report describes a case of successful treatment of a patient with myelopathy secondary to atlanto-occipital assimilation without instability, using posterior simple decompressive surgery.

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

2013-01-01

80

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

PubMed Central

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.

Bokhari, Rakan

2012-01-01

81

Cervical myelopathy caused by atlantoaxial instability in a patient with an os odontoideum and total aplasia of the posterior arch of the atlas: a case report  

PubMed Central

Introduction Congenital hypoplasia of the atlas has rarely been reported. Myelopathy caused by the complete absence of the posterior arch of the atlas has not been reported. This case report describes the diagnosis and successful treatment of a myelopathy due to the complete absence of the posterior arch of the atlas. Case presentation A 59-year-old Japanese man experienced pain in his nuchal region with progressive spasticity, numbness and hypesthesia in his upper and lower limbs. Deep tendon reflexes in his upper and lower limbs were increased. The complete absence of the posterior arch of the atlas and atlantoaxial instability were found in a roentgenogram. Magnetic resonance imaging detected high signal intensity on T2-weighted images in his spinal cord at the level of cervical vertebrae 1 to 2. Our patient underwent posterior occipito-C4 fixation with pedicle screws. After the operation, the pain in his nuchal region disappeared and his symptoms of myelopathy improved. Only slight numbness of his upper limbs remained. Conclusions This is the first report of myelopathy due to the complete absence of the posterior arch of the atlas.

2012-01-01

82

Cervical spinous process reconstruction.  

PubMed

Posterior neck deformity with an unsightly crater-like defect may result after cervicothoracic laminectomies. The authors present a new technique, spinous process reconstruction, to address this problem. A 64-year-old man presented with progressive quadriparesis secondary to cervical spondylotic myelopathy. Previously he had undergone multiple neck surgeries including cervicothoracic decompressive laminectomy. Postoperatively, he developed severe craniocervical spinal deformity and a large painful concave surgical defect in the neck. The authors performed craniocervical decompression and craniocervicothoracic instrumented stabilization. At the same time, cervicothoracic spinous process reconstruction was performed using titanium mesh to address the defect. Cervicothoracic decompressive laminectomy results in varying degrees of neck defect with resulting unsightly and an often painful surgical wound defect despite an appropriate multilayer closure. The presented spinous process reconstruction is a simple technique to address this problem with good clinical outcome. PMID:24206034

Panchal, Ripul R; Duong, Huy T; Shahlaie, Kiarash; Kim, Kee D

2014-01-01

83

Cervical spondylosis. An update.  

PubMed Central

Cervical spondylosis is caused by degenerative disc disease and usually produces intermittent neck pain in middle-aged and elderly patients. This pain usually responds to activity modification, neck immobilization, isometric exercises, and medication. Neurologic symptoms occur infrequently, usually in patients with congenital spinal stenosis. For these patients, magnetic resonance imaging is the preferred initial diagnostic study. Because involvement of neurologic structures on imaging studies may be asymptomatic, consultation with a neurologist is advised to rule out other neurologic diseases. In most cases of spondylotic radiculopathy, the results of conservative treatment are so favorable that surgical intervention is not considered unless pain persists or unless there is progressive neurologic deficit. If indicated, a surgical procedure may be done through the anterior or posterior cervical spine; results are gratifying, with long-term improvement in 70% to 80% of patients. Cervical spondylotic myelopathy is the most serious and disabling condition of this disease. Because many patients have nonprogressive minor impairment, neck immobilization is a reasonable treatment in patients presenting with minor neurologic findings or in whom an operation is contraindicated. This simple remedy will result in improvement in 30% to 50% of patients. Surgical intervention is indicated for patients presenting with severe or progressive neurologic deficits. Anterior cervical approaches are generally preferred, although there are still indications for laminectomy. Surgical results are modest, with good initial results expected in about 70% of patients. Functional outcome noticeably declines with long-term follow-up, which raises the question of whether, and how much, surgical treatment affects the natural course of the disease. Prospective randomized studies are needed to answer these questions. Images Figure 1. Figure 2. Figure 3.

McCormack, B M; Weinstein, P R

1996-01-01

84

Sprengel deformity and Klippel-Feil syndrome leading to cervical myelopathy presentation in old age  

PubMed Central

Klippel-Feil syndrome is a rare condition characterized by the congenital fusion of two of the seventh cervical vertebrae. A 50-year-old woman presented with a 2-year history of neck pain and ataxia for 1 year. She had not urinary incontinence. She was referred to a neurosurgeon by a neurologist because of her progressive gait ataxia. Risk for brachial plexus injury because of compression or stretching by the clavicle accelerate with age. Therefore, the surgical approach of adults’ patients with Sprengel's deformity can intend suitable surgical conclusions.

Mirhosseini, Seyyed Ahmad; Mirhosseini, Seyyed Mohammad Mahdy; Bidaki, Reza; Boshrabadi, Ahmad Pourrashidi

2013-01-01

85

Cervical myelopathy caused by soft-tissue mass in diffuse idiopathic skeletal hyperostosis  

PubMed Central

A rare case of cervical spinal cord compression in diffuse idiopathic skeletal hyperostosis (DISH or Forestier’s Disease) caused by a craniocervical mass of soft-tissue is reported. The objective is to describe an uncommon mechanism of spinal cord compression in DISH. Three weeks after a cardiac infarction a 69-year-old man slowly developed spastic tetraparesis. Magnetic resonance tomography showed a craniocervical tumor compressing the spinal cord and a massive DISH of the cervical spine. An extended mass of yellowish amorphous material was removed from between the dura, the posterior odontoid process and the posterior aspect of vertebral body C2 reaching to the upper part of C3.The histologic appearance indicated connective tissue and cell-degenerated cartilaginous tissue. There was no inflammatory component and no evidence of neoplasia. No ossification of the posterior longitudinal ligament (OPLL) was found. After removal and craniocervical stabilization the patient’s neurologic function improved remarkably. The increase of mechanical stress on the atlantoaxial segment and enhanced proliferation reaction of the connective tissue in DISH are suggested as the underlying pathomechanisms in the formation of this soft-tissue mass.

Hubbe, Ulrich; Glocker, Franz Xaver

2007-01-01

86

HEREDITARY MYELOPATHIES  

PubMed Central

Hereditary myelopathies are a diverse group of disorders in which major aspects of the clinical syndrome involve spinal cord structures. Hereditary myelopathic syndromes can be recognized as four clinical paradigms: (1) spinocerebellar ataxia, (2) motor neuron disorder, (3) leukodystrophy, and (4) distal motor-sensory axonopathy. This review illustrates these hereditary myelopathy paradigms with clinical examples with an emphasis on clinical recognition and differential diagnosis.

Fink, John K.

2009-01-01

87

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

PubMed Central

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. Recommendations to individual patients must consider possible unique circumstances.

Murphy, Donald R; Coulis, Christopher M; Gerrard, Jonathan K

2009-01-01

88

Biomechanical analysis of cervical myelopathy due to ossification of the posterior longitudinal ligament: Effects of posterior decompression and kyphosis following decompression  

PubMed Central

Cervical ossification of the posterior longitudinal ligament (OPLL) results in myelopathy. Conservative treatment is usually ineffective, thus, surgical treatment is required. One of the reasons for the poor surgical outcome following laminoplasty for cervical OPLL is kyphosis. In the present study, a 3-dimensional finite element method (3D-FEM) was used to analyze the stress distribution in preoperative, posterior decompression and kyphosis models of OPLL. The 3D-FEM spinal cord model established in this study consisted of gray and white matter, as well as pia mater. For the preoperative model, 30% anterior static compression was applied to OPLL. For the posterior decompression model, the lamina was shifted backwards and for the kyphosis model, the spinal cord was studied at 10, 20, 30, 40 and 50° kyphosis. In the preoperative model, high stress distributions were observed in the spinal cord. In the posterior decompression model, stresses were lower than those observed in the preoperative model. In the kyphosis model, an increase in the angle of kyphosis resulted in augmented stress on the spinal cord. Therefore, the results of the present study indicated that posterior decompression was effective, but stress distribution increased with the progression of kyphosis. In cases where kyphosis progresses following surgery, detailed follow-ups are required in case the symptoms worsen.

NISHIDA, NORIHIRO; KANCHIKU, TSUKASA; KATO, YOSHIHIKO; IMAJO, YASUAKI; YOSHIDA, YUICHIRO; KAWANO, SYUNICHI; TAGUCHI, TOSHIHIKO

2014-01-01

89

RADIATION MYELOPATHY  

Microsoft Academic Search

A survey was made of 38 cases of radiation myelopathy with regard to ; early symptoms and signs, differential diagnosis, prognosis, nature of the ; primary lesion irradiated, and latency between irradiation and the development of ; neurological symptoms. Death occurred in 17 of these cases, 1 month to 4 yr ; after the first neurologic symptoms, as a result

CHRISTOPHER A. PALLIS; SYDNEY LOUIS; ROWLAND L. MORGAN

1961-01-01

90

High-resolution nuclear magnetic resonance spectroscopic study of metabolites in the cerebrospinal fluid of patients with cervical myelopathy and lumbar radiculopathy  

PubMed Central

There have been few reports describing substances related to oxidative and intermediary metabolism in the cerebrospinal fluid (CSF) in patients with spinal degenerative disorders. This study investigated whether the concentrations of metabolites in the CSF differed between patients with spinal degenerative disorders and controls, and whether the concentrations of these metabolites correlated with the severity of symptoms. CSF samples were obtained from 30 patients with cervical myelopathy (Group M), 30 patients with lumbar radiculopathy (Group R), and 10 volunteers (control). Metabolites in these CSF samples were measured by nuclear magnetic resonance spectroscopy. There were no differences in the concentrations of lactate, alanine, acetate, glutamate, pyruvate, or citrate between Groups M and R, between Group M and the control, or between Group R and the control. In Group M, neither symptom duration nor the Japanese Orthopaedic Association score correlated with the concentration of any metabolite. In Group R, the symptom duration positively correlated with the concentration of lactate, glutamate, and citrate in CSF. The duration of nerve root block showed a negative correlation with the concentrations of acetate in CSF of the patients in Group R. In patients with lumbar radiculopathy, there is a possibility of increased aerobic metabolic activity or decreased gluconeogenic activity in patients with shorter symptom duration, and increased aerobic metabolic activity in patients with severe inflammation around a nerve root.

Morio, Yasuo; Meshitsuka, Shunsuke; Yamane, Koji; Nanjo, Yoshiro; Teshima, Ryota

2010-01-01

91

Spontaneous vertebral arteriovenous fistula causing cervical myelopathy and acute ischemic strokes treated by endovascular balloon-assisted coiling and Onyx embolization.  

PubMed

Vertebral arteriovenous fistulas (VAVF) are infrequent lesions characterized by abnormal communication of the extracranial vertebral artery or one of its branches to the surrounding venous plexuses, without the presence of any intervening vessels. We describe a rare occurrence of a patient with VAVF presenting with acute ischemic stroke, encephalomalacia from multiple prior embolic events, and cervical myelopathy, which was successfully treated by coil-assisted Onyx embolization (ev3 Endovascular, Plymouth, MN, USA) with balloon for flow arrest. Our patient demonstrates that point occlusion with embolization for VAVF can be a feasible, safe, and effective treatment option for complete obliteration of the fistula, with subsequent reduction in the volume of the intra-spinal canal venous plexus. Although it is postulated that thromboembolism is less common because of redirection of flow to the venous side of the fistula, our patient also illustrates the potential for to-fro flow in such a fistula to result in embolic injury to the distal circulation. PMID:23972561

John, Seby; Jaffari, Neda; Lu, Mei; Hussain, Muhammad S; Hui, Ferdinand

2014-01-01

92

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

PubMed Central

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.

Hassan, K. M.; Sahni, Hirdesh; Jha, Atul

2012-01-01

93

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

PubMed Central

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.

Hur, Jung-Woo; Kim, Jin-Sung; Shin, Myeong-Hoon; Ryu, Kyeong-Sik

2014-01-01

94

Bilateral C5 motor paralysis following anterior cervical surgery--a case report.  

PubMed

Numerous authors have reported C5 root palsies following posterior cervical surgery, and several mechanisms of injury have been proposed. Similar deficits after anterior cervical procedures are considered to occur less commonly. We report on a 48-year-old male who underwent multi-level anterior discectomy and fusion for cervical spondylotic myelopathy. Bilateral C5 nerve root deficits were noticed in the immediate postoperative period, and treated non-operatively. A postoperative magnetic resonance imaging (MRI) scan showed an increase in cervical lordosis accompanied by a posterior shifting of the spinal cord. Potential mechanisms of nerve root injury in this situation are discussed, and the literature on postoperative C5 root deficits is reviewed. The patient returned to his preoperative occupation as an operating room nurse 6 months following surgery, with complete neurologic recovery occurring over an 11-month period. C5 deficits following anterior cervical surgery occur more frequently than generally assumed. Improved lordosis and longitudinal lengthening of the cervical spinal column in multilevel anterior decompression and interbody fusion can paradoxically result in a traction injury to the spinal cord and C5 nerve roots. PMID:15963639

David, Kenny S; Rao, Raj D

2006-10-01

95

The characteristics of bony ankylosis of the facet joint of the upper cervical spine in rheumatoid arthritis patients  

PubMed Central

This study investigated the bony ankylosis of the upper cervical spine facet joints in patients with a cervical spine involvement due to rheumatoid arthritis (RA) using computed tomography (CT) and then examined the characteristics of the patients showing such ankylosis. Forty-six consecutive patients who underwent surgical treatment for RA involving the cervical spine were reviewed. The radiographic diagnoses included atlanto-axial subluxation in 30 cases, vertical subluxation (VS) in 10 cases, VS + subaxial subluxation in 3 cases and cervical spondylotic myelopathy in 3 cases. The patients were classified into two groups, those developing bony ankylosis or not and then the differences in the patient characteristics between the two groups was investigated. Furthermore, cervical spine disorders and surgeries were also evaluated in patients who demonstrated such bony ankylosis. The CT reconstruction image demonstrated bony ankylosis in 12 patients (group BA), and the remaining 34 cases (group NB) showed no bony ankylosis. The level at which bony ankylosis occurred was atlanto-occipital joint (AOJ) in eight cases, atlanto-axial joint (AAJ) in two cases and AOJ, AAJ in two cases. No differences were observed between the two groups (age P > 0.54, gender P > 0.39, duration of RA P > 0.72). There was a significant difference between two groups in the patients showing obvious neurological impairment (P = 0.017). In BA group, arthrodesis or decompression was adapted for a caudal region of bony ankylosis. In conclusion, bony ankylosis of the facet joint of the upper cervical spine was detected in 12 of 46 RA patients with involvement of the cervical spine who thus required surgery. These findings showed that the patients demonstrating such ankylosis showed severe cervical myelopathy. In addition, we suggest that the occurrence of bony ankylosis was a risk factor for instability of AAJ, and subaxial instability or stenosis.

Nishinome, Masahiro; Sorimachi, Yasunori; Ara, Tsuyoshi; Nakajima, Takashi; Iizuka, Yoichi; Takagishi, Kenji

2009-01-01

96

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

PubMed

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. PMID:24526422

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

2014-03-01

97

Neck Pain Following Cervical Laminoplasty: Does Preservation of the C2 Muscle Attachments and/or C7 Matter?  

PubMed Central

Study Design?Systematic review. Objective?In patients aged 18 years or older, with cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament (OPLL), does sparing the C2 muscle attachments and/or C7-preserving cervical laminoplasty lead to reduced postoperative axial pain compared with conventional C3 to C7 laminoplasty? Do these results vary based on early active postoperative cervical motion? Methods?A systematic review of the English-language literature was undertaken for articles published between 1970 and August 17, 2012. Electronic databases and reference lists of key articles were searched to identify studies evaluating C2/C3- or C7-preserving cervical laminoplasty for the treatment of cervical spondylotic myelopathy (CSM) or OPLL in adults. Studies involving traumatic onset, cervical fracture, infection, deformity, or neoplasms were excluded, as were noncomparative studies. Two independent reviewers assessed the level of evidence quality using the grading of recommendations assessment, development and evaluation (GRADE) system, and disagreements were resolved by consensus. Results?We identified 11 articles meeting our inclusion criteria. Only the randomized controlled trial (RCT) showed no significant difference in late axial pain (at 12 months) when C7 spinous muscle preservation was compared with no preservation. However, seven other retrospective cohort studies showed significant pain relief in the preserved group compared with the nonpreserved group. The preservation group included those with preservation of the C7 spinous process and/or attached muscles, the deep extensor muscles, or C2 muscle attachment and/or C3 laminectomy (as opposed to laminoplasty). One study that included preservation of either the C2 or C7 posterior paraspinal muscles found that only preservation of the muscles attached to C2 resulted in reduced postoperative pain. Another study that included preservation of either the C7 spinous process or the deep extensor muscles found that only preservation of C7 resulted in reduced postoperative pain. Conclusion?Although there is conflicting data regarding the importance of preserving C7 and/or the semispinalis cervicis muscle attachments to C2, there is enough evidence to suggest that surgeons should make every attempt to preserve these structures whenever possible since there appears to be little downside to doing so, unless it compromises the neurologic decompression.

Riew, K. Daniel; Raich, Annie L.; Dettori, Joseph R.; Heller, John G.

2013-01-01

98

Anterior cervical discectomy plus intervertebral polyetheretherketone cage fusion over three and four levels without plating is safe and effective long-term.  

PubMed

Anterior cervical discectomy and fusion (ACDF) is an established treatment for single-level cervical spondylotic myelopathy and radiculopathy, yet its stand-alone use for multi-level disease of the subaxial cervical spine remains controversial. We report a prospectively studied case series of 30 patients receiving polyetheretherketone (PEEK) cage fusion over three and four cervical levels without anterior plating. Seven (23.3%) four-level procedures (all C3 to C7) were performed, the other 23 (76.7%) being three-level, with 19 (64.4%) at C4 to C7 and four (12.3%) at C3 to C6. Long-term follow-up of more than 2 years was available in 67% of patients. This cohort showed statistically significant improvements in visual analogue score for neck pain (p=0.0006), arm pain (p=0.0003) and Japanese Orthopaedic Association myelopathy score (p=0.002). Fused segment heights increased by 0.6-1.1%. Adjacent segment disease requiring ACDF at C3-4 was seen in 6.7% of patients (one after trauma) at a mean follow-up of 62 months. Same segment recurrence requiring posterior decompression with instrumented fusion was found in 10% of patients at a mean follow-up of 49 months, only one of whom had radiological evidence of cage subsidence. The results suggest the procedure is safe and effective with potentially less morbidity than anterior plating, shorter inpatient stays than posterior approaches, acceptable same segment recurrence and lower than predicted adjacent segment disease rates. PMID:23890411

Pereira, Erlick A C; Chari, Aswin; Hempenstall, Jonathan; Leach, John C D; Chandran, Hari; Cadoux-Hudson, Tom A D

2013-09-01

99

Radiation myelopathy: a review  

SciTech Connect

Radiation myelopathy is a serious potential complication associated with radiation therapy to the spinal cord. Its exact cause is unknown. It represents a spectrum of syndromes, the most common of which are acute transient radiation myelopathy and chronic progressive radiation myelitis. A review of the literature indicates that cord damage is related to a number of controllable factors including dose fraction size, treatment time, total dose, length of cord irradiated, technical and clerical errors. Other less well understood factors that appear to contribute to the risk such as combined chemoradiotherapy effects and hyperthermia should also be recognized. A better awareness and understanding of these factors should ultimately lead to safer and more effective treatments. 56 references.

Goldwein, J.W.

1987-01-01

100

Pregabalin and Radicular Pain Study (PARPS) for Cervical Spondylosis in a Multiracial Asian Population  

PubMed Central

Background Pain from cervical spondylosis (CS) may result from degenerative spinal canal stenosis (cervical spondylotic myelopathy (CSM)) or lateral recesses compromise, leading to nerve root compression (cervical spondylotic radiculopathy (CSR)). Pregabalin was shown to be effective in randomized, placebo-controlled trials for post-herpetic neuralgia and diabetic neuropathy. We evaluate its efficacy in CS with underlying CSR or CSM in a prospective study comprising Asian patients for the first time. Methods Patients with CS and CSR or CSM (clinical, MRI, or electrophysiological evidence) presenting with neuropathic pain were recruited. We excluded patients with diabetes, underlying neurological disease or who were previously on antiepileptics. Pregabalin 75 mg bd was administered for 4 weeks, after which dosage was increased to 150 mg bd for another 4 weeks if the visual analog scale (VAS) was not reduced by 50%. In addition, we monitored the short form McGill pain questionnaire (SFMPQ) at baseline, 4 weeks and 8 weeks. Mood changes were monitored using the hospital anxiety and depression score (HADS) with an identical timeline. Results We recruited 50 patients, of which 23 completed the trial. Of the 27 who withdrew, 12 (44%) were for somnolence. Thirteen patients’ (54%) dosages remained at 75 mg and 11 patients’ (46%) dosages were escalated to 150 mg bd. There were significantly reducing trends from baseline for VAS (ANOVA, F(1, 21) = 25.4, P < 0.0005), SFMPQ (sensory) (F(1, 22) = 11.2, P = 0.003), and SFMPQ (affective) (F(1, 21) = 10.9, P = 0.008). For VAS, there was significant reduction at 4 weeks (P = 0.001) and 8 weeks (P < 0.0005) compared to baseline. For SFMPQ (sensory), there was significant reduction at 4 weeks (P = 0.01) and 8 weeks (P = 0.006) in scores compared to baselines. For SFMPQ (affective), there was significant reduction at 4 weeks (P = 0.04) and 8 weeks (P = 0.008) in scores compared to baseline. No significant anxiety (F(1, 4) = 1.3, P = 0.32) or depression (F(1, 4) = 0.06, P = 0.82) changes were observed in the HADS. Conclusion Pregabalin is efficacious in alleviation of pain symptoms related to CSR as a first-line single agent, evaluated by quantitative severity and other experiential scales. No significant mood changes reported in other studies were demonstrated. Somnolence was commonest adverse effect leading to high dropout rates, occurring early even at the lowest dose. The findings suggest the need for further studies of efficacy at lower dosages, particularly in the Asian population.

Lo, Yew Long; Cheong, Priscilia Woon Ting; George, Jane Mary; Tan, Seang Beng; Yue, Wai Mun; Guo, Chang Ming; Fook-Chong, Stephanie

2014-01-01

101

The Natural History and Clinical Syndromes of Degenerative Cervical Spondylosis  

PubMed Central

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

Kelly, John C.; Groarke, Patrick J.; Butler, Joseph S.; Poynton, Ashley R.; O'Byrne, John M.

2012-01-01

102

[Radiation myelopathy and plexopathy].  

PubMed

Radiation myelopathy (RM) is a relatively rare disorder characterized by white matter lesions of the spinal cord resulting from irradiation. It is divided into two forms by the latent periods: transient RM and delayed RM. The delayed RM develops usually non-transverse myelopathy symptoms such as dissociated sensory disturbance, unilateral leg weakness, and gait disturbance with asymmetric steps. Spinal MRI shows initially cord swelling and long T1/T2 intramedullary lesion with enhancement, then exhibits cord atrophy. Histopathological findings of delayed RM are white matter necrosis, demyelination, venous wall thickening and hyalinization. Glial theory and vascular hypothesis have been proposed to explain its pathophysiology. Several therapies such as adrenocorticosteroid, anticoagulation and hyperbaric oxygen have been tried to this disease with variable benefits. Radiation plexopathy is classified into two major types by the location: radiation-induced brachial plexopathy (BP) and radiation-induced lumbosacral plexopathy (LSP). The BP initially emerges as arm and shoulder pain, whereas LSP as leg weakness. Myokymia and fasciculations are observed in both types. Electrophysiological study reveals findings of peripheral neuropathy. It is often difficult to distinguish the radiation plexopathy from cancer invasion to the plexus, but MRI is useful to differentiate between these diseases. Pathological findings are small vessel obstruction, thick fibrosis, axonal degeneration and demyelination. Its pathomechanism is presumed that radiation-induced fibrous tissue compresses the nerve root as well as microvascular obstruction of the nerve. Adrenocorticosteroid and anticoagulation are considered as the strategy for symptomatic relief. PMID:18306658

Shimazaki, Haruo; Nakano, Imaharu

2008-02-01

103

Pathology of radiation myelopathy  

PubMed Central

After nothing the rarity of papers describing the pathology of delayed radiation necrosis of the spinal cord, the clinical and pathological findings from four cases are presented. The main pathological features are asymmetric demyelination of the lateral columns and to a lesser degree the posterior and anterior columns of white matter, with coagulative necrosis at the level of irradiation which affected the grey matter to a lesser degree. There is ascending and descending secondary tract degeneration, and poor glial response in the lesions themselves. Vascular changes, mainly hyalilne thickening of arteriolar walls, are present, but not in degree sufficient to explain the primary lesion. The discussion of the pathogenesis of the myelopathy weighs the merits of a primary vascular lesion against those of a primary effect of the radiation on neural tissue. The latter is favoured. Images

Burns, R. J.; Jones, A. N.; Robertson, J. S.

1972-01-01

104

Canine degenerative myelopathy.  

PubMed

Canine degenerative myelopathy (DM) is an adult-onset fatal neurodegenerative disease that occurs in many breeds. The initial upper motor neuron spastic paraparesis and general proprioceptive ataxia in the pelvic limbs progress to a flaccid lower motor neuron tetraparesis. Recently, a missense mutation in the superoxide dismutase 1 (SOD1) gene was found to be a risk factor for DM, suggesting that DM is similar to some forms of human amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease). This article reviews the current knowledge of canine DM with regard to its signalment, clinical spectrum, diagnostic approach, and treatment. The implications of the SOD1 mutation on both diseases are discussed, comparing pathogenic mechanisms while conveying perspectives to translational medicine. PMID:20732599

Coates, Joan R; Wininger, Fred A

2010-09-01

105

Urodynamic profile in myelopathies: A follow-up study  

PubMed Central

Aims: To study the significance of filling cystometry in assessment and management of neurogenic bladder in myelopathies and correlate neurological recovery and bladder management in the follow up. Study Design: Retrospective analysis of reports of filling cystometry in patients with traumatic and non-traumatic myelopathy. Setting: Neuro-rehabilitation unit of a tertiary care university hospital. Methods: The study was carried out between September 2005 and June 2006 and included all subjects with myelopathy who underwent filling cystometry. ASIA impairment scale was used to assess neurological status during admission as well as in the follow up. Bladder management was advised based on the cystometric findings. Neurological recovery and mode of bladder management were correlated during the follow up after a minimum of 6 months. Results: Fifty-two subjects (38 males, 14 females), mean age 33.26 ± 14.66 years (10–80) underwent filling cystometry. Twenty patients had cervical, 24 had thoracic and 8 had lumbar myelopathy. Cystometric findings were overactive detrusor observed in 43 patients, (21 had detrusor sphincter dyssynergia (DSD), 22 without DSD) and areflexic/underactive detrusor in 9. Post-void residual (>15% of voided urine) was significant in 27 patients. Twenty-three patients (44%) reported for follow up (16 males, 7 females) after a mean duration of 9.04 ± 2.44 months (6–15 months). Neurological recovery was seen in 61% cases, while 1 patient showed deterioration. Only 26% patients reported change in bladder management during follow up. Correlation between neurological recovery and bladder management was found to be insignificant (P > 0.05) using spearman correlation co-efficient. Conclusions: Filling cystometry is valuable for assessment and management of neurogenic bladder after myelopathy. No significant relationship was observed between neurological recovery and neurogenic bladder management in the follow up in the present study.

Gupta, Anupam; Taly, Arun B.; Srivastava, Abhishek; Thyloth, Murali

2009-01-01

106

Stability of cervical spine after one-level corpectomy using different numbers of screws and plate systems.  

PubMed

Anterior corpectomy and reconstruction using a plate with locking screws are standard procedures for the treatment of cervical spondylotic myelopathy. Although adding more screws to the construct will normally result in improved fixation stability, several issues need to be considered. Past reports have suggested that increasing the number of screws can result in the increase in spinal rigidity, decreased spine mobility, loss of bone and, possibly, screw loosening. In order to overcome this, options to have constrained, semi-constrained or hybrid screw and plate systems were later introduced. The purpose of this study is to compare the stability achieved by four and two screws using different plate systems after one-level corpectomy with placement of cage. A three-dimensional finite-element model of an intact C1-C7 segment was developed from computer tomography data sets, including the cortical bone, soft tissue and simulated corpectomy fusion at C4-C5. A spinal cage and an anterior cervical plate with different numbers of screws and plate systems were constructed to a fit one-level corpectomy of C5. Moment load of 1.0 N m was applied to the superior surface of C1, with C7 was fixed in all degrees of freedom. The kinematic stability of a two-screw plate was found to be statistically equivalent to a four-screw plate for one-level corpectomy. Thus, it can be a better option of fusion and infers comparable stability after one-level anterior cervical corpectomy, instead of a four-screw plate. PMID:24622982

Rosli, Ruwaida; Abdul Kadir, Mohammed R; Kamarul, Tunku

2014-04-01

107

Contribution of disc degeneration to osteophyte formation in the cervical spine: a biomechanical investigation.  

PubMed

Cervical spine disorders such as spondylotic radiculopathy and myelopathy are often related to osteophyte formation. Bone remodeling experimental-analytical studies have correlated biomechanical responses such as stress and strain energy density to the formation of bony outgrowth. Using these responses of the spinal components, the present study was conducted to investigate the basis for the occurrence of disc-related pathological conditions. An anatomically accurate and validated intact finite element model of the C4-C5-C6 cervical spine was used to simulate progressive disc degeneration at the C5-C6 level. Slight degeneration included an alteration of material properties of the nucleus pulposus representing the dehydration process. Moderate degeneration included an alteration of fiber content and material properties of the anulus fibrosus representing the disintegrated nature of the anulus in addition to dehydrated nucleus. Severe degeneration included decrease in the intervertebral disc height with dehydrated nucleus and disintegrated anulus. The intact and three degenerated models were exercised under compression, and the overall force-displacement response, local segmental stiffness, anulus fiber strain, disc bulge, anulus stress, load shared by the disc and facet joints, pressure in the disc, facet and uncovertebral joints, and strain energy density and stress in the vertebral cortex were determined. The overall stiffness (C4-C6) increased with the severity of degeneration. The segmental stiffness at the degenerated level (C5-C6) increased with the severity of degeneration. Intervertebral disc bulge and anulus stress and strain decreased at the degenerated level. The strain energy density and stress in vertebral cortex increased adjacent to the degenerated disc. Specifically, the anterior region of the cortex responded with a higher increase in these responses. The increased strain energy density and stress in the vertebral cortex over time may induce the remodeling process according to Wolff's law, leading to the formation of osteophytes. PMID:11562150

Kumaresan, S; Yoganandan, N; Pintar, F A; Maiman, D J; Goel, V K

2001-09-01

108

Transcranial magnetic stimulation screening for cord compression in cervical spondylosis  

Microsoft Academic Search

ObjectiveCervical spondylosis (CS) often results in various degrees of cord compression, which can be evaluated functionally with transcranial magnetic stimulation (TMS). We investigate the use of TMS as a screening tool for myelopathy in CS.

Y. L. Lo; L. L. Chan; W. Lim; S. B. Tan; C. T. Tan; J. L. T. Chen; S. Fook-Chong; P. Ratnagopal

2006-01-01

109

[Treatment of cervical vertebrae bodies pathologic fractures].  

PubMed

Treatment results of 32 patients with pathologic fractures of cervical vertebrae bodies were analyzed. Vertebral destruction was due to tumour metastases (18 patients), nonspecific spondylitis (12 patients) and fibrocystic displasia (2 patients). Myelopathy with local and radicular pain syndrome was registered in all cases before the operation. All patients underwent the destroyed vertebral body replacement by the carbonic implant with collapanoplasty. Pain was relieved in all cases, full and partial myelopathy regression was registered in 27 and 5 patients, respectively. PMID:20336046

Kavalerski?, G M; Karanadze, A N; Gordeev, G G; Fazilov, Sh K; Nikuradze, V K

2010-01-01

110

4- and 5-level anterior fusions of the cervical spine: review of literature and clinical results  

PubMed Central

In the future, there will be an increased number of cervical revision surgeries, including 4- and more-levels. But, there is a paucity of literature concerning the geometrical and clinical outcome in these challenging reconstructions. To contribute to current knowledge, we want to share our experience with 4- and 5-level anterior cervical fusions in 26 cases in sight of a critical review of literature. At index procedure, almost 50% of our patients had previous cervical surgeries performed. Besides failed prior surgeries, indications included degenerative multilevel instability and spondylotic myelopathy with cervical kyphosis. An average of 4.1 levels was instrumented and fused using constrained (26.9%) and non-constrained (73.1%) screw-plate systems. At all, four patients had 3-level corpectomies, and three had additional posterior stabilization and fusion. Mean age of patients at index procedure was 54 years with a mean follow-up intervall of 30.9 months. Preoperative lordosis C2-7 was 6.5° in average, which measured a mean of 15.6° at last follow-up. Postoperative lordosis at fusion block was 14.4° in average, and 13.6° at last follow-up. In 34.6% of patients some kind of postoperative change in construct geometry was observed, but without any catastrophic construct failure. There were two delayed unions, but finally union rate was 100% without any need for the Halo device. Eleven patients (42.3%) showed an excellent outcome, twelve good (46.2%), one fair (3.8%), and two poor (7.7%). The study demonstrated that anterior-only instrumentations following segmental decompressions or use of the hybrid technique with discontinuous corpectomies can avoid the need for posterior supplemental surgery in 4- and 5-level surgeries. However, also the review of literature shows that decreased construct rigidity following more than 2-level corpectomies can demand 360° instrumentation and fusion. Concerning construct rigidity and radiolographic course, constrained plates did better than non-constrained ones. The discussion of our results are accompanied by a detailed review of literature, shedding light on the biomechanical challenges in multilevel cervical procedures and suggests conclusions.

Koller, Heiko; Ferraris, Luis; Maier, Oliver; Hitzl, Wolfgang; Metz-Stavenhagen, Peter

2007-01-01

111

Cervical artificial disc replacement (C-ADR): global perspectives on use and trends  

PubMed Central

Study design:?Cross-sectional survey. Objectives:?To obtain information from the global community regarding cervical artificial disc replacement (C-ADR) use and trends before and after US Food and Drug Administration (FDA) approval of devices in 2007 and summarize available information on utilization and government approval for devices. Methods:?Data on utilization and approval were sought from PubMed, Google, FDA, and manufacturers’ websites. The 6195 members of AOSpine International were invited to participate in a survey to assess global C-ADR use and trends. Results:?Publically available data on utilization, trends, and approval outside of the US and Europe is limited. No studies of utilization were found. Of 1479 professionals responding to the survey, 50% had C-ADR specific training and reported ever performing C-ADR. Most respondents believed that C-ADR was safe and effective, but approximately one quarter responded that they did not know. Of those who had done C-ADR, 49% reported performing ? 1 before December compared with 92% after January 2008 and 51.3% indicated that all their C-ADRs were placed in a single level; 27% reported ? 1 failures that required revision. The majority foresee that C-ADR use will increase in the next 5 years. Most respondents believed that the best indication is radiculopathy from soft-disc pathology rather than myelopathy or disorders arising from spondylotic (hard-disc) pathology. Conclusion:?More C-ADR has been performed after January 2008. Most respondents expect the number to increase. There may be differences in failure rates when performed inside or outside of a sponsored research trial.

Rhee, John; Van Alstyne, Ellen M.; Skelly, Andrea C.

2012-01-01

112

Myelopathy but normal MRI: where next?  

Microsoft Academic Search

For most patients presenting with a spinal cord syndrome MR scanning has become the key investigation in establishing the diagnosis. However, myelopathy with normal spinal imaging remains a common clinical conundrum. In this review we discuss the diagnoses to consider for the neurologist presented with a patient with “MR normal myelopathy”. We will illustrate this scenario with a series of

S H Wong; M Boggild; T P Enevoldson; N A Fletcher

2008-01-01

113

Reversible hepatic myelopathy: a case report.  

PubMed

We report a case of reversible hepatic myelopathy. A 42-year-old female patient with 3-year history of alcoholic liver cirrhosis developed spastic gait, hyperreflexia and mild somatosensory disturbance in her lower extremities. The increased level of serum ammonia and the deficits of N30 and P38 in the tibial somatosensory evoked potentials (SEP) in conjunction with exclusion of the other known causes of myelopathy supported the diagnosis of her hepatic myelopathy. The ammonia lowering therapy by the oral administration of lactulose successfully improved the spastic gait accompanied with the emergence of N30 and P38 in the tibial SEP. Although liver transplantation was known to be the only therapy for hepatic myelopathy in the literatures, our case showed that the ammonia lowering therapy can be effective for the early stage of hepatic myelopathy. PMID:24705837

Hirozawa, Daisuke; Fukada, Kei; Yaegaki, Takahide; Hoshi, Taku; Sawada, Jinichi; Hazama, Takanori

2014-01-01

114

Complete paraplegia resulting from surfer's myelopathy.  

PubMed

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. PMID:22257974

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

2013-09-01

115

Magnetic resonance imaging in patients with progressive myelopathy following spinal surgery.  

PubMed Central

Thirty one patients with insidious progressive myelopathy 2 to 8 years following surgery of the cervical spine were subjected to magnetic resonance imaging (MRI). In 15 patients operated on for vascular malformations or intramedullary tumours, syringomyelia and cystic lesions of the spinal cord were shown. Seven of these patients also showed a combination of a recurrent tumour and spinal atrophy. Out of 16 patients who had surgery for herniated disc or spinal stenosis of the cervical spine, four had syringomyelia and 12 had spinal cord atrophy. There was no syringomyelia in the 12 patients submitted to MRI prior to surgery. Images

Avrahami, E; Tadmor, R; Cohn, D F

1989-01-01

116

A rare presentation of subacute progressive ascending myelopathy secondary to cement leakage in percutaneous vertebroplasty.  

PubMed

Percutaneous vertebroplasty is used to manage osteoporotic vertebral body compression fractures. Although it is relatively safe, complications after vertebroplasty ranging from minor to devastatingly major ones have been described. Cement leakage into the spinal canal is one such complication. Subacute progressive ascending myelopathy is an infrequent neurologic complication after spinal cord injury, typically presenting as ascending neurologic deficit within weeks after the initial insult. The precise cause of subacute progressive ascending myelopathy still remains an enigma, considering the rarity of this disorder. The authors present the case of a 62-yr-old woman with osteoporotic vertebral fracture who underwent percutaneous vertebroplasty and developed T6 complete paraplegia because of cement leakage. A few weeks later, the neurologic level ascended to higher cervical level (C3). To date, no case of subacute progressive ascending myelopathy secondary to cement leakage after percutaneous vertebroplasty has been reported. Literature is reviewed regarding subacute progressive ascending myelopathy, and the rehabilitation challenges in the management of this patient are discussed. PMID:24322431

Bhide, Rohit Prakash; Barman, Apurba; Varghese, Shiela Mary; Chatterjee, Ahana; Mammen, Suraj; George, Jacob; Thomas, Raji

2014-05-01

117

Myelopathy and Quadriparesis due to Spinal Cord Compression of C1 Laminar Osteochondroma.  

