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Sample records for cervical spondylotic myelopathy

  1. [Laminoplasty for cervical spondylotic myelopathy].

    PubMed

    Fransen, P

    2014-10-01

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

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

    PubMed Central

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

    2012-01-01

    Cervical spondylotic myelopathy is a progressive disease and a common cause of acquired disability in the elderly. A variety of surgical interventions are available to halt or improve progression of the disease. Surgical options include anterior or posterior approaches with and without fusion. These include anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, cervical disc replacement, laminoplasty, laminectomy with and without fusion, and combined approaches. Recent investigation into the ideal approach has not found a clearly superior choice, but individual patient characteristics can guide treatment. PMID:22312563

  3. Application of magnetic resonance imaging in cervical spondylotic myelopathy

    PubMed Central

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

    2014-01-01

    Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction and is caused by static or dynamic repeated compression of the spinal cord resulting from degenerative arthritis of the cervical spine and some biological injuries to the cervical spine. The T2 signal change on conventional magnetic resonance imaging (MRI) is most commonly associated with neurological deficits. Diffusion tensor imaging and MR spectroscopy show altered microstructure and biochemistry that reflect patient-specific pathogenesis and can be used to predict neurological outcome and response to intervention. Functional MRI can help to assess the neurological functional recovery after decompression surgery for CSM. PMID:25349665

  4. Advances in MR Imaging for Cervical Spondylotic Myelopathy

    PubMed Central

    Ellingson, Benjamin M.; Salamon, Noriko; Holly, Langston T.

    2016-01-01

    Cervical spondylosis is the most common cause of nontraumatic spinal cord injury and is the most common cause of spinal cord dysfunction in the elderly. Magnetic resonance imaging (MRI) is an invaluable tool for the diagnosis and assessment of cervical spondylosis due to its sensitivity to soft tissues; however, standard MR techniques have some limitations in predicting neurological impairment and response to intervention. Therefore, there is great interest in novel MR techniques including diffusion tensor imaging (DTI) and MR spectroscopy (MRS) as imaging biomarkers for neurological impairment and tools for understanding spinal cord physiology. This review outlines the pathogenesis of cervical spondylotic myelopathy (CSM), the correlative abnormalities observed on standard MRI, the biological implications and current status of DTI and MRS as clinical tools, and future directions of MR technology in the management of CSM patients. PMID:23917647

  5. Cervical spondylotic myelopathy: Part I: anatomical and pathomechanical considerations *

    PubMed Central

    Burns, SH; Mior, SA; O’Connor, SM

    1991-01-01

    This two part series reviews the recent literature concerning the etiology and clinical presentation of cervical spondylotic myelopathy (CSM). CSM is the most common neurological spinal cord disorder after middle age. It is caused by the compromise of the cervical spinal cord from narrowing of the spinal canal. In Part I, a review of the anatomy and the pathomechanics of the cervical spine pertinent to CSM is discussed. Emphasis is placed upon the intricate relationship between the osseous, neurological and vascular structures. The consequences of degenerative changes upon this relationship is evidenced by the resulting neurovascular compression. In turn, compression may lead to spinal cord ischemia with characteristic clinical results. ImagesFigure 3Figure 5

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

    PubMed Central

    Qizhi, Sun; Peijia, Li; Lei, Sun; Junsheng, Chen; Jianmin, Li

    2016-01-01

    Background: Noncontiguous cervical spondylotic myelopathy (CSM) is a special degenerative disease because of the intermediate normal level or levels between supra and infraabnormal levels. Some controversy exists over the optimal procedure for two noncontiguous levels of CSM. The study was to evaluate the outcomes of the anterior cervical discectomy and fusion (ACDF) with zero-profile devices for two noncontiguous levels of CSM. Materials and Methods: 17 consecutive patients with two noncontiguous levels of CSM operated between December 2009 and August 2012 were included in the study. There were 12 men and 5 women with a mean age of 60.7 years (range 45–75 years). Involved disc levels were C3/4 and C5/6 in 11 patients and C4/5 and C6/7 in six patients. Preoperative plain radiographs, computed tomography (CT) with 3-D reconstruction and magnetic resonance imaging (MRI) of the cervical spine were taken in all patients. All radiographs were independently evaluated by 2 spine surgeons and 1 radiologist. The outcomes were assessed by the average operative time, blood loss, Japanese Orthopedic Association (JOA) score, improvement rate, neck dysfunction index (NDI), swallowing quality of life (SWAL-QOL) score, the cervical lordosis and complications. Results: The mean followup was 48.59 months (range 24-56 months). The average operative time and blood loss was 105.29 min and 136.47 ml, respectively. The preoperative JOA score was 8.35, which significantly increased to 13.7 at the final followup (P < 0.01). The NDI score was significantly decreased from preoperative 13.06 to postoperative 3.35 (P < 0.01). The operation also provided a significant increase in the cervical lordosis (P < 0.01) from preoperative 10.17° to postoperative 17.06°. The fusion rate was 94.1% at 6 months postoperatively, and 100% at 12 months after surgery. The mean SWAL-QOL score decreased from preoperative 68.06 to immediate postoperatively 65.65 and then increased to 67.65 at final followup

  7. Anterior approaches for cervical spondylotic myelopathy: which? When? How?

    PubMed

    Emery, Sanford E

    2015-04-01

    Cervical spondylotic myelopathy is a degenerative disorder with an unfavorable natural history. Surgical treatment options have evolved substantially over time, with both anterior and posterior methods proving successful for certain patients with specific characteristics. Anterior decompression of the spinal canal plus fusion techniques for stabilization has several advantages and some disadvantages when compared to posterior options. Understanding the pros and cons of the approaches and techniques is critical for the surgeon to select the best operative treatment strategy for any given patient to achieve the best outcome. Multiple decision-making factors are involved, such as sagittal alignment, number of levels, shape of the pathoanatomy, age and comorbidities, instability, and pre-operative pain levels. Any or all of these factors may be relevant for a given patient, and to varying degrees of importance. Choice of operative approach will therefore be dependent on patient presentation, risks of that approach for a given patient, and to some degree surgeon experience. PMID:25652554

  8. Imaging of Spinal Cord Injury: Acute Cervical Spinal Cord Injury, Cervical Spondylotic Myelopathy, and Cord Herniation.