PubMed

The aim of this paper is to show that osteochondromas of the cervical vertebrae can cause myelopathy and neck pain.The reported etiology, diagnosis, treatment and differential diagnosis were reviewed. Osteochondromas may present as a solitary lesion with no genetic component or as multiple lesions as a part of a genetic disorder known as hereditary multiple exostosis. Osteochondromas of the spine are rarely encountered in clinical practice. These lesions are reported more commonly with neural compression in cases associated with hereditary multiple exostosis. The authors describe a unusual clinical manifestation of a solitary osteochondroma located in the right posterior arch of the atlas. Complete removal of the tumor was performed resulting in the relief of neck pain and spastic quadriparesis. Although unusual, osteochondromas of the cervical spine must be considered in patients with persistent neck pain and progressive symptoms of myelopathy. Computed tomography and magnetic resonance imaging in conjunction with plain radiograms is the neuroradiological modality of choice. The diagnosis and surgical excision of these tumors are important because they can cause spinal stenosis resulting in neural tissue compression and myelopathy. PMID:22439091

Er, Uygur; Sim?ek, Serkan; Yi?itkanl?, Kaz?m; Adaba?, Aysegül; Kars, Hamit Zafer

2012-03-01

118

Tri-level surgical treatment of cervical spinal cord compression in a Thoroughbred yearling  

PubMed Central

A Thoroughbred yearling was presented with neurological, radiographic, and myelographic abnormalities consistent with cervical vertebral stenotic myelopathy. Surgical correction was performed by using ventral cervical interbody fusion at 3 intervertebral spaces. The patient recovered uneventfully from surgery. The neurological status remained unchanged initially; however, significant improvement was noted 37 weeks postoperatively.

Huggons, Nick

2007-01-01

119

Progressive ascending myelopathy: atypical forms of multiple sclerosis or what else?  

PubMed

The spinal cord can be affected by multiple heterogeneous disorders often difficult to diagnose. We describe ten patients affected by a progressive ascending myelopathy with a poor prognosis. The patients, during the follow-up period, underwent neurological examinations, cerebrospinal fluid analysis, hematological, microbiological, auto-antibodies screening, brain and spinal cord magnetic resonance imaging (MRI) and electroneurophysiological study. At disease onset spinal cord MRI showed ?1 myelopathic lesions extended for <2 segments and then evidenced a progressive spinal cord atrophy without any new lesion. All patients showed an increase of the visual evoked potential P100 latency. All of them showed two or more clinical recurrences of myelitis and then, after a period ranging from 3 to 5 years from the disease onset, a progressive course. Five patients became unresponsive to intravenous high-dose steroid treatments and/or intravenous immunoglobulins and to any other therapeutic attempts, developed a progressive ascending myelopathy to tetraplegia and died from respiratory failure. The other five patients are in progressive phase of the disease with an initial involvement of the upper limbs and show mild cervical spinal cord atrophy at MRI, configuring the early stage of an ascending progressive myelopathy. In our opinion, the more suitable diagnosis is an atypical form of MS although is not possible to exclude a new nosological entity that could be included in the expanding range of spinal cord diseases. PMID:21512739

Nociti, Viviana; Batocchi, Anna Paola; Luigetti, Marco; Conte, Amelia; Lorusso, Vita Santa; Roiati, Silvia; Tartaglione, Tommaso; Del Grande, Alessandra; Sabatelli, Mario

2011-11-01

120

Subacute myelopathy caused by spinal venous infarction.  

PubMed Central

A 44 year old female presented with a subacute myelopathy in association with pelvic venous thrombosis. It is inferred from the temporal relationship of these events that the patient suffered a subacute spinal venous infarction. This is discussed along with the aetiology, anatomical distribution and management of the condition. Images Figure 1

Clarke, C. E.; Cumming, W. J.

1987-01-01

121

Endoscopic fenestration of posterior fossa arachnoid cyst for the treatment of presyrinx myelopathy--case report.  

PubMed

A 32-year-old man presented with an arachnoid cyst of the posterior fossa manifesting as cervical syringomyelic myelopathy. Magnetic resonance (MR) imaging demonstrated edematous enlargement and T2 prolongation of the cervical spinal cord, indicating a "presyrinx" state. MR imaging showed the inferior wall of the cyst, which disturbed cerebrospinal fluid (CSF) pulsatile movement between the intraspinal and intracranial subarachnoid spaces. The cyst wall was fenestrated with a neuroendoscope. The presyrinx state and the CSF movement improved. Posterior fossa arachnoid cyst, as well as Chiari malformation, can cause CSF flow disturbance at the craniocervical junction and syringomyelia. Endoscopic fenestration is less invasive than foramen magnum decompression and should be the procedure of choice. PMID:12416571

Nomura, Sadahiro; Akimura, Tatsuo; Imoto, Hirochika; Nishizaki, Takafumi; Suzuki, Michiyasu

2002-10-01

122

Research on the effectiveness of intermittent cervical traction therapy, using short-latency somatosensory evoked potentials  

Microsoft Academic Search

.   Short-latency somatosensory evoked potentials (SSEPs) were measured before and after intermittent cervical traction therapy\\u000a to serve as objective indicators of therapy effectiveness. The subjects were 29 patients with myelopathy, 23 with cervical\\u000a radiculopathy, 28 with cervical sprain, and 26 healthy individuals. SSEPs were recorded by stimulating the median nerve, and\\u000a the negative potentials elicited from the brachial plexus (N9),

Mikihiko Hattori; Yasumasa Shirai; Takafumi Aoki

2002-01-01

123

Cervical degenerative intraspinal cyst: a case report and literature review involving 132 cases.  

PubMed

Intraspinal and extradural cysts in the cervical spine are rare disorders that may cause myelopathy or radiculopathy. A synovial cyst or ganglion derived from the facet joint and that from a ligamentum flavum have been reported. We report a surgical case of degenerative intraspinal cyst, causing cervical myelopathy. MRI of a case revealed cystic lesion at C4-5. Spinal cord was compressed by cyst and symptoms of myelopathy were also observed. The patient with cervical spinal canal stenosis underwent laminoplasty and excision of the cyst. The patient recovered well immediately after the surgery. Literature review showed that 133 patients have been reported, including the present case. Previous reports indicated that most cysts occurred in old patients and at the atlanto-axial or C7-T1 junction, and laminectomy or laminoplasty with excision of the cyst gave good results in most cases. PMID:23195823

Machino, Masaaki; Yukawa, Yasutsugu; Ito, Keigo; Kato, Fumihiko

2012-01-01

124

Minimum 2-year outcome of cervical laminoplasty with deep extensor muscle-preserving approach: impact on cervical spine function and quality of life  

Microsoft Academic Search

In this retrospective cohort study, two surgical methods of conventional open-door laminoplasty and deep extensor muscle-preserving\\u000a laminoplasty were allocated for the treatment of cervical myelopathy, and were specifically compared in terms of axial pain,\\u000a cervical spine function, and quality of life (QOL) with a minimum follow-up period of 2 years. Eighty-four patients were divided\\u000a into two groups and received either

Yoshihisa Kotani; Kuniyoshi Abumi; Manabu Ito; Hideki Sudo; Masahiko Takahata; Shigeki Ohshima; Yoshihiro Hojo; Akio Minami

2009-01-01

125

Combined optic neuropathy and myelopathy secondary to copper deficiency.  

PubMed

We report two patients, both with a history of gastric surgery, who presented with progressive optic neuropathy and myelopathy. The patients' symptoms were initially attributed to vitamin B12 deficiency and/or neuromyelitis optica; however, after the neurologic deficits continued to progress with the use of conventional treatments, further evaluation was initiated, and a severe copper deficiency was revealed. Copper deficiency is a rare cause of progressive optic neuropathy and myelopathy and should be considered in the differential diagnosis. It is crucial to elicit a history of gastric surgery or other risk factors for hypocupremia in those patients undergoing an evaluation for subacute or chronically progressive optic neuropathy or myelopathy. PMID:20451943

Pineles, Stacy L; Wilson, Christina A; Balcer, Laura J; Slater, Robert; Galetta, Steven L

2010-01-01

126

Intracranial dural fistula as a cause of diffuse MR enhancement of the cervical spinal cord  

Microsoft Academic Search

Spinal MR findings are reported in a patient with progressive myelopathy and intracranial dural arteriovenous fistula draining into spinal veins. Associated with previously reported abnormalities on T1 weighted and T2 weighted images, postcontrast T1 weighted images disclosed diffuse intense enhancement of the cervical cord itself. This enhancement decreased after endovascular treatment.

Valérie Bousson; Laurent Brunereau; Katayoun Vahedi; René Chapot

1999-01-01

127

Cervical cyst of the ligamentum flavum and C7-T1 subluxation: case report  

Microsoft Academic Search

A patient with progressive gait disturbance resulting from a cyst of the cervical ligamentum flavum associated with C7-T1 listhesis is reported. Surgical removal of the cyst improved the patient’s myelopathy. Intraspinal degenerative cysts are preferentially located in the lumbar region:unusual is the cervical localization. Differential diagnosis includes ligamentum flavum cyst, synovial and ganglion cysts. Association between degenerative intraspinal cysts and

Roberto Gazzeri; Marcelo Galarza; Leonardo Gorgoglione; Michele Bisceglia; Vincenzo D’Angelo

2005-01-01

128

Acute compressive myelopathy due to vertebral haemangioma.  

PubMed

A 47-year-old woman with a history of anaemia presented to the emergency room with an acute onset of leg weakness. Physical examination of the bilateral lower extremities was significant for 0/5 muscle strength in all muscle groups with decreased pinprick and temperature sensation. A sensory level at the umbilicus was appreciated. Fine touch and proprioception were preserved. Bowel and bladder function were intact. CT revealed several thoracic, vertebral haemangiomatas. An MRI was suggestive of an epidural clot at the T8-T10-weighted posterior epidural space. At the level of the lesion, the cerebrospinal fluid space was completely effaced, and the flattened spinal cord exhibited signs of oedema and compressive myelopathy. The patient immediately underwent surgical decompression of the spinal cord. An epidural clot and vessel conglomeration were identified. A postoperative spinal angiogram confirmed the diagnosis of vertebral haemangioma. At 1-month follow-up, the patient regained strength and sensation. PMID:24777075

Macki, Mohamed; Bydon, Mohamad; Kaloostian, Paul; Bydon, Ali

2014-01-01

129

Cervical Dysplasia  

MedlinePLUS

... a cervical loop electrosurgical excision procedure (LEEP) or cone biopsy (another type of excision using a scalpel ... Cervical or endocervical biopsies and cervical LEEP and cone biopsy specimens are sent to a pathologist for ...

130

Cervical Polyps  

MedlinePLUS

Cervical polyps are growths that usually come from the cervical canal opening in the vagina. 210482 InteliHealth 2010-10- ... that connects the uterus to the vagina. Cervical polyps are growths that usually appear on the cervix ...

131

Surgical management of congenital cervical kyphosis.  

PubMed

Congenital cervical kyphosis is a rare clinical condition. The purpose of this study was to review the surgical management and outcomes of 12 consecutive cases of congenital cervical kyphosis management by the same surgical team. The authors retrospectively analyzed the records of 12 patients (5 men and 7 women) with an average age of 18.4 years (range, 15-31 years) who underwent surgery for congenital cervical kyphosis at the authors' institution between 2001 and 2005. All patients had congenital cervical kyphosis; those with secondary kyphosis deformity due to causes such as infection, tumors, and surgery were excluded. The indications for surgery were signs of spinal cord compression with progression of clinical symptoms such as decreased muscle strength and paresthesia. All patients had radiographic evidence of cervical kyphosis. Six patients underwent anterior decompression, autogenous bone grafting, and instrumentation, and the other 6 patients underwent combined anterior-posterior surgery. All surgeries were performed successfully with no complications. Bone graft fusion occurred in 11 patients. In 1 patient who underwent anterior surgery, the bone graft was partly absorbed, and pseudarthrosis was noted at 3 years postoperatively. Mean Japan Orthopaedic Association cervical myelopathy score and mean Cobb angle were significantly improved at 1 week and 1 year postoperatively compared with preoperative values. Anterior and combined anterior-posterior surgical approaches are useful for the correction of congenital cervical kyphosis. Bone graft fusion is also critical for maintaining the surgical correction. Choice of surgical methods depends on the patient's clinical condition. PMID:22955408

He, Zhimin; Liu, Yang; Xue, Feng; Xiao, Haijun; Yuan, Wen; Chen, Deyu

2012-09-01

132

Traumatic myelopathy: current concepts in imaging.  

PubMed

Traumatic myelopathy is a frequent complication after spinal trauma. The prognosis is often very poor, and the condition has important socioeconomic consequences. Knowledge of the epidemiology and imaging features is mandatory to ensure correct diagnosis and timely intervention. Imaging studies play an increasing role in the diagnosis and follow-up of this condition. Computed tomography remains the first-line investigation whenever spinal cord injury is suspected. It may indicate the presence of spinal cord lesions by visualizing vertebral lesions, but it cannot assess the spinal cord itself. Magnetic resonance imaging (MRI) can depict possible spinal cord edema, hemorrhage, or transection, and it is essential in diagnosing and predicting the outcome of spinal cord injury. Follow-up should also be performed with MRI to evaluate long-term intramedullary changes. Diffusion-weighted imaging and diffusion tensor imaging are promising new techniques that allow very early detection of spinal cord injury by measuring the diffusion within the spinal cord, thereby providing information on white matter integrity. However, technical limitations of these new techniques prompt further investigation to improve specificity. PMID:24896747

De Smet, Eline; Vanhoenacker, Filip M; Parizel, Paul M

2014-07-01

133

Cervical cyst of the ligamentum flavum and C7-T1 subluxation: case report.  

PubMed

A patient with progressive gait disturbance resulting from a cyst of the cervical ligamentum flavum associated with C7-T1 listhesis is reported. Surgical removal of the cyst improved the patient's myelopathy. Intraspinal degenerative cysts are preferentially located in the lumbar region:unusual is the cervical localization. Differential diagnosis includes ligamentum flavum cyst, synovial and ganglion cysts. Association between degenerative intraspinal cysts and listhesis is discussed. To our knowledge, this is the first case of cyst of the ligamentum flavum associated with cervical subluxation. PMID:15981000

Gazzeri, Roberto; Galarza, Marcelo; Gorgoglione, Leonardo; Bisceglia, Michele; D'Angelo, Vincenzo

2005-10-01

134

Cervical dysplasia  

MedlinePLUS

... Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin . 2012;62(3):147- ...

135

Cervical polyps  

MedlinePLUS

Cervical polyps are fingerlike growths on the lower part of the uterus that connects with the vagina ( cervix ). ... The cause of cervical polyps is not completely understood. They may ... to increased levels of the female hormone, estrogen Chronic ...

136

Hirayama disease: three cases assessed by F wave, somatosensory and motor evoked potentials and magnetic resonance imaging not supporting flexion myelopathy.  

PubMed

Traumatic chronic injury of the cervical spinal cord caused by neck flexion ("flexion myelopathy") is one of the suggested pathogenetic mechanisms for Hirayama disease (HD). Neurophysiological data, especially reporting particularly N13 cervical somatosensory response, are scarce and conflicting in HD. F wave, somatosensory evoked potentials (SEP), motor evoked potentials (MEP) and magnetic resonance imaging (MRI) studies were assessed in 3 HD male patients (aged 22, 36, and 51 years) with the aim of evaluating the functional effects of neck flexion in HD. Median and ulnar F waves, median, ulnar and posterior tibial SEP, and upper and lower limb MEP were performed bilaterally in standard conditions and during neck flexion in the patients. Cervical spinal MRI study was performed in standard position in two patients and both in standard and flexed positions in the third patient. F wave, SEP, and MEP findings did not show statistically significant differences in standard conditions and during neck flexion both in HD patients and controls. MRI with neck in standard position was normal in two patients, while in the third patient revealed cervical anterior horns signal changes and cord atrophy. In this patient, MRI with the neck in flexion showed that the spinal cord was normally located, was not compressed within the cervical canal and that there were no abnormalities of the dural sac. These findings suggest that in a complex disorder like HD no definite conclusions can be drawn from the present paper and some cases of HD without evidence of "flexion myelopathy" might have a different pathogenetic mechanism. PMID:18941932

Ammendola, Angelo; Gallo, Antonio; Iannaccone, Teresa; Tedeschi, Gioacchino

2008-10-01

137

Identifying Myelopathy Caused by Thoracic Syringomyelia: A Case Report  

PubMed Central

Myelopathy is a form of neurological disease caused by compression of the spinal cord. Upper and lower quarter screens are commonly used in identifying myelopathy, although most of the screen components demonstrate poor or unstudied diagnostic value. The purpose of this case report is to describe the diagnostic process in detecting syringomyelia, an intramedullary lesion that may cause myelopathy. The patient was a 47-year-old female with a thoracic syrinx that was discovered by spinal magnetic resonance imaging (MRI) following a complicated and delayed clinical diagnostic course. Following surgical intervention and a two-week inpatient rehabilitation stay, the patient was discharged using a rolling walker for ambulation and was performing most transfers with modified independence. A complicating pattern of signs and symptoms combined with a diagnostic process guided by poorly studied screen components demonstrates the diagnostic dilemma associated with identifying the cause of myelopathy within the thoracic spine. This also indicates the need for further investigation of individual and clustered components of the neurological screen to improve the ability to identify patients in need of complete imaging studies in a more timely fashion.

Rene Hudson, Beverly; Cook, Chad; Goode, Adam

2008-01-01

138

Tandem keyhole foraminotomy in the treatment of cervical radiculopathy: retrospective review of 35 cases  

PubMed Central

Background There has been no report regarding the results of two-level keyhole foraminotomy. The purpose of this study was to detail clinical outcomes following consecutive two-level cervical foraminotomy (tandem keyhole foraminotomy (TKF)) in patients with radiculopathy. Methods The authors conducted a retrospective review of 35 cases involving patients treated by a single surgeon using TKF. Clinical symptoms, data of physical examinations, pathology and clinical outcomes were detailed and discussed about this surgical method. Results Patients consisted of cervical disc herniation (CDH) (19/35), cervical spondylotic radiculopathy (CSR) (13/35), and cervical spondylotic amyotrophy (CSA) (3/35). TKF was performed from C3 to C5 in 2 patients (6%), from C4 to C6 in 7 patients (20%), from C5 to C7 in 23 patients (66%), and from C6 to T1 in 3 patients (8%). The mean operative duration was 99.2 min (range, 72 to 168 min). The mean estimated blood loss was 55.8 g (range, 0 to 200 g). Radicular pain was relieved within 3 months in 88% (29/32) and in 97% (31/32) at final follow-up. Resolution of muscle weakness was recognized within 6 months after operation in all CSA cases. Sixty-six percent of patients showed a greater than 20% deficit in grip weakness on the affected side compared with the normal side. After pain was relieved, grip strength improved by more than 15%. Conclusions TKF is a safe and highly effective procedure for patients with cervical radiculopathy and does not require invasive preoperative examinations. Further investigation is required to determine the effects of consecutive facetectomy.

2014-01-01

139

Treatment of portosystemic shunt myelopathy with a stent graft deployed through a transjugular intrahepatic route.  

PubMed

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. PMID:22996588

Jain, Deepak; Arora, Ankur; Deka, Pranjal; Mukund, Amar; Bhatnagar, Shorav; Jindal, Deepti; Kumar, Niteen; Pamecha, Viniyendra

2013-08-01

140

Compressive myelopathy due to intervertebral disk extrusion in a llama (Lama glama).  

PubMed

A 12-year-old intact female llama was euthanized following acute onset of spastic tetraparesis and recumbency with inability to rise. Postmortem examination revealed caudal cervical spinal cord compression due to a mass within the ventral spinal canal arising from the C6-C7 intervertebral disk space and attached to an irregularly thickened annulus fibrosis. On histopathologic examination, the mass was composed of amorphous acellular basophilic to amphophilic material admixed with irregularly arranged collagen bundles. The amorphous material was metachromatic and contained multiple small foci of markedly vacuolated round cells, characteristic of origin from the nucleus pulposus. Severe necrosis of all white matter tracts with astrocytic reaction was present in the overlying spinal cord segment. Ascending and descending Wallerian degeneration and dissecting interstitial astrogliosis were present within white matter tracts above and below the lesion, respectively. The diagnosis was compressive myelopathy due to chronic extrusion of the nucleus pulposus of the C6-C7 intervertebral disk. To the authors' knowledge, this is the first report of intervertebral disk disease in a camelid. PMID:16566272

Valentine, Beth A; Saulez, Montague N; Cebra, Christopher K; Fischer, Kay A

2006-01-01

141

Cervical Cancer  

Cancer.gov

Cervical cancer is a disease in which cancer develops in the tissues of the cervix. The Cancer Genome Atlas is studying the two main types of cervical cancer. Squamous cell carcinoma develops in the thin, flat, squamous cells that line the vagina. Adenocarcinoma arises in the glandular cells in the vagina that secrete mucus. Risk factors for cervical cancer include smoking and human papillomavirus (HPV) infection. In the future, the HPV vaccine will lower the infection rate.

142

Thoracic myelopathy secondary to seizure following scoliosis surgery.  

PubMed

The incidence of spinal injuries is increased in people with epilepsy although compressive thoracic myelopathy has not been reported. We describe a 15-year-old girl with SCN1A mutation (Dravet syndrome), refractory generalized tonic-clonic seizures, and prior posterior instrumentation and fusion for scoliosis, who presented with progressive lower extremity weakness. Junctional kyphosis with disc herniation and spinal cord compression directly rostral to the instrumentation was apparent on imaging. On history, the patient had suffered a particularly severe convulsive seizure just before developing symptoms. Surgical decompression and stabilization led to a complete neurologic recovery. This unusual presentation of myelopathy illustrates the need to consider this complication in patients with epilepsy and spinal instrumentation. PMID:22140129

Myers, Kenneth A; Payne, Eric T; Esser, Michael J; Kirton, Adam; Howard, Jason J

2012-07-01

143

Myelopathy in a Previously Asymptomatic HIV1Infected Patient  

Microsoft Academic Search

A wide variety of disorders of diverse pathogenic mechanisms can trigger spinal cord dysfunction in HIV-1-infected patients.\\u000a The most common such condition is HIV-1-associated myelopathy (HM) which characteristically complicates advanced HIV-1 disease\\u000a in patients with low CD4 cell counts and previous AIDS-defining diagnoses. We describe an unusual presentation of HM in a\\u000a previously asymptomatic patient with a relatively preserved CD4

W. A. Eyer-Silva; I. Auto; J. F. C. Pinto; C. A. Morais-de-Sá

2001-01-01

144

Management of Cervical Spine Injuries in Athletes  

PubMed Central

Objective: Although the incidence of catastrophic cervical spine injury in sport has been significantly reduced over the past 3 decades, the injury warrants continued attention because of the altered quality of life that often accompanies such an injury. The purpose of our literature review was to provide athletic trainers with an understanding of the mechanisms, anatomical structures, and complications often associated with sport-related cervical spine injury. We also present the most current recommendations for management and treatment of these potentially catastrophic injuries. Data Sources: A review of the most pertinent literature between 1970 and 2005 was conducted using MEDLINE and the search terms spinal cord injury, cervical spine injury, neurosurgical trauma, cervical spinal stenosis, and catastrophic spine injury. Data Synthesis: Flexion of the head places the cervical spine into a straight line and prevents the neck musculature from assisting in force absorption. This mechanism is the primary cause of cervical fracture, dislocation, and quadriplegia. The most serious of the syndromes described in the literature involves a complete spinal cord injury with transverse myelopathy. This injury typically results in total loss of spinal function below the level of the lesion. Conclusions/Recommendations: Spinal trauma may result in a variety of clinical syndromes, according to the type and severity of the impact and bony displacement, as well as subsequent secondary insults such as hemorrhage, ischemia, and edema. Athletic trainers should be prepared to promptly recognize these potentially catastrophic injuries and follow the recommendations of the Inter-Association Task Force for the Appropriate Care of the Spine Injured Athlete in managing such injuries.

Bailes, Julian E; Petschauer, Meredith; Guskiewicz, Kevin M; Marano, Gary

2007-01-01

145

Hypothesis on the pathogenesis of vacuolar myelopathy, dementia, and peripheral neuropathy in AIDS  

Microsoft Academic Search

Certain aspects of the clinical syndrome of dementia, cerebral atrophy, predominantly sensory neuropathy, and vacuolar myelopathy in AIDS resemble those seen in vitamin B12 deficiency. Pathologically, there are similarities not only in the changes in the spinal cord, but also in the brain and peripheral nerves. The pathogenesis of vacuolar myelopathy may be secondary to a combination of immune mediated

S V Tan; R J Guiloff

1998-01-01

146

Neurological improvement associated with resolution of irradiation-induced myelopathy: serial magnetic resonance imaging and positron emission tomography findings.  

PubMed

We document serial magnetic resonance imaging (MRI) and [(18)F] 2-fluoro-2-deoxyglucose (FDG)-positron emission tomography (PET) findings in the process of improvement from delayed radiation necrosis of the spinal cord. A 61-year-old woman underwent radiotherapy for an oral carcinoma. Forty-six months later she developed a left-sided Brown-Séquard syndrome, suggesting incomplete cervical cord transection below the cervico-thoracic junction. Two months after starting steroid therapy, she had gradual clinical improvement, which continues 8 years after the termination of radiotherapy. Neurological improvement was associated with gradual resolution of an extensive high-intensity area within the cervico-thoracic spinal cord on MRI. Initially, the FDG-PET showed linear and uniform increase in FDG uptake throughout the cervical spinal cord with standardized uptake value of 2.68 +/- 0.16 (mean +/- SD), but it returned to normal value (1.90 +/- 0.14) at final follow-up. Considering that the normalization of FDG uptake correlated with neurological recovery, the uniform- and diffuse-increased FDG uptake noted in the initial course of myelopathy could reflect the metabolic activity of the compromised spinal cord. PMID:18681929

Uchida, Kenzo; Nakajima, Hideaki; Takamura, Takaharu; Kobayashi, Shigeru; Tsuchida, Tatsuro; Okazawa, Hidehiko; Baba, Hisatoshi

2009-07-01

147

Cervical Cancer  

MedlinePLUS

... for cervical cancer are related to sexual practices. Sexually transmitted infections (STIs) may make your cells more likely to ... had many sexual partners Being infected with a sexually transmitted infection (STI) or having had a sex partner who ...

148

Cervical Adenocarcinoma  

MedlinePLUS

... in a Pap test or biopsy by the primary care physician. How does a pathologist diagnose cervical adenocarcinoma? ... abnormal Pap test or has other symptoms, the primary care doctor will perform a colposcopy to remove a ...

149

Paravertebral muscles in disease of the cervical spine.  

PubMed Central

OBJECTIVES: Cervical spine disorders are common in the older population. The paravertebral muscles are essential to the support and stabilisation of the cervical spine but have been little studied. The aim was to determine whether pathological changes develop in these muscles in patients with severe cervical spine disease, which, if present, might contribute to the pathogenesis and symptomatology of their disorder. METHODS: Open biopsies of superficial and deep paravertebral muscles were obtained during the course of surgical procedures to alleviate cervical myelopathy. Most of these patients had cervical spondylosis or rheumatoid arthritis involving the cervical spine. The biopsies were compared with muscle obtained at necropsy from patients without a history of cervical spine or neuromuscular disorder. RESULTS: Muscle from both the study and control groups showed a similar range and severity of abnormalities. In several patients, grouped fibre atrophy suggested chronic partial denervation. Most biopsies showed type 1 fibre predominance and selective type 2 fibre atrophy. Ragged red fibres were a frequent finding and electron microscopy disclosed accumulations of mitochondria, a small proportion of which contained rounded, or longitudinally oriented, single osmiophilic inclusions. Fibres containing core-like areas were also frequent. These pathological features were seen with increasing severity and frequency with increasing age. CONCLUSIONS: The paravertebral cervical muscles develop pathological abnormalities with increasing age with both neurogenic and myopathic features, the pathogenesis of which is probably multifactorial. Such a muscle disorder would be expected to be accompanied by functional impairment which may contribute to the development and symptomatology of cervical spine disease with increasing age. Images

Wharton, S B; Chan, K K; Pickard, J D; Anderson, J R

1996-01-01

150

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

PubMed Central

To date, several studies were conducted to find which procedure is superior to the others for the treatment of cervical myelopathy. The goal of surgical treatment should be to decompress the nerves, restore the alignment of the vertebrae, and stabilize the spine. Consequently, the treatment of cervical degenerative disease can be divided into decompression of the nerves alone, fixation of the cervical spine alone, or a combination of both. Posterior approaches have historically been considered safe and direct methods for cervical multisegment stenosis and lordotic cervical alignment. On the other hand, anterior approaches are indicated to the patients with cervical compression with anterior factors, relatively short-segment stenosis, and kyphotic cervical alignment. Recently, posterior approach is widely applied to several cervical degenerative diseases due to the development of various instruments. Even if it were posterior approach or anterior approach, each would have its complication. There is no Class I or II evidence to suggest that laminoplasty is superior to other techniques for decompression. However, Class III evidence has shown equivalency in functional improvement between laminoplasty, anterior cervical fusion, and laminectomy with arthrodesis. Nowadays, each surgeon tends to choose each method by evaluating patients' clinical conditions.

Nishizawa, Kazuya; Mori, Kanji; Saruhashi, Yasuo; Matsusue, Yoshitaka

2012-01-01

151

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

PubMed Central

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

Bartels, Ronald HMA; Verbeek, Andre LM; Grotenhuis, J Andre

2007-01-01

152

Delayed radiation myelopathy: Differential diagnosis with positron emission tomography/computed tomography examination  

PubMed Central

Myelopathy is a rare but serious complication of radiation therapy (RT). Radiation myelopathy is white matter damage to the spinal cord developed after a certain period of application of ionizing radiation. Factors such as radiation dose and time between applications affect the occurrence as well as the severity of myelopathy. In those patients, positron emission tomography/computed tomography examination has a very important role both in the diagnosis and in the differential diagnosis of lesions. In this case report, the case of progressive paraparesis, developed in a 52-year-old female patient operated with pulmonary mucinous cystadenocarcinoma diagnosis and who received chemotherapy and RT following surgery, has been reported.

Kadir, Tufan; Sarica, Feyzi Birol; Ozgur, Kardes; Cekinmez, Melih; Nur, Altinors Mehmet

2012-01-01

153

Cervical arthroplasty: the beginning, the middle, the end?  

PubMed

Cervical arthroplasty has developed as an alternative to spinal fusion for the treatment of cervical radiculopathy and myelopathy. The popularity of artificial discs has grown as the evidence of complications following arthrodesis has increased, making the theoretical advantages (motion preservation, altering the natural history of disease, prevention of adjacent segment disease) of disc replacement more attractive. However, as more discs are implanted and the length of follow-up increases, reported complications such as heterotopic ossification, device migration and spontaneous fusion of arthroplasty devices are growing. As a result, surgeons and patients face a challenge when deciding between motion-preserving or fusion surgery. Currently, there is inadequate evidence to promote extensive use of artificial discs for cervical spondylosis, despite promising short-term and intermediate clinical outcomes. However, there is also insufficient evidence to cease using them completely. The use of arthroplasty over fusion in the long term can only be justified if the incidence of adjacent segment disease decreases as a result. Despite the level of investment and research into arthroplasty outcomes, long-term follow-up has yet to be completed and has not convincingly demonstrated the effect of artificial discs on adjacent segment disease. Further long-term randomised trials are necessary to determine whether cervical arthroplasty is able to reduce the incidence of adjacent segment disease and, in doing so, replace arthrodesis as the gold standard treatment for cervical spondylosis. PMID:21815734

Richards, O; Choi, D; Timothy, J

2012-02-01

154

Cervical tumors.  

PubMed

Imaging the cervix for benign and malignant disease can be achieved using transvaginal ultrasound, computed tomography (CT), magnetic resonance imaging, and 18-fluorodeoxyglucose positron emission tomography. The best established role of imaging is in cervical carcinoma where magnetic resonance imaging, CT and increasingly positron emission tomography-CT are the most frequently used imaging modalities. These have a role in staging, treatment selection, recurrent disease, and imaging complications of treatment. Histopathological diagnosis of cervical disorders cannot be made on the basis of imaging alone but certain imaging features may provide an indication as to the underlying diagnosis. We describe the imaging features of some malignant tumor subtypes in which a preoperative diagnosis may alter management. Benign lesions of the cervix are usually detected incidentally or during investigations for dysfunctional vaginal bleeding. We describe the imaging features of the commonly encountered benign cervical lesions. PMID:20974359

Sahdev, Anju

2010-10-01

155

Diffusion tensor MR imaging (DTI) metrics in the cervical spinal cord in asymptomatic HIV-positive patients  

Microsoft Academic Search

Introduction  This study was conducted to compare diffusion tensor MR imaging (DTI) metrics of the cervical spinal cord in asymptomatic\\u000a human immunodeficiency virus (HIV)-positive patients with those measured in healthy volunteers, and to assess whether DTI\\u000a is a valuable diagnostic tool in the early detection of HIV-associated myelopathy (HIVM).\\u000a \\u000a \\u000a \\u000a \\u000a Methods  MR imaging of the cervical spinal cord was performed in 20 asymptomatic

Christina Mueller-Mang; Meng Law; Thomas Mang; Julia Fruehwald-Pallamar; Michael Weber; Majda M. Thurnher

2011-01-01

156

[Prevalence of cervical spine inflammatory changes in rheumatoid arthritis patients and the value of neurological examination in their diagnosis].  

PubMed

The aim of the study was to evaluate prevalence of cervical spine inflammatory changes, especially atlantoaxial pathology, and their possible relation to subjective and objective neurological symptoms in rheumatoid arthritis patients. 100 patients (88 female and 12 male) aged 23 to 85 (61.4 +/- 12.9), with the mean disease duration of 12.5 +/- 9.5 years were included in the study. According to radiological examination (lateral and antero-posterior X-ray of the cervical spine) supplemented by MR of the cervical spine or CT of the atlanto-axial joint in suspected cases, 26% of patients had only inflammation, next 15% of patients presented with instability of the atlanto-axial joint and 9% developed basilar invagination of the dens of axis. 18% of patients presented subaxial cervical instability. Neurological examitation was performed by independent neurologist in 99 patients, only 14 presented abnormalities suggesting cervical myelopathy. Two of them showed no patology of the cervical spine. Remaining patients presented: C1/C2 inflammation in 4 cases, anterior atlanto-axial subluxation (AAS) in two cases, basilar invagination in 4 cases and instability with medullary compression on lower cervical levels only--in two cases. There were 4 cases of coexisting C1/C2 changes with medullary compression due to discopathy and (in 3 of them) instability on lower cervical levels. In 6 cases surgical stabilisation was proposed (5 patients with basilar invagination and 1 patient with AAS and myelopathy). There was statistically significant correlation between symptoms (like: paraesthesiae, intermittent problems with hearing and seeing), neurological examination and degree of radiological damage of atlanto-axial joint. The authors concluded that careful medical history and neurological examination can be useful in making decision of further radiological diagnostic procedures of the cervical spine in rheumatoid arthritis. PMID:18416295

Raczkiewicz-Papierska, Anna; Bachta, Artur; Naga?ska, Ewa; Zagrodzka, Magdalena; Skrobowska, Ewa; T?ustochowicz, Ma?gorzata; Dudek, Anna; T?ustochowicz, Witold

2006-10-01

157

Subacute progressive ascending myelopathy following spinal cord injury: MRI appearances and clinical presentation  

Microsoft Academic Search

Study design:Retrospective Case Review.Objectives:To describe the clinical presentation and course of patients with magnetic resonance imaging (MRI) features of subacute progressive ascending myelopathy (SPAM). A rare complication of spinal cord injury.Setting:National Spinal Injuries Centre, Stoke Mandeville Hospital, UK.Materials and methods:A retrospective review of the case notes and MRI studies of 11 cases with typical MRI features of ascending myelopathy presenting

A C Planner; P M Pretorius; A Graham; T M Meagher

2008-01-01

158

Cervical Cancer Prevention  

MedlinePLUS

... risk factors increase the risk of cervical cancer: HPV Infection The most common cause of cervical cancer ... may decrease the risk of cervical cancer: Preventing HPV infection HPV may be prevented by the following: ...

159

Esophageal perforation following cervical spine surgery: A review with considerations in airway management.  

PubMed

Anterior cervical discectomy and fusion (ACDF) is a commonly performed surgery for the treatment of spondylosis, radiculopathy, myelopathy, and trauma to the cervical spine. Esophageal perforation is a rare yet serious complication following ACDF with an incidence of 0.02 to 1.52%. We describe a case of a 24-year-old man who underwent ACDF and corpectomy following a motor vehicle accident who subsequently developed delayed onset esophageal perforation requiring surgical intervention. We believe that the detailed review of the surgical management of esophageal perforation following cervical spine surgery will provide a deeper understanding for the Intensivist in regards to postoperative airway management in these types of patients. Careful extubation over a soft flexible exchange catheter should take place to help reduce the risk of perforation in the event reintubation is required. PMID:24459627

Amhaz, Hassan H; Kuo, Ruth; Vaidya, Rahul; Orlewicz, Marc S

2013-10-01

160

Esophageal perforation following cervical spine surgery: A review with considerations in airway management  

PubMed Central

Anterior cervical discectomy and fusion (ACDF) is a commonly performed surgery for the treatment of spondylosis, radiculopathy, myelopathy, and trauma to the cervical spine. Esophageal perforation is a rare yet serious complication following ACDF with an incidence of 0.02 to 1.52%. We describe a case of a 24-year-old man who underwent ACDF and corpectomy following a motor vehicle accident who subsequently developed delayed onset esophageal perforation requiring surgical intervention. We believe that the detailed review of the surgical management of esophageal perforation following cervical spine surgery will provide a deeper understanding for the Intensivist in regards to postoperative airway management in these types of patients. Careful extubation over a soft flexible exchange catheter should take place to help reduce the risk of perforation in the event reintubation is required.

Amhaz, Hassan H; Kuo, Ruth; Vaidya, Rahul; Orlewicz, Marc S

2013-01-01

161

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

PubMed

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. PMID:9087365

Alfonso, E R; De Gregorio, M A; Mateo, P; Escó, R; Bascón, N; Morales, F; Bellosta, R; López, P; Gimeno, M; Roca, M; Villavieja, J L

1997-01-01

162

Biomarkers in Cervical Cancer  

PubMed Central

Cervical cancer, a potentially preventable disease, remains the second most common malignancy in women worldwide. Human papillomavirus (HPV) is the single most important etiological agent in cervical cancer, contributing to neoplastic progression through the action of viral oncoproteins, mainly E6 and E7. Cervical screening programs using Pap smear testing have dramatically improved cervical cancer incidence and reduced deaths, but cervical cancer still remains a global health burden. The biomarker discovery for accurate detection and diagnosis of cervical carcinoma and its malignant precursors (collectively referred to as high-grade cervical disease) represents one of the current challenges in clinical medicine and cytopathology.