    PubMed

    Talekar, Kiran; Poplawski, Michael; Hegde, Rahul; Cox, Mougnyan; Flanders, Adam

    2016-10-01

    We review the pathophysiology and imaging findings of acute traumatic spinal cord injury (SCI), cervical spondylotic myelopathy, and briefly review the much less common cord herniation as a unique cause of myelopathy. Acute traumatic SCI is devastating to the patient and the costs to society are staggering. There are currently no "cures" for SCI and the only accepted pharmacologic treatment regimen for traumatic SCI is currently being questioned. Evaluation and prognostication of SCI is a demanding area with significant deficiencies, including lack of biomarkers. Accurate classification of SCI is heavily dependent on a good clinical examination, the results of which can vary substantially based upon the patient׳s condition or comorbidities and the skills of the examiner. Moreover, the full extent of a patients׳ neurologic injury may not become apparent for days after injury; by then, therapeutic response may be limited. Although magnetic resonance imaging (MRI) is the best imaging modality for the evaluation of spinal cord parenchyma, conventional MR techniques do not appear to differentiate edema from axonal injury. Recently, it is proposed that in addition to characterizing the anatomic extent of injury, metrics derived from conventional MRI and diffusion tensor imaging, in conjunction with the neurological examination, can serve as a reliable objective biomarker for determination of the extent of neurologic injury and early identification of patients who would benefit from treatment. Cervical spondylosis is a common disorder affecting predominantly the elderly with a potential to narrow the spinal canal and thereby impinge or compress upon the neural elements leading to cervical spondylotic myelopathy and radiculopathy. It is the commonest nontraumatic cause of spinal cord disorder in adults. Imaging plays an important role in grading the severity of spondylosis and detecting cord abnormalities suggesting myelopathy. PMID:27616315

  9. Comparisons of three anterior cervical surgeries in treating cervical spondylotic myelopathy

    PubMed Central

    2014-01-01

    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). Compared the pre-and postoperative ROM of C2–7, operative, upper and lower levels of each group respectively, the difference between preoperative ROM and postoperative ROM of group A were of statistically significant (P < 0.05), while was no statistically significant of group C (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 < 0.05). Conclusions Three operations are

  10. Diffusion tensor imaging of cervical spinal cord: A quantitative diagnostic tool in cervical spondylotic myelopathy

    PubMed Central

    Toktas, Zafer Orkun; Tanrıkulu, Bahattin; Koban, Orkun; Kilic, Turker; Konya, Deniz

    2016-01-01

    Background: Diffusion tensor imaging (DTI) is a novel magnetic resonance imaging (MRI) technique potentially able to evaluate the microscopic structural organization of white matter fibers. Aim: This study aimed to compare fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values obtained by DTI in stenotic versus nonstenotic cervical spinal segments of patients with clinical and neurological evidence of cervical spondylotic myelopathy (CSM). Materials and Methods: This prospective study included 21 patients with CSM but without T2 changes on conventional MRI. Diffusion tensor (DT) images from the stenotic and nonstenotic segments of the subjects were obtained. FA and ADC values were estimated and compared with stenotic versus nonstenotic segments. Statistical Analysis: Paired t-test was used [Statistical Package for the Social Sciences (SPSS) 12.0]. Results: In the most stenotic segments, the mean FA value was significantly lower (0.4228 ± 0.1090 vs 0.6884 ± 0.0075, P < 0.001) and the mean ADC value was significantly higher (1.312 ± 0.2405 vs 0.9183 ± 0.1477, P < 0.001) when compared to nonstenotic segments. In addition, there was a negative correlation between FA and ADC values (r = 0.63, P = 0.002). Conclusions: DTI of the cervical spine seems to be a promising novel imaging modality in patients with CSM. Advances in Knowledge: DTI may offer increased diagnostic sensitivity as compared to standard MRI and enables earlier detection of the disease. PMID:27041882

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

    PubMed

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

    2013-11-01

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

  12. Comparison of two reconstructive techniques in the surgical management of four-level cervical spondylotic myelopathy.

    PubMed

    Li, FengNing; Li, ZhongHai; Huang, Xuan; Chen, Zhi; Zhang, Fan; Shen, HongXing; Kang, YiFan; Zhang, YinQuan; Cai, Bin; Hou, TieSheng

    2015-01-01

    To compare the clinical efficacy and radiological outcome of treating 4-level cervical spondylotic myelopathy (CSM) with either anterior cervical discectomy and fusion (ACDF) or "skip" corpectomy and fusion, 48 patients with 4-level CSM who had undergone ACDF or SCF at our hospital were analyzed retrospectively between January 2008 and June 2011. Twenty-seven patients received ACDF (Group A) and 21 patients received SCF. Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI) score, and Cobb's angles of the fused segments and C2-7 segments were compared in the two groups. The minimum patient follow-up was 2 years. No significant differences between the groups were found in demographic and baseline disease characteristics, duration of surgery, or follow-up time. Our study demonstrates that there was no significant difference in the clinical efficacy of ACDF and SCF, but ACDF involves less intraoperative blood loss, better cervical spine alignment, and fewer postoperative complications than SCF. PMID:25692140

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

    PubMed

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

    2016-03-01

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

  14. Cervical spondylotic myelopathy: a review of surgical indications and decision making.

    PubMed Central

    Law, M. D.; Bernhardt, M.; White, A. A.