Yim, Eun-Kyoung; Park, Jong-Sup

2006-01-01

163

Sudden myelopathy secondary to therapeutic total-body hyperthermia after spinal-cord irradiation  

SciTech Connect

Hyperthermia is a new method of treatment receiving increasing clinical attention in cancer therapy. Its efficacy has been well demonstrated in animals, but its indications, contraindications, and appropriate place in cancer therapy have yet to be defined. We report three cases of acute myelopathy in patients undergoing hyperthermia after spinal-cord irradiation within the preceding two months. Post-mortem examination in one case revealed findings similar to those seen in myelopathy resulting from long-term irradiation. Several neurologic side effects have been reported previously with total-body hyperthermia - most commonly peripheral neuropathy, but not myelopathy. The mechanism of action of hyperthermia in cancer therapy (with or without prior irradiation) is unknown. The experience reported suggests that in some patients hyperthermia may potentiate radiation-induced damage to the spinal cord or otherwise interact to cause acute spinal-cord necrosis.

Douglas, M.A.; Parks, L.C.; Bebin, J.

1981-03-05

164

Artificial Cervical Disc Arthroplasty (ACDA): tips and tricks  

PubMed Central

Abstract: Background: Anterior cervical discectomy and fusion (ACDF) is currently treatment of choice for managing medical therapy refractory cervical degenerative disc disease. Numerous studies have demonstrated the effectiveness of ACDF; patients generally experience rapid recoveries, and dramatic improvement in their pain and quality of life. However, as several studies reported symptomatic adjacent segment disease attributed to fusions’ altered kinematics, cervical disc arthroplasty emerged as a new motion-sparing alternative to fusion. Fusion at one level increases motion at adjacent levels along with increased intradiscal pressures. This phenomenon can result in symptomatic adjacent level degeneration, which can necessitate reoperation at these levels. The era of cervical arthroplasty began in Europe in the late 1990s. In recent years, artificial cervical disc arthroplasty (ACDA) has been increasingly used by spine surgeons for degenerative cervical disc disease. There have been several reports of safety, efficacy and indications of ACDA. Cervical arthroplasty offers several theoretical advantages over anterior cervical discectomy and fusion (ACDF) in the treatment of selected patients with medically refractory cervical radiculopathy. Preserving motion at the operated level, cervical TDR has the potential to decrease the occurrence of adjacent segment degeneration. There are a few studies on the efficacy and effectiveness of ACDA compared to cervical fusion. However, the true scenery of cervical arthroplasty yet to be identified. Objective: This study is intended to define patients' characteristics and outcomes of ACDA by a single surgeon in Iran. Methods: This retrospective study was performed in two general Hospitals in Tehran, Iran from 2005 To 2010. All patients were operated by one senior neurospine surgeon. One hundred fifty three patients were operated in this period. All patients signed the informed consent form prior to surgery. All patients presented with cervical discopathy who had myelopathy or radiculopathy and failed conservative management, undergoing cervical disc arthroplasty by ACDA were included, consecutively. Patients were followed for at least 2 years. Exclusion criteria was age greater than 60 years, non compliance with the study protocol, osteoporosis, infection, congenital or post traumatic deformity, malignancy metabolic bone disease, and narrow cervical canal (less than 12 mm). Heterotopic ossification and adjacent segment degenerative changes were assessed at 2 years follow up by means of neutral and dynamic xrays and CT/MRI if clinically indicated. Neck and upper extremity pain were assessed before the procedure and in the first post-operative visit and 3 months later by means of visual analogue scale. A standard approach was performed to the anterior cervical spine. Patients were positioned supine while holding neck in neutral position. A combination of sharp and blunt dissection was performed to expose longus coli musculature and anterior cervical vertebrae. Trachea and esophagus were retracted medially and carotid artery and jugular vein laterally. After a thorough discectomy, the intersomatic space is distracted in a parallel way by a vertebral distracter. Followed by Caspar distractor is applied to provide a working channel into posterior disc space. In this stage, any remnant disc materials as well as osteophytes are removed and foraminal decompression is done. Posterior longitudinal ligament (PLL) opening and removal, although discouraged by some, is done next. In order to define the size of the prosthesis, multiple trials are tested. It is important not to exceed the height of the healthy adjacent disc to avoid facet joint overdistraction. An specific insertor is applied to plant the prosthesis in disc space. Control X-rays are advised to check the precise positioning of the implant. Results: one hundred-fifty three patients including 87 females and 66 males were included. The mean age was 41 for females and 42 for males. Affected level was C5-C6 in 81 cases, C6-C7 in 72

Khadivi, Masoud; Rahimi Movaghar, Vafa; Abdollahzade, Sina

2012-01-01

165

Cervical disc arthroplasty: a critical review and appraisal of the latest available evidence.  

PubMed

Anterior cervical discectomy and fusion (ACDF) has been a very successful procedure in the management of cervical radiculopathy and myelopathy. Concerns with adjacent segment disease and the desire to preserve physiological motion have led to technological and clinical efforts for cervical disc arthroplasty. The suggested move to cervical disc replacement has led to this latter procedure being one of the most scrutinised surgical treatments in the twenty-first century. Short- and medium-term prospective randomised clinical trials and systematic reviews show cervical disc replacement to be at least as good as ACDF as regards the clinical outcomes in the management of degenerative cervical spondylosis. This is logical since the neural decompression procedure is essentially the same. However, the rationale for arthroplasty over arthrodesis has been built on two main proposed roles: the preservation of segmental motion and the prevention of adjacent segment disease. Whilst results thus far show that this first role seems to be achieved, its clinical significance is as yet unproven; the second is so far not proven. In addition, the long-term fate of the implants is also unknown. Long-term safety and efficacy, therefore, still await further clinical studies. PMID:24309922

Demetriades, Andreas K; Ringel, Florian; Meyer, Bernhard

2014-01-01

166

Clinical experience using polyetheretherketone (PEEK) intervertebral structural cage for anterior cervical corpectomy and fusion.  

PubMed

Anterior cervical corpectomy and fusion (ACCF) is commonly performed for various pathologies involving the cervical spine. Although polyetheretherketone (PEEK) cages have been widely used following anterior cervical discectomy and fusion (ACDF), clinical literature demonstrating its efficacy following ACCF is sparse. A retrospective review of patients enrolled in a prospective database who underwent single/multi-level ACCF was performed. Fifty-nine patients were identified who underwent corpectomy reconstruction with PEEK cages for symptomatic degenerative, neoplastic, infectious, or traumatic pathologies of the cervical spine. Thirty-five patients having at least 6 months follow-up (FU) were included in the final analysis. The mean age of patients was 51 years (range, 18-81 years) with FU ranging from 6 to 33 months (mean, 6.6 months). None of the patients had dysphagia at last FU. There was no implant failure with fusion occurring in all patients. While 57% of patients (20/35) remained stable with no progression of myelopathy, 43% (15/35) improved one (11 patients) or two (four patients) Nurick grades after surgery. The use of PEEK cages packed with autograft or allograft is safe and effective following anterior cervical corpectomy, demonstrating high fusion rates and good clinical results. This synthetic material obviates the morbidity associated with autograft harvest and possible infectious risks of allograft. The wide array of cage dimensions facilitates ease of use in patients of all sizes and appears safe for use in the typical pathologic conditions encountered in the cervical spine. PMID:24018256

Kasliwal, Manish K; O'Toole, John E

2014-02-01

167

Diffusion-weighted imaging in noncompressive myelopathies: a 33-patient prospective study.  

PubMed

Diffusion-weighted imaging (DWI) is frequently used to differentiate cerebral lesions. The aim of our study was to evaluate the diagnostic value of DWI and the measurement of the apparent diffusion coefficient (ADC) in noncompressive myelopathy explorations. Thirty-three patients presenting a spinal cord syndrome due to a noncompressive myelopathy underwent spinal cord MRI between September 2005 and November 2008. For each patient, the ADC was calculated in the pathological spinal cord. ADC values were also measured in the healthy spinal cord of ten control subjects. Statistical analysis was based on the Student's t test. Twenty-one patients presented an inflammatory myelopathy: Nine patients presented multiple sclerosis, three patients presented a parainfectious myelopathy, two patients acute disseminated encephalomyelitis, one patient neuromyelitis optica, one patient systemic lupus erythematosus, and five patients a myelopathy of unknown aetiology. Six patients presented a spinal cord infarction. ADC values were significantly lower in spinal cord infarct (mean ADC = 0.81 +/- 0.08 x 10(-3) mm(2)/s) than in inflammatory spinal cord lesions (mean ADC = 1.37 +/- 0.23 x 10(-3) mm(2)/s) and in healthy control spinal cord (mean ADC = 0.93 +/- 0.07 x 10(-3) mm(2)/s). These results are important to differentiate ischaemic from inflammatory myelopathies, especially at the acute phase when clinical presentation and extensive work-up are not able to show an aetiologic diagnosis. Although these results are similar to those described in cerebral explorations, ADC measurements remain technically limited for the moment. PMID:20425119

Marcel, Christophe; Kremer, Stéphane; Jeantroux, Jérémy; Blanc, Frédéric; Dietemann, Jean-Louis; De Sèze, Jérôme

2010-09-01

168

Cervicitis of unknown etiology.  

PubMed

Cervicitis has been described by some as the female counterpart of urethritis in men. Over the years a number of clinical and microscopy-based definitions have been suggested in the literature. Clinical manifestations include mucopurulent discharge from the cervix, cervical friability (easy bleeding from the cervix with passage of a swab) and cervical ectopy. Microscopic definitions involving the use of Gram stain of cervical secretions have included either more than 10 white blood cells (WBCs) or more than 30 WBCs per high-power field. Combinations of these clinical and microscopic findings have been used in attempts to increase the accuracy of cervicitis diagnosis. When cervicitis was initially recognized as a clinical entity, several investigators reported the primary pathogens causing cervicitis as Neisseria gonorrhoeae and Chlamydia trachomatis. It is now well established that most cases of cervicitis are not caused by these two organisms. Most cases of cervicitis are of unknown etiology. PMID:24859465

Taylor, Stephanie N

2014-07-01

169

Rehabilitation outcomes following infections causing spinal cord myelopathy.  

PubMed

Study design:Retrospective, open-cohort, consecutive case series.Objective:To describe the demographic characteristics, clinical features and outcomes in patients undergoing initial in-patient rehabilitation after an infectious cause of spinal cord myelopathy.Setting:Spinal Rehabilitation Unit, Melbourne, Victoria, Australia. Admissions between 1 January 1995 and 31 December 2010.Methods:The following data were recorded: aetiology of spinal cord infection, risk factors, rehabilitation length of stay (LOS), level of injury (paraplegia vs tetraplegia), complications related to spinal cord damage and discharge destination. The American Spinal Injury Association (ASIA) Impairment Scale (AIS) and functional independence measure (FIM) were assessed at admission and at discharge.Results:Fifty-one patients were admitted (men=32, 62.7%) with a median age of 65 years (interquartile range (IQR) 52-72, range 22-89). On admission, 37 (73%) had paraplegic level of injury and most patients (n=46, 90%) had an incomplete grade of spinal damage. Infections were most commonly bacterial (n=47, 92%); the other causes were viral (n=3, 6%) and tuberculosis (n=1, 2%). The median LOS was 106 days (IQR 65-135). The most common complications were pain (n=47, 92%), urinary tract infection (n=27, 53%), spasticity (n=25, 49%) and pressure ulcer during acute hospital admission (n=19, 37%). By the time of discharge from rehabilitation, patients typically showed a significant change in their AIS grade of spinal damage (P<0.001). They also showed significant improvement (P<0.001) in their FIM motor score (at admission: median=27, IQR 20-34; at discharge: median=66, IQR 41-75).Conclusion:Most patients returned home with a good level of functioning with respect to mobility, bladder and bowel status, and their disability improved significantly. PMID:24663003

New, P W; Astrakhantseva, I

2014-06-01

170

Acute traumatic cervical cord injury in patients with os odontoideum.  

PubMed

We retrospectively reviewed acute cervical cord injury after minor trauma in 10 patients with os odontoideum. Their clinical history, neurological symptoms, radiological investigations, follow-up period, American Spinal Injury Association impairment classification and motor score were reviewed. Before their traumatic injury, three patients were asymptomatic and seven reported myelopathic symptoms, including four patients with neck pain, two patients with unsteadiness and one patient with dizziness. Falls were the most common cause of injury (n=6), followed by minor motor vehicle accidents (n=3) and assault (n=1). MRI and dynamic cervical lateral radiographs showed that all patients had atlantoaxial instability and cord compression. Most patients had spinal cord thinning and hyperintensity on T2-weighted MRI. Spinal cord compression was posterior (n=5), or both anterior and posterior (n=5). All patients underwent posterior rigid screw fixation and fusion, including atlantoaxial fusion (n=8) and occipitocervical fusion (n=2). We conclude that patients with asymptomatic or myelopathic atlantoaxial instability secondary to os odontoideum are at risk for acute spinal cord injury after minor traumatic injury. Fixation and fusion should be undertaken as prophylactic treatment for patients at risk of developing myelopathy and to avoid the neurological deterioration associated with acute traumatic cervical cord injury. PMID:20655229

Zhang, Zhengfeng; Zhou, Yue; Wang, Jian; Chu, Tongwei; Li, Changqing; Ren, Xianjun; Wang, Weidong

2010-10-01

171

Congenital Stenosis of the Cervical Spine: Diagnosis and Management  

PubMed Central

An analysis of 11 cases of congenital stenosis of the cervical spine seen over the past three years is reported. The authors' experiences at an urban community hospital, as well as a large Veterans Administration Hospital, lead them to conclude that this disorder is a neurologically significant anomaly which is probably more common than published reports would imply. It can be clinically and radiographically distinguished from “pure” cervical spondylosis, to which it is related, and its treatment should be appropriately modified. It appears to have a predilection for young adult black males, and cervical myelopathy is the predominant clinical feature. Varying degrees of trauma, a disease endemic to the inner city, plays a major role in precipitating the neurological catastrophes associated with this potentially correctable disorder. Proper management of this entity demands a heightened awareness of its existence as well as a high standard of neurological and roentgenographic diagnosis, and operative performance. A flexible operative strategy which takes into account the specific biomechanical factors involved in this disorder as well as the patient's individual physiological and social status is imperative. Surgery offers a good opportunity for improving neurological function. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6Figure 7Figure 8Figure 9

Countee, Roger W.; Vijayanathan, Thurairasah

1979-01-01

172

Cervical dysplasia - series (image)  

MedlinePLUS

Conization is a procedure in which a "cone" of tissue is removed. This procedure is performed for more advanced cervical dysplasia, which remains limited to the cervix (cervical intraepithelial neoplasia, high ...

173

ICSN - Cervical Cancer  

Cancer.gov

Skip to Main Content Search International Cancer Screening Network Sponsored by the National Cancer Institute Home | About ICSN | Collaborative Projects | Meetings | Cancer Sites | Publications | Contact Us Cervical Cancer (Archived Tables): Home Cervical

174

Cervical spondylosis (image)  

MedlinePLUS

Cervical spondylosis is a disorder that results from abnormal growth of the bones of the neck and degeneration and ... neck pain is a key indication of cervical spondylosis. It may be the only symptom in many ...

175

Complications of transpedicular screw fixation in the cervical spine.  

PubMed

Today, posterior stabilization of the cervical spine is most frequently performed by lateral mass screws or spinous process wiring. These techniques do not always provide sufficient stability, and anterior fusion procedures are added secondarily. Recently, transpedicular screw fixation of the cervical spine has been introduced to provide a one-stage stable posterior fixation. The aim of the present prospective study is to examine if cervical pedicle screw fixation can be done by low risk and to identify potential risk factors associated with this technique. All patients stabilized by cervical transpedicular screw fixation between 1999 and 2002 were included. Cervical disorders included multisegmental degenerative instability with cervical myelopathy in 16 patients, segmental instability caused by rheumatoid arthritis in three, trauma in five and instability caused by infection in two patients. In most cases additional decompression of the spinal cord and bone graft placement were performed. Pre-operative and post-operative CT-scans (2-mm cuts) and plain X-rays served to determine changes in alignment and the position of the screws. Clinical outcome was assessed in all cases. Ninety-four cervical pedicle screws were implanted in 26 patients, most frequently at the C3 (26 screws) and C4 levels (19 screws). Radiologically 66 screws (70%) were placed correctly (maximal breach 1 mm) whereas 20 screws (21%) were misplaced with reduction of mechanical strength, slight narrowing of the vertebral artery canal (<25%) or the lateral recess without compression of neural structures. However, these misplacements were asymptomatic in all cases. Another eight screws (9%) had a critical breach. Four of them showed a narrowing of the vertebral artery canal of more then 25%, in all cases without vascular problems. Three screws passed through the intervertebral foramen, causing temporary paresis in one case and a new sensory loss in another. In the latter patient revision surgery was performed. The screw was loosened and had to be corrected. The only statistically significant risk factor was the level of surgery: all critical breaches were seen from C3 to C5. Percutaneous application of the screws reduced the risk for misplacement, although this finding was not statistically significant. There was also a remarkable learning curve. Instrumentation with cervical transpedicular screws results in very stable fixation. However, with the use of new techniques like percutaneous screw application or computerized image guidance there remains a risk for damaging nerve roots or the vertebral artery. This technique should be reserved for highly selected patients with clear indications and to highly experienced spine surgeons. PMID:15912352

Kast, E; Mohr, K; Richter, H-P; Börm, W

2006-03-01

176

Screening for Cervical Cancer  

MedlinePLUS

... causes cervical cancer. To learn more about these tests and what happens during them, visit the Web sites listed at the end of this fact ... statement. To learn more, visit the Task Force Web site. USPSTF Recommendation Grades ... Happens During Screening Tests Screening for Cervical Cancer Get Tested for Cervical ...

177

Cervical surgery for ossification of the posterior longitudinal ligament: One spine surgeon's perspective  

PubMed Central

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.

Epstein, Nancy E.

2014-01-01

178

ADXS11-001 High Dose HPV+ Cervical Cancer  

ClinicalTrials.gov

Effects of Immunotherapy; Metastatic/Recurrent Cervical Cancer; Cervical Adenocarcinoma; Cervical Adenosquamous Cell Carcinoma; Cervical Squamous Cell Carcinoma; Cervical Small Cell Carcinoma; Stage III Cervical Cancer; Stage IVA Cervical Cancer; Stage IVB Cervical Cancer

2014-06-16

179

Double-level cervical total disc replacement for adjacent segment disease: is it a useful treatment? Description of late onset heterotopic ossification and review of the literature.  

PubMed

We report a rare case of double-level adjacent segment disease (ASD), occurring ten years later an anterior cervical discectomy (ACD) without fusion, treated by cervical arthroplasty, highlighting the outcome at long-term follow-up and focusing on heterotopic ossification. In 1995 a 25-year-old man satisfactorily underwent ACD at C4/C5. At that time MRI also showed signs of degenerative disc disease (DDD) at C3/C4 and C5/C6. Ten years later, a new MRI scan showed a large C3/C4 and a smaller C5/C6 soft disc hernia together with spondylotic changes at the level above and below the site of the first surgery. At C4/C5 imaging revealed a kyphotic stable "pseudoarthrosis" with anterior bridging osteophyte. The patient underwent double-level arthroplasty with ProDisc-C. Clinical and radiological outcome was satisfactory. 3 and 5 years after surgery, X-rays and CT scan documented the progressive development of heterotopic ossification, with gradual reduction of range of motion. A late onset heterotopic ossification can neutralize the theoretical advantages of cervical arthroplasty, which should be considered an effective surgical option only in selected cases. ACDF and restoration of normal lordosis can be a viable alternative in cervical revision surgery, as motion preservation can not be always mantained for a long time. PMID:24825036

Barbagallo, G M V; Certo, F; Visocchi, M; Sciacca, G; Albanese, V

2014-01-01

180

Thoracic Disc Herniation of the Adjacent Segment With Acutely Progressing Myelopathy  

PubMed Central

We report a case of a 66-year-old woman with progressing myelopathy. Her history revealed instrumented fusion from T10 to S1 for degenerative lumbar kyphosis and spinal stenosis. The plain radiographs showed narrowing of the intervertebral disc space with a gas shadow and sclerotic end-plate changes at T9-T10. Magnetic resonance imaging revealed a posterolateral mass compressing the spinal cord at the T9-T10 level. The patient was treated with a discectomy through the posterior approach combined with posterior instrumentation. The patient's symptoms and myelopathy resolved completely after the discectomy and instrumented fusion. The thoracic disc herniation might have been caused by the increased motion and stress concentration at the adjacent segment.

Oh, In-Soo; Seo, Jun-Yeong; Kim, Yoon-Chung

2010-01-01

181

Myelopathy among zinc-smelter workers in Upper Silesia during the late 19th century.  

PubMed

Zinc-induced myeloneuropathy was recently (re)discovered and its pathophysiology elaborated as resulting from secondary copper deficiency. However, myelopathy was a recognized problem among European zinc-smelter workers in the late 19th century, although these early reports have been overlooked in recent studies and reports. The purpose of this article is to translate and review German-language reports of myelopathy among zinc-smelter workers in Upper Silesia (now southern Poland) by Schlockow from the 1870s. Disease manifestations among zinc-smelter workers developed after sustained zinc exposure over many years. The earliest symptoms were sensory and included paresthesias, dysesthesias, allodynia, and formication in the lower extremities, particularly the feet. Workers ultimately developed a clinical picture resembling subacute combined degeneration of the spinal cord with a spastic-ataxic gait with prominent proprioceptive impairment, sensory disequilibrium, and rombergism. PMID:24688096

Lanska, Douglas J; Remler, Bernd

2014-04-01

182

Surgical resection of neoplastic cervical spine lesions in relation to the vertebral artery V2 segment.  

PubMed

Neoplastic cervical spine lesions are seen infrequently by the spinal surgeon. The surgical management of these tumors, particularly with associated neurovascular compromise, is challenging in terms of achieving proper resection and spinal stabilization and ensuring no subsequent recurrence or failure of fixation. In this report we highlight some of the problems encountered in the surgical management of tumors involving the cervical spine with techniques applied for gross total resection of the tumor without compromising the vertebral arteries. Ten patients with neoplastic cervical spine lesions were managed in our study. The common cardinal presentation was neck and arm pain with progressive cervical radiculo-myelopathy. All patients had plain X-rays, computer tomography scans, and magnetic resonance imaging of the cervical spine. Digital subtraction or magnetic resonance angiograms were performed on both vertebral arteries when the pathology was found to be in proximity to the vertebral artery. When a tumor blush with feeders was evident, endovascular embolization to minimize intraoperative bleeding was also considered. A single approach or a combined anterior cervical approach for corpectomy and cage-with-plate fixation and posterior decompression for resection of the rest of the tumor with spinal fixation was then accomplished as indicated. All cases made a good neurological recovery and had no neural or vascular complications. On the long-term follow-up of the survivors there was no local recurrence or surgical failure. Only three patients died: two from the primary malignancy and one from pulmonary embolism. This report documents a safe and reliable way to deal with neoplastic cervical spine lesions in proximity to vertebral arteries with preservation of both arteries. PMID:21577335

Al Barbarawi, Mohamed; Odat, Ziad; Alheis, Mwaffaq; Qudsieh, Suhair; Qudsieh, Tareq

2010-01-01

183

The spinal cord in rheumatoid arthritis with clinical myelopathy: a computed myelographic study.  

PubMed Central

Thirty one patients with suspected myelopathy due to rheumatoid arthritis were examined by plain radiography and 27 had computed myelography. Clinical features and radiological findings were compared. Deformity of the spinal cord could occur in the absence of combined anterior and posterior compression and correlated closely with clinical features only when considered in combination with skeletal and adjacent soft tissue abnormalities. The best surgical results were achieved by transoral odontoidectomy. Images

Stevens, J M; Kendall, B E; Crockard, H A

1986-01-01

184

Progression of spinal cord atrophy by traumatic or inflammatory myelopathy in the pediatric patients: case series  

Microsoft Academic Search

Study design:Case series.Objective:To present spinal cord atrophy in pediatric patients who had spinal cord injury developed after trauma or acute transverse myelitis, and had no motor recovery later.Setting:Department of Rehabilitation Medicine, Tertiary National University Children's Hospital, Seoul, Korea.Methods:Case series.Results:Two pediatric patients with paraplegia due to acute transverse myelitis and one pediatric patient with paraplegia due to traumatic myelopathy were included

M S Bang; S J Kim

2009-01-01

185

HTLV1-associated myelopathy\\/tropical spastic paraparesis accompanied with psoriasis  

Microsoft Academic Search

Two adult females developed HTLV-1-associated myelopathy\\/tropical spastic paraparesis (HAM\\/TSP) and psoriasis. Both showed chronic progressive paraparesis and sharply demarcated erythematous scaling plaques on their extremities and trunk. One patient had polymyositis while in the other anti-thyroid antibodies, antinuclear antibodies and SS-A antibody, all autoantibodies, were positive. Both patients were treated by intramuscular injections of interferon-? for 2 to 4 weeks,

Akihiro Watanabe; Masakazu Kawajiri; Koji Ikezoe; Manabu Osoegawa; Hiroyuki Murai; Hirofumi Ochi; Takayuki Taniwaki; Jun-ichi Kira

2004-01-01

186

[A case of intravascular large B-cell lymphoma associated with transverse myelopathy].  

PubMed

We present a 68-year-old man suffering from transverse myelopathy since May 2010. The spinal cord MRI showed a T2- hyperintense lesion invading the Th5 level spinal cord. Although the patient transiently responded to steroid-pulse therapy, his neurological symptoms degenerated three months after wards. On admission, he had an apparent hepatosplenomegaly, but no lymphadenopathy. A laboratory examination revealed bicytopenia and increased levels ofLDH and soluble IL-2 receptors. Histological analysis ofa skin biopsy specimen demonstrated proliferation of large atypical lymphoid cells positive for CD20 and CD79a in the small capillaries, leading to our diagnosis of intravascular large B-cell lymphoma(IVLBCL). Thus, the patient's progressive myelopathy was probably caused by IVLBCL invasion. The patient responded well to Rituximab-combined CHOP therapy(R-CHOP), and his neurological symptoms improved immediately. A spinal cord MRI showed the disappearance of the abnormal signal after two courses of R -CHOP. IVLBCL often presents with neurological manifestations, including transverse myelopathy. PMID:22083204

Seki, Masanori; Sugawara, Tomohiro; Yamamoto, Katsutoshi; Takahashi, Taro; Harigae, Hideo

2011-11-01

187

Pediatric cervical spine instability  

PubMed Central

Cervical spine instability in children is rare but not exceptional and may be due to many factors. Although it mostly occurs at the upper cervical spine, all vertebrae from the occiput to T1 may be involved. It may be acute or chronic, occurring secondary to trauma or due to congenital anomaly, skeletal or metabolic dystrophy or rheumatoid arthritis. It can be isolated or associated with other musculoskeletal or visceral anomalies. A thorough knowledge of embryology, anatomy, physiology and physiopathology of the cervical spine in children is essential to avoid pitfalls, recognize normal variants and identify children at risk of developing cervical spine instability and undertake the appropriate treatment.

El Hage, Samer; Rachkidi, Rami; Kharrat, Khalil; Dagher, Fernand; Kreichati, Gabi

2008-01-01

188

Osteoradionecrosis of the cervical vertebrae in patients irradiated for head and neck cancers.  

PubMed

Osteoradionecrosis (ORN) is one of the common late adverse effects that follow radiation therapy for head and neck cancers. ORN usually develops on the mandible and less frequently on the maxilla. We present three cases of ORN of the cervical vertebrae, which is rarely reported. Two patients suffered from secondary osteomyelitis after neoadjuvant chemotherapy followed by definitive concurrent chemoradiation therapy with a hyperfractionated and an accelerated hyperfractionated regimen, respectively. For these patients, the high intensity of treatment was considered the cause of ORN. The third patient underwent concurrent chemoradiation therapy for upper thoracic esophageal cancer and subsequently underwent endoscopic laser resection and radiation therapy for hypopharyngeal cancer. ORN developed in the area of reirradiation. In this case, an excessive radiation dose was considered the cause. ORN of cervical vertebrae, different from that of the mandible and maxilla, has a risk of radiculopathy and myelopathy. In the future, ORN of cervical vertebrae will increase because metachronous double cancers will increase and opportunities for reirradiation, in turn, will increase. To prevent this, it is necessary to optimize the treatment schedule for radiation therapy, including the total dose, fractionation, and concurrent chemotherapy, and to decrease the volume of cervical vertebrae within the irradiation field. PMID:20585930

Kosaka, Yasuhiro; Okuno, Yoshishige; Tagawa, Yumiko; Ueki, Nami; Itoh, Kyo; Shinohara, Shogo; Kikuchi, Masahiro

2010-06-01

189

Single-level calcified cervical disk herniation in a 13-year-old girl.  

PubMed

This article describes a case of a 13-year-old girl with single-level calcified cervical disk herniation. The patient was treated conservatively for a symptomatic intervertebral calcification that caused neurological compression, and the data were reviewed retrospectively. Previous reports have shown that the natural history of the disease is self-limiting with a benign course and an excellent prognosis. However, on rare occasions when the calcified nucleus pulposus herniates into the spinal canal and compresses the spinal cord or its roots, neurological abnormalities can occur, such as radiculopathy and myelopathy. This also raises the question of whether operative therapy will eventually be necessary. In the current case, conservative treatment was applied. Plain radiographs are usually sufficient to determine the presence and extent of a calcified cervical disk, and computed tomography or magnetic resonance imaging can detect an associated disk herniation. Conservative treatment with antalgics, muscle relaxants, neurotrophic drugs, and a cervical collar were applied. The patient was completely free of symptoms 3 weeks after the initial treatment. Magnetic resonance imaging indicated complete vertebral canal clearance at final follow-up. Cervical intervertebral disk calcification and herniation is a rare disorder in children with an obscure etiology but a good prognosis. Conservative therapy produces satisfactory results, even if clinical symptoms due to nerve root or spinal cord compression are present. Surgical treatments are only suitable in rare cases with severe progressive radicular pain or neurological deficit. PMID:22868626

Li, Min; Rong, Weiping; Pan, Xianming; Yu, Lin

2012-08-01

190

Bevacizumab, Radiation Therapy, and Cisplatin in Treating Patients With Previously Untreated Locally Advanced Cervical Cancer  

ClinicalTrials.gov

Cervical Adenocarcinoma; Cervical Adenosquamous Cell Carcinoma; Cervical Squamous Cell Carcinoma; Stage IB Cervical Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer

2014-05-12

191

New surgical technique to secure the bone strut during anterior cervical corpectomy and fusion: kusabi fixation technique--technical note.  

PubMed

Fixation using an anterior cervical plate is frequently used in anterior cervical discectomy or corpectomy and fusion procedures because of the higher fusion rate than without instrumentation. The surgical outcomes with the anterior plate technique are acceptable, but various hardware-related complications have been reported. The authors describe a new surgical technique, called the kusabi fixation technique, for securing the bone strut during anterior cervical corpectomy using cylindrical cages. Following corpectomy, the trimmed bone strut was placed into the space drilled-out. Two small holes of 5-6-mm diameter and 5-mm depth were drilled out at the interface of two bones at the top and bottom of the bone strut in a diagonal orientation. Two cylindrical cages filled with autologous bone tips were tapped into the interface. Eight patients with myelopathy were treated by this method. All procedures were uneventfully performed as a single level surgery (two vertebral bodies and one disk level). Solid bone union was obtained in all patients at 6 months after the operation. Apparent alignment change in the cervical spine was observed in only one patient, who developed asymptomatic kyphosis. No instrumentation failure or significant complications related to the surgery occurred. Precise biomechanical aspects and long-term radiographic analysis compared with the plate fixation technique should be established, but this new method provides another way to secure the bone strut in anterior cervical corpectomy and fusion. PMID:20098036

Tani, Satoshi; Homma, Takao; Uchikado, Hisaaki; Nagashima, Hiroyasu; Isoshima, Akira; Ohhashi, Hiroki; Tochigi, Satoru; Abe, Toshiaki

2010-01-01

192

Smoking and Cervical Cancer  

PubMed Central

Cervical cancer (CC) is the third most common cancer in women worldwide; however, CC is a preventable disease, and much effort should be done to prevent it. Persistence of high-risk HPV infection is the strongest epidemiologic risk factor for CC, however it is not sufficient for development of the disease it cofactors should be present. In 2004; IARC listed cervical cancer among those causally related to smoking. Smoking interferes with incidence and prevalence of HPV infection and is associated with cervical intraepithelial neoplasia and invasive CC. Multiple factors seem to intervene on cervical carcinogenesis related with tobacco, especially by direct local carcinogenic effect and local immunosuppression. Smoking addition is also closely related with other confounding factors, like unfavorable psychosocial events, systemic immunity, contraception, and nutrition, which got difficult epidemiologic evaluation of smoking role on cervical carcinogenesis. Smoking habits should be taken in account in clinical practice and in research concerning CC.

Fonseca-Moutinho, Jose Alberto

2011-01-01

193

Visualization of the Foramen Intervertebral Nerve Root of Cervical Spine with 3.0 Tesla Magnetic Resonance Imaging: A Comparison of Three-dimensional Acquisition Techniques.  

PubMed

Identification of the compression factor in cervical disc herniation and cervical spondylotic radioculopathy is often problematic when using two-dimensional magnetic resonance imaging (MRI). This prompted us to compare and examined three-dimensional sequences, coherent oscillatory state acquisition for the manipulation of image contrast (COSMIC), fast imaging employing steady state acquisition (FIESTA) and T2 star weighted MR angiography (SWAN) with 3.0-Tesla (T) MRI to visualize the foramen intervertebral nerve root for the cervical spine. Fat-suppressed COSMIC (FS-COSMIC) sequence gave the highest signal intensity ratio (1.85±0.06) of the nerve root and vertebral arch. A significant difference in signal intensity ratio of the nerve root was found between FS-COSMIC and FIESTA sequences. No significant difference was found between the FS-COSMIC and FIESTA sequences in the cerebrospinal fluid and the spinal cord. The FS-COSMIC sequence proved to be the most suitable sequence for intra and extra dura matter. PMID:25055947

Shishido, Hiroki; Takashima, Hiroyuki; Takebayashi, Tsuneo; Akatsuka, Yoshihiro; Imamura, Rui; Nagahama, Hiroshi; Shirase, Ryuzi

2014-07-01

194

[Problems of the cervical defects].  

PubMed

The problem of cervical defects is a repeatedly discussed issue. Nowadays, thanks to the dental materials excessive development, the problem of cervical defects once again, has become the center of dentist' interest. The presented article summarizes the historical and current opinion views of cervical defects etiology, as well as their treatment opportunities. It's no more a secret, that successful treatment of cervical defects requires the elimination of the causing agent, without which the failure of any cervical restoration becomes unavoidable. PMID:17966190

El-Lababidi, Adel

2007-01-01

195

Neuroimmunological aspects of human T cell leukemia virus type 1-associated myelopathy/tropical spastic paraparesis.  

PubMed

Human T cell leukemia virus type 1 (HTLV-1) is a human retrovirus etiologically associated with adult T cell leukemia/lymphoma and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Only approximately 0.25-4 % of infected individuals develop HAM/TSP; the majority of infected individuals remain lifelong asymptomatic carriers. Recent data suggest that immunological aspects of host-virus interactions might play an important role in the development and pathogenesis of HAM/TSP. This review outlines and discusses the current understanding, ongoing developments, and future perspectives of HAM/TSP research. PMID:23943469

Saito, Mineki

2014-04-01

196

[Lumbar radiation myelopathy. Case report on localization of lumbar radiation sequelae].  

PubMed

The case of a patient with a radiation lesion of the lumbosacral cord following prophylactic radiation therapy of the paraortic lymph nodes for seminoma is reported. Seven months after radiotherapy he suffered from a pure anterior cell syndrome, followed by a loss of pain and temperature sensation. Ten years later he developed a complete transversal syndrome at the level of L 1. This case indicates the existence of a lumbar radiation myelopathy caused by a lesion at the level of the conus medullaris. PMID:4000318

Berlit, P

1985-04-01

197

Cervical Cancer Stage IVA  

MedlinePLUS

... Home About My Pictures Browse Search Quick Search Image Details Cervical Cancer Stage IVA View/Download: Small: ... Added: 4/23/2012 Reuse Restrictions: Yes - This image is copyright protected. Any use of this image ...

198

Cervical Cancer Stage IVB  

MedlinePLUS

... Home About My Pictures Browse Search Quick Search Image Details Cervical Cancer Stage IVB View/Download: Small: ... Added: 4/23/2012 Reuse Restrictions: Yes - This image is copyright protected. Any use of this image ...

199

Cervical Cancer Stage IIIB  

MedlinePLUS

... Home About My Pictures Browse Search Quick Search Image Details Cervical Cancer Stage IIIB View/Download: Small: ... Added: 4/23/2012 Reuse Restrictions: Yes - This image is copyright protected. Any use of this image ...

200

Cervical Cancer Stage IB  

MedlinePLUS

... Home About My Pictures Browse Search Quick Search Image Details Cervical Cancer Stage IB View/Download: Small: ... Added: 4/23/2012 Reuse Restrictions: Yes - This image is copyright protected. Any use of this image ...

201

Cervical Cancer Stage IIIA  

MedlinePLUS

... Home About My Pictures Browse Search Quick Search Image Details Cervical Cancer Stage IIIA View/Download: Small: ... Added: 4/23/2012 Reuse Restrictions: Yes - This image is copyright protected. Any use of this image ...

202

Cervical Cancer Stage IA  

MedlinePLUS

... Home About My Pictures Browse Search Quick Search Image Details Cervical Cancer Stage IA View/Download: Small: ... Added: 4/23/2012 Reuse Restrictions: Yes - This image is copyright protected. Any use of this image ...

203

Cervical Radiculopathy (Pinched Nerve)  

MedlinePLUS

... American Academy of Orthopaedic Surgeons. Cervical Radiculopathy (Pinched Nerve) Some people have neck pain that may radiate ... an injury near the root of a spinal nerve. A nerve root injury is sometimes referred to ...

204

Cervical Cancer (PDQ): Screening  

MedlinePLUS

... often in black women than in white women. Human papillomavirus (HPV) infection is the major risk factor ... Although most women with cervical cancer have the human papillomavirus (HPV) infection , not all women with an ...