    1993-01-01

    Cervical spondylotic myelopathy (CSM) is frequently underdiagnosed and undertreated. The key to the initial diagnosis is a careful neurologic examination. The physical findings may be subtle, thus a high index of suspicion is helpful. Poor prognostic indicators and, therefore, absolute indications for surgery are: 1. Progression of signs and symptoms. 2. Presence of myelopathy for six months or longer. 3. Compression ratio approaching 0.4 or transverse area of the spinal cord of 40 square millimeters or less. Improvement is unusual with nonoperative treatment and almost all patients progressively worsen. Surgical intervention is the most predictable way to prevent neurologic deterioration. The recommended decompression is anterior when there is anterior compression at one or two levels and no significant developmental narrowing of the canal. For compression at more than two levels, developmental narrowing of the canal, posterior compression, and ossification of the posterior longitudinal ligament, we recommend posterior decompression. In order for posterior decompression to be effective there must be lordosis of the cervical spine. If kyphosis is present, anterior decompression is needed. Kyphosis associated with a developmentally narrow canal or posterior compression may require combined anterior and posterior approaches. Fusion is required for instability. Images Figure 1 PMID:8209553

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

    PubMed Central

    Jia, Wen-yu; Wang, Xia; Chen, Bin; Shahbaz, Muhammad; Nie, Lin; Cheng, Lei

    2015-01-01

    Hypertension is the most prevalent cardiovascular disease, and various risk factors are known to be involved in it. Cervical spondylotic myelopathy (CSM) is the most common non-traumatic cause of myelopathy, which displays neurological symptoms and may induce systemic symptoms. To date, it is still unknown whether CSM is associated with hypertension, and if so, whether the decompression operations can attenuate CSM associated hypertension. Here, a total of 309 patients with CSM who received anterior or posterior decompression surgery were enrolled as subjects. Blood pressure measurements were performed before and within one week after the surgery. Among the 309 subjects, 144 (46.6%) of them exhibited hypertension before surgery, a significantly higher ratio than that of the whole population. One week after surgery, blood pressure of 106 (73.6%) patients turned back to normal. Blood pressure of another 37(25.7%) patients decreased with different degrees, although still higher than normal. Moreover, it appears that both approaches were effective in improving blood pressure, while the posterior approach was more effective in decreasing systolic blood pressure. We speculate this type of hypertension might result from hyperactivity of sympathetic nervous system as the heart rate of these patients decreased after surgery as well. Collectively, compression of spinal cord in CSM patients might be associated with hypertension, and decompression surgery largely attenuated this type of hypertension. These findings prove CSM to be a potential associated factor of high blood pressure and may shed light on therapies of hypertension in clinics. PMID:26193469

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

    PubMed Central

    Li, FengNing; Li, ZhongHai; Huang, Xuan; Chen, Zhi; Zhang, Fan; Shen, HongXing; Kang, YiFan; Zhang, YinQuan; Cai, Bin; Hou, TieSheng

    2015-01-01

    To compare the clinical efficacy and radiological outcome of treating 4-level cervical spondylotic myelopathy (CSM) with either anterior cervical discectomy and fusion (ACDF) or “skip” corpectomy and fusion, 48 patients with 4-level CSM who had undergone ACDF or SCF at our hospital were analyzed retrospectively between January 2008 and June 2011. Twenty-seven patients received ACDF (Group A) and 21 patients received SCF. Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI) score, and Cobb's angles of the fused segments and C2-7 segments were compared in the two groups. The minimum patient follow-up was 2 years. No significant differences between the groups were found in demographic and baseline disease characteristics, duration of surgery, or follow-up time. Our study demonstrates that there was no significant difference in the clinical efficacy of ACDF and SCF, but ACDF involves less intraoperative blood loss, better cervical spine alignment, and fewer postoperative complications than SCF. PMID:25692140

  17. Predictors of Outcome in Patients with Cervical Spondylotic Myelopathy Undergoing Unilateral Open-Door Laminoplasty

    PubMed Central

    Shin, Ji-Won; Jin, Sung-Won; Choi, Jong-Il; Kim, Bum-Joon; Kim, Sang-Dae; Lim, Dong-Jun

    2015-01-01

    Objective This study aimed to analyze prognostic factors affecting surgical outcomes of expansive laminoplasty for cervical spondylotic myelopathy (CSM). Methods Using the Frankel scale and Japanese Orthopaedic Association (JOA) scale, we retrospectively reviewed the outcomes of 45 consecutive patients who underwent modified unilateral open-door laminoplasty using hydroxyapatite spacers and malleable titanium miniplates between June 2008 and May 2014. The patients were assigned to the good and poor clinical outcome groups, with good outcome defined as a JOA recovery rate >75%. Results The mean preoperative JOA scale was significantly higher in the good outcome group (14.95±3.21 vs. 10.78±6.07, p<0.001), whereas the preoperative cervical range of motion (ROM) in this group was significantly lower (29.89°±10.11 vs. 44.35°± 8.88, p<0.001). In univariate analysis, a high preoperative JOA scale (odds ratio (OR) 1.271, 95% confidence interval (CI) 1.005-1.607) and low preoperative cervical ROM(OR 0.858, 95% CI 0.786-0.936) were statistically correlated with good outcomes. Furthermore, these factors demonstrated an independent association with clinical outcomes (preoperative JOA scale: OR 1.344, 95% CI 1.019-1.774, p=0.036; preoperative cervical ROM: OR 0.860, 95% CI 0.788-0.940, p=0.001). Conclusion In this study, a high preoperative JOA scale was associated with good clinical outcome after laminoplasty, whereas a higher preoperative cervical spine ROM was associated with poor clinical outcome. This may suggests that cervical mobility and preoperative neurological status affect clinical outcomes of laminoplasty. PMID:26834814

  18. Functional cortical reorganization in cases of cervical spondylotic myelopathy and changes associated with surgery.

    PubMed

    Bhagavatula, Indira Devi; Shukla, Dhaval; Sadashiva, Nishanth; Saligoudar, Praveen; Prasad, Chandrajit; Bhat, Dhananjaya I

    2016-06-01

    OBJECTIVE The physiological mechanisms underlying the recovery of motor function after cervical spondylotic myelopathy (CSM) surgery are poorly understood. Neuronal plasticity allows neurons to compensate for injury and disease and to adjust their activities in response to new situations or changes in their environment. Cortical reorganization as well as improvement in corticospinal conduction happens during motor recovery after stroke and spinal cord injury. In this study the authors aimed to understand the cortical changes that occur due to CSM and following CSM surgery and to correlate these changes with functional recovery by using blood oxygen level-dependent (BOLD) functional MRI (fMRI). METHODS Twenty-two patients having symptoms related to cervical cord compression due to spondylotic changes along with 12 age- and sex-matched healthy controls were included in this study. Patients underwent cervical spine MRI and BOLD fMRI at 1 month before surgery (baseline) and 6 months after surgery. RESULTS Five patients were excluded from analysis because of technical problems; thus, 17 patients made up the study cohort. The mean overall modified Japanese Orthopaedic Association score improved in patients following surgery. Mean upper-extremity, lower-extremity, and sensory scores improved significantly. In the preoperative patient group the volume of activation (VOA) was significantly higher than that in controls. The VOA after surgery was reduced as compared with that before surgery, although it remained higher than that in the control group. In the preoperative patient group, activations were noted only in the left precentral gyrus (PrCG). In the postoperative group, activations were seen in the left postcentral gyrus (PoCG), as well as the PrCG and premotor and supplementary motor cortices. In postoperative group, the VOA was higher in both the PrCG and PoCG as compared with those in the control group. CONCLUSIONS There is over-recruitment of sensorimotor cortices

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

    PubMed

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

    2013-07-01

    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

  20. Comparative Analysis of VOCs in Exhaled Breath of Amyotrophic Lateral Sclerosis and Cervical Spondylotic Myelopathy Patients

    PubMed Central

    Wang, Changsong; Li, Mingjuan; Jiang, Hongquan; Tong, Hongshuang; Feng, Yue; Wang, Yue; Pi, Xin; Guo, Lei; Nie, Maomao; Feng, Honglin; Li, Enyou

    2016-01-01

    Amyotrophic lateral sclerosis (ALS) is an incurable neurological degenerative disease. It can cause irreversible neurological damage to motor neurons; typical symptoms include muscle weakness and atrophy, bulbar paralysis and pyramidal tract signs. The ALS-mimicking disease cervical spondylotic myelopathy (CSM) presents similar symptoms, but analysis of breath volatile organic compounds (VOCs) can potentially be used to distinguish ALS from CSM. In this study, breath samples were collected from 28 ALS and 13 CSM patients. Subsequently, gas chromatography/mass spectrometry (GCMS) was used to analyze breath VOCs. Principal component analysis (PCA) and orthogonal partial least-squares discriminant analysis (OPLSDA) were the statistical methods used to process the final data. We identified 4 compounds with significantly decreased levels in ALS patients compared with CSM controls: (1) carbamic acid, monoammonium salt; (2) 1-alanine ethylamide, (S)-; (3) guanidine, N,N-dimethyl-; and (4) phosphonic acid, (p-hydroxyphenyl)-. Currently, the metabolic origin of the VOCs remains unclear; however, several pathways might explain the decreasing trends observed. The results of this study demonstrate that there are specific VOC profiles associated with ALS and CSM patients that can be used to differentiate between the two. In addition, these metabolites could contribute to a better understanding of the underlying pathophysiological mechanisms of ALS. PMID:27212435

  1. Comparative Analysis of VOCs in Exhaled Breath of Amyotrophic Lateral Sclerosis and Cervical Spondylotic Myelopathy Patients.

    PubMed

    Wang, Changsong; Li, Mingjuan; Jiang, Hongquan; Tong, Hongshuang; Feng, Yue; Wang, Yue; Pi, Xin; Guo, Lei; Nie, Maomao; Feng, Honglin; Li, Enyou