205

ICSN - Cervical Cancer  

Cancer.gov

Skip to Main Content Search International Cancer Screening Network Sponsored by the National Cancer Institute Home | About ICSN | Collaborative Projects | Meetings | Cancer Sites | Publications | Contact Us Cervical Cancer Incidence and Mortality Rates Organization

206

Cervical Cancer Screening Programs  

Cancer.gov

Skip to Main Content Search International Cancer Screening Network Sponsored by the National Cancer Institute Home | About ICSN | Collaborative Projects | Meetings | Cancer Sites | Publications | Contact Us Cervical Cancer: Mortality Rates | Organization

207

Cervical Cancer Screening Programs  

Cancer.gov

Skip to Main Content Search International Cancer Screening Network Sponsored by the National Cancer Institute Home | About ICSN | Collaborative Projects | Meetings | Cancer Sites | Publications | Contact Us Cervical Cancer (Archived Tables): Home Organization

208

Herniated Cervical Disc  

MedlinePLUS

... are sometimes prescribed for more severe arm and neck pain because of their very powerful anti-inflammatory effect. ... caused by a herniated cervical disc. However, some neck pain may persist. Most patients respond well to discectomy; ...

209

Cervical Cancer Participation Rates  

Cancer.gov

Skip to Main Content Search International Cancer Screening Network Sponsored by the National Cancer Institute Home | About ICSN | Collaborative Projects | Meetings | Cancer Sites | Publications | Contact Us Cervical Cancer (Archived Tables): Home Participation

210

Cervical Cancer Screening  

MedlinePLUS

... often in black women than in white women. Human papillomavirus (HPV) infection is the major risk factor ... Although most women with cervical cancer have the human papillomavirus (HPV) infection , not all women with an ...

211

Cervical Cancer Other Characteristics  

Cancer.gov

Skip to Main Content Search International Cancer Screening Network Sponsored by the National Cancer Institute Home | About ICSN | Collaborative Projects | Meetings | Cancer Sites | Publications | Contact Us Cervical Cancer: Mortality Rates | Organization

212

Cervical Cancer Other Characteristics  

Cancer.gov

Skip to Main Content Search International Cancer Screening Network Sponsored by the National Cancer Institute Home | About ICSN | Collaborative Projects | Meetings | Cancer Sites | Publications | Contact Us Cervical Cancer (Archived Tables): Home Other

213

An Unusual Case of Subclinical Peripheral Neuropathy and Cervical Spondylosis in Atopic Myelitis  

PubMed Central

Many cases of atopic myelitis have been reported in Japan; however very few were described in western countries. An 82-year-old woman with a past medical history of atopic dermatitis and asthma presented with progressive paresthesia (tingling) of both hands and tetraparesis. Before the onset of neurological symptoms, she complained of ichthyosis of both legs for 5 weeks. Magnetic resonance imaging demonstrated multisegmental degenerative arthritis, degenerative disc disease, and abnormal spinal cord signal intensity over several cervical segments, suggesting the diagnosis of myelitis. Total serum IgE level was elevated. Nerve conduction studies revealed asymmetric axonal sensorimotor neuropathy. The cerebrospinal fluid specimen showed lymphocytic pleocytosis and elevated protein level. Based on clinical, imaging, and laboratory findings, atopic myelitis was diagnosed. The diagnosis of atopic myelitis should be considered in myelopathy patients with history of atopy and elevated serum IgE levels.

Ozlu, Pelin; Ince, Ferda

2013-01-01

214

Hepatic myelopathy with spastic paraparesis: report of two cases and review of the literature.  

PubMed

PURPOSE: The present report illustrates two men aged for 59 and 43 years, respectively, who presented with slowly progressive spastic paraparesis. STUDY DESIGN: Two case reports and review of literature. METHODS: The patent's history, clinical examination, biology, magnetic resonance imaging (MRI) findings and treatment are reported. We also discuss the pathogenesis and various treatment options. RESULTS: Neurologic examination showed spastic paraparesis without other neurological disorders. MRI of the spinal cord and brain were normal. Cytologic examination of cerebrospinal fluid from each patient was normal. Hemogram disclosed a pancytopenia. Partial thromboplastin time was prolonged. Liver function tests revealed raised serum bilirubin, normal alanine aminotransferase and aspartate aminotransferase, reduced total protein and albumin. Plasma ammonia was elevated. Blood vitamin B12 and folate values were in normal ranges. Serum antibodies to human T cell lymphotropic virus, human immunodeficiency virus, syphilis and hepatitis C virus were absent. Hepatitis B virus antibody assay was positive. The electromyographic evaluation for second motor neuron involvement was also normal. Endoscopy revealed esophageal varices and a spleno-renal shunt. CONCLUSIONS: Hepatic myelopathy remains a default diagnosis assigned only after the exclusion of other causes of spastic paraparesis and partial transverse myelopathy. An accurate history, along with appropriate imaging and laboratory findings, is crucial. PMID:23728397

Ben Amor, Sana; Saied, Mohamed Zakaria; Harzallah, Mohamed Salah; Benammou, Sofiene

2013-06-01

215

MRI morphometric characterisation of the paediatric cervical spine and spinal cord in children with MPS IVA (Morquio-Brailsford syndrome).  

PubMed

Nearly all children with MPS IVA develop skeletal deformities affecting the spine. At the atlanto-axial spine, odontoid hypoplasia occurs. GAG deposition around the dens, leads to peri-odontoid infiltration. Transverse/alar ligament incompetence causes instability. Atlanto-axial instability is associated with cord compression and myelopathy, leading to major morbidity and mortality. Intervention is often required. Does the presence of widened bullet shaped vertebra in platyspondily encroach on the spinal canal and cause spinal stenosis in MPS IVA? So far, there have been no standardised morphometric measurements of the paediatric MPS IVA cervical spine to evaluate whether there is pre-existing spinal stenosis predisposing to compressive myelopathy or whether this is purely an acquired process secondary to instability and compression. This study provides the first radiological quantitative analysis of the cervical spine and spinal cord in a series of affected children. MRI morphometry indicates that the MPS IVA spine is narrower at C1-2 level giving an inverted funnel shape. There is no evidence of a reduction in the Torg ratio (canal-body ratio) in the cervical spine. The spinal canal does not exceed 11 mm at any level, significantly smaller than normal historical cohorts (14 mm). The sagittal diameter and axial surface area of both spinal canal and cord are reduced. C1-2 level cord compression was evident in the canal-cord ratio but the Torg ratio was not predictive of cord compression. In MPS IVA the reduction in the space available for the cord (SAC) is multifactorial rather than due to congenital spinal stenosis. PMID:23404316

Solanki, Guirish A; Lo, William B; Hendriksz, Christian J

2013-03-01

216

Cervical perineural cyst masquerading as a cervical spinal tumor.  

PubMed

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. PMID:24761204

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

2014-04-01

217

Cervical cancer - screening and prevention  

MedlinePLUS

... Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin . 2012;62(3):147- ...

218

Cervical Spinal Motion During Intubation.  

National Technical Information Service (NTIS)

Ten fresh human cadavers were intubated while recording cervical motion using a cinefluoroscopic technique. Segmental cervical motion from the occiput through C5 was measured in both the intact spine and following the creation of a Type II odontoid fractu...

V. C. Traynelis

2000-01-01

219

Cervical Spinal Canal Stenosis and Central Disc Herniation C3/4 in a Man with Primary Complaint of Thigh Pain  

PubMed Central

Purpose?The purpose of this report is to describe the clinical course of a patient who had a primary complaint of isolated right lateral thigh pain 3 years prior that was nonresponsive to conservative measures. Hypoesthesia in the lateral side of the right forearm, deltoid and biceps, as well as triceps paresis, was also diagnosed. Results?Immediately after surgery, the patient reported substantial improvement in his right thigh symptoms. The signs and symptoms associated with the right C6 and C7 radiculopathy did improve. Conclusion?Although the presentation described in this case is somewhat unique, the eventual myelopathic signs and symptoms were not. It was these myelopathic signs and symptoms that led to cervical magnetic resonance imaging, the diagnosis of cervical cord compressive myelopathy, and surgical management.

Akhavan-Sigari, R.; Rohde, V.; Alaid, A.

2013-01-01

220

Cervical disk injuries in athletes  

Microsoft Academic Search

Cervical disk injuries are defined as a cervical injury associated with neurological deficits, radicular symptoms, or radiological evidence of disk degeneration, but not with a fracture or a dislocation of the cervical spine. Thirty cases covering the period from July 1982 to June 1984 were analyzed, and the following findings are presented. Fifty percent of the injuries were sustained in

K. Kumano; T. Umeyama

1986-01-01

221

Cervical Total Disc Arthroplasty  

PubMed Central

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 arthroplasty devices have come onto the market and completed Food and Drug Administration Investigational Device Exemption trials. Though some of the early results demonstrate equivalency of arthroplasty to fusion, compelling evidence of benefits in terms of symptomatic adjacent segment degeneration are lacking. In addition, non-industry-sponsored studies indicate that these devices are equivalent to fusion in terms of adjacent segment degeneration. Longer-term studies will eventually provide the definitive answer.

Basho, Rahul; Hood, Kenneth A.

2012-01-01

222

Jordanian women's attitudes towards cervical screening and cervical cancer.  

PubMed

This paper looks at Jordanian women's attitudes towards cervical screening and cervical cancer. The sample consisted of 600 women attending gynaecology clinics at King Hussein Medical Centre, Amman, Jordan. Seventy-five per cent of women had never had a smear before; however, the majority agreed that it is important; 34.5% of women did not know the significance of a positive cervical smear; 77% of women were not aware of causes of cervical cancer. Finally, when asked who would they like to take their cervical smear test, a clear preference was stated for a female doctor or a female nurse. These findings provide a useful background for developing strategies to increase the uptake of cervical smears among Jordanian women. It also emphasises the need to educate and promote awareness of women to risk factors for cervical cancer and to the need for screening programmes. PMID:12521469

Maaita, M; Barakat, M

2002-07-01

223

Stress and cervical dysplasia.  

PubMed

The aim of the study was to evaluate the relationship between personality, stress and cervical dysplasia. Twenty women with cervical dysplasia were compared to a control group of 23 healthy women. An evaluation of their personality was made by the 16 PF questionnaire; stressing events were investigated with the Paykel scale; hormonal repercussions were studied by using serum and urinary cortisol titers. Significant differences were found in intellectual capability and fancifulness, as well as in cortisol levels. Considering the significant issues that have emerged, we feel that this research is worthy of further investigation and that new evaluation parameters are necessary. PMID:9641233

De Punzio, C; Salvestroni, C; Guazzelli, G; Papa, M C; Freschi, G; Ferdeghini, M; Masoni, S

1998-01-01

224

Immunopathogenesis of HTLV-1-assoaciated myelopathy/tropical spastic paraparesis (HAM/TSP).  

PubMed

Human T-cell lymphotropic virus type 1 (HTLV-1) is associated with adult T-cell leukemia/lymphoma (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Only a limited percentage of infected individuals develop disease in response to the virus while the majority remain asymptomatic, and HAM/TSP is the most common clinical manifestation of the virus. HAM/TSP is an inflammatory disease of the central nervous system (CNS); however, the mechanism by which HTLV-1 induces HAM/TSP is not yet clear. CD4(+) T lymphocytes are the main reservoirs of HTLV-1 in vivo and perform an important role in the immunological response to this retrovirus. This virus-host interaction may provoke changes in the immunological response, such as the enhanced production of inflammatory cytokines and the spontaneous proliferation of T CD4(+) lymphocytes, which are implicated in the pathogenesis of HAM/TSP. PMID:24704970

Fuzii, Hellen Thais; da Silva Dias, George Alberto; de Barros, Rodrigo Jose Saraiva; Falcão, Luiz Fabio Magno; Quaresma, Juarez Antonio Simoes

2014-05-28

225

HTLV-1-associated myelopathy/tropical spastic paraparesis accompanied with psoriasis.  

PubMed

Two adult females developed HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and psoriasis. Both showed chronic progressive paraparesis and sharply demarcated erythematous scaling plaques on their extremities and trunk. One patient had polymyositis while in the other anti-thyroid antibodies, antinuclear antibodies and SS-A antibody, all autoantibodies, were positive. Both patients were treated by intramuscular injections of interferon-alpha for 2 to 4 weeks, resulting in amelioration of paraparesis. After the therapy psoriasis and polymyositis markedly improved in one patient without any additional therapy, while in the other simultaneous use of topical corticosteroids was effective. This is the first report to describe occurrences of psoriasis in HAM/TSP patients. Although there are several reports indicating interferon-alpha induces or exacerbates psoriasis, our experience suggests that psoriasis associated with HAM/TSP can be successfully managed even during interferon-alpha therapy. PMID:15178221

Watanabe, Akihiro; Kawajiri, Masakazu; Ikezoe, Koji; Osoegawa, Manabu; Murai, Hiroyuki; Ochi, Hirofumi; Taniwaki, Takayuki; Kira, Jun-ichi

2004-06-15

226

Management of surgical splenorenal shunt-related hepatic myelopathy with endovascular interventional techniques  

PubMed Central

We present a case with hepatic myelopathy (HM) due to a surgical splenorenal shunt that was successfully treated by endovascular interventional techniques. A 39-year-old man presented with progressive spastic paraparesis of his lower limbs 14 mo after a splenorenal shunt. A portal venogram identified a widened patent splenorenal shunt. We used an occlusion balloon catheter initially to occlude the shunt. Further monitoring of the patient revealed a decrease in his serum ammonia level and an improvement in leg strength. We then used an Amplatzer vascular plug (AVP) to enable closure of the shunt. During the follow up period of 7 mo, the patient experienced significant clinical improvement and normalization of blood ammonia, without any complications. Occlusion of a surgically created splenorenal shunt with AVP represents an alternative therapy to surgery or coil embolization that can help to relieve shunt-induced HM symptoms.

Wang, Mao-Qiang; Liu, Feng-Yong; Duan, Feng

2012-01-01

227

Solitary Osteochondroma of the Thoracic Spine with Compressive Myelopathy; A Rare Presentation  

PubMed Central

A 19-year-old man presented with a 5-year history of back pain radiating to the lower extremities and paresthesis of the toes during the last year. Plain X-ray revealed a large cauliflower shaped exophytic mass at the level of T8, T9 and T10 vertebrae. Computed tomography (CT) and magnetic resonance imaging (MRI) showed an abnormal bony mass arising from the posterior arch of T9 with protrusion to the spinal canal and marked cord compression. The cortex and medulla of the lesion had continuity with those of the T9 vertebra. Surgical en bloc resection was performed and the patient’s symptoms resolved. The histopathologic diagnosis was osteochondroma. In patients with symptoms of myelopathy, in addition to more common etiologies, one should also be aware of rare entities such as osteochondroma.

Mehrian, Payam; Karimi, Mohammad Ali; Kahkuee, Shahram; Bakhshayeshkaram, Mehrdad; Ghasemikhah, Reza

2013-01-01

228

[Alcoholic cerebellar degeneration with pyramidal sign--in relation to alcoholic myelopathy].  

PubMed

Two cases of alcoholic cerebellar degeneration with pyramidal sign were reported. Patient 1 with alcohol dependence syndrome was a 46-year-old woman. After the alcohol abuse of about eight years, she complained of gait disturbance. The gait disturbance progressively worsened in about two months and she could not ambulate freely by herself. Neurological examination revealed nystagmus, ataxic and spastic gait, slight weakness and spasticity of the lower extremities, hyperreflexia of the extremities, bilateral Babinski's signs, and incoordination of the lower extremities. Examination of liver function and serum B12 was normal. Cranial CT scan and MRI revealed atrophy of the cerebellar vermis and dorsal part of the cerebellum. Though neurological signs slightly improved after the admission to our hospital and the abstinence from alcohol abuse, ataxic gait and hyperreflexia of the extremities have continued. Patient 2 was a 58-year-old man. He was a heavy drinker, but was not a patient with alcohol dependence syndrome. After the heavy drinking of about 40 years, he complained of gait disturbance. The gait disturbance had progressively worsened in about four months. Neurological examination revealed ataxic gait, hyperreflexia of the lower extremities, and bilateral Babinski's signs. Laboratory examination revealed slight liver dysfunction with minimal GPT and moderate gamma-GTP elevation. Examination of serum B12 was normal. Cranial CT scan and MRI revealed atrophy of the cerebellar vermis. Though bilateral Babinski's signs disappeared after the abstinence from heavy drinking, ataxic gait and hyperreflexia of the lower extremities have continued. Alcoholic myelopathy without hepatic cirrhosis was rarely reported. In the relation of alcoholic cerebellar degeneration to alcoholic myelopathy, our cases are interesting and important. PMID:8476668

Tsuchiya, K; Watabiki, S; Shiojiri, T; Matsumoto, A; Tsukagoshi, H

1993-02-01

229

Cisplatin and Radiation Therapy With or Without Tirapazamine in Treating Patients With Cervical Cancer  

ClinicalTrials.gov

Cervical Adenocarcinoma; Cervical Adenosquamous 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

2014-06-18

230

Vaccine Therapy in Treating Patients With Persistent or Recurrent Cervical Cancer  

ClinicalTrials.gov

Cervical Adenocarcinoma; Cervical Adenosquamous Cell Carcinoma; Cervical Small Cell Carcinoma; Cervical Squamous Cell Carcinoma; Recurrent Cervical Cancer; Stage III Cervical Cancer; Stage IVA Cervical Cancer; Stage IVB Cervical Cancer

2014-03-07

231

Cerclage and cervical insufficiency  

Microsoft Academic Search

Since the cervical cerclage was introduced to clinical practice 50 years ago, the efficacy of the operation has not been established by evidence-based standards for many indications. Serious flaws in the methods employed to study the safety and efficacy of cerclage have led to confusion and misuse of the operation, although some investigators maintain that current standards make randomized clinical

James H Harger

2002-01-01

232

Antemortem diagnosis and successful management of noncompressive segmental myelopathy in a Siberian-Bengal mixed breed tiger.  

PubMed

A 10-yr-old female spayed mixed breed tiger presented for a 9-day history of acute and nonprogressive paralysis of the pelvic limbs. Magnetic resonance imaging revealed a lesion suggestive of fibrocartilaginous embolic myelopathy with regional spinal cord edema, decreased disk signal intensity at L2-L3, and mild intervertebral disk protrusion at L1-L2 and L2-L3. Cerebral spinal fluid analysis showed no overt evidence of infection or neoplasia. Medical therapy was instituted, including corticosteroids and gastroprotectants as well as nursing care and physical therapy. The tiger began showing clinical improvement 2 wk after initiating treatment, progressing to the point where the animal was standing and intermittently walking. Three months after diagnosis, the tiger had regained muscle strength of its hind limbs and walked regularly with improving coordination. This case is the first report of antemortem diagnosis and successful medical management of suspected fibrocartilaginous embolic myelopathy in a large exotic felid. PMID:24450082

Flower, Jennifer E; Lynch, Kate; Clark-Price, Stuart C; Welle, Kenneth R; O'Brien, Robert; Whittington, Julia K

2013-12-01

233

Synovial chondromatosis of the lumbar spine with compressive myelopathy: a case report with review of the literature  

Microsoft Academic Search

Synovial chondromatosis has been rarely reported to occur in the spine with only one case found in the lumbar spine. We describe\\u000a another case of synovial chondromatosis in the lumbar spine in a 41-year-old man who presented with compressive myelopathy.\\u000a The tumor was located in the left ventrolateral corner of the epidural space just below the L4–L5 intervertebral space. Besides

Ibrahim Fikry Abdelwahab; Daniel Contractor; Stefano Bianchi; George Hermann; Benjamin Hoch

2008-01-01

234

Cetuximab, Cisplatin, and Radiation Therapy in Treating Patients With Stage IB, Stage II, Stage III, or Stage IVA Cervical Cancer  

ClinicalTrials.gov

Cervical Adenocarcinoma; Cervical Adenosquamous Cell 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

2013-12-12

235

C2/C3 pathologic fractures from polyostotic fibrous dysplasia of the cervical spine treated with percutaneous vertebroplasty  

PubMed Central

We will discuss a potential role of percutaneous vertebroplasty (PVP) in the management of patients with severe fibrous dysplasia of the spine with multiple cervical lesions and C2–C3 pathologic fractures that may not be a good surgical candidate. Polyostotic fibrous dysplasia involvement of the cervical spine is rare. Review of literature indicates only few reported cases of surgical management with one case of mortality indicating increased risks associated with surgical intervention. While PVP is commonly used for the treatment of osteoporotic thoracolumbar vertebral compression fractures, its role in vertebral stabilization for fibrous dysplasia has not been reported. A 35-year-old man with McCune–Albright syndrome and severe polyostotic fibrous dysplasia of C2 and C3 vertebrae presented with severe neck pain, radiculopathy, quadriparesis and myelopathy. The lesion had pathologic fractures, and there was an os odontoideum with cervical cord atrophy at the C1 level. After discussing need for aggressive surgical management and potential complications, we offered PVP due to surgical risks involved. PVP was performed with a posterolateral transpedicular approach without complication. The patient had remarkable improvement in clinical relief of neck pain and improvement of myelopathic symptoms at 1-year follow-up. We present a case that illustrates a potential use of PVP in the management of a patient with symptomatic spinal fibrous dysplasia with associated pathologic fractures who was poor surgical candidate.

Dang, David; Christoforidis, Greg; Chiocca, E. Antonio; Gabriel, Joshue

2007-01-01

236

Spontaneous cervical epidural hematoma presenting as brown-sequard syndrome following repetitive korean traditional deep bows.  

PubMed

Spontaneous cervical epidural hematoma (SCEH) is an uncommon cause of acute nontraumatic myelopathy. SCEH presenting as Brown-Sequard syndrome is extremely rare. A 65-year-old man had motor weakness in the left extremities right after his mother's funeral. He received thrombolytic therapy under the impression of acute cerebral infarction at a local hospital. However, motor weakness of the left extremities became aggravated without mental change. After being transferred to our hospital, he showed motor weakness in the left extremities with diminished pain sensation in the right extremities. Diagnosis of SCEH was made by cervical magnetic resonance imaging. He underwent left C3 to C5 hemilaminectomy with hematoma removal. It is important for physicians to be aware that SCEH can be considered as one of the differential diagnoses of hemiplegia, since early diagnosis and management can influence the neurological outcome. We think that increased venous pressure owing to repetitive Korean traditional deep bows may be the cause of SCEH in this case. PMID:23526134

Seon, Hyo-Jeong; Song, Min-Keun; Han, Jae-Young; Choi, In-Sung; Lee, Sam-Gyu

2013-02-01

237

Spontaneous Cervical Epidural Hematoma Presenting as Brown-Sequard Syndrome Following Repetitive Korean Traditional Deep Bows  

PubMed Central

Spontaneous cervical epidural hematoma (SCEH) is an uncommon cause of acute nontraumatic myelopathy. SCEH presenting as Brown-Sequard syndrome is extremely rare. A 65-year-old man had motor weakness in the left extremities right after his mother's funeral. He received thrombolytic therapy under the impression of acute cerebral infarction at a local hospital. However, motor weakness of the left extremities became aggravated without mental change. After being transferred to our hospital, he showed motor weakness in the left extremities with diminished pain sensation in the right extremities. Diagnosis of SCEH was made by cervical magnetic resonance imaging. He underwent left C3 to C5 hemilaminectomy with hematoma removal. It is important for physicians to be aware that SCEH can be considered as one of the differential diagnoses of hemiplegia, since early diagnosis and management can influence the neurological outcome. We think that increased venous pressure owing to repetitive Korean traditional deep bows may be the cause of SCEH in this case.

Seon, Hyo-Jeong; Song, Min-Keun; Han, Jae-Young; Choi, In-Sung

2013-01-01

238

Difficult-to-wean: High index of suspicion  

PubMed Central

Patient: Female, 57 Final Diagnosis: Syryngomyelia • cervical Symptoms: Acute respiratory insufficiency Medication: — Clinical Procedure: — Specialty: Pulmonology Objective: Rare disease Background: Failed planned extubation occurs in a minority of patients with acute respiratory failure requiring invasive mechanical ventilation. In patients presenting with acute respiratory failure with no identifiable cardiopulmonary causes, uncommon conditions, such as cervical spondylotic myelopathy, should be considered. In very rare instances, when cervical spondylotic myelopathy and syringomyelia present concomitantly, they can be devastating. Case Report: A 57-year-old woman visited the emergency room (ER) after feeling unwell for several days. She was brought to the ER with acute respiratory distress and obtunded state with GCS of 6/15. She was hypotensive and agonally breathing. Her initial neurologic evaluation was unrevealing. Based on these findings, she was intubated. Over the next several days, she was difficult to wean from the ventilator and had persistent respiratory acidosis. After a short-lived extubation, the patient was again re-intubated. This time the neurologic evaluation showed decreased movements of all muscle groups against gravity and forces, with generalized weakness. An MRI of the brain and cervical spine demonstrated moderate degenerative disc disease and syringomyelia extending from C2 to C7 level. The patient underwent de-compression laminectomy. After failing several weaning trials, she underwent bronchoscopically-assisted tracheotomy. Conclusions: Acute cardiopulmonary and intensive care unit-acquired neuromuscular conditions have been attributed as a major cause of difficult weaning and extubation. Failure to identify and correct other rare combinations (such as cervical degenerative disc disease and syringomyelia) may cause acute respiratory failure and subsequent failure to wean and extubation, resulting in high rates of mortality and morbidity.

Gelaye, Alehegn; Patel, Brijesh; Farra, Wassim; Kole, Bruce

2014-01-01

239

Early cervical cancer  

Microsoft Academic Search

Opinion statement  Early cervical cancer includes a broad range of disease, from clinically undetectable microinvasive cancer to large, bulky\\u000a tumors that replace the entire cervix. Further subgrouping of this category is therefore necessary to define the optimal treatment\\u000a approach for individual cases. The International Federation of Gynecology and Obstetrics (FIGO) staging system stratifies\\u000a stage I tumors into two broad categories, stage

Karen H. Lu; Thomas W. Burke

2000-01-01

240

Early Invasive Cervical Cancer  

PubMed Central

Purpose To compare MRI, CT, clinical exam and histopathological analysis for predicting lymph node involvement in women with cervical carcinoma, verified by lymphadenectomy. Methods A 25-center ACRIN/GOG study enrolled 208 patients with biopsy-proven invasive cervical cancer for MRI and CT prior to attempted curative radical hysterectomy. Each imaging study was interpreted prospectively by one onsite radiologist, and retrospectively by 4 independent offsite radiologists, all blinded to surgical, histopathological and other imaging findings. Likelihood of parametrial and uterine body involvement was rated on a 5-point scale. Tumor size measurements were attempted in 3 axes. Association with histologic lymph node involvement, scored as absent, pelvic only and common iliac or paraaortic, was evaluated using Cochran-Mantel Haenszel statistics, univariate and multivariate logistic regression, generalized estimating equations, accuracy statistics and ROC analysis. Results Lymphatic metastases were found in 34% of women; 13% had common iliac nodal metastases, and 9% had paraortic nodal metastases. Based on the retrospective multi-observer re-reads, average AUC for predicting histologic lymph node involvement between MRI and CT for tumor size were higher for MRI versus CT, although formal statistic comparisons could not be conducted. Multivariate analysis showed improved model fit incorporating predictors from MRI, but not CT, over and above the initial clinical and biopsy predictors, although the increase in discriminatory ability was not statistically significant. Conclusion MRI findings may help predict the presence of histologic lymph node involvement in women with early invasive cervical carcinoma, thus providing important prognostic information.

Mitchell, Donald G; Snyder, Bradley; Coakley, Fergus; Reinhold, Caroline; Thomas, Gillian; Amendola, Marco A.; Schwartz, Lawrence H; Woodward, Paula; Pannu, Harpreet; Atri, Mostafa; Hricak, Hedvig

2008-01-01

241

Systems biology approaches reveal a specific interferon-inducible signature in HTLV-1 associated myelopathy.  

PubMed

Human T-lymphotropic virus type 1 (HTLV-1) is a retrovirus that persists lifelong in the host. In ?4% of infected people, HTLV-1 causes a chronic disabling neuroinflammatory disease known as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The pathogenesis of HAM/TSP is unknown and treatment remains ineffective. We used gene expression microarrays followed by flow cytometric and functional assays to investigate global changes in blood transcriptional profiles of HTLV-1-infected and seronegative individuals. We found that perturbations of the p53 signaling pathway were a hallmark of HTLV-1 infection. In contrast, a subset of interferon (IFN)-stimulated genes was over-expressed in patients with HAM/TSP but not in asymptomatic HTLV-1 carriers or patients with the clinically similar disease multiple sclerosis. The IFN-inducible signature was present in all circulating leukocytes and its intensity correlated with the clinical severity of HAM/TSP. Leukocytes from patients with HAM/TSP were primed to respond strongly to stimulation with exogenous IFN. However, while type I IFN suppressed expression of the HTLV-1 structural protein Gag it failed to suppress the highly immunogenic viral transcriptional transactivator Tax. We conclude that over-expression of a subset of IFN-stimulated genes in chronic HTLV-1 infection does not constitute an efficient host response but instead contributes to the development of HAM/TSP. PMID:22291590

Tattermusch, Sonja; Skinner, Jason A; Chaussabel, Damien; Banchereau, Jacques; Berry, Matthew P; McNab, Finlay W; O'Garra, Anne; Taylor, Graham P; Bangham, Charles R M

2012-01-01

242

Systems Biology Approaches Reveal a Specific Interferon-Inducible Signature in HTLV-1 Associated Myelopathy  

PubMed Central

Human T-lymphotropic virus type 1 (HTLV-1) is a retrovirus that persists lifelong in the host. In ?4% of infected people, HTLV-1 causes a chronic disabling neuroinflammatory disease known as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The pathogenesis of HAM/TSP is unknown and treatment remains ineffective. We used gene expression microarrays followed by flow cytometric and functional assays to investigate global changes in blood transcriptional profiles of HTLV-1-infected and seronegative individuals. We found that perturbations of the p53 signaling pathway were a hallmark of HTLV-1 infection. In contrast, a subset of interferon (IFN)-stimulated genes was over-expressed in patients with HAM/TSP but not in asymptomatic HTLV-1 carriers or patients with the clinically similar disease multiple sclerosis. The IFN-inducible signature was present in all circulating leukocytes and its intensity correlated with the clinical severity of HAM/TSP. Leukocytes from patients with HAM/TSP were primed to respond strongly to stimulation with exogenous IFN. However, while type I IFN suppressed expression of the HTLV-1 structural protein Gag it failed to suppress the highly immunogenic viral transcriptional transactivator Tax. We conclude that over-expression of a subset of IFN-stimulated genes in chronic HTLV-1 infection does not constitute an efficient host response but instead contributes to the development of HAM/TSP.

Tattermusch, Sonja; Skinner, Jason A.; Chaussabel, Damien; Banchereau, Jacques; Berry, Matthew P.; McNab, Finlay W.; O'Garra, Anne; Taylor, Graham P.; Bangham, Charles R. M.

2012-01-01

243

Myelopathy due to lumbar disc herniation in the presence of a tethered cord.  

PubMed

Study design:Single case report.Objectives:To present a case of lumbar disc herniation causing compression of a tethered cord that was successfully treated with lumbar decompression and fusion.Background:A tethered cord is a rare pathology associated with a congenital spinal malformation, spinal dysraphism. Furthermore, myelopathy due to lumbar disc herniation in the presence of a tethered cord is extremely rare.Methods:Single case report.Results:A 43-year-old male with a history of spina bifida presented to our clinic for an evaluation of a progressive spastic gait disturbance and numbness in the lower limbs. A neurological examination revealed muscle weakness and pyramidal tract signs in the lower limbs. Magnetic resonance imaging of the lumbar spine showed disc herniation at L2-3 causing compression of a low-lying cord. Surgical intervention, including herniotomy via a posterolateral approach and instrumented posterolateral fusion, was performed, and a good outcome was achieved 1 year after the surgery.Conclusion:The potential for lumbar disc herniation in the presence of a tethered cord should be taken into account in the differential diagnosis of spinal pathologies causing spastic gait disturbances. Furthermore, posterior decompression and fusion is a useful treatment option in such cases. PMID:24902642

Endo, F; Iizuka, H; Iizuka, Y; Kobayashi, R; Mieda, T; Takagishi, K

2014-06-01

244

Invasive cervical resorption: treatment challenges  

PubMed Central

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 repair the defect. But after 2 mon, more resorption extended apically. Considering root stability and recurrence potential, we decided to extract the tooth. Invasive cervical resorption in advanced stages may present great challenges for clinicians. Therefore, prevention and early detection must be stressed when dealing with patients presenting history of potential predisposing factors.

Kim, Yookyung; Lee, Chan-Young; Kim, Euiseong

2012-01-01

245

Spontaneous cervical intradural disc herniation.  

PubMed

Cervical intradural disc herniation (IDH) is a rare condition with very few case reports in the literature. We report a 64-year-old man who presented with sudden onset neck pain and rapidly progressing weakness in the left upper and lower limb. There was no history of trauma. MRI of the cervical spine showed a C6-C7 disc prolapse, for which he underwent a C6-C7 discectomy and fusion with bone graft through an anterior cervical approach. To our knowledge, all patients with a cervical IDH reported in the literature have a traumatic etiology. To the best of our knowledge, we report the first patient with a spontaneous cervical IDH. PMID:24210799

Warade, Abhijit G; Misra, Basant K

2014-05-01

246

The Biomechanics of Cervical Spondylosis  

PubMed Central

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.

Ferrara, Lisa A.

2012-01-01

247

Outcome of single level anterior cervical discectomy and fusion using nano-hydroxyapatite/polyamide-66 cage  

PubMed Central

Background: Cages have been widely used for the anterior reconstruction and fusion of cervical spine. Nonmetal cages have become popular due to prominent stress shielding and high rate of subsidence of metallic cages. This study aims to assess fusion with n-HA/PA66 cage following one level anterior cervical discectomy. Materials and Methods: Forty seven consecutive patients with radiculopathy or myelopathy underwent single level ACDF using n-HA/PA66 cage. We measured the segmental lordosis and intervertebral disc height on preoperative radiographs and then calculated the loss of segmental lordosis correction and cage subsidence over followup. Fusion status was evaluated on CT scans. Odom criteria, Japanese Orthopedic Association (JOA) and Visual Analog Pain Scales (VAS) scores were used to assess the clinical results. Statistically quantitative data were analyzed while Categorical data by ?2 test. Results: Mean correction of segmental lordosis from surgery was 6.9 ± 3.0° with a mean loss of correction of 1.7 ± 1.9°. Mean cage subsidence was 1.2 ± 0.6 mm and the rate of cage subsidence (>2 mm) was 2%. The rate of fusion success was 100%. No significant difference was found on clinical or radiographic outcomes between the patients (n=27) who were fused by n-HA/PA66 cage with pure local bone and the ones (n=20) with hybrid bone (local bone associating with bone from iliac crest). Conclusions: The n-HA/PA66 cage is a satisfactory reconstructing implant after anterior cervical discectomy, which can effectively promote bone graft fusion and prevent cage subsidence.

Yang, Xi; Liu, Limin; Song, Yueming; Kong, Qingquan; Zeng, Jiancheng; Tu, Chongqi

2014-01-01

248

[Inicidental finding: patient with cervical spine trauma].  

PubMed

An ossification of the posterior longitudinal ligament, often presenting asymptomatically, can cause a symptomatic myelopathy after trauma. Keeping this entity in mind in daily clinical routine will help in making the correct diagnosis and in administering the corresponding therapy. PMID:22337517

Schmidt, M; Abächerli, C; Niemann, T

2012-02-15

249

Quantitative analysis of heparanase gene expression in normal cervical, cervical intraepithelial neoplastic, and cervical carcinoma tissues.  

PubMed

Heparanase is an endoglycosidase that specifically cleaves heparan sulfate side chains of heparan sulfate proteoglycans, the major proteoglycans in the extracellular matrix and cell surfaces. Traditionally, heparanase activity was implicated in cellular invasion associated with angiogenesis, inflammation, and cancer metastasis. More recently, heparanase up-regulation was documented in an increasing number of primary human tumors. Iotan this study, we sought to investigate the expression of heparanase messenger RNA (mRNA) in normal cervical tissue and intraepithelial cervical lesion and its clinicopathologic importance in invasive cervical cancer. Gene expression of heparanase was assessed by quantitative real-time reverse transcriptase polymerase chain reaction in 28 normal cervical, 26 intraepithelial neoplastic, and 48 cervical cancer tissue samples. Heparanase mRNA expression was different between the 3 groups and lower in normal cervical specimens in relationship with intraepithelial cervical lesions and invasive cervical cancer tissue samples (P = 0.048). Gradually increasing expression of heparanase was evident as the cells progressed from low-grade to high-grade squamous intraepithelial lesions (P = 0.002). In invasive cervical cancer cases, there was a direct correlation between heparanase expression and tumor size (P = 0.002). In cases treated with radical hysterectomy and pelvic lymphadenectomy, the heparanase mRNA expression was significantly higher in tumors exhibiting lymph vascular space invasion (P = 0.044) and in cases with big tumor size (P = 0.005). In our study, we did not find any significant correlation between disease-free and overall survival rates and expression of heparanase (P = 0.396 and P = 0.712, respectively). The results of this study suggest that the gene expression of heparanase in cervical cancer enhances growth, invasion, and angiogenesis of the tumor and may have therapeutic applications. PMID:19955948

Varchalama, Eugene; Rodolakis, Alexander; Strati, Areti; Papageorgiou, Theocharis; Valavanis, Christos; Vorgias, George; Lianidou, Evi; Antsaklis, Aristidis

2009-12-01

250

Myélopathies cervicales  

Microsoft Academic Search

Cervical myelopathy is a clinical syndrome related to a cervical spinal stenosis; it is the most frequent type of myelopathy occurring after the age of 50. Cervical spondylosis is the main aetiology, but many other diseases may produce significant reduction of the size of the spinal canal and a myelopathy. Congenital stenosis can induce a myelopathy in rare cases, but

J. Brunon; C. Nuti; R. Duthel; M.-J. Fotso; B. Dumas

2005-01-01

251

Temsirolimus in Treating Patients With Cervical Cancer That Is Recurrent, Locally Advanced, Metastatic, or Cannot Be Removed By Surgery  

ClinicalTrials.gov

Cervical Adenocarcinoma; Cervical Adenosquamous Cell Carcinoma; Cervical Squamous Cell Carcinoma; Recurrent Cervical Cancer; Stage IIIA Cervical Cancer; Stage IIIB Cervical Cancer; Stage IVA Cervical Cancer; Stage IVB Cervical Cancer

2014-03-07

252

Secondary prevention of cervical cancer part 1: screening for cervical cancer and its precursors.  

PubMed

Discussion of screening for cervical cancer and it precursors, management of abnormal cervical cancer screening test, and evidence-based management of women with cervical intraepithelial neoplasia. PMID:24785416

Boisen, Michelle; Diedrich, Justin T; Lonky, Neal M; Guido, Richard

2014-06-01

253

Extreme cervical elongation after sacrohysteropexy.  

PubMed

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 severe cervical elongation can be important in the pre-operative evaluation. It can alter the operative plan to a uterus-sparing technique or it can alert the surgeon to a difficult entry in the abdominal cavity during vaginal hysterectomy. PMID:23052629

Vierhout, Mark E; Fütterer, Jurgen J

2013-09-01

254

[Cervical teratoma in a child].  