    2016-01-01

    Amyotrophic lateral sclerosis (ALS) is an incurable neurological degenerative disease. It can cause irreversible neurological damage to motor neurons; typical symptoms include muscle weakness and atrophy, bulbar paralysis and pyramidal tract signs. The ALS-mimicking disease cervical spondylotic myelopathy (CSM) presents similar symptoms, but analysis of breath volatile organic compounds (VOCs) can potentially be used to distinguish ALS from CSM. In this study, breath samples were collected from 28 ALS and 13 CSM patients. Subsequently, gas chromatography/mass spectrometry (GCMS) was used to analyze breath VOCs. Principal component analysis (PCA) and orthogonal partial least-squares discriminant analysis (OPLSDA) were the statistical methods used to process the final data. We identified 4 compounds with significantly decreased levels in ALS patients compared with CSM controls: (1) carbamic acid, monoammonium salt; (2) 1-alanine ethylamide, (S)-; (3) guanidine, N,N-dimethyl-; and (4) phosphonic acid, (p-hydroxyphenyl)-. Currently, the metabolic origin of the VOCs remains unclear; however, several pathways might explain the decreasing trends observed. The results of this study demonstrate that there are specific VOC profiles associated with ALS and CSM patients that can be used to differentiate between the two. In addition, these metabolites could contribute to a better understanding of the underlying pathophysiological mechanisms of ALS. PMID:27212435

  2. Anterior Cervical Corpectomy with free vascularized fibular graft versus multilevel discectomy and grafting for Cervical Spondylotic Myelopathy

    PubMed Central

    Addosooki, Ahmad I; El-deen, Mohamed Alam

    2015-01-01

    Purpose A retrospective study to compare the radiologic and clinical outcomes of 2 different anterior approaches, multilevel anterior cervical discectomy with fusion (ACDF) using autologus ticortical bone graft versus anterior cervical corpectomy with fusion (ACCF) using free vascularized fibular graft (FVFG) for the management of cervical spondylotic myelopathy(CSM). Methods A total of 15 patients who underwent ACDF or ACCF using FVFG for multilevel CSM were divided into two groups. Group A (n = 7) underwent ACDF and group B (n = 8) ACCF. Clinical outcomes using Japanese Orthopaedic Association (JOA) score, perioperative parameters including operation time and hospital stay, radiological parameters including fusion rate and cervical lordosis, and complications were compared. Results Both group A and group B demonstrated significant increases in JOA scores. Patients who underwent ACDF experienced significantly shorter operation times and hospital stay. Both groups showed significant increases in postoperative cervical lordosis and achieved the same fusion rate (100 %). No major complications were encountered in both groups. Conclusion Both ACDF and ACCF using FVFG provide satisfactory clinical outcomes and fusion rates for multilevel CSM. However, multilevel ACDF is associated with better radiologic parameters, shorter hospital stay and shorter operative times. PMID:26767152

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

    PubMed Central

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

    2016-01-01

    In this prospective study, we made an unbiased voxel-based analysis to investigate above-stenosis spinal degeneration and its relation to impairment in patients with cervical spondylotic myelopathy (CSM). Twenty patients and 18 controls were assessed with high-resolution MRI protocols above the level of stenosis. Cross-sectional areas of grey matter (GM), white matter (WM), and posterior columns (PC) were measured to determine atrophy. Diffusion indices assessed tract-specific integrity of PC and lateral corticospinal tracts (CST). Regression analysis was used to reveal relationships between MRI measures and clinical impairment. Patients showed mainly sensory impairment. Atrophy was prominent within the cervical WM (13.9%, p = 0.004), GM (7.2%, p = 0.043), and PC (16.1%, p = 0.005). Fractional anisotropy (FA) was reduced in the PC (−11.98%, p = 0.006) and lateral CST (−12.96%, p = 0.014). In addition, radial (+28.47%, p = 0.014), axial (+14.72%, p = 0.005), and mean (+16.50%, p = 0.001) diffusivities were increased in the PC. Light-touch score was associated with atrophy (R2 = 0.3559, p = 0.020) and FA (z score 3.74, p = 0.003) in the PC, as was functional independence and FA in the lateral CST (z score 3.68, p = 0.020). This study demonstrates voxel-based degeneration far above the stenosis at a level not directly affected by the compression and provides unbiased readouts of tract-specific changes that relate to impairment. PMID:27095134

  4. Risk Factor Analysis for C5 Palsy after Double-Door Laminoplasty for Cervical Spondylotic Myelopathy

    PubMed Central

    Ikuta, Ko; Ikeuchi, Hiroko; Shiraki, Makoto; Komiya, Norihiro; Kitamura, Takahiro; Senba, Hideyuki; Shidahara, Satoshi

    2016-01-01

    Study Design A retrospective comparative study. Purpose To clarify the risk factors related to the development of postoperative C5 palsy through radiological studies after cervical double-door laminoplasty (DDL). Overview of Literature Although postoperative C5 palsy is generally considered to be the result of damage to the nerve root or segmental spinal cord, the associated pathology remains controversial. Methods A consecutive case series of 47 patients with cervical spondylotic myelopathy treated by DDL at our institution between April 2008 and April 2015 were reviewed. Postoperative C5 palsy occurred in 5 of 47 cases after DDL. We investigated 9 radiologic factors that have been reported to be risk factors for C5 palsy in various studies, and statistically examined these between the two groups of palsy and the non-palsy patients. Results We found a significant difference between patients with and without postoperative C5 palsy with regards to the posterior shift of spinal cord at C4/5 (p=0.008). The logistic regression analyses revealed posterior shift of the spinal cord at C4/5 (odds ratio, 12.066; p=0.029; 95% confidence interval, 1.295–112.378). For the other radiologic factors, there were no statistically significant differences between the two groups. Conclusions In the present study, we showed a significant difference in the posterior shift of the spinal cord at C4/5 between the palsy and the non-palsy groups, indicating that the "tethering phenomenon" was likely a greater risk factor for postoperative C5 palsy. PMID:27114771