PubMed

Teratomas are unusual tumors derived from all 3 germs cells layers: endoderm, mesoderm, and ectoderm, with varying proportions. The cervical area is exceptionally affected. We report 4 cases of cervical teratoma. The clinically and radiologically suggested diagnosis was confirmed by histology. We describe herein the main clinical, radiological, and histological aspects and outcomes of this disease. Despite its most often benign histologic nature, cervical teratoma may threaten newborn infants' life due to airway compression. A multidisciplinary approach to the disease starting at delivery is required to improve the prognosis. PMID:24011439

Ksia, A; Mosbahi, S; Zrig, A; Achour, Z; Khadhar, M-K; Chioukh, F; Sahnoun, L; Krichene, I; Mekki, M; Belghith, M; Stambouli, L; Golli, M; Zakhama, A; Monastiri, K; Nouri, A

2013-10-01

255

Tropical spastic paraparesis and HTLV-1 associated myelopathy: clinical, epidemiological, virological and therapeutic aspects.  

PubMed

In 1980, Human T cell leukemia/lymphoma virus type 1 (HTLV-1) was the first oncogenic human retrovirus to be discovered. HTLV-1 belongs to the Retroviridae family, the Orthoretrovirinae subfamily and to the deltaretrovirus genus. HTLV-1 preferentially infects CD4(+) lymphoid cells in vivo. Three molecules have been identified for binding and/or entry of HTLV-1: heparan sulfate proteoglycans, neuropilin-1, and glucose transporter 1. An efficient transfer of the virus from an infected cell to a target cell can occur through the formation of a viral synapse and/or by virofilm structure. As for all retroviruses, HTLV-1 genome possesses three major ORFs (gag, pol and env) encoding the structural and enzymatic proteins. HTLV-1 encodes also some regulatory and auxillary proteins including the tax protein with transforming activities and the HBZ protein which plays a role in the proliferation and maintenance of the leukemic cells. HTLV-1 is present throughout the world with clusters of high endemicity including mainly Southern Japan, the Caribbean region, areas in South America and in intertropical Africa. The worldwide HTLV-1 infected population is estimated to be around 10-20 million. HTLV-1 has three modes of transmission: (1): mother to child, mainly linked to prolonged breast-feeding; (2): sexual, mainly occurring from male to female and (3): contaminated blood products. HTLV-1 possesses a remarkable genetic stability. HTLV-1 is the etiological agent of mainly two severe diseases: a malignant T CD4(+) cell lymphoproliferation, of very poor prognosis, named Adult T cell Leukemia/Lymphoma (ATLL), and a chronic neuro-myelopathy named Tropical spastic paraparesis/HTLV-1 Associated Myelopathy (TSP/HAM). The lifetime risk among HTLV-1 carriers is estimated to be around 0.25 to 3%. TSP/HAM mainly occurs in adults, with a mean age at onset of 40-50 years and it is more common in women than in men. Blood transfusion is a major risk factor for TSP/HAM development. Clinically, TSP/HAM is mainly defined as a chronic spastic paraparesis and minor sensory signs. The onset is insidious with often gait disturbance and urinary symptoms. In more than 90% of the cases, the neurological features involve: spasticity and/or hyperreflexia of the lower extremities, urinary bladder disturbance, lower extremity muscle weakness, and in around 50% of the cases, sensory disturbances with low back pain. Central functions and cranial nerves are usually spared. The clinical course is generally progressive without remission. High levels of antibodies titers directed against HTLV-1 antigens are present in blood and cerebrospinal fluid (CSF). A high HTLV-1 proviral load is frequently observed in the blood. Mild to moderate increase of proteins may be present in the CSF. However, intrathecal production of specific HTLV-1 antibody index provides additional data to support the diagnosis. Brain white matter lesions on magnetic resonance imaging are frequent. A mild atrophy of the thoracic spinal cord can also be observed. Pathologically, it is characterized by a chronic inflammation with perivascular lymphocytic cuffing and mild parenchymal lymphocytic infiltrates. The cells are mostly CD4(+) in early disease and mostly CD8(+) in latter disease. Pyramidal tract damage with myelin and axonal loss, mainly in the lower thoracic spinal cord are observed. TSP/HAM pathogenesis is still poorly understood and viral and host factors as the proviral load and the cellular immune response play a major role in disease progression. TSP/HAM can be associated with other HTLV-1 associated symptoms (uveitis, myositis, infective dermatitis). Therapy of TSP/HAM remains disappointing and symptomatic treatment remains still the mainstay of therapy. PMID:22405461

Gessain, A; Mahieux, R

2012-03-01

256

Probabilities of Radiation Myelopathy Specific to Stereotactic Body Radiation Therapy to Guide Safe Practice  

SciTech Connect

Purpose: Dose-volume histogram (DVH) results for 9 cases of post spine stereotactic body radiation therapy (SBRT) radiation myelopathy (RM) are reported and compared with a cohort of 66 spine SBRT patients without RM. Methods and Materials: DVH data were centrally analyzed according to the thecal sac point maximum (Pmax) volume, 0.1- to 1-cc volumes in increments of 0.1 cc, and to the 2 cc volume. 2-Gy biologically equivalent doses (nBED) were calculated using an {alpha}/{beta} = 2 Gy (units = Gy{sub 2/2}). For the 2 cohorts, the nBED means and distributions were compared using the t test and Mann-Whitney test, respectively. Significance (P<.05) was defined as concordance of both tests at each specified volume. A logistic regression model was developed to estimate the probability of RM using the dose distribution for a given volume. Results: Significant differences in both the means and distributions at the Pmax and up to the 0.8-cc volume were observed. Concordant significance was greatest for the Pmax volume. At the Pmax volume the fit of the logistic regression model, summarized by the area under the curve, was 0.87. A risk of RM of 5% or less was observed when limiting the thecal sac Pmax volume doses to 12.4 Gy in a single fraction, 17.0 Gy in 2 fractions, 20.3 Gy in 3 fractions, 23.0 Gy in 4 fractions, and 25.3 Gy in 5 fractions. Conclusion: We report the first logistic regression model yielding estimates for the probability of human RM specific to SBRT.

Sahgal, Arjun, E-mail: arjun.sahgal@rmp.uhn.on.ca [Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON (Canada) [Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON (Canada); Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada); Weinberg, Vivian [University of California San Francisco Helen Diller Family Comprehensive Cancer Center Biostatistics Core, San Francisco, California (United States)] [University of California San Francisco Helen Diller Family Comprehensive Cancer Center Biostatistics Core, San Francisco, California (United States); Ma, Lijun [Department of Radiation Oncology, University of California at San Francisco, San Francisco, California (United States)] [Department of Radiation Oncology, University of California at San Francisco, San Francisco, California (United States); Chang, Eric [Department of Radiation Oncology, University of Southern California and University of Texas MD Anderson Cancer Center, University of Texas, Houston, Texas (United States)] [Department of Radiation Oncology, University of Southern California and University of Texas MD Anderson Cancer Center, University of Texas, Houston, Texas (United States); Chao, Sam [Department of Radiation Oncology and Neurosurgery, Cleveland Clinic, Cleveland, Ohio (United States)] [Department of Radiation Oncology and Neurosurgery, Cleveland Clinic, Cleveland, Ohio (United States); Muacevic, Alexander [European Cyberknife Center Munich in affiliation with University Hospitals of Munich, Munich (Germany)] [European Cyberknife Center Munich in affiliation with University Hospitals of Munich, Munich (Germany); Gorgulho, Alessandra [Department of Neurosurgery, University of California at Los Angeles, Los Angeles, California (United States)] [Department of Neurosurgery, University of California at Los Angeles, Los Angeles, California (United States); Soltys, Scott [Department of Radiation Oncology, Stanford University, Stanford, California (United States)] [Department of Radiation Oncology, Stanford University, Stanford, California (United States); Gerszten, Peter C. [Departments of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States)] [Departments of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States); Ryu, Sam [Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan (United States)] [Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan (United States); Angelov, Lilyana [Department of Radiation Oncology and Neurosurgery, Cleveland Clinic, Cleveland, Ohio (United States)] [Department of Radiation Oncology and Neurosurgery, Cleveland Clinic, Cleveland, Ohio (United States); Gibbs, Iris [Department of Radiation Oncology, Stanford University, Stanford, California (United States)] [Department of Radiation Oncology, Stanford University, Stanford, California (United States); Wong, C. Shun [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada)] [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada); Larson, David A. [Department of Radiation Oncology, University of California at San Francisco, San Francisco, California (United States)] [Department of Radiation Oncology, University of California at San Francisco, San Francisco, California (United States)

2013-02-01

257

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

PubMed Central

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.

Gupta, Anupam; Taly, Arun B

2013-01-01

258

Motor conduction velocity in the human spinal cord: slowed conduction in multiple sclerosis and radiation myelopathy  

Microsoft Academic Search

Transcutaneous electrical stimulation of the central nervous system was used to measure motor conduction velocity in the human spinal cord in 21 subjects aged 22 to 75 years (mean 55 years), none of whom had neurological disease. The motor conduction velocity between the sixth cervical (C6) and first lumbar (L1) vertebral levels was 67.4 +\\/- 9.1 m\\/s. This probably represents

S J Snooks; M Swash

1985-01-01

259

Anterior Cervical Arachnoid Cyst  

PubMed Central

This report is composed of two patients with anteriorly located cervical intradural arachnoid cyst and review of 24 cases in Englishlanguage literature. Both of our patients were in the first two decades of life with neck pain and motor weakness. With suspicious diagnosis of anterior arachnoid cyst surgery was carried out in both cases, though laminectomy in one and laminoplasty in the other. The cyst wall was widely fenestrated with subsequent subtotal excision of the cyst. Both cases had good long-term outcome. The review disclosed male predominance. 73% of the patients were diagnosed within the first two decades of life. Neck pain and motor weakness were the dominant signs and symptoms of this pathology. Magnetic resonance imaging showing a cerebrospinal fluid (CSF) containing cyst was the best mode of diagnosis. Wide cyst fenestration with waying CSF into subarachnoid cyst was the most appropriate and applied surgery with optimal outcome.

Sharifi, Give

2013-01-01

260

Cervical cancer: a developmental perspective.  

PubMed

Cervical cancer is a disease that affects women worldwide. In some countries it is the leading cause of death among women. Although the incidence of cervical cancer has decreased with the advent of the Papanicolaou smear, it remains a problem in adult women. Cervical dysplasia most often affects women in their 20s; carcinoma in situ affects women 30 to 39 years of age; and invasive carcinoma affects women older than 40 years. These age groups fall into the final three of Erickson's eight stages of ego development. However, taking a developmental approach in planning nursing interventions for women with cervical cancer has its drawbacks. Much of developmental theory research has been conducted on nonrepresentative samples, with women being underrepresented. A template for exploring patient problems from a life stage (developmental) perspective has been developed within the context of three different nursing diagnoses (sexual dysfunction, spiritual distress, and alteration in family processes). PMID:8892133

Klemm, P R; Guarnieri, C

1996-09-01

261

Cervical Cancer HPV Vaccine Use  

Cancer.gov

Skip to Main Content Search International Cancer Screening Network Sponsored by the National Cancer Institute Home | About ICSN | Collaborative Projects | Meetings | Cancer Sites | Publications | Contact Us Cervical Cancer: Mortality Rates | Organization

262

Risks of Cervical Cancer Screening  

MedlinePLUS

... black women than in white women. Human papillomavirus (HPV) infection is the major risk factor for cervical ... disease. After certain positive Pap test results, an HPV test may be done. An HPV test is ...

263

Cervical thorium dioxide granuloma ('thorotrastoma').  

PubMed

An elderly woman had an expanding cervical mass that entrapped and compressed the adjacent cranial nerves, blood vessels, and muscles. The mass was dense on radiographs, extended from the skull base to low neck in the prevertebral and parapharyngeal tissues, and showed mixed intensity on MR. A previous direct carotid arteriogram with thorium dioxide as the contrast agent suggested the histologically proved diagnosis of a cervical thorium dioxide granuloma ("thorotrastoma"). PMID:7502983

Nguyen, B T; Yousem, D M; Hayden, R E; Montone, K T

1995-09-01

264

Infections of the Cervical Spine  

Microsoft Academic Search

\\u000a Spinal infections are relatively rare, accounting for only 2–4% of all osteomyelitis infections, and are located preferentially\\u000a in the thoracic and lumbar segments. Although the cervical segment is the less common spine localization, cervical spinal\\u000a infections present the highest incidence of neurological involvement [6].\\u000a \\u000a \\u000a Recent advances in diagnosis and management — with the introduction of antibiotics and more aggressive surgery

Luca Denaro; Umile Giuseppe Longo; Vincenzo Denaro

265

Tertiary prevention of cervical cancer.  

PubMed

Human pappilomavirus (HPV) has been recognized as the most common sexually transmitted disease in the world and over 100 different HPV types have been identified. Persistent HPV infection has been closely linked to the development of invasive cervical cancer. Although surgical and ablative therapies have been the mainstay of treatment, vaccination against the main oncogenic type of HPV is a reasonable preventive strategy for HPV-induced cervical cancer. PMID:24633405

Divine, Laura M; Huh, Warner K

2014-06-01

266

What Should You Ask Your Doctor about Cervical Cancer?  

MedlinePLUS

... for cervical cancer? What should you ask your doctor about cervical cancer? It is important for you ... and Staging Treating Cervical Cancer Talking With Your Doctor After Treatment What`s New in Cervical Cancer Research? ...

267

Cervical spine injury: tiger attack.  

PubMed

Reports of tiger attacks in the United States are rare. This article presents a case of a young woman who was violently attacked by a Siberian tiger and sustained penetrating trauma to the neck, cervical spine, and bilateral lower extremities. This article presents both diagnostic and therapeutic management of patients who may present with similar injuries. Animal bites from large animals are prone to infection in 10% to 20% of cases. Most infections are polymicrobial, with Pasteurella multicida being the most common isolate. Animal bites also mandate consideration of tetanus and rabies prophylaxis. The decision to administer postexposure rabies prophylaxis is dependent on the type of animal involved, whether the exposure was provoked, the local epidemiology of rabies, and the availability of the animal for observation or testing. Assessment of patients with cervical spine injury requires knowledge of possible associated injuries. Evaluation involves assessment of plain radiographs and computed tomography for evaluation of the cervical spine for bony injury. Furthermore, computed angiography is advantageous to noninvasively evaluate carotid or vertebral artery injury at the same setting in patients with deep cervical puncture wounds. Surgical treatment of unstable cervical spine fractures with lateral mass screw and rod fixation has been reported in the literature to have superior biomechanical properties compared to anterior and posterior instrumentation and fusion. In recent clinical studies, the use of lateral mass screws for traumatic injury of the cervical spine has been associated with excellent maintenance of alignment and minimal complications. PMID:19226051

Anderson, Meredith; Utter, Philip; Szatkowski, Jan; Patrick, Todd; Duncan, William; Turner, Norman; Dekutoski, Mark

2008-12-01

268

Psychometric properties of the Polish language version of the Chronic Pain Coping Inventory-42 for patients treated surgically due to herniated lumbar discs and spondylotic changes.  

PubMed

Background The development of a pain-management program tailored to the specific needs of patients with chronic low back pain (CLBP) requires the proper assessment of psychosocial factors affecting each individual. The Chronic Pain Coping Inventory-42 (CPCI-42) refers to coping strategies, which are commonly defined as the cognitive and behavioral techniques an individual may resort to in stressful or demanding situations. Evidence from a number of sources suggests that differences in pain coping strategies may significantly affect how an individual deals with chronic pain. We aimed to adapt the CPCI-42 to Polish cultural conditions (PL-CPCI-42) and then verify its psychometric properties based on a group of patients treated surgically due to herniated lumbar discs and coexisting spondylotic changes. Material and Methods The average age of the study participants (n=90) was 43.47 years (SD 10.21). The average duration of chronic low back pain (CLBP) was 49.37 months (SD 64.71). Lumbosacral spine X-rays and magnetic resonance imaging scans were performed and all patients completed the PL-CPCI-42 and the Polish versions of the Numeric Pain Rating Scale (NPRS-PL) twice. Internal consistency of the PL-CPCI-42, floor and ceiling effects, test-retest reliability, and criterion validity were analyzed. Results Resting, guarding, and coping self-statements were frequently used as coping strategies both in the test and in the retest, in contrast to relaxation and exercise/stretch. The NPRS-PL result was 5.70 cm in the test and 5.66 in the retest. Cronbach's alpha values were recorded for the asking for assistance, coping self-statements, and seeking social support domains (0.83, 0.80, 0.83, respectively). Test-retest reliability of the PL-CPCI-42 varied from 0.53 (relaxation domain) to 0.84 (asking for assistance and coping self-statements domains). Conclusions The present study provides evidence of the validity of the PL-CPCI-42 and supports its usefulness in assessing chronic pain coping strategies, which are especially important to pain adjustment and in the creation of multidisciplinary pain management programs for patients with severe CLBP. PMID:24824781

Misterska, Ewa; Jankowski, Roman; G?owacki, Maciej

2014-01-01

269

Psychometric properties of the Polish language version of the Chronic Pain Coping Inventory-42 for patients treated surgically due to herniated lumbar discs and spondylotic changes  

PubMed Central

Background The development of a pain-management program tailored to the specific needs of patients with chronic low back pain (CLBP) requires the proper assessment of psychosocial factors affecting each individual. The Chronic Pain Coping Inventory-42 (CPCI-42) refers to coping strategies, which are commonly defined as the cognitive and behavioral techniques an individual may resort to in stressful or demanding situations. Evidence from a number of sources suggests that differences in pain coping strategies may significantly affect how an individual deals with chronic pain. We aimed to adapt the CPCI-42 to Polish cultural conditions (PL-CPCI-42) and then verify its psychometric properties based on a group of patients treated surgically due to herniated lumbar discs and coexisting spondylotic changes. Material/Methods The average age of the study participants (n=90) was 43.47 years (SD 10.21). The average duration of chronic low back pain (CLBP) was 49.37 months (SD 64.71). Lumbosacral spine X-rays and magnetic resonance imaging scans were performed and all patients completed the PL-CPCI-42 and the Polish versions of the Numeric Pain Rating Scale (NPRS-PL) twice. Internal consistency of the PL-CPCI-42, floor and ceiling effects, test-retest reliability, and criterion validity were analyzed. Results Resting, guarding, and coping self-statements were frequently used as coping strategies both in the test and in the retest, in contrast to relaxation and exercise/stretch. The NPRS-PL result was 5.70 cm in the test and 5.66 in the retest. Cronbach’s alpha values were recorded for the asking for assistance, coping self-statements, and seeking social support domains (0.83, 0.80, 0.83, respectively). Test-retest reliability of the PL-CPCI-42 varied from 0.53 (relaxation domain) to 0.84 (asking for assistance and coping self-statements domains). Conclusions The present study provides evidence of the validity of the PL-CPCI-42 and supports its usefulness in assessing chronic pain coping strategies, which are especially important to pain adjustment and in the creation of multidisciplinary pain management programs for patients with severe CLBP.

Misterska, Ewa; Jankowski, Roman; Glowacki, Maciej

2014-01-01

270

Cerebrospinal fluid concentrations of soluble CD27 in HTLV-I associated myelopathy and multiple sclerosis  

PubMed Central

OBJECTIVES—Stimulation of T lymphocytes via the T cell receptor strongly enhances CD27 membrane expression and induces the release of a soluble 32 kDa form of CD27 (sCD27). CD27 is a member of the TNF receptor family, a group of molecules that have important roles in lymphocyte differentiation and survival. Raised concentrations of sCD27 have been reported in various immunopathological conditions and there is evidence that this molecule can serve as a marker of T cell activation in vivo. Concentrations of sCD27 in CSF were compared between patients with T cell mediated neurological disease and non-inflammatory controls. Also, the relation of CSF-sCD27 concentrations with clinical disease activity was investigated in patients with multiple sclerosis.?METHODS—Four groups were studied: (1) eight patients with HTLV-1 associated myelopathy/ tropical spastic paraparisis (HAM)/TSP), (2) eight HTLV-I carriers, (3) 41 patients with multiple sclerosis, and (4) 43 patients with other neurological disease (OND). Concentrations of CSF-sCD27 were determined by enzyme linked immunosorbent assay (ELISA).?RESULTS—Quantification of CSF-sCD27 differentiates patients with HAM/TSP from HTLV-I carriers (p<0.01) and from patients with OND (p<0.001). Moreover, the multiple sclerosis patient group was different from the OND group (p<0.0001). In patients with multiple sclerosis, CSF-sCD27 concentrations were higher in 24 patients with clinically active disease than in 17 with clinically stable disease. In addition, most of the patients with multiple sclerosis with high sCD27 concentrations showed an increase in EDSS, whereas none of the patients with low sCD27 had an EDSS increase.?CONCLUSIONS—As a reliable marker of immunological disease activity in inflammatory white matter disease is still not available, it is proposed that quantification of CSF-sCD27 concentrations is a good candidate. Also, it may serve as a tool to stratify neurological diseases in inflammatory and non-inflammatory states.??

Hintzen, R.; Paty, D.; Oger, J.

1999-01-01

271

Familial Clusters of HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis  

PubMed Central

Objective HTLV-1 proviral loads (PVLs) and some genetic factors are reported to be associated with the development of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). However, there are very few reports on HAM/TSP having family history. We aimed to define the clinical features and laboratory indications associated with HAM/TSP having family history. Methods Records of 784 HAM/TSP patients who were hospitalized in Kagoshima University Hospital and related hospitals from 1987 to 2012 were reviewed. Using an unmatched case-control design, 40 patients of HAM/TSP having family history (f-HAM/TSP) were compared with 124 patients suffering from sporadic HAM/TSP, who were admitted in series over the last 10 years for associated clinical features. Results Of the 784 patients, 40 (5.1%) were f-HAM/TSP cases. Compared with sporadic cases, the age of onset was earlier (41.3 vs. 51.6 years, p<0.001), motor disability grades were lower (4.0 vs. 4.9, p?=?0.043) despite longer duration of illness (14.3 vs. 10.2 years, p?=?0.026), time elapsed between onset and wheelchair use in daily life was longer (18.3 vs. 10.0 years, p?=?0.025), cases with rapid disease progression were fewer (10.0% vs. 28.2%, p?=?0.019), and protein levels in cerebrospinal fluid (CSF) were significantly lower in f-HAM/TSP cases (29.9 vs. 42.5 mg, p<0.001). There was no difference in HTLV-1 PVLs, anti-HTLV-1 antibody titers in serum and CSF, or cell number and neopterin levels in CSF. Furthermore, HTLV-1 PVLs were lower in cases with rapid disease progression than in those with slow progression in both f-HAM/TSP and sporadic cases. Conclusions We demonstrated that HAM/TSP aggregates in the family, with a younger age of onset and a slow rate of progression in f-HAM/TSP cases compared with sporadic cases. These data also suggested that factors other than HTLV-1 PVLs contribute to the disease course of HAM/TSP.

Nozuma, Satoshi; Matsuura, Eiji; Matsuzaki, Toshio; Watanabe, Osamu; Kubota, Ryuji; Izumo, Shuji; Takashima, Hiroshi

2014-01-01

272

Analysis of digitized cervical images to detect cervical neoplasia  

NASA Astrophysics Data System (ADS)

Cervical cancer is the second most common malignancy in women worldwide. If diagnosed in the premalignant stage, cure is invariably assured. Although the Papanicolaou (Pap) smear has significantly reduced the incidence of cervical cancer where implemented, the test is only moderately sensitive, highly subjective and skilled-labor intensive. Newer optical screening tests (cervicography, direct visual inspection and speculoscopy), including fluorescent and reflective spectroscopy, are fraught with certain weaknesses. Yet, the integration of optical probes for the detection and discrimination of cervical neoplasia with automated image analysis methods may provide an effective screening tool for early detection of cervical cancer, particularly in resource poor nations. Investigative studies are needed to validate the potential for automated classification and recognition algorithms. By applying image analysis techniques for registration, segmentation, pattern recognition, and classification, cervical neoplasia may be reliably discriminated from normal epithelium. The National Cancer Institute (NCI), in cooperation with the National Library of Medicine (NLM), has embarked on a program to begin this and other similar investigative studies.

Ferris, Daron G.

2004-05-01

273

Intermittent cervical traction for cervical radiculopathy caused by large-volume herniated disks  

Microsoft Academic Search

Objective: To describe the use of intermittent cervical traction in managing 4 patients with cervical radiculopathy and large-volume herniated disks. Clinical Features: Four patients had neck pain radiating to the arm. The clinical examination was typical in all cases for radiculopathy of cervical origin. Magnetic resonance imaging (MRI) of the cervical spine revealed large-volume herniated disks in all patients. Intervention

Constantine Constantoyannis; Demetres Konstantinou; Harry Kourtopoulos; Nicolas Papadakis

2002-01-01

274

Biomechanical analysis of cervical orthoses in flexion and extension: A comparison of cervical collars and cervical thoracic orthoses  

Microsoft Academic Search

The analysis of current cervical collars (Aspen and Miami J collars) and cervical thoracic orthoses (CTOs) (Aspen 2-post and Aspen 4-post CTOs) in reducing cervical interverte- bral and gross range of motion in flexion and extension was per- formed using 20 normal volunteer subjects. The gross sagittal motion of the head was measured relative to the horizon with the use

Thomas M. Gavin; Gerard Carandang; Robert Havey; Patrick Flanagan; Alexander Ghanayem; Avinash G. Patwardhan

2003-01-01

275

Internet-Based Cervical Cytology Screening Program.  

National Technical Information Service (NTIS)

Cervical cancer is theoretically completely preventable by effective screening using cervical cytology methods (the Pap test). The process of preparing and interpreting Pap tests remains one of the last high-volume manual processes in the clinical laborat...

D. C. Wilbur

2005-01-01

276

Neuropathology of cervical dystonia.  

PubMed

The aim of this study was to search for neuropathological changes in postmortem brain tissue of individuals with cervical dystonia (CD). Multiple regions of formalin-preserved brains were collected from patients with CD and controls and examined with an extensive battery of histopathological stains in a two-stage study design. In stage one, 4 CD brains underwent a broad screening neuropathological examination. In stage two, these 4 CD brains were combined with 2 additional CD brains, and the subjective findings were quantified and compared to 16 age-matched controls. The initial subjective neuropathological assessment revealed only two regions with relatively consistent changes. The substantia nigra had frequent ubiquitin-positive intranuclear inclusions known as Marinesco bodies. Additionally, the cerebellum showed patchy loss of Purkinje cells, areas of focal gliosis and torpedo bodies. Other brain regions showed minor or inconsistent changes. In the second stage of the analysis, quantitative studies failed to reveal significant differences in the numbers of Marinesco bodies in CD versus controls, but confirmed a significantly lower Purkinje cell density in CD. Molecular investigations revealed 4 of the CD cases and 2 controls to harbor sequence variants in non-coding regions of THAP1, and these cases had lower Purkinje cell densities regardless of whether they had CD. The findings suggest that subtle neuropathological changes such as lower Purkinje cell density may be found in primary CD when relevant brain regions are investigated with appropriate methods. PMID:23195594

Prudente, C N; Pardo, C A; Xiao, J; Hanfelt, J; Hess, E J; Ledoux, M S; Jinnah, H A

2013-03-01

277

Cervical cancer screening at crossroads.  

PubMed

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, and has 6-8 CIN-treated women for each prevented cancer case. The discovery of human papillomavirus (HPV) as the cause of cervical cancer dramatically changed perspectives for disease control. Screening with HPV testing was launched around 1990, and preventive HPV vaccination was licensed in 2006. Long-term randomized controlled trials (RCT) demonstrated that HPV testing provides better protection against cervical cancer than cytology, but it requires extra repeated testing. HPV vaccination RCTs, furthermore, have proved that HPV vaccination protects against vaccine-type high-grade CIN in women vaccinated prior to sexual activity, but less so in women vaccinated later. The challenge now is therefore to find an algorithm for screening of a heterogeneous population including non-vaccinated women; women vaccinated prior to start of sexual activity; and women vaccinated later. PMID:25046198

Lynge, Elsebeth; Rygaard, Carsten; Baillet, Miguel Vazquez-Prada; Dugué, Pierre-Antoine; Sander, Bente Braad; Bonde, Jesper; Rebolj, Matejka

2014-08-01

278

Myelopathy and polyneuropathy caused by nitrous oxide toxicity: a case report.  

PubMed

A 19-year-old man presented with a 1-month history of progressive 4-limb numbness and gait imbalance. Physical examination revealed mild general muscular weakness, areflexia, and wide-based, ataxic, steppage gait. Sensory tests showed diminished superficial sensation below the level of the cervical-thoracic junction and a glove-and-stocking pattern of sensory loss at the 4 extremities. An initial magnetic resonance imaging examination of the cervical spine revealed an increased bilateral signal from the posterior and anterior columns on T(2)-weighted images. Nerve conduction velocity and electromyographic tests revealed polyneuropathy. On further inquiry, the patient admitted to chronic recreational use of nitrous oxide. The final diagnosis was nitrous oxide-induced neurotoxicity. The patient was treated for 5 days with injections of 1000 ?g/day vitamin B(12), followed by an additional 2-month treatment at a dose of 1000 ?g/week. The numbness resolved after the first week, but there remained a mild sensory ataxic gait. The patient recovered fully after 2 months of treatment and nitrous oxide abstinence. We recommend an investigation of the patient's history of nitrous oxide exposure in cases where an individual presents to the emergency department or outpatient department with acute numbness characterized by megaloblastic red blood cells and symmetric neurologic deficits. PMID:22169583

Hsu, Chih-Kang; Chen, Yue-Quen; Lung, Vei-Zen; His, Sheng-Chuan; Lo, Huan-Chu; Shyu, Hann-Yeh

2012-07-01

279

Radioprotective Effect of Melatonin on The Cervical Spinal Cord in Irradiated Rats  

PubMed Central

Objective: It has been suggested that the vascular endothelial growth factor (VEGF) gene expression plays an important role in radiation-induced injury to the spinal cord. This study assesses the radioprotective effects of N-acetyl-5-methoxytryptamine (melatonin) through its modulation of VEGF expression after localized irradiation of the cervical spinal cord. Materials and Methods: In this experimental study, we divided 192 male rats into four groups: 1. control (n=48); 2. rats that received an intraperitoneal (IP) injection of melatonin (n=48); 3. rats that received an IP injection of melatonin 30 minutes prior to cervical spinal cord gamma irradiation [dose: 22 Gy; (n=48)]; and 4. rats that received an IP injection of vehicle prior to spinal cord irradiation (n=48). The changes in VEGF expression were assessed using real-time RT-PCR and enzyme-linked immunosorbent assays. Samples for light microscopy were stained with hematoxylin and eosin (H&E). The differences among the groups were analyzed using the analysis of variance (ANOVA) test followed by Tukey’s multiple comparisons test. Results: Up-regulation of VEGF expression was observed from 8 to 22 weeks after irradiation (p<0.05). Paralysis and other radiation-induced myelopathy manifestations developed within 22 weeks after irradiation. VEGF expression in the melatonin pre-treatment group significantly down-regulated in the 20th and 22nd weeks after irradiation compared to the radiation-only group. Conclusion: The results support the hypothesis that modulation of VEGF expression by melatonin administration may increase the survival rate of irradiated animals.

Haddadi, Gholamhassan; Shirazi, Alireza; Sepehrizadeh, Zargham; Mahdavi, Seied Rabie; Haddadi, Maryam

2013-01-01

280

Hereditary occurrence of lateral cervical fistulas.  

PubMed

Three cases of hereditary lateral cervical fistulas are reported. The patients had lateral cervical fistulas bilaterally and different types of auricular malformations. The mothers of the patients also had lateral cervical fistulas. Moreover, one mother had bilateral microtias and the other mothers bilateral preauricular fistulas. The literature is reviewed and discussed. PMID:3377420

Takato, T; Fukuda, O

1988-05-01

281

Cervical Spinal Cord Injury and Deglutition Disorders  

Microsoft Academic Search

The association of cervical spinal cord injury and swallowing disorders is clinically well recognized. This study was performed to determine the clinical significance and the outcome of deglutition disorders observed in the initial treatment of cervical spinal cord injury in our tertiary care spinal cord injury unit. All patients with cervical spinal cord injury admitted to our facility for initial

Rainer Abel; Silke Ruf; Bernhard Spahn

2004-01-01

282

Electrophysiological studies in cervical spondylosis.  

PubMed

This paper reports a study of 57 patients with cervical spondylosis who underwent nerve conduction velocity (NCV), cervical somatosensory evoked potentials (CSEP), and concentric needle electromyography (EMG) as an aid to diagnosis. The results were analyzed in two groups. In Group I, there were 24 patients with radiological changes of cervical spondylosis in the absence of clear neurological signs. Nine patients in this group had abnormal electrophysiological recordings. In Group II, there were 33 patients with clinical signs, and 22 had abnormal electrophysiological recordings. The CSEP was abnormal in 12 of 14 patients who had evidence of nerve root filling defects on myelography. It is concluded that NCV, CSEP, and concentric needle electromyography are useful tests in distinguishing between root lesions and peripheral entrapment neuropathy. Although the methods available are not sufficiently precise to localize the level involved, they can be used as a screen prior to myelography or enhanced computed tomography (CT) scanning if surgery is proposed. PMID:2562447

Khan, M R; McInnes, A; Hughes, S P

1989-09-01

283

Cranio cervical tuberculous hypertrophic pachymeningitis  

PubMed Central

Background: Hypertrophic pachymeningitis is a unique clinical entity characterized by fibrosis and thickening of dura mater resulting in neurological dysfunction. It could be idiopathic or due to variety of inflammatory and infectious conditions. Tuberculous hypertrophic pachymeningitis involving cranio cervical region is rarely reported. Case Description: A 50-year-old female presented with history of progressive quadriparesis and stiffness of neck for 2 years, dysphagia to liquid for past 3 months. Her condition rapidly deteriorated when another physician prescribed her corticosteroid. Physical examination revealed high cervical compressive myelo-radiculopathy with lower cranial nerve palsy and neck rigidity. Series of serum analysis, cerebrospinal fluid (CSF) study and contrast magnetic resonance imaging (MRI) clinched the diagnosis. She improved on antitubercular treatment. Conclusion: In case of multilevel cervical compressive myelo-radiculopathy with lower cranial involvement, possibility of hypertrophic pachymeningitis should be kept in mind. Before diagnosing it as idiopathic, infectious causes should be excluded otherwise prescription of corticosteroid will flare up the disease process.

Senapati, Satya Bhusan; Mishra, Sudhansu Sekhar; Das, Srikanta; Parida, Deepak Kumar; Satapathy, Mani Charan

2014-01-01

284

Cervical carcinogenesis and contraception.  

PubMed

Cytologic evaluation of cervical smears has been carried out in 3,374 women who used different modes of contraception (Lippes loop, copper T200, copper T220, copper devices containing higher copper content than the copper T200, CuT380 Ag, levonorgestrel IUD, injections of noresthisterone oenanthate, and subdermal implants of levonorgestrel) under the Contraceptive Testing Programme of Indian Council of Medical Research for periods ranging from 6 months to 15 yr. While no case of severe dysplasia or malignancy was noticed with any type of contraceptive, 113 dysplastic smears (99 mild and 14 moderate) were encountered on follow-up, giving an incidence of 3.3%, which was statistically insignificant compared with the pretreatment incidence of 1.4% (47 of 3,374). The highest incidence of dysplasia was seen with devices containing a high copper content (9.2%), followed by CuT200 (6.1%) and levonorgestrel implants (4.2%), and was lowest with Lippes loop (1.8%), injection of noresthisterone oenanthate (1.7%), and CuT380 Ag (1.5%), but statistics higher than the pretreatment incidence of 1.4% were seen only with CuT200 and devices containing high copper content. Retrogression of dysplasia was seen in 85 of the 94 posttreatment dysplasia cases and in all 47 pretreatment dysplasia cases, whereas in the remaining nine posttreatment cases of dysplasia the lesion persisted for 6-12 mo, necessitating discontinuation of contraception. The accumulated follow-up data indicate that the CuT380 Ag device is a promising IUD for the future in view of its low incidence of dysplasia determined during its use up to 5 yr. However, more prolonged follow-up in larger numbers of subjects is required to confirm its innocuousness on long-term retention. PMID:1935511

Misra, J S; Engineer, A D; Das, K; Tandon, P

1991-01-01

285

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

PubMed

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. PMID:24781845

Abdul Jabbar Alhassany, Ali

2014-01-01

286

Alopecia areata possibly induced by autoimmune reaction in a patient with human T-cell lymphotropic virus-1-associated myelopathy.  

PubMed

A 38-year-old female patient suffered from alopecia areata totalis followed by human T-cell lymphotropic virus-1-associated myelopathy (HAM). These two diseases have recently been considered to be related to cell-mediated autoimmune reactions. Immunohistochemistry revealed accumulation of CXCR3+ CD8+ T cells around hair bulbs in alopecic lesions. Furthermore, flow cytometric analysis showed the elevated frequency of CD8+ human leukocyte antigen DR+ -activated T cells at the initial time and declined at the hair regrowth phase with HAM. CD4+ CD25+ adult T-cell leukemia/lymphoma cells were elevated at hair loss phase and decreased after improvement of hair loss. These results suggest that autoreactive and cytotoxic CD8(+) T cells induce not only alopecia areata but also HAM in ATL patients. This case highlights that the autoimmune reactions may play an important role in the pathogenesis of alopecia areata and HAM. PMID:23668541

Ito, Taisuke; Shimada, Shinichiro; Mori, Tatsuyoshi; Tokura, Yoshiki

2013-05-01

287

External cervical resorption: a review.  

PubMed

External cervical resorption (ECR) is the loss of dental hard tissue as a result of odontoclastic action; it usually begins on the cervical region of the root surface of the teeth. The etiology, predisposing factors, diagnosis, and management of ECR are reviewed. Effective management and appropriate treatment can only be carried out if the true nature and exact location of the ECR lesion are known. The role of cone beam computed tomography as a diagnostic adjunct for the management of ECR is also reviewed. PMID:19410071

Patel, Shanon; Kanagasingam, Shalini; Pitt Ford, Thomas

2009-05-01

288

Cervical spine in Treacher Collins syndrome.  

PubMed

Treacher Collins syndrome is a congenital syndrome with characteristic craniofacial malformations, which are well described in the literature. However, the presence of cervical spine dysmorphology in this syndrome has been minimally described. This study reviews cervical spine radiographs of 40 patients with Treacher Collins syndrome. In this sample, 7 of 40 patients displayed cervical spine anomalies, with 3 of these patients displaying multiple cervical spine anomalies. The patterns of spinal anomalies were variable, suggesting that the underlying genetic mutation has variable expressivity in cervical spine development as it does elsewhere in the craniofacial skeleton. PMID:22627438

Pun, Amy Hoi-Ying; Clark, Bruce Eric; David, David John; Anderson, Peter John

2012-05-01

289

Cervical Spinal Cord Injuries in Patients with Cervical Spondylosis  

Microsoft Academic Search

Eighty-eight patients over age 40 with traumatic cervical spinal cord injuries were clinically and radiographically evaluated, and comparison was made with 35 spinal cord injury patients under age 36. While most older patients sustained obvious bony and\\/or ligamentous damage commensurate with their neurologic findings, 25 (28%) of the 88 patients had no demonstrable bony abnormalities and 17 (20%) of the

Victor S. Regenboge; Lee F. Roger; Kwang S. Kim

290

Cervical spinal cord injuries in patients with cervical spondylosis.  

PubMed

Eighty-eight patients over age 40 with traumatic cervical spinal cord injuries were clinically and radiographically evaluated, and comparison was made with 35 spinal cord injury patients under age 36. While most older patients sustained obvious bony and/or ligamentous damage commensurate with their neurologic findings, 25 (28%) of the 88 patients had no demonstrable bony abnormalities and 17 (20%) of the 88 patients had only minimal evidence of bony injury. Of particular interest are the patients with severe cord injuries, yet no bony abnormalities, who seem to form a distinct subgroup of the cervical spinal cord injury patient on the basis of radiographic and clinical features. Of these 25 patients, 24 (96%) had severe cervical spondylosis. Fourteen (56%) of the 25 patients were injured in falls, five (36%) of these 14 being of a seemingly trivial nature. Of the 42 patients with minimal or no demonstrable bony abnormalities, 33 (79%) were evaluated with plain tomography and no occult fractures or other significant pathology was demonstrated. Pantopaque myelography in 27 (64%) of the 42 cases revealed no extruded disk or other surgical lesion in any patient. In large measure, these injuries can be attributed to cervical spondylosis, which narrows the canal and makes the cord more susceptible to compression by the bulging ligamenta flava during hyperextension. PMID:3484576

Regenbogen, V S; Rogers, L F; Atlas, S W; Kim, K S

1986-02-01

291

Cervical Whiplash: Considerations in the Rehabilitation of Cervical Myofascial Injury  

PubMed Central

Cervical whiplash, usually the result of impact injuries at high speed, is a typically 20th-century problem. This article describes the biomechanical stresses that result in whiplash and outlines the treatment programs that can be expected to help the patient through the four stages of recovery to achieve functional rehabilitation.

Ameis, Arthur

1986-01-01

292

Percutaneous cervical nucleoplasty in the treatment of cervical disc herniation  

PubMed Central

Percutaneous disc decompression procedures have been performed in the past. Various percutaneous techniques such as percutaneous discectomy, laser discectomy, and nucleoplasty have been successful. Our prospective study was directly to evaluate the results of percutaneous cervical nucleoplasty (PCN) surgery for cervical disc herniation, and illustrate the effectiveness of PCN in symptomatic patients who had cervical herniated discs. From July of 2002 to June of 2005, 126 consecutive patients with contained cervical disc herniations have presented at the authors’ clinic and treated by PCN. The patients’ gender distribution for PCN was 65 male, 61 female. The age of patients ranged from 34 to 66 years (mean 51.9 ± 10.2 years). The levels of involvement were 21 cases at C3–4, 30 cases at C4–5, 40 cases at C5–6, and 35 cases at C6–7. The clinical outcomes, pain reduction and the segment stability were all recorded during this study. A clinical outcome was quantified by the Macnab standard and using VAS. The angular displacement (AD) ?11° or horizontal displacement (HD) ?3 mm was considered to be radiographically unstable. In the results of this study, puncture of the needle into the disc space was accurately performed under X-ray guidance in all cases. There was one case where the Perc-D Spine Wand had broken in the disc space during the procedure. The partial Perc-D Spine Wand, which had broken in the disc space could not be removed by the percutaneous cervical discectomy and thus remained there. There were no recurrent cases or complications in our series. Macnab standard results were excellent in 62 cases, good in 41 cases and fair in 23 cases. The rate of excellent and good was 83.73%. The VAS scores demonstrated statistically significant improvement in PCN at the 2-week, 1, 3, 6, and 12-month follow-up visits when compared to preoperational values (P < 0.01). There were no cases of instability following the PCN procedure. There was no significant difference in stability either preoperatively or postoperatively (P > 0.05). Our findings confirm that PCN for the treatment of cervical disc herniation results in a good outcome without any tampering of the stability of the cervical spine. Hence, PCN as a procedure is safe, minimally invasive, less traumatic, requiring less time with an excellent clinical outcome. PCN should be performed for those patients who fail conservative medical management including medication, physical therapy, behavioral management, psychotherapy, and who are unwilling to undergo a more invasive technique such as spinal surgery.

Li, Jian; Zhang, Zai-Heng

2008-01-01

293

Cervical traction using EMG biofeedback  

Microsoft Academic Search

The increase of age-related diseases such as musculoskeletal and neurological dysfunction will require increased use of rehabilitation therapy. The effectiveness of this treatment depends of the skill of the therapist and the functionality inherent in the therapeutic device used. Here, a new EMG biofeedback controlled therapeutic traction machine was developed to relieve neck pain or cervical compression syndrome. Through EMG

M. Y. Lee; M. K. Wong; F. T. Tang; W. H. Chang; Y. L. Chen

1996-01-01

294

Cervical Thorium Dioxide Granuloma ('Thorotrastoma')  

Microsoft Academic Search

Summary: An elderly woman had an expanding cervical mass that entrapped and compressed the adjacent cranial nerves, blood vessels, and muscles. The mass was dense on radio- graphs, extended from the skull base to low neck in the prever- tebral and parapharyngeal tissues, and showed mixed intensity on MR. A previous direct carotid arteriogram with thorium diox- ide as the

Binh T. Nguyen; David M. Yousem; Richard E. Hayden; Kathleen T. Montone

295

Cervical spine: sport injuries biomechanics  

Microsoft Academic Search

An improved and detailed 3-D FE model of human cervical spine was created using digitized geometric measurement. The model was validated with the in-vivo studies of Moroney [5], Panjabi [6] and Fuller [7]. Clinical instability of the spine for two cases involving flexion and compression loading (simulating injuries in motorcycle vaulting, football and diving accidents) were analyzed. The instability was

Abraham Tchako; Ali M. Sadegh

2005-01-01

296

Spinal surgery -- cervical - series (image)  

MedlinePLUS

... problems include: pain that interferes with daily activities neck pain that extends (radiates) to the shoulder or arm ... done while the patient is deep asleep and pain-free (general anesthesia). For the neck (cervical spine), an incision may be made either ...

297

How Is Cervical Cancer Staged?  

MedlinePLUS

... of the cervix. This stage is also called carcinoma in situ (CIS) which is part of cervical intraepithelial neoplasia ... Stage IVB (any T, any N, M1): The cancer has spread to distant organs beyond the pelvic area, such as the lungs or liver. Last Medical Review: 04/11/2013 ...

298

Robotic Surgery for Cervical Cancer  

PubMed Central

The development of robotic technology has facilitated the application of minimally invasive techniques for the treatment and evaluation of patients with early, advanced, and recurrent cervical cancer. The application of robotic technology for selected patients with cervical cancer and the data available in the literature are addressed in the present review paper. The robotic radical hysterectomy technique developed at the Mayo Clinic Arizona is presented with data comparing 27 patients who underwent the robotic procedure with 2 matched groups of patients treated by laparoscopic (N = 31), and laparotomic radical hysterectomy (N = 35). A few other studies confirmed the feasibility and safety of robotic radical hysterectomy and comparisons to either to the laparoscopic or open approach were discussed. Based on data from the literature, minimally invasive techniques including laparoscopy and robotics are preferable to laparotomy for patients requiring radical hysterectomy, with some advantages noted for robotics over laparoscopy. A prospective randomised trial is currently being perfomred under the auspices of the American Association of Gyneoclogic Laparoscopists comparing minimally invasive radical hysterectomy (laparoscopy or robotics) with laparotomy. For early cervical cancer radical parametrectomy and fertility preserving trachelectomy have been performed using robotic technology and been shown to be feasible, safe, and easier to perform when compared to the laparoscopic approach. Similar benefits have been noted in the treatment of advanced and recurrent cervical cancer where complex procedures such as extraperitoneal paraortic lymphadenectomy and pelvic exenteration have been required. Conclusion: Robotic technology better facilitates the surgical approach as compared to laparoscopy for technically challenging operations performed to treat primary, early or advanced, and recurrent cervical cancer. Although patient advantages are similar or slightly improved with robotics, there are multiple advantages for surgeons.

Zanagnolo, Vanna L.

2008-01-01

299

Robotic surgery for cervical cancer.  

PubMed

The development of robotic technology has facilitated the application of minimally invasive techniques for the treatment and evaluation of patients with early, advanced, and recurrent cervical cancer. The application of robotic technology for selected patients with cervical cancer and the data available in the literature are addressed in the present review paper. The robotic radical hysterectomy technique developed at the Mayo Clinic Arizona is presented with data comparing 27 patients who underwent the robotic procedure with 2 matched groups of patients treated by laparoscopic (N = 31), and laparotomic radical hysterectomy (N = 35). A few other studies confirmed the feasibility and safety of robotic radical hysterectomy and comparisons to either to the laparoscopic or open approach were discussed. Based on data from the literature, minimally invasive techniques including laparoscopy and robotics are preferable to laparotomy for patients requiring radical hysterectomy, with some advantages noted for robotics over laparoscopy. A prospective randomised trial is currently being performed under the auspices of the American Association of Gyneoclogic Laparoscopists comparing minimally invasive radical hysterectomy (laparoscopy or robotics) with laparotomy. For early cervical cancer radical parametrectomy and fertility preserving trachelectomy have been performed using robotic technology and been shown to be feasible, safe, and easier to perform when compared to the laparoscopic approach. Similar benefits have been noted in the treatment of advanced and recurrent cervical cancer where complex procedures such as extraperitoneal paraortic lymphadenectomy and pelvic exenteration have been required. Conclusion: Robotic technology better facilitates the surgical approach as compared to laparoscopy for technically challenging operations performed to treat primary, early or advanced, and recurrent cervical cancer. Although patient advantages are similar or slightly improved with robotics, there are multiple advantages for surgeons. PMID:19108008

Magrina, Javier F; Zanagnolo, Vanna L

2008-12-31

300

Recurrent Spontaneous Rupture of the Urinary Bladder in a Patient With Human T-lymphotropic Virus Type 1-Associated Myelopathy: A Case Report and Literature Review.  

PubMed

Recurrent spontaneous rupture of the urinary bladder has rarely been reported in English articles. This condition may be difficult to diagnosis before a laparotomy due to acute peritonitis. Herein we describe a case of recurrent spontaneous rupture of the bladder in a 39-year-old woman with human T-lymphotropic virus type 1 (HTLV-1) -associated myelopathy/topical spastic paraparesis (HAM/TSP). PMID:24719820

Feizzadeh Kerigh, Behzad; Boostani, Reza; Ghoreifi, Alireza

2014-03-01

301

Recurrent Spontaneous Rupture of the Urinary Bladder in a Patient With Human T-lymphotropic Virus Type 1-Associated Myelopathy: A Case Report and Literature Review  

PubMed Central

Recurrent spontaneous rupture of the urinary bladder has rarely been reported in English articles. This condition may be difficult to diagnosis before a laparotomy due to acute peritonitis. Herein we describe a case of recurrent spontaneous rupture of the bladder in a 39-year-old woman with human T-lymphotropic virus type 1 (HTLV-1) -associated myelopathy/topical spastic paraparesis (HAM/TSP).

Feizzadeh Kerigh, Behzad; Boostani, Reza; Ghoreifi, Alireza

2014-01-01

302

Misdiagnosis in a case of non-compressive myelopathy due to a lumbar spinal intradural fistula supplied by the Artery of Adamkiewicz  

PubMed Central

Background: Spinal vascular malformations comprise a rare but significant group of spinal disorders where clinching the diagnosis early is absolutely necessary since the morbidity increases as the time goes by. These malformations present mainly with symptoms of myelopathy with a gradually worsening course and thus early diagnosis and intervention may revert the symptoms to some extent. Owing to ignorance, sometimes the diagnosis may be missed or delayed and this delay can make a significant difference in the final outcome. Case Description: A 44-year-old male presented to us with an 8-month history of gradually worsening difficulty in walking and lower limb paraesthesias along with recent bladder complaints. Earlier, the imaging had revealed prolapsed lumbar disc and he had undergone L4-5 micro-discectomy few months back. As his symptoms worsened further, he developed paraparesis and then a more detailed analysis revealed a missed spinal arterio-venous fistula at L4-5 level causing congestive myelopathy. He was re-operated and the fistula was disconnected which led to an improvement months after surgery. Conclusion: Thus, to differentiate between compressive and non-compressive myelopathy and detailed investigation of the latter to identify the actual cause remains imperative. Misdiagnosis leading to a wrong surgery caused further deterioration which could have been avoided by careful analysis of imaging. Open surgery remains the preferred treatment for the fistulas supplied by the artery of Adamkiewicz.

Kumar, Ashish; Deopujari, Chandrashekhar E.; Mhatre, Mayur

2011-01-01

303

Secondary prevention of cervical cancer part 2: initial management of abnormal cervical cancer screening test.  

PubMed

Cervical cancer screening has become more complex with the addition of HPV testing to pap testing. This chapter covers evidence based national recommendations for managing abnormal cervical cancer screening tests. PMID:24785417

Guido, Richard

2014-06-01

304

Invasive cervical resorption following trauma.  

PubMed

Invasive cervical resorption is an insidious and often aggressively destructive form of external root resorption which may occur as a late complication following dental trauma particularly where it involves damage to cementum and supporting tissues. While this resorption may be evident clinically as a pink coronal discolouration, later with cavitation of the enamel, often there are no obvious external signs and the condition is only detected radiographically. It is characterised by the invasion of the cervical region of the root by fibrovascular tissue which progressively resorbs dentine, enamel and cementum. The dental pulp remains protected by an intact layer of dentine and predentine until late in the process. Ectopic calcifications can be observed in advanced lesions both within the invading fibrous tissue and deposited directly onto the resorbed dentine surface. The aetiology of invasive cervical resorption is unknown but trauma has been documented as a potential predisposing factor. A recent study by the author of 222 patients with a total of 257 teeth which displayed varying degrees of invasive cervical resorption showed that trauma alone was a potential predisposing sole factor in 14% of patients and 15.1% of teeth. Trauma in combination with bleaching, orthodontics or delayed eruption was found in an additional 11.2% of patients or 10.6% of teeth and of these a combination of trauma and bleaching occurred in a relatively high proportion of 7.7% of patients or 7.4% of teeth. This study also revealed that of other potential predisposing factors orthodontics was the most common sole factor constituting 21.2% of patients and 24.1% of teeth examined. Successful treatment of invasive cervical resorption is dependent on the extent of the resorptive process. Teeth with invasive cervical resorption have been divided into four classes. Whilst several treatment modalities are possible, a clinical evaluation of the treatment of this condition by the topical application of a 90% aqueous solution of trichloracetic acid, curettage, endodontic therapy where necessary and restoration with a glass ionomer cement has been evaluated on 94 patients with a total of 101 teeth with a minimum follow-up period of three years. Results indicate a satisfactory treatment outcome can be anticipated in Class 1, 2 and 3 cases. In Class 4 resorption no treatment or alternative therapy is recommended. Diagnosis of lesions at an early stage of development is highly desirable and therefore the patients who have a potential for the development of this condition by virtue of a history such as trauma should be monitored radiographically at intervals throughout life. PMID:11411085

Heithersay, G S

1999-08-01

305

Cervical cancer: combined modality therapy.  

PubMed

Prospective, randomized studies conducted over the past 10 years have changed the management of patients with advanced cervical cancer. The reviewed studies evaluated the use of surgery, irradiation, and chemotherapy in patients with various stages of cervical carcinoma in the absence and presence of high-risk factors for recurrence. A study by the Radiation Therapy Oncology Group (RTOG) compared pelvic with pelvic plus prophylactic para-aortic irradiation in patients with stages IB (> 4 cm), IIA, and IIB cervical cancer. The 10-year survival advantage was 11% for patients treated with prophylactic para-aortic irradiation. A follow-up study compared pelvic plus prophylactic para-aortic irradiation and brachytherapy with pelvic irradiation, brachytherapy, and chemotherapy with cisplatin and 5-FU in patients with IB-to IVA-stage cervical cancer. Overall and disease-free survivals were significantly improved in patients receiving chemotherapy. In patients with a prevalence of stage IIB and III, the Gynecologic Oncology Group (GOG) demonstrated that treatment with hydroxyurea alone was inferior to cisplatin or cisplatin, 5-FU, and hydroxy-urea in patients treated concurrently with pelvic irradiation and brachytherapy, and the GOG adopted irradiation and weekly cisplatin as standard therapy. Further GOG studies suggest that irradiation and weekly cisplatin chemotherapy without hysterectomy is the optimal treatment for patients with stage IB cervical cancer. High-risk factors for recurrence include tumor size, depth of tumor invasion, lymphovascular space involvement, and lymph node involvement. Prospective, randomized studies conducted by the GOG evaluated the effectiveness of various treatments in patients with high-risk factors. In one study that did not use chemotherapy, the recurrence-free interval was about 10% better for stage IB patients receiving postoperative irradiation after radical hysterectomy and pelvic lymphadenectomy compared with those who received no further therapy. Patients with Stages IB and IIA disease who, following radical hysterectomy and lymph node dissection, are identified as having positive pelvic lymph nodes and positive parametrial involvement, are at higher risk for recurrence and death than the high-risk group described above. An intergroup study conducted by the GOG, RTOG, and Southwest Oncology Group compared postoperative pelvic irradiation alone with postoperative pelvic irradiation plus concurrent chemotherapy in this group of patients. Overall and progression-free survivals were superior for patients receiving chemotherapy, and their greatest survival occurred in patients who received 3 or 4 chemotherapy cycles compared with 1 or 2 cycles or no chemotherapy. These findings are summarized with respect to their implications fortreatment of patients with advanced cervical cancer. PMID:11504285

Grigsby, P W

2001-01-01

306

Defective antioxidant systems in cervical cancer.  

PubMed

Cervical cancer remains a great problem for woman health, as it is the second deadly cancer of females worldwide. The infection of human papilloma virus (HPV) is the major risk factor for this cancer, although several other factors are also associated. Oxidative stress or antioxidant deficiency has been frequently identified to be associated with cervical cancer. Defects in the antioxidant enzyme systems are reported to play important role behind this antioxidant deficiency, which is responsible for the production of reactive oxygen species and ultimately, DNA damage in cervical cells. In response, cells become more vulnerable to HPV infection for cervical cancer development. Recently, antioxidant therapies or dietary supplementation of antioxidants have gained considerable interests in the cervical cancer treatment. In this study, we have reviewed the association of defective antioxidant systems and cervical cancer development. The recent advances in both of the basic and clinical research focusing on possible antioxidant therapy have also been discussed. PMID:23616011

Jiang, Bin; Xiao, Songshu; Khan, Md Asaduzzaman; Xue, Min

2013-08-01

307

Cervical disc arthroplasty: Pros and cons  

PubMed Central

Background: Cervical disc arthroplasty has emerged as a promising potential alternative to anterior cervical discectomy and fusion (ACDF) in appropriately selected patients. Despite a history of excellent outcomes after ACDF, the question as to whether a fusion leads to adjacent segment degeneration remains unanswered. Numerous US investigational device exemption trials comparing cervical arthroplasty to fusion have been conducted to answer this question. Methods: This study reviews the current research regarding cervical athroplasty, and emphasizes both the pros and cons of arthroplasty as compared with ACDF. Results: Early clinical outcomes show that cervical arthroplasty is as effective as the standard ACDF. However, this new technology is also associated with an expanding list of novel complications. Conclusion: Although there is no definitive evidence that cervical disc replacement reduces the incidence of adjacent segment degeneration, it does show other advantages; for example, faster return to work, and reduced need for postoperative bracing.

Moatz, Bradley; Tortolani, P. Justin

2012-01-01

308

Snare-assisted Trans-brachial Stenting for the Cervical Internal Carotid Artery Stenosis of Patient with Aorto-Iliac Occlusion  

PubMed Central

Summary We describe a case of endo-luminal stent placement with Snare-assist for a cervical internal carotid artery stenosis in which percutaneous access was obtained via the brachial artery. A 68-year-old man with known disease of the carotid, peripheral, and coronary arteries, with Human T-cell Lymphotrophic Virus type-1 (HTLV-1) Associated Myelopathy (HAM) presented for endoluminal revascularization of a severe, progressive right internal carotid artery stenosis, but with aorto-iliac occlusion. Transfemoral access was complicated by an aorto-iliac occlusion. A trans-brachial approach was successfully attempted, and a SMARTer stent (Cordis Endovascular, Miami Lakes, FL) was successfully placed through a 7-French Shuttle-SL guide sheath (Cook, Bloomington) under Snare-assist. The trans-brachial approach is becoming an increasingly viable alternative route for stent placement in patients with contra-indicated or complicated femoral access routes. As devices become increasingly more pliable and smaller, the trans-brachial route will be used with increasing frequency in the select patient population for stenting of both the cervical and intracranial circulation.

Oowaki, H.; Matsuura, N; Ishikawa, M.

2006-01-01

309

Cervical neurofibromas in children with NF1  

Microsoft Academic Search

Background. Children with neurofibromatosis type 1 (NF1) are at increased risk of developing plexiform neurofibroma throughout the body,\\u000a including the cervical soft tissues. However, the incidence of cervical soft tissue tumors and the value of screening MR for\\u000a children with NF1 are not known. Purpose. The purposes of this study were to determine the incidence and clinical significance of cervical

Charles J. Chung; K. B. Armfield; Suresh K. Mukherji; Lynn A. Fordham; W. L. Krause

1999-01-01

310

Biomechanical analysis of the anterior cervical fusion  

Microsoft Academic Search

This paper presents a biomechanical analysis of the cervical C5–C6 functional spine unit before and after the anterior cervical discectomy and fusion. The aim of this work is to study the influence of the medical procedure and its instrumentation on range of motion and stress distribution. First, a three-dimensional finite element model of the lower cervical spine is obtained from

P. C. Fernandes; P. R. Fernandes; J. O. Folgado; J. Levy Melancia

2011-01-01

311

Comparison of Adverse Events Between the Bryan Artificial Cervical Disc and Anterior Cervical Arthrodesis  

Microsoft Academic Search

Study Design. Randomized controlled study. Objective. To compare the rates of adverse events associated with disc arthroplasty versus those of anterior cervical discectomy and arthrodesis with allograft and plate. Summary of Background Data. Cervical disc arthro- plasty as a substitute for fusion has been developed to maintain motion and, theoretically, prevent adjacent seg- ment degeneration. Currently, cervical arthroplasty de- vices

Paul A. Anderson; Rick C. Sasso; K. Daniel Riew

2008-01-01

312

Cervical competence as a continuum: A study of ultrasonographic cervical length and obstetric performance  

Microsoft Academic Search

OBJECTIVE: Our purpose was to investigate the hypothesis that cervical competence is a continuum that is related to cervical length and is reflected by pregnancy history.STUDY DESIGN: A cross-sectional study was performed of cervical length measured by transvaginal ultrasonography in women with prior preterm delivery at ? 26 weeks, 27 to 32 weeks, and 33 to 35 weeks compared with

Jay D. Iams; Francee F. Johnson; Jiri Sonck; Larry Sachs; Cathy Gebauer; Philip Samuels

1995-01-01

313

Os odontoideum: rare cervical lesion.  

PubMed

We report the case of a 22-year-old Marine who presented to the emergency department, after a martial arts exercise, with transient weakness and numbness in all extremities. Computed tomography cervical spine radiographs revealed os odontoideum. Lateral flexion-extension radiographs identified atlanto-axillary instability. This abnormality is rare and can be career ending for military members who do not undergo surgical fusion. PMID:22224150

Robson, Kristie A

2011-11-01

314

Os Odontoideum: Rare Cervical Lesion  

PubMed Central

We report the case of a 22-year-old Marine who presented to the emergency department, after a martial arts exercise, with transient weakness and numbness in all extremities. Computed tomography cervical spine radiographs revealed os odontoideum. Lateral flexion–extension radiographs identified atlanto-axillary instability. This abnormality is rare and can be career ending for military members who do not undergo surgical fusion.

Robson, Kristie A

2011-01-01

315

Cervical muscle strength after laminoplasty  

Microsoft Academic Search

.  ?To determine changes in cervical muscle strength after laminoplasty and to evaluate the relation between muscle strength\\u000a and neck pain, we measured maximum isometric muscle strength using a handheld dynamometer. We also investigated neck pain\\u000a before surgery and every month after surgery in 21 subjects who had undergone French-door laminoplasty. Muscle strength decreased\\u000a particularly 1 month after surgery, the extensor

Sueo Nakama; Kikuko Nitanai; Yoichi Oohashi; Teruaki Endo; Yuichi Hoshino

2003-01-01

316

Laparoscopic Fertility Sparing Management of Cervical Cancer  

PubMed Central

Fertility can be preserved after conservative cervical surgery. We report on a 29-year-old woman who was obese, para 0, and diagnosed with cervical insufficiency at the first trimester of current pregnancy due to a previous trachelectomy. She underwent laparoscopic transabdominal cervical cerclage (LTCC) for cervical cancer. The surgery was successful and she was discharged two days later. The patient underwent a caesarean section at 38 weeks of gestation. Laparoscopic surgery is a minimally invasive approach associated with less pain and faster recovery, feasible even in obese women.

Facchini, Chiara; Rapacchia, Giuseppina; Montanari, Giulia; Casadio, Paolo; Pilu, Gianluigi; Seracchioli, Renato

2014-01-01

317

Epithelial-mesenchymal transition in cervical carcinoma  

PubMed Central

During the progression of epithelial cancer, cells usually lose epithelial characteristic features and gain a mesenchymal phenotype. Cervical cancer is a common female malignancy worldwide. Despite the generally good prognosis for early-stage cervical cancer patients, many patients still die as a result of metastasis and recurrence. Epithelial-mesenchymal transition (EMT) has been implicated in the metastasis of primary tumors and provides molecular mechanisms for cervical cancer metastasis. Here we provide an up-to-date overview regarding the program of EMT in cervical cancer. In the stepwise progression of cervical cancer, human papilloma viral proteins contribute to the cell transformation and the conversion of typical epithelial cells to the epithelial carcinoma cells with hybrid epithelial and mesenchymal characteristics. Molecules related to the EMT program of cervical cancer cells are summarized in this review paper. Several soluble factors acting on their cognate receptors stimulate the mesenchymal transition of cervical epithelial cells. Ion transport system as well as cytoskeletal modulators also stimulate the progression of EMT program in cervical carcinoma cells. Transcriptional factors such as Snail, Twist1, Twist2, and six1 homeoproteins are involved in the complicated regulation and cervical cancer metastasis. Among the various signalings associated with EMT program, Snail is a central transcription factor which governs EMT program. In contrast to tumor promoters, several tumor suppressors such as SFRP1/2 and LMX-1A have been reported to suppress tumorigenesis as well as metastatic spread through inhibiting the EMT program.

Lee, Mei-Yi; Shen, Meng-Ru

2012-01-01

318

Laparoscopic fertility sparing management of cervical cancer.  

PubMed

Fertility can be preserved after conservative cervical surgery. We report on a 29-year-old woman who was obese, para 0, and diagnosed with cervical insufficiency at the first trimester of current pregnancy due to a previous trachelectomy. She underwent laparoscopic transabdominal cervical cerclage (LTCC) for cervical cancer. The surgery was successful and she was discharged two days later. The patient underwent a caesarean section at 38 weeks of gestation. Laparoscopic surgery is a minimally invasive approach associated with less pain and faster recovery, feasible even in obese women. PMID:24696772

Facchini, Chiara; Rapacchia, Giuseppina; Montanari, Giulia; Casadio, Paolo; Pilu, Gianluigi; Seracchioli, Renato

2014-04-01

319

Epithelial-mesenchymal transition in cervical carcinoma.  

PubMed

During the progression of epithelial cancer, cells usually lose epithelial characteristic features and gain a mesenchymal phenotype. Cervical cancer is a common female malignancy worldwide. Despite the generally good prognosis for early-stage cervical cancer patients, many patients still die as a result of metastasis and recurrence. Epithelial-mesenchymal transition (EMT) has been implicated in the metastasis of primary tumors and provides molecular mechanisms for cervical cancer metastasis. Here we provide an up-to-date overview regarding the program of EMT in cervical cancer. In the stepwise progression of cervical cancer, human papilloma viral proteins contribute to the cell transformation and the conversion of typical epithelial cells to the epithelial carcinoma cells with hybrid epithelial and mesenchymal characteristics. Molecules related to the EMT program of cervical cancer cells are summarized in this review paper. Several soluble factors acting on their cognate receptors stimulate the mesenchymal transition of cervical epithelial cells. Ion transport system as well as cytoskeletal modulators also stimulate the progression of EMT program in cervical carcinoma cells. Transcriptional factors such as Snail, Twist1, Twist2, and six1 homeoproteins are involved in the complicated regulation and cervical cancer metastasis. Among the various signalings associated with EMT program, Snail is a central transcription factor which governs EMT program. In contrast to tumor promoters, several tumor suppressors such as SFRP1/2 and LMX-1A have been reported to suppress tumorigenesis as well as metastatic spread through inhibiting the EMT program. PMID:22347518

Lee, Mei-Yi; Shen, Meng-Ru

2012-01-01

320

Genetic susceptibility of cervical cancer  

PubMed Central

Epidemiological and laboratory-based studies have identified infection with one of 15 high-risk human papillomavirus (HPV) types as a necessary but not sufficient cause of cervical cancer. The prevalence of genital HPV infections is high in young women, but most of the infections regress without interventions. Host genetic variations in genes involved in immune response pathways may be related to HPV clearance, and HPV E6/E7 oncoproteins interacting or downstream genes, both coding and non-coding, may contribute to the outcome of high risk HPV infection and cervical cancer. Of specific interest for this review has been the selection of genetic variants in genes involved in the above-referred pathways with a summary of their applications in association studies. Because the supportive and opposing data have been reported in different populations, well-designed international collaborative studies need to be conducted to define the consistency of the associations, paving the way to better define the patients at high risk of developing cervical cancer.

Chen, Xiaojun; Jiang, Jie; Shen, Hongbing; Hu, Zhibin

2011-01-01

321

[Cervical cancer prevention: an update].  

PubMed

It has been seen an increase of the cervical cancer and of intraepithelial cancer in the last years. The most important risk factors for cervical cancer are sexual conduct, early of sexual relationships, number of partners, cigarettes, oral anticonceptive, pregnancy, immunosuppression, sexually transmitted illness. And an important role of the Human Papilloma Virus. The HPV has been classified in 3 groups; low risk, the most frequents are 11 and 6, middle risk, tipe 31, 33 and 35, and high risk, 16 and 18, that have frequent association with cervical cancer and with high grade intraepithelial lesions. The cervicovaginal citology is still the most accurate diagnosis method to detect SIL or CIN and invasive cancer in early stages, it is discussed the periodicity and group of women to whom the method must point. There are different options depending if it is a SIL of low or high grade or and cancer. With the possibility of doing follow up or treatment, such as. LLETZ, Laser, Criotraphy, cone and interferon for the preneoplastic lesions. The achievement of a vaccine for HPV could have a significant impact on these pathology. PMID:16972742

Irico, G; Escobar, H; Marinelli, B

2005-01-01

322

Management of Complex Cervical Instability.  

PubMed

Purpose Illustrative cases are presented to demonstrate the surgical management of complex instability of the cervical spine.Methods Six patients with different underlying pathologies are presented along with their clinical and radiologic findings, surgical procedures, complications, and outcomes.Results Five patients underwent anteroposterior (AP) decompression and stabilization, of which two required secondary posterior stabilization because of dislocation or subsidence of the anterior osteosynthesis. In another case, a patient with a two-level corpectomy, a stable situation was achieved with an anterior approach only. The outcomes, measured according to Odom's criteria, were excellent in one patient, good in three patients, and fair in two patients.Conclusions In cases of complex cervical instability, combined AP decompression and stabilization minimizes the risk of anterior plate failure or dislocation of the vertebral body prosthesis. However, there may be increased risk of adjacent-level degeneration. Therefore, a combined procedure should be considered in selected patients. Not all patients with cervical instability require circumferential surgery. In two-level corpectomy cases, the decision between the less invasive anterior-only approach and the more stable combined approach can be difficult. However, in patients with proof of poor bone quality or with metabolic disorders, a more stable combined approach should be considered. PMID:23765918

König, Stefan Alexander; Ranguis, Sebastian; Spetzger, Uwe

2013-06-13

323

INCREASING THE CERVICAL LORDOSIS WITH CHIROPRACTIC BIOPHYSICS SEATED COMBINED EXTENSION-COMPRESSION AND TRANSVERSE LOAD CERVICAL TRACTION WITH CERVICAL MANIPULATION: NONRANDOMIZED CLINICAL CONTROL TRIAL  

Microsoft Academic Search

Background: Cervical lordosis has been shown to be an important outcome of care; however, few conservative methods of rehabilitating sagittal cervical alignment have been reported. Objective: To study whether a seated, retracted, extended, and compressed position would cause tension in the anterior cervical ligament, anterior disk, and muscle structures, and thereby restore cervical lordosis or increase the curvature in patients

Deed E. Harrison; Donald D. Harrison; Joeseph J. Betz; Tadeusz J. Janik; Burt Holland; Christopher J. Colloca; Jason W. Haas

324

Radiation Therapy and Cisplatin With or Without Epoetin Alfa in Treating Patients With Cervical Cancer and Anemia  

ClinicalTrials.gov

Anemia; Cervical Adenocarcinoma; Cervical Adenosquamous Cell Carcinoma; Cervical Squamous Cell Carcinoma; Drug/Agent Toxicity by Tissue/Organ; Radiation Toxicity; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage IVA Cervical Cancer

2014-02-12

325

Comparison of cervical disk implants and cervical disk fusion treatments in human cadaveric models.  

PubMed

Articulating cervical disk implants have been proposed as an alternative to disk fusion in the treatment of cervical disk disease. To examine the mechanical effect of articulating cervical disk implants (ACDI) versus simulated cervical disk fusion, a mechanical test device was constructed and cadaveric tests were carried out. While results show little effect on the pressures above and below the treatment level, the percent hysteretic behavior of the specimens trended to be higher for the ACDI, indicating that these implants retain more of the natural energy absorption capability of the cervical spine. PMID:16813439

Davies, M A; Bryant, S C; Larsen, S P; Murrey, D B; Nussman, D S; Laxer, E B; Darden, B V

2006-08-01

326

Cervical Cancer: Screening and Therapeutic Perspectives  

Microsoft Academic Search

Cervical cancer is a major cause of mortality and premature death among women in their most productive years in low- and medium-resourced countries in Asia, Africa and Latin America, despite the fact that it is an eminently preventable cancer. While cytology screening programmes have resulted in a substantial reduction of cervical cancer mortality in developed countries, they have been shown

Rengaswamy Sankaranarayanan; Somanathan Thara; Pulikottil Okkuru Esmy; Partha Basu

2008-01-01

327

Intraosseous Schwannoma (Neurilemmoma) of the Cervical Spine  

PubMed Central

Purpose: To report on an extremely rare tumour located in the cervical spine, its treatment and result. Review of the literature. Patient: Case report of a 38-year-old woman with an intraosseous schwannoma of the cervical spine. Results: After local curettage no evidence for local recurrence at long-term follow-up.

Veth, Rene P. H.; Pruszczynski, Maciej; Lemmens, J. Albert M.; van Laarhoven, Erik W.

2001-01-01

328

Cervical Spinal Motion During Orotracheal Intubation.  

National Technical Information Service (NTIS)

Ten fresh human cadavers were intubated while recording cervical motion using a cinefluoroscopic technique. Segmental cervical motion from the occiput through C5 was measured in both the intact spine and following the creation of a C4-5 posterior-ligament...

V. C. Traynelis

1999-01-01

329

Cervical Spinal Motion During Orotracheal Intubation.  

National Technical Information Service (NTIS)

Sixteen fresh human cadavers were intubated while recording cervical motion using a cine fluoroscopic technique. Segmental cervical motion from the occiput through C5 was measured in both the intact spine and following the creation of a C4-5 posterior lig...

V. C. Traynelis

1998-01-01

330

[Dysphagia in patients undergoing anterior cervical surgery].  

PubMed

Dysphagia is one of the complications of anterior cervical surgery. Although common, few articles were published on this subject. Its incidence and duration varies depending on the author. We show a prospective study, analyzing the incidence, duration and quality of the dysphagia after anterior cervical surgery. PMID:15273851

Falavigna, Asdrubal; Righesso Neto, Orlando; Ferraz, Fernando Antonio Patriani; Martinato, Geraldo; Riegel, Rafael Ernesto

2004-06-01

331

Cervical Spine MRI in Abused Infants.  

ERIC Educational Resources Information Center

This study attempted to use cervical spine magnetic resonance imaging (MRI) to detect cord injury in 12 dead children with head injury from child abuse. Eighty percent of children autopsied had small cervical spine hemorrhages; MRI did not identify them and did not identify cord injury in any child studied, indicating that MRI scans are probably…

Feldman, Kenneth W.; And Others

1997-01-01

332

Classification Cervical Cancer Using Histology Images  

Microsoft Academic Search

This papers reports on methodologies and outcome of a study aiming at developing robust tool to evaluate and classify histology images of cervical cancer. Using the histology images acquired from the pathology laboratories in an Indonesian hospital, this study aims to classify cervical biopsy images based on four well known discriminatory features a) the ratio of nuclei to cytoplasm b)

Rahmadwati; G. Naghdy; M. Ross; C. Todd; E. Norachmawati

2010-01-01

333

Biomechanics of Upper Cervical Spine Injuries.  

National Technical Information Service (NTIS)

Cervical spine injuries continue to form a significant problem in the U.S.A., in spite of major advances in their medical management. The goal of the study was to produce clinical fractures experimentally, using fresh cadaveric cervical spine specimens. T...

M. Panjabi

1993-01-01

334

DEK overexpression in uterine cervical cancers.  