  5. Effects of brain derived neurotrophic factor Val66Met polymorphism in patients with cervical spondylotic myelopathy.

    PubMed

    Abode-Iyamah, Kingsley O; Stoner, Kirsten E; Grossbach, Andrew J; Viljoen, Stephanus V; McHenry, Colleen L; Petrie, Michael A; Dahdaleh, Nader S; Grosland, Nicole M; Shields, Richard K; Howard, Matthew A

    2016-02-01

    Cervical spondylotic myelopathy (CSM) is the leading cause of spinal cord related disability in the elderly. It results from degenerative narrowing of the spinal canal, which causes spinal cord compression. This leads to gait instability, loss of dexterity, weakness, numbness and urinary dysfunction. There has been indirect data that implicates a genetic component to CSM. Such a finding may contribute to the variety in presentation and outcome in this patient population. The Val66Met polymorphism, a mutation in the brain derived neurotrophic factor (BDNF) gene, has been implicated in a number of brain and psychological conditions, and here we investigate its role in CSM. Ten subjects diagnosed with CSM were enrolled in this prospective study. Baseline clinical evaluation using the modified Japanese Orthopaedic Association (mJOA) scale, Nurick and 36-Item Short Form Health Survey (SF-36) were collected. Each subject underwent objective testing with gait kinematics, as well as hand functioning using the Purdue Peg Board. Blood samples were analyzed for the BDNF Val66Met mutation. The prevalence of the Val66Met mutation in this study was 60% amongst CSM patients compared to 32% in the general population. Individuals with abnormal Met allele had worse baseline mJOA and Nurick scores. Moreover, baseline gait kinematics and hand functioning testing were worse compared to their wild type counterpart. BDNF Val66Met mutation has a higher prevalence in CSM compared to the general population. Those with BDNF mutation have a worse clinical presentation compared to the wild type counterpart. These findings suggest implication of the BDNF mutation in the development and severity of CSM. PMID:26461908

  6. Diabetes and cervical myelopathy.

    PubMed

    Houten, John K; Lenart, Christopher

    2016-05-01

    Diabetes may affect the typical physical findings associated with cervical spondylotic myelopathy, as coexisting diabetic neuropathy may dampen expected hyperreflexia and also produce non-dermatomal extremity numbness. Most large studies of surgically treated diabetic patients with cervical spondylotic myelopathy have focused upon infection rates rather than exploring any differences in the presenting physical signs. We conducted a retrospective study of the pattern of presenting neurological signs and symptoms and of the clinical outcomes in 438 patients surgically treated for cervical spondylotic myelopathy, 79 of whom had diabetes. Compared with non-diabetic patients, those with diabetes were slightly older and had lower preoperative modified Japanese Orthopaedic Association (mJOA) scores. Those with diabetes also had a significantly higher incidence of hyporeflexia and a higher incidence of a positive Babinski sign, but there was no difference in the appearance of the Hoffman sign. The magnitude of mJOA improvement after surgery was comparable. We conclude that diabetes may alter the typical signs and symptoms of cervical spondylotic myelopathy and suggest that knowledge of the differences may aid in securing a prompt and accurate diagnosis. PMID:26747704

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

    PubMed Central

    Fei, Qi; Li, Jinjun; Su, Nan; Wang, Bingqiang; Li, Dong; Meng, Hai; Wang, Qi; Lin, Jisheng; Ma, Zhao; Yang, Yong

    2015-01-01

    Background Whether anterior cervical discectomy with fusion (ACDF) or anterior cervical corpectomy with fusion (ACCF) is superior in the treatment of cervical spondylotic myelopathy remains controversial. Therefore, we conducted a meta-analysis to quantitatively compare the efficacy and safety of ACDF and ACCF in the treatment of cervical spondylotic myelopathy. Methods PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System, People’s Republic of China), and CNKI (China National Knowledge Infrastructure, People’s Republic of China) were systematically searched to identify all available studies comparing efficacy and safety between patients receiving ACDF and ACCF. The weighted mean difference (WMD) was pooled to compare the Japanese Orthopaedic Association scores, visual analog scale scores, hospital stay, operation time, and blood loss. The risk ratio was pooled to compare the incidence of complications and fusion rate. Pooled estimates were calculated by using a fixed-effects model or a random-effects model according to the heterogeneity among studies. Results Eighteen studies (17 observational studies and one randomized controlled trial) were included in this meta-analysis. Our results suggest that hospital stay (WMD =−1.33, 95% confidence interval [CI]: −2.29, −0.27; P=0.014), operation time (WMD =−26.9, 95% CI: −46.13, −7.67; P=0.006), blood loss (WMD =−119.36, 95% CI: −166.94, −71.77; P=0.000), and incidence of complications (risk ratio =0.51, 95% CI: 0.33, 0.80; P=0.003) in the ACDF group were significantly less than that in the ACCF group. However, other clinical outcomes, including post-Japanese Orthopaedic Association score (WMD =−0.27, 95% CI: −0.57, 0.03; P=0.075), visual analog scale score (WMD =0.03, 95% CI: −1.44, 1.50; P=0.970), and fusion rate (risk ratio =1.04, 95% CI: 0.99, 1.09; P=0.158), between the two groups were not significantly different. Conclusion Evidence from the meta

  8. Analysis of the outcome in patients with cervical spondylotic myelopathy, undergone canal expansive laminoplasty supported with instrumentation in a group of Indian population – a prospective study