PubMed

The purpose of the present paper was to investigate the significance of DEK protein expression in uterine cervical lesions and its relationship with HPV infection status. DEK protein expression was studied in 253 cervical lesions, including 30 non-neoplastic cervix with or without squamous metaplasia, 64 cervical intra-epithelial neoplasias (CIN; CIN-1, n = 28; CIN-2, n = 17; CIN-3, n = 19), 102 squamous cell carcinomas (SCC), 51 adenocarcinomas, and six adenosquamous cell carcinomas (adenoSCC) on immunohistochemistry. For comparison, HPV-positive and -negative cervical cancer cell lines were also included. The HPV screening was performed using TaKaRa polymerase chain reaction. On immunohistochemistry DEK was found to be negative in all 30 non-neoplastic cervical epithelia, but it was positive in 96.1% of SCC (98/102), 92.2% of adenocarcinomas (47/51), 100% of adenoSCC (6/6), 85.7% of CIN-1 (24/28), 94.1% of CIN-2 (16/17), and 89.5% of CIN-3 (17/19). There was no significant difference between HPV-positive and -negative cervical lesions. Also, strongly positive staining was observed in all aforementioned cervical cancer cell lines regardless of HPV infection, according to immunocytochemistry. In summary, DEK plays an important role in the carcinogenesis of cervical cancers, and can be helpful for early diagnosis, and is a potential therapeutic target. PMID:18477217

Wu, Qunying; Li, Zhuhu; Lin, Hai; Han, Longzhe; Liu, Shuangping; Lin, Zhenhua

2008-06-01

335

Recurrent cervical carcinoma after primary radical surgery  

Microsoft Academic Search

Objective: This study was undertaken to investigate prognostic factors in patients with recurrent cervical carcinoma who had undergone a primary radical hysterectomy and pelvic lymphadenectomy. Study Design: A retrospective analysis of 177 patients with recurrent cervical carcinoma after radical hysterectomy and pelvic lymphadenectomy for stage IB to II disease at a single institution was performed to evaluate clinicopathologic parameters, time

Chin-Jung Wang; Chyong-Huey Lai; Huei-Jean Huang; Ji-Hong Hong; Hung-Hsueh Chou; Kuan-Gen Huang; Jen-Daw Lin

1999-01-01

336

Medical Interventions: Vaccine to Prevent Cervical Cancer  

Cancer.gov

As recently as the 1940s, cervical cancer was a major cause of death among women of childbearing age in the U.S. but widespread introduction of the Pap test in the 1950s helped reduce cervical cancer incidence and mortality in this country by more than 70 percent.

337

Cervical epidural hematoma in a child  

PubMed Central

Pediatric cervical epidural hematoma is an uncommon diagnosis and very few cases have been reported so far. The condition is difficult to diagnose and requires immediate surgical intervention to obtain the best possible neurological outcome. Most of the cases are of a spontaneous origin. We report a case of traumatic cervical epidural hematoma, which was managed surgically, resulting in complete neurological recovery.

Gupta, Vishnu; Kundra, Sandeep; Chaudhary, AK; Kaushal, RK

2012-01-01

338

Cervical Cancer Rates by Race and Ethnicity  

MedlinePLUS

... of getting cervical cancer, followed by Hispanic, white, American Indian/Alaska Native, and Asian/Pacific Islander women. Cervical ... from race categories (white, black, Asian/Pacific Islander, American Indian/Alaska Native). Death Rates by Race/Ethnicity From ...

339

Cervical vertigo--reality or fiction?  

PubMed

Neck afferents not only assist the coordination of eye, head, and body, but they also affect spatial orientation and control of posture. This implies that stimulation of, or lesions in, these structures can produce cervical vertigo. In fact, unilateral local anesthesia of the upper dorsal cervical roots induces ataxia and nystagmus in animals, and ataxia without nystagmus in humans. If cervical vertigo exists outside these experimental conditions, it is obviously characterized by ataxia and unsteadiness of gait, and not by a clear rotational or linear vertigo. Neurological, vestibular, and psychosomatic disorders must first be excluded before the dizziness and unsteadiness in cervical pain syndromes can be attributed to a cervical origin. To date, however, the syndrome remains only a theoretical possibility awaiting a reliable clinical test to demonstrate its independent existence. PMID:9390801

Brandt, T

1996-01-01

340

Pathology Case Study: Cervical Adenopathy  

NSDL National Science Digital Library

This is a case study presented by the University of Pittsburgh Department of Pathology, which describes a 78-year-old male who presented with a 6 month history of cervical adenopathy. Visitors are given patient history, microscopic description, differential diagnosis, and immunohistochemistry, including images, and are given the opportunity to diagnose the patient. A "Final Diagnosis" section provides a discussion of the findings as well as references. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in hematopathology.

Craig, Fiona; Krishnamurti, Uma

2008-03-27

341

Triapine, Cisplatin, and Radiation Therapy in Treating Patients With Cervical Cancer or Vaginal Cancer  

ClinicalTrials.gov

Recurrent Cervical Cancer; Recurrent Vaginal Cancer; Stage IB Cervical Cancer; Stage II Vaginal Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage III Vaginal Cancer; Stage IVA Cervical Cancer; Stage IVA Vaginal Cancer; Stage IVB Cervical Cancer; Stage IVB Vaginal Cancer; Therapy-related Toxicity

2014-04-21

342

Oral prednisolone in the treatment of cervical radiculopathy: A randomized placebo controlled trial  

PubMed Central

Background: Steroids are commonly used in the treatment of cervical radiculopathy (CR), but there is limited information in this regard. We evaluated the efficacy of oral prednisone in the treatment of CR. Materials and Methods: This randomized, double-blinded, placebo-controlled trial was conducted on adult patients with neck/shoulder pain for at least 1 month with no alarm symptoms/sings of malignancy, infection, or severe myelopathy, and no contraindication for corticosteroid use. Patients were allocated to receive prednisolone 50 mg/day for 5 days that was tapered within the following 5 days, or placebo. All patients also received acetaminophen 325 mg three times a day and ranitidine 150 mg two times a day. Neck disability index (NDI) and the verbal rating scale (VRS) were used to evaluate the outcomes. Results: A total of 59 patients (31 female, mean ± SD age = 46.2 ± 9.0 years) completed the study. A significant decrease was observed regarding the NDI and VAS scores from baseline to the end of study in both groups (P < 0.001). However, for both the NDI (35.7 ± 21.4 vs. 12.9 ± 10.2) and VRS (4.4 ± 2.7 vs. 1.6 ± 1.2), the amount of decrease was greater in the prednisone compared with the placebo group (P < 0.001). Based on the clinically important change in NDI, pain was improved in 75.8% (22/29) of the prednisolone and 30% (9/30) of the placebo group (P < 0.001). Conclusion: A short course of oral steroid therapy with prednisolone is highly effective in reducing pain in patients referring with uncomplicated CR. Further studies are warranted on dosing, duration, and long-term efficacy and safety of oral steroid therapy, compared with injection approach.

Ghasemi, Majid; Masaeli, Ali; Rezvani, Majid; Shaygannejad, Vahid; Golabchi, Khodayar; Norouzi, Rasul

2013-01-01

343

A biomechanical comparison of posterior cervical stabilization constructs  

Microsoft Academic Search

The overall aim of this study is to compare the effectiveness of cervical lateral mass plate (CLMP) fixation to that of cervical lateral mass rod (CLMR) fixation and transpedicular fixation in providing stability to the cervical spine. Twenty-one cervical spines will be tested intact and with instrumentation in varying degrees of instability including posterior instability, anterior\\/posterior instability, corpectomy, and reconstructed

R. P. Morris; B. Svagr; R. M. Patterson; J. Yang; A. J. Muffoletto; J. W. Simmons

2002-01-01

344

Sagittal alignment and the Bryan cervical artificial disc  

Microsoft Academic Search

Object: The authors evaluated cervical spine radiographs to determine sagittal alignment in patients who underwent one- or two-level arthroplasty with the Bryan cervical artificial disc prosthesis. Methods: The curvature of the surgically treated spinal segments and the overall curvature of the cervical spine were evaluated in 13 patients who underwent 16 cervical arthroplasty device placements. Preoperative and postoperative lateral radiographs

J. Patrick Johnson; Carl Lauryssen; Helen O. Cambron; Robert Pashman; John J. Regan; Neel Anand; Robert Bray

2004-01-01

345

Is 58% sensitivity for detection of cervical intraepithelial neoplasia 3 and invasive cervical cancer optimal for cervical screening?  

PubMed Central

Recent Food and Drug Administration (FDA) approval of a Roche cobas human papillomavirus (HPV) test application as a first line primary cervical screening tool in women 25 and older introduces a new era of complex cervical screening choices. Perhaps the most surprising findings in Roche's supporting ATHENA trial data were the unexpectedly low verification bias-adjusted CIN3+ sensitivities documented by the FDA for both the proposed cobas HPV testing algorithm (58.26%) and Pap testing algorithm (42.63%). These unexpectedly low sensitivity estimates suggest intuitively that there is still considerable room for improvement in cervical screening, and available data from large systems point to routine cytology and HPV co-testing as offering the greatest protection against development of cervical cancer. Observational studies of large populations screened over time remain essential to document actual protection from development of cervical cancer with any new cervical screening options, as natural history studies and available data from large systems indicate that most CIN2/3 cases detected in short term clinical trials would not progress to invasive cervical cancer. Interpretation of ATHENA trial data and its application to routine clinical practice is further limited by published studies which document that a significant proportion of CIN2/3 biopsy diagnoses in the ATHENA trial could not be confirmed as accurate when evaluated with p16 immunohistochemistry and that cytology laboratory performance in the trial was notably suboptimal.

Austin, R. Marshall; Zhao, Chengquan

2014-01-01

346

Cervical spinal cord compression after thyroidectomy under general anesthesia.  

PubMed

Cervical spinal cord injury is a rare but serious complication after general anesthesia. The risk factors include traumatic cervical injury, cervical spine instability, and difficult airway management. It has also occurred in the absence of cervical instability. Here we report a patient who had a history of intermittent neck pain without numbness. Preoperative radiologic examinations showed degenerative changes in the cervical spine. She developed progressive tingling and numbness in her limbs after thyroidectomy under general anesthesia. Magnetic resonance imaging showed a cervical disc protruding into the canal at C5-C6, which was considered to be induced by surgical positioning. She recovered after anterior cervical decompression and internal fixation surgery. PMID:23828450

Yao, Wenlong; Qiu, Jin; Zhou, Zhiqiang; Zhang, Lin; Zhang, Chuanhan

2014-02-01

347

Invasive cervical resorption: a review.  

PubMed

Invasive cervical resorption is a relatively uncommon form of external root resorption exhibiting no external signs. The resorptive condition is often detected by routine radiographic examination. The clinical features vary from a small defect at the gingival margin to a pink coronal discoloration of the tooth crown resulting in ultimate cavitation of the overlying enamel which is painless unless pulpal or periodontal infection supervenes. Radiographic features of lesions vary from well-delineated to irregularly bordered mottled radiolucencies, and these can be confused with dental caries. A characteristic radiopaque line generally separates the image of the lesion from that of the root canal, because the pulp remains protected by a thin layer of predentin until late in the process. Histopathologically, the lesions contain fibrovascular tissue with resorbing clastic cells adjacent to the dentin surface. More advanced lesions display fibro-osseous characteristics with deposition of ectopic bonelike calcifications both within the resorbing tissue and directly on the dentin surface. How to cite this article: Kandalgaonkar SD, Gharat LA, Tupsakhare SD, Gabhane MH. Invasive Cervical Resorption: A Review. J Int Oral Health 2013;5(6):124-30 . PMID:24453457

Kandalgaonkar, Shilpa D; Gharat, Leena A; Tupsakhare, Suyog D; Gabhane, Mahesh H

2013-12-01

348

DNA vaccines for cervical cancer  

PubMed Central

Human papillomavirus (HPV), particularly type 16, has been associated with more than 99% of cervical cancers. There are two HPV oncogenic proteins, E6 and E7, which play a major role in the induction and maintenance of cellular transformation. Thus, immunotherapy targeting these proteins may be employed for the control of HPV-associated cervical lesions. Although the commercially available preventive HPV vaccines are highly efficient in preventing new HPV infection, they do not have therapeutic effects against established HPV infection or HPV-associated lesions. Since T cell-mediated immunity is important for treating established HPV infections and HPV-associated lesions, therapeutic HPV vaccine should aim at generating potent E6 and E7-specific T cell-mediated immune responses. DNA vaccines have now developed into a promising approach for antigen-specific T cell-mediated immunotherapy to combat infection and cancer. Because dendritic cells are the most potent professional antigen-presenting cells, and are highly effective in priming antigen-specific T cells, several DNA vaccines have employed innovative strategies to modify the properties of dendritic cells (DCs) for the enhancement of the DNA vaccine potency. These studies have revealed impressive pre-clinical data that has led to several ongoing HPV DNA vaccine clinical trials.

Huang, Chien-Fu; Monie, Archana; Weng, Wei-Hung; Wu, TC

2010-01-01

349

Cervical cytology biobanking in Europe.  

PubMed

A cervical cytology biobank (CCB) is an extension of current cytopathology laboratory practice consisting in the systematic storage of Pap smears or liquid-based cytology samples from women participating in cervical cancer screening with the explicit purpose to facilitate future scientific research and quality audit of preventive services. A CCB should use an internationally agreed uniform cytology terminology, be integrated in a national or regional screening registry, and be linked to other registries (histology, cancer, vaccination). Legal and ethical principles concerning personal integrity and data safety must be respected strictly. Biobank-based studies require approval of ethical review boards. A CCB is an almost inexhaustible resource for fundamental and applied biological research. In particular, it can contribute to answering questions on the natural history of HPV infection and HPV-induced lesions and cancers, screening effectiveness, exploration of new biomarkers, and surveillance of the short- and long-term effects of the introduction of HPV vaccination. To understand the limitations of CCB, more studies are needed on the quality of samples in relation to sample type, storage procedures, and duration of storage. PMID:20872354

Arbyn, Marc; Van Veen, Evert-Ben; Andersson, Kristin; Bogers, Johannes; Boulet, Gaëlle; Bergeron, Christine; von Knebel-Doeberitz, Magnus; Dillner, Joakim

2010-01-01

350

Cervical characteristics of Noonan syndrome.  

PubMed

BACKGROUND/OBJECTIVES A short neck and low posterior hairline are characteristics of Noonan syndrome (NS) and are hallmarks of basilar invagination/impression. However, it is seldom that NS has been directly linked with this symptom. Thus, this study aimed to investigate basilar impression in NS subjects compared with control subjects and individuals exhibiting Turner Syndrome (TS). SUBJECTS/METHODS The degree of basilar impression and vertical positional differences of the third and fourth cervical vertebrae and hyoid bone in NS (n = 9, mean age: 12.1 years), TS (n = 9, mean age: 12.1 years), and control subjects (n = 9, mean age: 12.0 years) were investigated using lateral cephalometric radiographs. Differences between the three groups were compared using the Steel-Dwass test. Vertical positional differences in the anatomical structures within each group were compared using the Wilcoxon signed-rank test accompanied by a Bonferroni-Holm correction. RESULTS The distance by which the odontoid tip extended past McGregor's line in subjects with NS was significantly greater compared with TS and control subjects. The third and fourth cervical vertebrae were positioned significantly superiorly in subjects with NS compared with TS and control subjects and, in NS, were also significantly superior to the hyoid bone. There was no difference in the position of the hyoid bone itself between the groups. CONCLUSION/IMPLICATION These results suggest that basilar impression may be a frequently found symptom of NS. PMID:23660838

Miyamoto, Jun J; Yabunaka, Tomoe; Moriyama, Keiji

2014-04-01

351

Cervical Screening a Study on the Prevalence of the Risk-factors for Developing Cervical Cancer Among Young Women  

Microsoft Academic Search

This study had three aims: to determine the prevalence of the risk-factors for contracting HPV (the Human Papillomavirus) and developing cervical cancer among young women; to establish if there are any links between the presence of these risk-factors, attendance for cervical screening and abnormal cervical screening results; and to ascertain the key barriers to the prevention of cervical cancer. The

Jennifer Cann

2008-01-01

352

Positron Emission Tomography Using Fluoromisonidazole F 18 and Fludeoxyglucose F 18 to Find Oxygen in Tumor Cells of Patients Undergoing Treatment for Newly Diagnosed Stage IB, Stage II, Stage III, or Stage IV Cervical Cancer  

ClinicalTrials.gov

Cervical Adenocarcinoma; Cervical Squamous Cell Carcinoma; Stage IB Cervical Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage IVA Cervical Cancer; Stage IVB Cervical Cancer

2014-06-10

353

Elongated Styloid Process and Cervical Spondylosis  

PubMed Central

SUMMARY Background Dysphagia, is a significant sign of many different lesions in upper digestive system especially in proximal esophagus. Tumors, gastroesophageal reflux, achalasia and extrinsic compressions are the most common causes that may lead to dysphagia in geriatric population. Cervical osteophyte induced dysphagia, is one of the uncommon reasons of dysphagia, therefore other causes of dysphagia must be excluded to establish the exact diagnosis. Eagle syndrome is one of the considerable reason which may lead to misdiagnosis in patients with cervical osteophytes. In this case report, we represent four patients who had dysphagia due to anteriorly located cervical osteophytes and evaluate the patients with special reference to Eagle syndrome. Material and methods After a detailed anamnesis and ENT examination, cervical plain radiographs in four projections and Towne radiographs were obtained for every patient. After that, magnetic resonance imaging (MRI) of cervical spine and barium swallowing studies were performed to evaluate the presence of esophageal compression. Results Eagle syndrome was excluded due to absence of other symptoms and physical signs, eventhough unilateral or bilateral elongation of styloid processes was found in all of the patients. Conclusion Cervical osteophytes induced dysphagia is a rare clinical entity, diagnosis should be done by a careful examination, intensive radiologic evaluation. Moreover, all the other causes like Eagle syndrome should be excluded during the diagnosis of cervical osteophyte induced dysphagia.

Unlu, Zeliha; Orguc, Sebnem; Eskiizmir, Gorkem; Aslan, Asim; Bayindir, Petek

2008-01-01

354

Aberrant DNA methylation in cervical carcinogenesis.  

PubMed

Persistent infection with high-risk types of human papillomavirus(HPV) is known to cause cervical cancer; however, additional genetic and epigenetic alterations are required for progression from precancerous disease to invasive cancer. DNA methylation is an early and frequent molecular alteration in cervical carcinogenesis. In this review, we summarize DNA methylation within the HPV genome and human genome and identify its clinical implications. Methylation of the HPV long control region (LCR) and L1 gene is common during cervical carcinogenesis and increases with the severity of the cervical neoplasm. The L1 gene of HPV16 and HPV18 is consistently hypermethylated in invasive cervical cancers and can potentially be used as a clinical marker of cancer progression. Moreover, promoters of tumor suppressor genes (TSGs) involved in many cellular pathways are methylated in cervical precursors and invasive cancers. Some are associated with squamous cell carcinomas, and others are associated with adenocarcinomas. Identification of methylated TSGs in Pap smear could be an adjuvant test in cervical cancer screening for triage of women with high-risk HPV, atypical squamous cells of undetermined significance, or low grade squamous intraepithelial lesion (LSIL). However, consistent panels must be validated for this approach to be translated to the clinic. Furthermore, reversion of methylated TSGs using demethylating drugs may be an alternative anticancer treatment, but demethylating drugs without toxic carcinogenic and mutagenic properties must be identified and validated. PMID:22943599

Yang, Hui-Juan

2013-01-01

355

The etiology of cervical artery dissection  

PubMed Central

Abstract The etiology of cervical artery dissection (CAD) is unclear, although a number of risk factors have been reported to be associated with the condition. On rare occasions, patients experience CAD after cervical spine manipulation, making knowledge about the cervical arteries, the predisposing factors, and the pathogenesis of the condition of interest to chiropractors. This commentary reports on the relevant anatomy of the cervical arteries, developmental features of CAD, epidemiology of the condition, and mechanisms of dissection. The analysis of CAD risk factors is confusing, however, because many people are exposed to mechanical events and known pathophysiological associations without ever experiencing dissection. No cause-and-effect relationship has been established between cervical spine manipulation and CAD, but it seems that cervical manipulation may be capable of triggering dissection in a susceptible patient or contributing to the evolution of an already existing CAD. Despite the many risk factors that have been proposed as possible causes of CAD, it is still unknown which of them actually predispose patients to CAD after cervical spine manipulation.

Haneline, Michael T.; Rosner, Anthony L.

2007-01-01

356

Ciclosporin A Proof of Concept Study in Patients with Active, Progressive HTLV-1 Associated Myelopathy/Tropical Spastic Paraparesis  

PubMed Central

Introduction Patients with HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) become progressively impaired, with chronic pain, immobility and bladder, bowel and sexual dysfunction. Tested antiretroviral therapies have not been effective and most patients are offered a short course of corticosteroids or interferon-?, physiotherapy and symptomatic management. Pathogenesis studies implicate activated T-lymphocytes and cytokines in tissue damage. We therefore tested the hypothesis that inhibition of T-cell activation with ciclosporin A would be safe and clinically beneficial in patients with early and/or clinically progressing HAM/TSP. Materials and Methods Open label, proof of concept, pilot study of 48 weeks therapy with the calcineurin antagonist, ciclosporin A (CsA), in seven patients with ‘early’ (50% deterioration in timed walk during the preceding three months) HAM/TSP. Primary outcomes were incidence of clinical failure at 48 weeks and time to clinical failure. Results All patients completed 72 weeks study participation and five showed objective evidence of clinical improvement after 3 months treatment with CsA. Two patients exhibited clinical failure over 6.4 person-years of follow-up to week 48. One patient had a >2 point deterioration in IPEC (Insituto de Pesquisa Clinica Evandro Chagas) disability score at weeks 8 and 12, and then stopped treatment. The other stopped treatment at week 4 because of headache and tremor and deterioration in timed walk, which occurred at week 45. Overall pain, mobility, spasticity and bladder function improved by 48 weeks. Two patients recommenced CsA during follow-up due to relapse. Conclusions These data provide initial evidence that treatment with CsA is safe and may partially reverse the clinical deterioration seen in patients with early/progressive HAM/TSP. This trial supports further investigation of this agent's safety and effectiveness in larger, randomised controlled studies in carefully selected patients with disease progression.

Martin, Fabiola; Castro, Hannah; Gabriel, Carolyn; Adonis, Adine; Fedina, Alexandra; Harrison, Linda; Brodnicki, Liz; Demontis, Maria A.; Babiker, Abdel G.; Weber, Jonathan N.; Bangham, Charles R. M.; Taylor, Graham P.

2012-01-01

357

The Japanese guideline for cervical cancer screening.  

PubMed

Cervical cancer is the 11th leading cause of death from cancer for females in Japan. In 2005, there were 2486 deaths from cervical cancer, accounting for 1.8% of the total number of cancer deaths in Japan. Cervical cancer screening using conventional cytology has been conducted worldwide. The guideline for cervical cancer screening was developed based on the established method. The efficacies of conventional and liquid-based cytology, human papillomavirus testing alone and two combination methods were evaluated. On the basis of the balance of the benefits and harms, recommendations for population-based and opportunistic screening were formulated. Five methods of cervical cancer screening were evaluated. On the basis of the analytic framework involving key questions, 3450 articles published from January 1985 to October 2007 were selected using MEDLINE and other methods. After the systematic literature review, 66 articles were confirmed. The results of 33 studies were consistent, and the evidence was sufficient to evaluate the effect of conventional cytology screening. The accuracy of liquid-based cytology was almost equal to that of conventional cytology. Although human papillomavirus testing and combination methods showed high sensitivity, no study has evaluated the reduction in mortality from cervical cancer. Except for the possibility of overdiagnosis, no serious adverse effects of cervical cancer screening were found. Cervical cancer screening using conventional and liquid-based cytology is recommended for population-based and opportunistic screening due to sufficient evidence. Cervical cancer screening using either human papillomavirus testing alone or two combination methods is not recommended for population-based screening due to insufficient evidence. PMID:20436034

Hamashima, Chisato; Aoki, Daisuke; Miyagi, Etsuko; Saito, Eiko; Nakayama, Tomio; Sagawa, Motoyasu; Saito, Hiroshi; Sobue, Tomotaka

2010-06-01

358

Pediatric cervical spine fractures: predominantly subtle presentation.  

PubMed

Previous description of cervical spine fractures in children have emphasized high mortality injuries to the upper cervical vertebra. Our experience suggests a much wider spectrum of injury. The medical records of all children with cervical spine fractures admitted to Children's Hospital between January 1, 1985 and December 31, 1989 were reviewed. The average age of the 50 patients was 11 years (range, 2.7 to 18.8 years) and 62% were boys. Motor vehicle-related accidents (54%), sports injuries (18%), and falls (12%) accounted for the majority of the fractures. Twenty-nine patients (58%) had an associated head injury. Fifty percent of the patients were transported from the accident scene and 44% were interhospital transfers. All patients receiving medical care prior to referral had appropriate cervical spine stabilization. On admission 30% of the patients were unresponsive. Thirty-one children were alert and verbal at the time of evaluation and 30 complained of neck pain and tenderness (97%). Twenty-five of the 31 patients (83%) had no demonstrable neurological deficit on initial physical examination. Lateral cervical spine radiographs were diagnostic in 49 children (98%). A relatively even distribution of fractures occurred at all levels of the cervical spine. The anatomic site of the injury did not correlate with age. Sixteen patients (32%) died. Of the 34 who survived, only 6 had a persistent neurological deficit. Children with cervical spine fractures have two distinct patterns of presentation: lethal or intact. The majority of children with cervical spine fractures presented with no complaints of neck pain and/or tenderness need a complete radiographic evaluation of their cervical spine. PMID:1919996

Dietrich, A M; Ginn-Pease, M E; Bartkowski, H M; King, D R

1991-08-01

359

Complicated septic cervical and lumbar discitis  

PubMed Central

A 69-year-old lady presented with back pain for 5 days associated with spiking temperatures, lower limb weakness and urinary retention. Urgent MRI showed discitis at the disc between cervical vertebra seven (C7), thoracic vertebra one (T1) and lumbar vertebra three and four (L3-4), associated dural inflammation, stenosis of the cervical spinal canal and cervical cord oedema at the level of C3. No definite epidural abscess was seen. She was transferred to the spinal unit for observation. Following transfer she rapidly developed respiratory compromise and required emergency spinal decompression later that day.

Idris, Salah; Collum, Niall

2012-01-01

360

Cervical diskography performed with a "prong deflector" for improved access to the cervical disk spaces.  

PubMed

The "prong deflector" tool improves accuracy and ease of access to the cervical disk spaces for use in cervical diskography. The tool allows control, deflection, and stabilization of vital neck structures (carotid artery, thyroid cartilages and pharynx) while allowing fluoroscopic visualization during needle insertion without direct operator radiation exposure. Use of the prong deflector resulted in marked reduction of fluoroscopy per cervical level studied because of more rapid access to disk space. PMID:15891152

Bartynski, Walter S; Grahovac, Stephen Z; Rothfus, William E

2005-05-01

361

Occipito-Cervical Fusion with the Cervical Cotrel-Dubousset Rod System  

Microsoft Academic Search

Summary  ?Diseases and conditions which cause instability of the cranio-cervical junction and the adjacent upper cervical spine are\\u000a relatively common and potentially life-threatening. Direct internal occipito-cervical fusion (OCF) is a modern means of surgical\\u000a treatment in such cases, and has some advantages over simple immobilization of the affected segments. The present study was\\u000a designed to evaluate surgical handling, results, and complications

V. Heidecke; N. G. Rainov; W. Burkert

1998-01-01

362

Internet-Based Cervical Cytology Screening System.  

National Technical Information Service (NTIS)

This project explores the combination of computerized automated primary screening of cervical cytology specimens in remote sites with interpretation of device-selected images transmitted via the Internet. The project is in 3 phases: 1) hardware/software a...

B. A. Crothers D. C. Wilbur J. A. Gelfand J. H. Eichhorn M. S. Ro

2007-01-01

363

Treatment Options by Stage (Cervical Cancer)  

MedlinePLUS

... used for cervical cancer: Carcinoma in Situ (Stage 0) In carcinoma in situ (stage 0) , abnormal cells ... Treatment Options by Stage Carcinoma in Situ (Stage 0) Treatment of carcinoma in situ (stage 0) may ...

364

Cervical Cancer Incidence and Mortality Rates  

Cancer.gov

Skip to Main Content Search International Cancer Screening Network Sponsored by the National Cancer Institute Home | About ICSN | Collaborative Projects | Meetings | Cancer Sites | Publications | Contact Us Cervical Cancer: Mortality Rates | Organization

365

Congenital narrowing of the cervical spinal canal.  

PubMed Central

The clinical and laboratory findings in six patients with congenital narrowing of the cervical spinal canal and neurological symptoms are described. A variable age of onset and an entirely male occurrence were found. Signs and symptoms of spinal cord dysfunction predominated in all but one patient. Symptoms were produced in five patients by increased physical activity alone. Congenital narrowing of the cervical spinal canal may result in cord compression without a history of injury and occasionally without evidence of significant bony degenerative changes. The clinical features may be distinguishable from those found in cervical spondylosis without congenital narrowing. Intermittent claudication of the cervical spinal cord appears to be an important feature of this syndrome. Surgery improved four out of five people.

Kessler, J T

1975-01-01

366

The Posterior Cervical Lymph Node in Toxoplasmosis  

PubMed Central

Posterior cervical node enlargement is characteristic of clinical toxoplasmosis in adults. Lymph node biopsies from 37 patients, who were tested for toxoplasmosis by serologic and isolation studies, were examined. A characteristic pattern of sinus histiocytosis was seen in 17 of 18 posterior cervical nodes and in only 1 of 4 lymph nodes from other sites from patients with toxoplasmosis. The characteristic pattern was not seen in posterior cervical nodes or in lymph nodes from other sites from patients with other diseases. Lymphoma obscured the characteristic changes of toxoplasmosis in the posterior cervical nodes and other nodes of 5 patients with these coexisting diseases. Organisms were seen in tissue sections in only 2 instances. T gondii was isolated from mice in 14 of 17 attempts using nodes from patients with toxoplasmosis, but from none of 8 attempts using nodes from patients with other diseases. ImagesFig 3Fig 4Fig 1Fig 2

Gray, George F.; Kimball, Anne C.; Kean, B. H.

1972-01-01

367

Embarazo ectópico cervical. Tratamiento médico conservador  

Microsoft Academic Search

ObjectiveCervical ectopic pregnancy is a rare complication that can have severe consequences if an early diagnosis is not made. This diagnosis should always be considered in vaginal bleeding in the first trimester of pregnancy.

A. Rubio; F. Jiménez; M. Herrero; S. Alcalá; C. Sabadell; I. Bruna; M. L. Cano

2005-01-01

368

Cervical Spondylosis (Arthritis of the Neck)  

MedlinePLUS

... Orthopaedic Surgeons. Cervical Spondylosis (Arthritis of the Neck) Neck pain is extremely common. It can be caused by ... have all been linked to higher risks of neck pain and spondylosis: • Genetics - if your family has a ...

369

Airway management in cervical spine injury  

PubMed Central

To minimize risk of spinal cord injury, airway management providers must understand the anatomic and functional relationship between the airway, cervical column, and spinal cord. Patients with known or suspected cervical spine injury may require emergent intubation for airway protection and ventilatory support or elective intubation for surgery with or without rigid neck stabilization (i.e., halo). To provide safe and efficient care in these patients, practitioners must identify high-risk patients, be comfortable with available methods of airway adjuncts, and know how airway maneuvers, neck stabilization, and positioning affect the cervical spine. This review discusses the risks and benefits of various airway management strategies as well as specific concerns that affect patients with known or suspected cervical spine injury.

Austin, Naola; Krishnamoorthy, Vijay; Dagal, Arman

2014-01-01

370

Traumatic cervical epidural hematoma in an infant  

PubMed Central

An 8-month-old male infant had presented with a history of a fall from the crib a fortnight ago. He had developed progressive weakness of both lower limbs. On examination, the infant had spastic paraplegia. Magnetic resonance (MR) imaging of the cervical spine showed an epidural hematoma extending from the fourth cervical (C4) to the first dorsal (D1) vertebral level with cord compression. The patient had no bleeding disorder on investigation. He underwent cervical laminoplasty at C6 and C7 levels. The epidural hematoma was evacuated. The cervical cord started pulsating immediately. Postoperatively, the patient's paraplegia improved dramatically in 48 hours. According to the author's literature search, only seven cases of post-traumatic epidural hematoma have been reported in pediatric patients, and our patient is the youngest. The present case report discusses the etiopathology, presentation, and management of this rare case.

Rangarajan, Vithal; Mavani, Sandip B; Nadkarni, Trimurti D; Goel, Atul H

2013-01-01

371

Estrogen and ER?: Culprits in Cervical Cancer?  

PubMed Central

Estrogen and its receptors are implicated in the promotion and prevention of various cancers. While the uterine cervix is highly responsive to estrogen, the role of estrogen in cervical cancer, which is strongly associated with human papillomavirus (HPV) infections, is poorly understood. Recent studies in HPV transgenic mouse models provide evidence that estrogen and its nuclear receptor promote cervical cancer in combination with HPV oncogenes. While epidemiological studies further support this hypothesis, there is little experimental data assessing the hormonal responsiveness of human cervical cancers. If these cancers are dependent upon estrogen, then drugs targeting estrogen and its receptors may be effective in treating and/or preventing cervical cancer, the second leading cause of death by cancer amongst women worldwide.

Chung, Sang-Hyuk; Franceschi, Silvia; Lambert, Paul F.

2010-01-01

372

Cervical premalignant lesions and their management  

PubMed Central

Cervical cancer is the tenth most common cancer in women in developed countries that have national screening programs, while it is in the second line in underdeveloped countries. According to Ministry of Health registry data, cervical cancer is the eighth most common cancer among female cancers in Turkey. Today, the most effective screening for cervical cancer is to obtain smears from the cervix. Therefore, periodic screening programs are of great importance in identifying preinvasive lesions to prevent their progression to invasive cancer. Today, with the use of human papilloma virus (HPV) vaccine, screening programs have brought new insights into the prevention of cervical cancer. Management of preinvasive lesions has to be known by each obstetrics and gynecology specialist. Redundant procedures and treatments can be avoided by directing patients correctly at this step. Cancer phobia should not be created. Ablative or destructive treatments should not be done without histological diagnosis; hysterectomy, which has an equal risk of recurrence, should not be recommended.

Kose, Faruk M.; Naki, Murat M.

2014-01-01

373

Cisplatin and Radiation Therapy With or Without Carboplatin and Paclitaxel in Patients With Locally Advanced Cervical Cancer  

ClinicalTrials.gov

Cervical Adenocarcinoma; Cervical Adenosquamous Cell Carcinoma; Cervical Squamous Cell Carcinoma; Chemotherapeutic Agent Toxicity; Cognitive/Functional Effects; Psychosocial Effects of Cancer and Its Treatment; Radiation Toxicity; Sexuality and Reproductive Issues; Stage IB Cervical Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage IVA Cervical Cancer

2014-06-25

374

Cervical spine injuries in American football.  

PubMed

American football is a high-energy contact sport that places players at risk for cervical spine injuries with potential neurological deficits. Advances in tackling and blocking techniques, rules of the game and medical care of the athlete have been made throughout the past few decades to minimize the risk of cervical injury and improve the management of injuries that do occur. Nonetheless, cervical spine injuries remain a serious concern in the game of American football. Injuries have a wide spectrum of severity. The relatively common 'stinger' is a neuropraxia of a cervical nerve root(s) or brachial plexus and represents a reversible peripheral nerve injury. Less common and more serious an injury, cervical cord neuropraxia is the clinical manifestation of neuropraxia of the cervical spinal cord due to hyperextension, hyperflexion or axial loading. Recent data on American football suggest that approximately 0.2 per 100,000 participants at the high school level and 2 per 100,000 participants at the collegiate level are diagnosed with cervical cord neuropraxia. Characterized by temporary pain, paraesthesias and/or motor weakness in more than one extremity, there is a rapid and complete resolution of symptoms and a normal physical examination within 10 minutes to 48 hours after the initial injury. Stenosis of the spinal canal, whether congenital or acquired, is thought to predispose the athlete to cervical cord neuropraxia. Although quite rare, catastrophic neurological injury is a devastating entity referring to permanent neurological injury or death. The mechanism is most often a forced hyperflexion injury, as occurs when 'spear tackling'. The mean incidence of catastrophic neurological injury over the past 30 years has been approximately 0.5 per 100,000 participants at high school level and 1.5 per 100,000 at the collegiate level. This incidence has decreased significantly when compared with the incidence in the early 1970s. This decrease in the incidence of catastrophic injury is felt to be the result of changes in the rules in the mid-1970s that prohibited the use of the head as the initial contact point when blocking and tackling. Evaluation of patients with suspected cervical spine injury includes a complete neurological examination while on the field or the sidelines. Immobilization on a hard board may also be necessary. The decision to obtain radiographs can be made on the basis of the history and physical examination. Treatment depends on severity of diagnosed injury and can range from an individualized cervical spine rehabilitation programme for a 'stinger' to cervical spine decompression and fusion for more serious bony or ligamentous injury. Still under constant debate is the decision to return to play for the athlete. PMID:19691361

Rihn, Jeffrey A; Anderson, David T; Lamb, Kathleen; Deluca, Peter F; Bata, Ahmed; Marchetto, Paul A; Neves, Nuno; Vaccaro, Alexander R

2009-01-01

375

Chemoradiotherapy for Cervical Cancer in 2010  

Microsoft Academic Search

The introduction of concurrent chemotherapy and radiotherapy for the definitive treatment of cervical cancer constituted a\\u000a major advance in the management of cervical cancer, resulting in a significant improvement in local control, progression-free\\u000a survival, and overall survival. Since the publication of the results of seminal trials demonstrating the benefits of platinum-based\\u000a chemotherapy, investigations of new cytotoxic and targeting agents have

Ann H. Klopp; Patricia J. Eifel

2011-01-01

376

Development of Consensus Educational Materials on HPV & Cervical Cancer for Europe  

Cancer.gov

1 Development of Development of Consensus Educational Materials Consensus Educational Materials on HPV & Cervical Cancer for Europe on HPV & Cervical Cancer for Europe Philip Davies Philip Davies European Cervical Cancer Association European Cervical

377

Automated image analysis of uterine cervical images  

NASA Astrophysics Data System (ADS)

Cervical Cancer is the second most common cancer among women worldwide and the leading cause of cancer mortality of women in developing countries. If detected early and treated adequately, cervical cancer can be virtually prevented. Cervical precursor lesions and invasive cancer exhibit certain morphologic features that can be identified during a visual inspection exam. Digital imaging technologies allow us to assist the physician with a Computer-Aided Diagnosis (CAD) system. In colposcopy, epithelium that turns white after application of acetic acid is called acetowhite epithelium. Acetowhite epithelium is one of the major diagnostic features observed in detecting cancer and pre-cancerous regions. Automatic extraction of acetowhite regions from cervical images has been a challenging task due to specular reflection, various illumination conditions, and most importantly, large intra-patient variation. This paper presents a multi-step acetowhite region detection system to analyze the acetowhite lesions in cervical images automatically. First, the system calibrates the color of the cervical images to be independent of screening devices. Second, the anatomy of the uterine cervix is analyzed in terms of cervix region, external os region, columnar region, and squamous region. Third, the squamous region is further analyzed and subregions based on three levels of acetowhite are identified. The extracted acetowhite regions are accompanied by color scores to indicate the different levels of acetowhite. The system has been evaluated by 40 human subjects' data and demonstrates high correlation with experts' annotations.

Li, Wenjing; Gu, Jia; Ferris, Daron; Poirson, Allen

2007-03-01

378

Cervical vertigo: myths, facts, and scientific evidence.  

PubMed

INTRODUCTION: Cervical vertigo is a controversial entity. While it was overemphasised in the past, it is overlooked nowadays, and it seems to combine elements of myth and reality. The purpose of this article is to review the most important aspects of this entity from a historical, pathophysiological, clinical, and therapeutic point of view. We also identify the main alternative diagnoses that led to it being recognised erroneously, and classify and organise the literature in order to review earlier articles which first described the disease. DEVELOPMENT: Some entities previously defined as cervical vertigo have survived the test of time and may be found in the literature today. This is true of rotational vertebral artery syndrome, post-traumatic cervical vertigo, and cervicogenic proprioceptive vertigo. Others, such as cervical sympathetic syndrome (Barré-Lieou syndrome), have been discredited. We present a clinical variant known as subclinical vertebrobasilar insufficiency in a context of cervical osteoarticular changes. CONCLUSIONS: Cervical vertigo has been a controversial entity for many years. Completing a clinical-pathophysiological assessment to explain the symptoms in a particular case proves to be the most reasonable bedside strategy, regardless of the name assigned to the disease in the end. At present, no complementary studies have demonstrated that the variant known as cervicogenic proprioceptive vertigo is an independent entity, and measuring its true impact is difficult. Once potentially severe causes of the symptoms have been ruled out, the most appropriate strategy seems to be use of manipulative and vestibular physical therapy. PMID:22981375

Yacovino, D A

2012-09-13

379

Multifactorial Etiology of Cervical Cancer: A Hypothesis  

PubMed Central

Cancer of the cervix is the second most common life-threatening cancer among women worldwide, with incidence rates ranging from 4.8 per 100,000 women per year in the Middle East to 44.3 per 100,000 in East Africa. Epidemiologic and clinical data demonstrate that human papillomaviruses (HPV), especially HPV-16 and HPV-18, play at least a major if not a necessary role in the etiology of cervical cancer. However, many investigators acknowledge that HPV is not sufficient to induce cervical cancer and that a multifactorial etiology is likely. HPV can be found in a growing proportion of patients with cervical cancer, approaching 100%, but is not yet found in every patient with disease. Other factors, such as herpes simplex virus type 2 infections, cigarette smoking, vaginal douching, nutrition, and use of oral contraceptives, have been proposed as contributing factors. In the first half of the 20th century, Peyton Rous and colleagues demonstrated the joint action of tars and Shope papillomavirus to consistently induce squamous cell carcinomas in rabbits. Using the Rous model as a prototype, one might hypothesize that some cases of cervical cancer arise from an interaction between oncogenic viruses and cervical tar exposures. Cervical tar exposures include cigarette smoking, use of tar-based vaginal douches, and long years of inhaling smoke from wood- and coal-burning stoves in poorly ventilated kitchens.

Haverkos, Harry W.

2005-01-01

380

[Uterine cervical carcinoma and human papillomaviruses].  

PubMed

For many years it has been thought that a significant proportion of cervical cancer could be attributed to sexually transmitted agents, such as sperm, smegma, Treponema pallidum, Gonococcus and herpes simplexvirus type 2. Recent advances of molecular biology, however, have revealed that human papillomavirus (HPV) might be the most causative virus of the disease. Since HPV type 16 DNA was found in a patient with cervical cancer in 1983, many HPV types have been cloned from cervical cancers, also from premalignant lesions (intraepithelial neoplasias). In Japan, we have found 6 new types of HPV (HPV 58, 59, 61, 62, 64, 67) in the female genital tract so far. Especially, HPV 58, which was cloned from a patient with cervical squamous cell carcinoma and was already fully sequenced, is thought to be an important agent for the development of cervical cancer as well as HPV 16. Now we are investigating extensively to clarify the real relationship between genital HPV infection and cervical cancer. PMID:1327090

Sugase, M

1992-06-01

381

Epidemiology and costs of cervical cancer screening and cervical dysplasia in Italy  

PubMed Central

Background We estimated the number of women undergoing cervical cancer screening annually in Italy, the rates of cervical abnormalities detected, and the costs of screening and management of abnormalities. Methods The annual number of screened women was estimated from National Health Interview data. Data from the Italian Group for Cervical Cancer Screening were used to estimate the number of positive, negative and unsatisfactory Pap smears. The incidence of CIN (cervical intra-epithelial neoplasia) was estimated from the Emilia Romagna Cancer Registry. Patterns of follow-up and treatment costs were estimated using a typical disease management approach based on national guidelines and data from the Italian Group for Cervical Cancer Screening. Treatment unit costs were obtained from Italian National Health Service and Hospital Information System of the Lazio Region. Results An estimated 6.4 million women aged 25–69 years undergo screening annually in Italy (1.2 million and 5.2 million through organized and opportunistic screening programs, respectively). Approximately 2.4% of tests have positive findings. There are approximately 21,000 cases of CIN1 and 7,000–17,000 cases of CIN2/3. Estimated costs to the healthcare service amount to €158.5 million for screening and €22.9 million for the management of cervical abnormalities. Conclusion Although some cervical abnormalities might have been underestimated, the total annual cost of cervical cancer prevention in Italy is approximately €181.5 million, of which 87% is attributable to screening.

Rossi, Paolo Giorgi; Ricciardi, Alessandro; Cohet, Catherine; Palazzo, Fabio; Furnari, Giacomo; Valle, Sabrina; Largeron, Nathalie; Federici, Antonio

2009-01-01

382

Manual Physical Therapy, Cervical Traction, and Strengthening Exercises in Patients With Cervical Radiculopathy: A Case Series  

Microsoft Academic Search

Study Design: A case series of consecutive patients with cervical radiculopathy. Background: A multitude of physical therapy interventions have been proposed to be effective in the management of cervical radiculopathy. However, outcome studies using consistent treatment approaches on a well-defined sample of patients are lacking. The purpose of this case series is to describe the outcomes of a consecutive series

Joshua A. Cleland; Julie M. Whitman; Julie M. Fritz; Jessica A. Palmer

2005-01-01

383

Increased Fusion Rates With Cervical Plating for Two Level Anterior Cervical Discectomy and Fusion  

Microsoft Academic Search

Study Design. A retrospective review of all patients surgically treated with a two-level anterior cervical disc- ectomy and fusion with and without anterior plate fixa- tion by a single surgeon. Objectives. To compare the clinical and radiographic success of two-level discectomy and the effect of anterior cervical plate fixation. Summary of Background Data. Prior studies of multi- segment fusions have

Jeffrey C. Wang; Paul W. McDonough; Kevin K. Endow; Rick B. Delamarter

384

Epidemiology of cervical cancer in Colombia  

PubMed Central

Worldwide, cervical cancer is the third most common cancer in women, and the first or second most common in developing countries. Cervical cancer remains in Colombia the first cause of cancer mortality and the second cause of cancer incidence among women, despite the existence of screening programs during the last 3 decades. Bucaramanga, Manizales and Cali reported rates around 20 per 100,000and Pasto 27 per 100,000. The Cali cancer registry has reported a progressive decrease in the age standardized incidence and mortality rates of cervical cancer over the past 40 years. Reasons for the decline in incidence and mortality of cervical cancer are multiple and probably include: improvement in socio-economic conditions, decrease in parity rates and some effect of screening programs. Human papilloma Virus is the main cause of cervical cancer, HPV natural history studies have now revealed that HPVs are the commonest of the sexually transmitted infections in most populations. Most HPV exposures result in spontaneous clearance without clinical manifestations and only a small fraction of the infected persons, known as chronic or persistent carriers, will retain the virus and progress to precancerous and cancer. HPV 16 and 18 account for 70% of cervical cancer and the 8 most common types. (HPV 16, 18, 45, 33, 31, 52, 58 and 35) account for about 90% of cervical cancer. Case-control studies also allowed the identification of the following cofactors that acting together with HPV increase the risk of progression from HPV persistent infection to cervical cancer: tobacco, high parity, long term use of oral contraceptives and past infections with herpes simplex type 2 and Chlamydia trachomatis. The demonstration that infection with certain types of human papillomavirus (HPV) is not only the main cause but also a necessary cause of cervical cancer has led to great advances in the prevention of this disease on two fronts: (i) Primary prevention by the use of prophylactic HPV vaccines; and (ii) secondary prevention by increasing the accuracy of cervical cancer screening.

Munoz, Nubia

2012-01-01

385

HPV-based Tests for Cervical Cancer Screening and Management of Cervical Disease  

PubMed Central

Current cervical cancer screening programs are changing due to the development of tests that detect the presence of human papillomavirus (HPV), the cause of cervical cancer. These tests are more sensitive than cytology-based methods for detecting cervical precancer and a negative test offers long-term assurance that cervical cancer will not develop and therefore longer screening intervals can be achieved. In screening programs, HPV-based tests have been approved to triage women with equivocal cytology results and as a primary testing method in conjunction with cytology. HPV-based tests also have a role in determining risk of recurrence after treatment for cervical precancer as well as in surveillance for vaccine-related changes in HPV genotype prevalence.

Luhn, Patricia; Wentzensen, Nicolas

2013-01-01

386

Prevalence and genotype distribution of human papillomavirus in non-neoplastic cervical tissue lesion: cervical erosion.  

PubMed

Human papillomavirus (HPV) infection is the commonest sexually transmitted infection, which is associated with various clinical conditions, ranging from asymptomatic infection to malignant disease of the cervix. The aim of this study was to evaluate the prevalence and genotypic distribution of HPV in women with cervical erosion and to compare the results with those in women with a clinically normal cervix. A further aim was to establish the association between HPV infection and cervical cytology results in women with and without cervical erosion. Cervical samples were collected by liquid-based method and consecutively evaluated for the presence of HPV DNA and for cervical cytology. HPV DNA was tested by a nested polymerase chain reaction (PCR) and typed by reverse dot blot genotyping. Cytological classification was made according to Bethesda 2001 criteria. The overall HPV prevalence was 16.9%; HPV DNA was positive in 20.2% of women with cervical erosion and 12.8% in women with normal cervix (P < 0.05). Multiple infections were found in 34.1% of the HPV-positive women. Commonest types were HPV 18 (32.9%), HPV 16 (29.5%), HPV 54 (20.5%), and HPV 6 (17%). Cervical cytology results were abnormal for 5.2% of women with cervical erosion and for 1.3% with clinically normal cervix (P < 0.05). This study detected a high prevalence of HPV infection in women with cervical erosion compared to women with a normal cervix. This data may contribute to the HPV epidemiology in the southeastern Turkey. It is recommended that women with cervical erosion should be given priority in HPV screening programs. PMID:21915876

Bayram, Aysen; Erk?l?ç, Suna; Balat, Özcan; Ek?i, Fahriye; U?ur, Mete Gürol; Öztürk, Ebru; Kaya, Gülsüm

2011-11-01

387

Surgical staging of cervical cancer.  

PubMed

Noninvasive radiologic methods to detect paraaortic lymph node metastases are reliable when combined with FNA of enlarged lymph nodes. However, the sensitivity is low, and undetected microscopic metastases leads to treatment failure. These patients with paraaortic lymph node metastasis are not treated with extended-field radiation, and they all die within 3 years. The CT scanning is probably the best diagnostic method to evaluate cervical cancer, because it can assess the primary tumor, the urinary tract, gastrointestinal tract, liver parenchyma, and retroperitoneum. It also permits the guidance of FNA and the arrangement of radiation ports. Surgical staging provides the direct assessment of the peritoneal cavity and the retroperitoneal spaces. Metastatic tumor, including enlarged lymph nodes, can be resected, but this is of dubious benefit. The operative morbidity is acceptable, with fewer intestinal complications when the extraperitoneal approach is used, and long-term morbidity is minimal when appropriate paraaortic radiation doses are employed (less than 5,000 cGy). Surgical staging has provided data on the frequency of paraaortic lymph node metastasis by stage of cervical cancer, and thus, treatment strategies can be better developed. Extended-field radiation results in 5-year survival rates of 20-25% in patients with microscopic paraaortic lymph node metastasis, patients who would not survive without the treatment. However, surgical staging has produced only a modest boost in survival rates, because of the high rate of pelvic and systemic failure. When extended-field radiation is used prophylactically or in patients with probable lymph node metastasis seen on radiographic studies, survival rates are similar to patients irradiated after surgical staging finds paraaortic lymph node disease. As our ability to predict, and detect nonsurgically, positive paraaortic node disease improves, extended radiation (or other adjuvant therapy) could be used more frequently without operation in patients who are at high risk for metastatic disease. In a study by Haie et al, prophylactic paraaortic radiation was given to patients at high risk for paraaortic metastasis. In patients with a high probability of local disease control, paraaortic radiation significantly reduced the incidence of paraaortic and distant metastases. Patients with known paraaortic lymph node metastases frequently have occult systemic metastases. In these same patients, pelvic failure is also common. Thus, until effective systemic therapies emerge, a marked improvement in survival is unlikely in patients who have paraaortic lymph node metastasis.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:2289352

Heaps, J M; Berek, J S

1990-12-01

388

Everted cervical vein for carotid patch angioplasty.  

PubMed

Because of the theoretic benefits of autologous vein we undertook an investigation to evaluate cervical veins (facial, external jugular) as patch material after carotid endarterectomy. A device that stimulated both circumferential fixation by sutures and radial tension exerted on in vivo patches was constructed to measure burst strength of tissue. Mean bursting pressure for groin saphenous vein (n = 10) was 94.5 +/- 15.1 pounds per square inch (psi), 75.5 +/- 8.9 psi for ankle saphenous vein (n = 10), 83.3 +/- 14.5 psi for everted (double layer) cervical vein (n = 5) and 10 +/- 3.3 psi for single layer cervical vein (n = 5). No significant differences between saphenous vein at any level and everted (double layer) cervical vein, but all were significantly different from single layer cervical vein (p less than 0.05). From June 1987 through November 1989, 19 patients underwent 21 carotid endarterectomies complemented with adjunctive everted cervical vein patch angioplasty. Indications for surgery were asymptomatic stenosis (53%), transient ischemic attack (29%), and cerebrovascular accident with recovery (18%). All patients were studied after surgery with duplex scanning. Asymptomatic recurrent stenosis was observed in one patient. Transient hypoglossal nerve dysfunction occurred in one other patient. One postoperative death occurred as a result of massive aspiration. These results indicate that everted cervical vein is comparable to the saphenous vein in resistance to bursting and can yield similar results as patch material after carotid endarterectomy. Accordingly, saphenous vein can be spared and lower extremity incisions avoided.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2231962

Yu, A; Dardik, H; Wolodiger, F; Raccuia, J; Kapadia, I; Sussman, B; Kahn, M; Pecoraro, J P; Ibrahim, I M

1990-11-01

389

What Are the Key Statistics about Cervical Cancer?  

MedlinePLUS

... factors for cervical cancer? What are the key statistics about cervical cancer? The American Cancer Society's estimates ... Symptoms of Cancer Treatments & Side Effects Cancer Facts & Statistics News About Cancer Expert Voices Blog Programs & Services ...

390

21 CFR 884.4250 - Expandable cervical dilator.  

Code of Federal Regulations, 2010 CFR

...Identification. An expandable cervical dilator is an instrument with two handles and two opposing blades used manually to dilate (stretch open) the cervical os. (b) Classification. Class III (premarket approval). (c) Date PMA or...

2009-04-01

391

Toe metastasis: A rare pattern of cervical cancer spread.  

PubMed

•Toe metastasis is a rare pattern of cervical cancer spread.•Enlarged erythematous toe is an important sign suggesting bone metastasis.•Toe metastasis represents a grave prognostic indicator of cervical cancer. PMID:24567886

Ciccone, Marcia A; Conturie, Charlotte L; Lee, Cassie M; Matsuo, Koji

2014-04-01

392

Study to Understand Cervical Cancer Early Endpoints and Determinants (SUCCEED)  

Cancer.gov

A study to comprehensively assess biomarkers of risk for progressive cervical neoplasia, and thus develop a new set of biomarkers that can distinguish those at highest risk of cervical cancer from those with benign infection

393

Understanding Cervical Changes: A Health Guide for Women  

Cancer.gov

Explains HPV Infection; cervical cancer screening tests including Pap test, HPV test, and Pap/HPV cotesting; new cervical cancer screening guidelines; possible Pap test results and Pap/HPV cotest results; follow-up testing; treatment; and HPV vaccination.

394

U.S. Cervical Cancer Rates Higher Than Thought  

MedlinePLUS

... Related MedlinePlus Pages African American Health Cervical Cancer Seniors' Health MONDAY, May 12, 2014 (HealthDay News) -- A new ... Health News on: African American Health Cervical Cancer Seniors' Health Recent Health News Page last updated on 13 ...

395

TTV and HPV co-infection in cervical smears of patients with cervical lesions  

PubMed Central

Background The female lower genital tract is a gateway for pathogens entering the host through the mucous membrane. One of the prevalent human viruses is Torque teno virus (TTV). The major reported routes of TTV transmission are fecal-oral and parenteral. Furthermore, other modes of transmission, e.g. sexual contact, are suggested. To investigate the sexual route of TTV transmission, cervical smears of healthy women and those with cervical lesions were screened for the presence of TTV DNA. Methods TTV DNA was studied in cervical smears of 95 patients with cervical lesions and 55 healthy women. Paired serum samples were available from 55 and 42 women, respectively. All healthy women had normal cytology while 44 patients had histologically confirmed low-grade lesion (LGL) and 51 high-grade lesion (HGL). TTV DNA was detected with primers specific for the non-coding region. In 40 paired cervical smears and serum samples, the phylogenetic group of TTV isolates was determined. The presence of HPV DNA in cervical smears was detected by means of PCR with MY09/11 primers. Results The prevalence of TTV DNA in cervical smears of healthy women was 52.7% and was comparable with that in paired serum samples (50%). Symptomatic women had significantly higher prevalence of TTV DNA in cervical smears (74.7%) than healthy controls. The TTV DNA prevalence in patient serum samples was 51%. The phylogenetic groups of TTV serum isolates were concordant with those of TTV from cervical smears of the same subjects. In cervical smears, a wider variety of TTV isolates was found. The viral loads in cervical smears were 10 to 1000 times as high as in sera. The HPV-positive study subjects had significantly higher TTV DNA prevalence than HPV negatives. The prevalence of TTV was not associated with disease severity. Conclusion High prevalence of TTV in cervical smears suggests that sexual transmission is another mode of expansion of TTV infection among the population. The higher viral load in cervical smears than in the respective serum samples might indicate active TTV replication in the female genital tract. Nevertheless, cooperation between TTV and HPV needs to be further investigated.

2009-01-01

396

Cervical Ripening in The Netherlands: A Survey  

PubMed Central

Objective. We aim to investigate methods and use of cervical ripening in women without and with a prior cesarean delivery in The Netherlands. Methods. In 2010, we conducted a postal survey in all Dutch hospitals with a labor ward. One gynecologist per hospital was addressed and was asked to respond on behalf of the staff. The questionnaire contained 31 questions concerning cervical ripening and induction of labor. We compared this survey to a similar Dutch survey conducted in 2006. Results. Response rate was 78% (70/92 hospitals). In women without a prior cesarean and in need of cervical ripening, all hospitals (100%) applied prostaglandins (either E1 or E2). In women with a prior cesarean, 21.4% of the hospitals performed an elective cesarean section if delivery was indicated (26.0% in 2006). In case of cervical ripening, 72.7% used mechanical methods (49.1% in 2006), 20.0% used prostaglandins (40.4% in 2006), 3.6% used a combination of prostaglandins and mechanical methods, and 3.6% used membrane-sweeping or oxytocin. Conclusions. In 2010, in The Netherlands, prostaglandins and Foley catheters were the preferred methods for cervical ripening in women without and with a prior cesarean, respectively. Use of mechanical methods in women with a prior cesarean has increased rapidly between 2006 and 2010, corresponding with decreasing use of prostaglandins and elective repeat cesarean sections.

Huisman, Claartje M. A.; Jozwiak, Marta; de Leeuw, Jan Willem; Mol, Ben Willem; Bloemenkamp, Kitty W. M.

2013-01-01

397

Cisplatin and Radiation Therapy With or Without Triapine in Treating Patients With Previously Untreated Stage IB-IVA Cervical Cancer or Stage II-IVA Vaginal Cancer  

ClinicalTrials.gov

Cervical Adenocarcinoma; Cervical Adenosquamous Cell Carcinoma; Cervical Squamous Cell Carcinoma; Stage IB Cervical Cancer; Stage II Vaginal Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Vaginal Cancer; Stage IIIA Cervical Cancer; Stage IIIB Cervical Cancer; Stage IVA Cervical Cancer; Stage IVA Vaginal Cancer; Vaginal Adenocarcinoma; Vaginal Squamous Cell Carcinoma

2014-05-30

398

21 CFR 884.4270 - Vibratory cervical dilators.  

Code of Federal Regulations, 2010 CFR

...884.4270 Vibratory cervical dilators. (a) Identification. A vibratory cervical dilator is a device designed to dilate the cervical os by stretching it with a power-driven vibrating probe head. The device is used to gain access to the...

2010-04-01

399

Clinical presentation of cervical ribs in the pediatric population.  

PubMed

Cervical ribs may cause thoracic outlet syndrome in adults, but symptoms are poorly described in children. In our series, 88.8% of the 322 children were asymptomatic. The most common symptoms were neck mass and pain. Useful diagnostic tools were cervical spine and chest radiographs. Differential diagnosis of a supraclavicular mass includes cervical ribs. PMID:23219244

Chan, Kenny H; Gitomer, Sarah A; Perkins, Jonathan N; Liang, Conan; Strain, John D

2013-03-01

400

Occult fracture-dislocation of the cervical spine  

Microsoft Academic Search

Occult injuries of the cervical spine in certain patients may lead to misdiagnosis or delayed diagnosis and treatment. The authors present a patient with an occult cervical spinal fracture-dislocation and review the literature. A 37 year-old male was involved in a motor vehicle accident. At his admission, the patient was alert and denied any pain in the cervical region, as

D. S. Korres; P. J. Papagelopoulos; H. G. Petrou; G. P. Tzagarakis; P. G. Triantafyllidis; J. Tsarouchas; G. Koundis

1999-01-01

401

Vaccines Against Human Papillomavirus and Cervical Cancer: Promises and Challenges  

Microsoft Academic Search

Cervical cancer and precancerous lesions of the genital tract are major threats to the health of women world- wide. The introduction of screening tests to detect cer- vical cancer precursor lesions has reduced cervical cancer rates in the developed world, but not in devel- oping countries. Human papillomavirus (HPV) is the primary etiologic agent of cervical cancer and dyspla- sia.

Ali Mahdavi; Bradley J. Monk

402

Biomechanics of the cervical spine 4: major injuries  

Microsoft Academic Search

This review presents considerations regarding major cervical spine injury, including some concepts that are presently undergoing evaluation and clarification. Correlation of certain biomechanical parameters and clinical factors associated with the causation and occurrence of traumatic cervical spine injuries assists in clarifying the pathogenesis and treatment of this diverse group of injuries. Instability of the cervical column based on clinical and

Joseph F Cusick; Narayan Yoganandan

2002-01-01

403

Biomechanics of the cervical spine. I: Normal kinematics  

Microsoft Academic Search

This review constitutes the first of four reviews that systematically address contemporary knowledge about the mechanical behavior of the cervical vertebrae and the soft-tissues of the cervical spine, under normal conditions and under conditions that result in minor or major injuries. This first review considers the normal kinematics of the cervical spine, which predicates the appreciation of the biomechanics of

Nikolai Bogduk; Susan Mercer

2000-01-01

404

Cervical cancer screening service utilisation in UK.  

PubMed

This study investigates empirically how past screening behaviour, individual and household characteristics affect the current uptake of cervical cancer screening in UK. For the conceptual framework, we use a modified Grossman model which is extended for non-economic factors. A dynamic version of a random effects panel probit model with initial conditions is estimated on the balanced sub-sample of the data. The analysis sample is restricted to women of age 16 and older and grouped into different age categories with respect to the NHS Cervical Screening Programme (NHSCSP). As dataset a balanced panel data of 857 women with 11,998 observations from the British Household Panel Study (BHPS) for the period from 1992 to 2008 is used for the analysis. Results suggest show that previous screening uptake, age, partner status, employment status and a previous GP visit have a significant influence on the likelihood of the uptake of cervical cancer screening. PMID:23917486

Labeit, Alexander; Peinemann, Frank; Kedir, Abbi

2013-01-01

405

Cervical Cancer Screening Service Utilisation in UK  

PubMed Central

This study investigates empirically how past screening behaviour, individual and household characteristics affect the current uptake of cervical cancer screening in UK. For the conceptual framework, we use a modified Grossman model which is extended for non-economic factors. A dynamic version of a random effects panel probit model with initial conditions is estimated on the balanced sub-sample of the data. The analysis sample is restricted to women of age 16 and older and grouped into different age categories with respect to the NHS Cervical Screening Programme (NHSCSP). As dataset a balanced panel data of 857 women with 11,998 observations from the British Household Panel Study (BHPS) for the period from 1992 to 2008 is used for the analysis. Results suggest show that previous screening uptake, age, partner status, employment status and a previous GP visit have a significant influence on the likelihood of the uptake of cervical cancer screening.

Labeit, Alexander; Peinemann, Frank; Kedir, Abbi

2013-01-01

406

Tennis elbow and the cervical spine.  

PubMed Central

The exact cause of tennis elbow, a common condition, is still obscure. While the condition may well be entirely due to a local disorder at the elbow, the results of a study of 50 patients whose condition was resistant to 4 weeks of treatment directed to the elbow suggest that the underlying condition may have been (at least in these patients) a reflex localization of pain from radiculopathy at the cervical spine. Clinical, radiologic and electromyographic findings supported this suggestion. The pain was demonstrated to be muscular tenderness, which was maximal and specific at motor points. Treatment directed to the cervical spine appeared to give relief in the majority of patients. The more resistant the condition, the more severe were the radiologic and electromyographic findings in the cervical spine. Images FIG. 3 FIG. 4

Gunn, C. C.; Milbrandt, W. E.

1976-01-01

407

[Ectopic pregnancy management: cervical and abdominal pregnancies].  

PubMed

Cervical or abdominal pregnancies are rare forms of ectopic pregnancy and their management differs for different authors. Besides, the literature is mainly made of case-reports. The aim is to propose one or more management possibilities, keeping in mind that the level of proof obtained from the references used is insufficient to be affirmative. For cervical pregnancy, although hysterectomy is the reference treatment (especially in advanced pregnancy or hemorrhagic life-threatening forms), technical improvements in ultrasonography make feasible the diagnosis of non or weakly symptomatic forms, which could be treated conservatively in order to preserve fertility of these women. In this diagnostic situation the present treatment standard is methotrexate combined with intra-amniotic feticide in case of viable cervical pregnancy. Diagnosis of abdominal pregnancy is often made late. Treatment consists in laparotomy which enables better vascular control. Placental ablation remains as often as not dangerous and in most cases, it is better to abandon the attempt. PMID:14699324

Riethmuller, D; Courtois, L; Maillet, R; Schaal, J-P

2003-11-01

408

Structural brain abnormalities in cervical dystonia  

PubMed Central

Background Idiopathic cervical dystonia is characterized by involuntary spasms, tremors or jerks. It is not restricted to a disturbance in the basal ganglia system because non-conventional voxel-based MRI morphometry (VBM) and diffusion tensor imaging (DTI) have detected numerous regional changes in the brains of patients. In this study scans of 24 patients with cervical dystonia and 24 age-and sex-matched controls were analysed using VBM, DTI and magnetization transfer imaging (MTI) using a voxel-based approach and a region-of-interest analysis. Results were correlated with UDRS, TWSTRS and disease duration. Results We found structural alterations in the basal ganglia; thalamus; motor cortex; premotor cortex; frontal, temporal and parietal cortices; visual system; cerebellum and brainstem of the patients with dystonia. Conclusions Cervical dystonia is a multisystem disease involving several networks such as the motor, sensory and visual systems.

2013-01-01

409

Acute Hydrocephalus Following Cervical Spinal Cord Injury  

PubMed Central

We present a case of acute hydrocephalus secondary to cervical spinal cord injury in a patient with diffuse ossification of the posterior longitudinal ligament (OPLL). A 75-year-old male patient visited the emergency department with tetraparesis and spinal shock. Imaging studies showed cervical spinal cord injury with hemorrhage and diffuse OPLL from C1 to C4. We performed decompressive laminectomy and occipitocervical fusion. Two days after surgery, his mental status had deteriorated to drowsiness with dilatation of the right pupil. Findings on brain computed tomography revealed acute hydrocephalus and subarachnoid hemorrhage in the cerebellomedullary cistern, therefore, extraventricular drainage was performed immediately. Acute hydrocephalus as a complication of cervical spine trauma is rare, however, it should be considered if the patient shows deterioration of neurologic symptoms.

Son, Seong; Park, Chan Woo; Kim, Woo Kyung

2013-01-01

410

Efficacy of prosultiamine treatment in patients with human T lymphotropic virus type I-associated myelopathy/tropical spastic paraparesis: results from an open-label clinical trial  

PubMed Central

Background Human T lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a chronic myelopathy characterized by motor dysfunction of the lower extremities and urinary disturbance. Immunomodulatory treatments are the main strategy for HAM/TSP, but several issues are associated with long-term treatment. We conducted a clinical trial with prosultiamine (which has apoptotic activity against HTLV-I-infected cells) as a novel therapy in HAM/TSP patients. Methods We enrolled 24 HAM/TSP patients in this open-label clinical trial. Prosultiamine (300 mg, orally) was administered once daily for 12 weeks. We monitored changes in the motor function of the lower extremities and urinary function as well as copy numbers of the HTLV-I provirus in peripheral blood mononuclear cells (PBMCs). Results Improvement in the motor function of the lower extremities based on a reduction in spasticity (for example, decrease in time required for walking and descending a flight of stairs) was observed. In an urodynamic study (UDS), bladder capacity and detrusor pressure and then maximum flow rate increased significantly. Detrusor overactivity and detrusor-sphincter dyssynergia improved in 68.8% and 45.5% of patients observed at pretreatment, respectively. Improvement in UDS corresponded with improvements in the score of nocturia-quality of life questionnaire. HTLV-I proviral copy numbers in PBMCs decreased significantly (approximately 15.4%) compared with pretreatment levels. Conclusions These data suggest that prosultiamine can safely improve motor dysfunction of the lower extremities and urinary disturbance as well as reduce HTLV-I provirus levels in peripheral blood. It therefore has potential as a new therapeutic tool for HAM/TSP patients. Trial registration University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) number, UMIN000005969. Please see related commentary: http://www.biomedcentral.com/1741-7015/11/183.

2013-01-01

411

Descriptive Epidemiology of Cervical Dystonia  

PubMed Central

Background Cervical dystonia (CD), the most common form of adult-onset focal dystonia, has a heterogeneous clinical presentation with variable clinical features, leading to difficulties and delays in diagnosis. Owing to the lack of reviews specifically focusing on the frequency of primary CD in the general population, we performed a systematic literature search to examine its prevalence/incidence and analyze methodological differences among studies. Methods We performed a systematic literature search to examine the prevalence data of primary focal CD. Sixteen articles met our methodological criteria. Because the reported prevalence estimates were found to vary widely across studies, we analyzed methodological differences and other factors to determine whether true differences exist in prevalence rates among geographic areas (and by gender and age distributions), as well as to facilitate recommendations for future studies. Results Prevalence estimates ranged from 20–4,100?cases/million. Generally, studies that relied on service-based and record-linkage system data likely underestimated the prevalence of CD, whereas population-based studies suffered from over-ascertainment. The more methodologically robust studies yielded a range of estimates of 28–183?cases/million. Despite the varying prevalence estimates, an approximate 2:1 female:male ratio was consistent among many studies. Three studies estimated incidence, ranging from 8–12 cases/million person-years. Discussion Although several studies have attempted to estimate the prevalence and incidence of CD, there is a need for additional well-designed epidemiological studies on primary CD that include large populations; use defined CD diagnostic criteria; and stratify for factors such as age, gender, and ethnicity.

Defazio, Giovanni; Jankovic, Joseph; Giel, Jennifer L.; Papapetropoulos, Spyridon

2013-01-01

412

Human papillomavirus cervical infection and associated risk factors in a region of Argentina with a high incidence of cervical carcinoma  

Microsoft Academic Search

Objective:To assess the prevalence and potential risk factors associated with human papillomavirus (HPV) cervical infection among women residing in a region of northeastern Argentina with a high incidence of cervical cancer. Methods: A case-control study of 330 women participating in a cervical cytological screening program conducted in Posadas city, Misiones, Argentina, from February 1997 to November 1998 was carried out.

S. A. Tonon; M. A. Picconi; J. B. Zinovich; D. J. Liotta; P. D. Bos; J. A. Galuppo; L. V. Alonio; J. A. Ferreras

1999-01-01

413

Cervical ribs: identification on MRI and clinical relevance.  

PubMed

To determine the prevalence of cervical ribs on cervical spine MRI and clinical relevance, we reviewed 2500 studies for cervical ribs and compression of neurovascular structures and compared to CT, when available. Brachial plexus or subclavian artery contact by cervical rib was identified on MRI and/or CT in 12 cases with diagnosis of thoracic outlet syndrome in one. Cervical ribs were identified on 1.2% (25/2083) of examinations, lower than on CT (2%), but MRI may offer equivalent anatomic explanation for patient symptoms. PMID:23759210

Walden, Michael J; Adin, Mehmet E; Visagan, Ravindran; Viertel, Valentina G; Intrapiromkul, Jarunee; Maluf, Fernando; Patel, Neil V; Alluwaimi, Fatma; Lin, Doris; Yousem, David M

2013-01-01

414

Is posterior fusion necessary with laminectomy in the cervical spine?  

PubMed Central

Background: Cervical decompressive laminectomy is a common procedure for addressing multilevel cervical spine pathology. The most common reasons for performing simultaneous posterior cervical fusion include the prevention of progressive postlaminectomy kyphotic deformity or other types of instability which can contribute to late neurological deterioration. Methods: The medical literature (Pub Med with MeSH) concerning cervical laminectomy, posterior cervical fusion, and complications of laminectomy/fusion was reviewed. Additionally, references from the articles were queried to find additional literature. Results: Multiple studies concluded that cervical laminectomy versus laminectomy and fusion produced similar short-term postoperative outcomes. Careful patient selection was warranted to minimize the complications associated with cervical laminectomy alone; these included postoperative kyphosis (6–46%) and late deterioration (10–37%). The addition of a posterior cervical fusion was associated with relatively low complication rates, and avoided the evolution of late deformity or delayed neurological deterioration. Conclusion: Although the short-term results of cervical laminectomy versus laminectomy and fusion are similar, there appear to be more complications associated with performing laminectomy alone over the long term. Here, we reviewed the pros and cons of posterior cervical decompression alone versus decompression with fusion/instrumentation to treat cervical pathology, highlighting the complications associated with each surgical alternative.

McAllister, Beck D.; Rebholz, Brandon J.; Wang, Jeffery C.

2012-01-01

415

Colposcopy and High Resolution Anoscopy in Screening For Anal Dysplasia in Patients With Cervical, Vaginal, or Vulvar Dysplasia or Cancer  

ClinicalTrials.gov

Cervical Intraepithelial Neoplasia Grade 1; Cervical Intraepithelial Neoplasia Grade 2; Cervical Intraepithelial Neoplasia Grade 3; Recurrent Cervical Cancer; Recurrent Vaginal Cancer; Recurrent Vulvar Cancer; Stage 0 Cervical Cancer; Stage 0 Vaginal Cancer; Stage 0 Vulvar Cancer; Stage I Vaginal Cancer; Stage I Vulvar Cancer; Stage IA Cervical Cancer; Stage IB Cervical Cancer; Stage II Vaginal Cancer; Stage II Vulvar Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage III Vaginal Cancer; Stage III Vulvar Cancer; Stage IV Vulvar Cancer; Stage IVA Cervical Cancer; Stage IVA Vaginal Cancer; Stage IVB Cervical Cancer; Stage IVB Vaginal Cancer

2012-06-08

416

The development of an improved physical surrogate model of the human spinal cord—Tension and transverse compression  

Microsoft Academic Search

To prevent spinal cord injury, optimize treatments for it, and better understand spinal cord pathologies such as spondylotic myelopathy, the interaction between the spinal column and the spinal cord during injury and pathology must be understood. The spinal cord is a complex and very soft tissue that changes properties rapidly after death and is difficult to model. Our objective was

Shannon G. Kroeker; Philip L. Morley; Claire F. Jones; Lynne E. Bilston; Peter A. Cripton

2009-01-01

417

Cervical Foraminal and Discal Height after Dynamic Rotational Plating in the Cervical Discectomy and Fusion  

PubMed Central

Study Design This is a retrospective study. Purpose To evaluate the effect of the dynamic rotational plate to the intervertebral foraminal and discal height after anterior cervical discectomy and fusion. Overview of Literature There is no report regarding the changes of foraminal and discal height following cervical dynamic rotational plating. Methods We reviewed the outcomes of 30 patients (36 levels), who were followed-up for an average of 15 months (range, 12-57 months) after undergoing fusions with anterior cervical dynamic rotational plating for cervical radiculopathy, from March 2005 to February 2009. The changes of foraminal and intervertebral discal height of the operated levels were observed on oblique and lateral radiographs obtained at the preoperative, postoperative and follow-up examinations. Results The foraminal and discal height increased sufficiently, immediately following the operation. However, follow-up results showed gradual decrease in the foraminal and discal height. After 6 months of the surgery, they showed little difference compared with the preoperative heights. However, clinically, patients showed improvements in radiating pain during the follow-up period. Conclusions Anterior cervical dynamic rotational plating was an effective treatment modality for cervical radiculopathy without the deterioration of the foraminal and intervertebral discal height.

Park, Jin-Oh; Moon, Seong-Hwan; Kim, In-Sung; Kim, Seok Woo; Kim, Yong-Chan; Kim, Tae-Hwan; Suh, Bo-Kyung; Nam, Ji Hoon; Lee, Hwan-Mo

2013-01-01

418

Cervical spinal arachnoid cyst in a dog.  

PubMed Central

An 18-month-old, intact male Akita presented with a 12-month history of progressive ataxia, hypermetria, and loss of conscious proprioception of the thoracic and pelvic limbs. Neurological examination and myelography localized a lesion at cervical vertebrae 1 and 2 consistent with an arachnoid cyst. Hemilaminectomy and cyst fenestration led to virtually full recovery. Images Figure 1.

Hashizume, C T

2000-01-01

419

NIH Research Leads to Cervical Cancer Vaccine  

MedlinePLUS

Skip Navigation Bar Home Current Issue Past Issues Sexually Transmitted Diseases NIH Research Leads to Cervical Cancer Vaccine Past ... Find Out More For more information on individual sexually transmitted infections, visit www.medlineplus.gov , www3.niaid.nih.gov ...