    PubMed Central

    Mandal, Subhadip; Banerjee, U.; Mukherjee, A.S.; Kundu, Srikanta

    2016-01-01

    Background Chronic compression of the cervical spinal cord leads to a clinical syndrome of cervical spondylotic myelopathy (CSM). Clinical symptoms of cervical spondylotic myelopathy (CSM) or cervical myeloradiculopathies result in spinal cord and root dysfunction. The primary aims of surgical intervention for multilevel myelopathy are to decompress the spinal cord and maintain stability of the cervical spine. Secondary aims are to minimize complications which include long-term pain and motion loss. Laminoplasty as either single-door or double-door technique and with/without instrumentation is an established mode of surgical treatment. The purpose of our study was to evaluate the result of single-door laminoplasty technique, supported with instrumented fixation in patients with multilevel degenerative cervical spondylotic myeloradiculopathy. Methods A prospective and without control study has been conducted in the institution in 17 patients with CSM, operated by canal expansive single-door laminoplasty (Hirabayashi technique) between April 2010 to April 2015. These patients were followed up for at least 3 years with both clinical and radiographic evaluations. Results On clinical evaluation, 15 of the 17 patients (87%) experienced relief of their symptoms. According to the Nurick classification, 11 patients’ demonstrated improvement by one grade, two patients improved by two grades, two patients were unchanged and two had worsening of the Nurick grade. Conclusions The results of this study regarding the use of open-door laminoplasty with instrumented fixation suggest that this technique is a satisfactory alternative for cases of multilevel cervical spondylotic myelopathy without deformation. Level of Evidence Level III therapeutic study. PMID:27441175

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

    PubMed

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

    2016-06-01

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

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

    PubMed Central

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

    2015-01-01

    Background: Posterior cervical decompression is an accepted treatment for multilevel cervical spondylotic myelopathy (CSM). Each posterior technique has its own advantages and disadvantages. In the present study, we compared the functional and radiological outcomes of expansive hemilaminectomy and laminoplasty with mini titanium plate in the treatment of multilevel CSM. Methods: Forty-four patients with multilevel CSM treated with posterior cervical surgery in Department of Orthopedic Surgery, Beijing Army General Hospital from March 2011 to June 2012 were enrolled in this retrospective study. Patients were divided into two groups by surgical procedure: Laminoplasty (Group L) and hemilaminectomy (Group H). Perioperative parameters including age, sex, duration of symptoms, operative duration, and intraoperative blood loss were recorded and compared. Spinal canal area, calculated using AutoCAD® software (Autodesk Inc., San Rafael, CA, USA), and neurological improvement, evaluated with Japanese Orthopedic Association score, were also compared. Results: Neurological improvement did not differ significantly between groups. Group H had a significantly shorter operative duration and significantly less blood loss. Mean expansion ratio was significantly greater in Group L (77.83 ± 6.41%) than in Group H (62.72 ± 3.86%) (P < 0.01). Conclusions: Both surgical approaches are safe and effective in treating multilevel CSM. Laminoplasty provides a greater degree of enlargement of the spinal canal, whereas expansive hemilaminectomy has the advantages of shorter operative duration and less intraoperative blood loss. PMID:26228218

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

    PubMed Central

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

    2014-01-01

    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. PMID:24740151

  12. Axonal plasticity underpins the functional recovery following surgical decompression in a rat model of cervical spondylotic myelopathy.

    PubMed

    Dhillon, Rana S; Parker, John; Syed, Yasir A; Edgley, Steve; Young, Adam; Fawcett, James W; Jeffery, Nick D; Franklin, Robin J M; Kotter, Mark R N

    2016-01-01

    Cervical spondylotic myelopathy (CSM) is the most common spinal cord disorder and a major cause of disability in adults. Improvements following surgical decompression are limited and patients often remain severely disabled. Post mortem studies indicate that CSM is associated with profound axonal loss. However, our understanding of the pathophysiology of CSM remains limited.To investigate the hypothesis that axonal plasticity plays a role in the recovery following surgical decompression, we adopted a novel preclinical model of mild to moderate CSM. Spinal cord compression resulted in significant locomotor deterioration, increased expression of the axonal injury marker APP, and loss of serotonergic fibres. Surgical decompression partially reversed the deficits and attenuated APP expression. Decompression was also associated with axonal sprouting, reflected in the restoration of serotonergic fibres and an increase of GAP43 expression. The re-expression of synaptophysin indicated the restoration of functional synapses following decompression. Promoting axonal plasticity may therefore be a therapeutic strategy for promoting neurological recovery in CSM. PMID:27552807

  13. Early detection of cervical spondylotic myelopathy using diffusion tensor imaging: Experiences in 1.5-tesla magnetic resonance imaging.

    PubMed

    Ahmadli, Uzeyir; Ulrich, Nils H; Yuqiang, Yao; Nanz, Daniel; Sarnthein, Johannes; Kollias, Spyros S

    2015-10-01

    The purpose of this study was to investigate the usefulness of diffusion tensor imaging (DTI) for early detection of pathological alterations in the myelon in patients with cervical spondylotic myelopathy (CSM) without T2-weighted imaging (T2W) signal abnormalities but with a narrowed spinal canal with corresponding clinical correlation. Axial DTI at 1.5T together with routine magnetic resonance imaging was performed on 18 patients fulfilling above mentioned criteria. Quantitative fractional anisotropy (FA) and apparent diffusion coefficient (ADC) maps were generated. Values at the narrowest cervical levels were compared to pre- and poststenotic levels and the interindividual means were tested for statistically significant differences by means of paired t-tests. The correlation between the grade and width of canal stenosis in the axial plane was measured. FA was significantly reduced at the stenotic level, compared to prestenotic level, whereas no significant differences were found when compared to poststenotic level. No significant differences between ADC values at stenotic level versus both adjacent non-stenotic levels were found, suggesting very early stage of degeneration. ADC values correlated significantly with the width of the spinal canal at the prestenotic level, but not at the poststenotic level. Findings indicate sufficient robustness of routine implementation of DTI at 1.5T to detect abnormalities in the spinal cord of CSM patients, before apparent T2W signal abnormalities and marked clinical deterioration. Therefore, larger and long-term studies should be conducted to establish the DTI scalar metrics that would indicate early intervention for a better clinical outcome in patients with clinical signs of CSM. PMID:26452521

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

    PubMed

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

    2016-09-01

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

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

    PubMed Central

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

    2016-01-01

    To assess the long-term clinical and radiographic outcomes of anterior cervical corpectomy and fusion (ACCF) with a neotype nano-hydroxyapatite/polyamide 66 (n-HA/PA66) strut in the treatment of cervical spondylotic myelopathy (CSM). Fifty patients with CSM who underwent 1- or 2-level ACCF with n-HA/PA66 struts were retrospectively investigated. With a mean follow-up of 79.6 months, the overall mean JOA score, VAS and cervical alignment were improved significantly. At last follow-up, the fusion rate was 98%, and the subsidence rate of the n-HA/PA66 strut was 8%. The “radiolucent gap” at the interface between the n-HA/PA66 strut and the vertebra was further noted to evaluate the osteoconductivity and osseointegration of the strut, and the incidence of it was 62% at the last follow-up. Three patients suffered symptomatic adjacent segment degeneration (ASD). No significant difference was detected in the outcomes between 1- and 2-level corpectomy at follow-ups. In conclusion, the satisfactory outcomes in this study indicated that the n-HA/PA66 strut was an effective graft for cervical reconstruction. Moreover, the osteoconductivity and osseointegration of the strut is still need to be optimized for future clinical application owing to the notably presence of “radiolucent gap” in present study. PMID:27225189

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

    NASA Astrophysics Data System (ADS)

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

    2016-05-01

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

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

    PubMed

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

    2015-09-01

    This study introduces the use of multivariate linear regression (MLR) and support vector regression (SVR) models to predict postoperative outcomes in a cohort of patients who underwent surgery for cervical spondylotic myelopathy (CSM). Currently, predicting outcomes after surgery for CSM remains a challenge. We recruited patients who had a diagnosis of CSM and required decompressive surgery with or without fusion. Fine motor function was tested preoperatively and postoperatively with a handgrip-based tracking device that has been previously validated, yielding mean absolute accuracy (MAA) results for two tracking tasks (sinusoidal and step). All patients completed Oswestry disability index (ODI) and modified Japanese Orthopaedic Association questionnaires preoperatively and postoperatively. Preoperative data was utilized in MLR and SVR models to predict postoperative ODI. Predictions were compared to the actual ODI scores with the coefficient of determination (R(2)) and mean absolute difference (MAD). From this, 20 patients met the inclusion criteria and completed follow-up at least 3 months after surgery. With the MLR model, a combination of the preoperative ODI score, preoperative MAA (step function), and symptom duration yielded the best prediction of postoperative ODI (R(2)=0.452; MAD=0.0887; p=1.17 × 10(-3)). With the SVR model, a combination of preoperative ODI score, preoperative MAA (sinusoidal function), and symptom duration yielded the best prediction of postoperative ODI (R(2)=0.932; MAD=0.0283; p=5.73 × 10(-12)). The SVR model was more accurate than the MLR model. The SVR can be used preoperatively in risk/benefit analysis and the decision to operate. PMID:26115898

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

    PubMed Central

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

    2016-01-01

    This study introduces the use of multivariate linear regression (MLR) and support vector regression (SVR) models to predict postoperative outcomes in a cohort of patients who underwent surgery for cervical spondylotic myelopathy (CSM). Currently, predicting outcomes after surgery for CSM remains a challenge. We recruited patients who had a diagnosis of CSM and required decompressive surgery with or without fusion. Fine motor function was tested preoperatively and postoperatively with a handgrip-based tracking device that has been previously validated, yielding mean absolute accuracy (MAA) results for two tracking tasks (sinusoidal and step). All patients completed Oswestry disability index (ODI) and modified Japanese Orthopaedic Association questionnaires preoperatively and postoperatively. Preoperative data was utilized in MLR and SVR models to predict postoperative ODI. Predictions were compared to the actual ODI scores with the coefficient of determination (R2) and mean absolute difference (MAD). From this, 20 patients met the inclusion criteria and completed follow-up at least 3 months after surgery. With the MLR model, a combination of the preoperative ODI score, preoperative MAA (step function), and symptom duration yielded the best prediction of postoperative ODI (R2 = 0.452; MAD = 0.0887; p = 1.17 × 10−3). With the SVR model, a combination of preoperative ODI score, preoperative MAA (sinusoidal function), and symptom duration yielded the best prediction of postoperative ODI (R2 = 0.932; MAD = 0.0283; p = 5.73 × 10−12). The SVR model was more accurate than the MLR model. The SVR can be used preoperatively in risk/benefit analysis and the decision to operate. PMID:26115898

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

    PubMed Central

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

    2015-01-01

    Study Design Cross-sectional. Purpose To translate and validate the Iranian version of the Copenhagen Neck Functional Disability Scale (CNFDS). Overview of Literature Instruments measuring patient-reported outcomes should satisfy certain psychometric properties. Methods Ninety-three cases of cervical spondylotic myelopathy were entered into the study and completed the CNFDS pre and postoperatively at the 6 month follow-up. The modified Japanese Orthopedic Association Score was also completed. The internal consistency, test-retest, convergent validity, construct validity (item scale correlation), and responsiveness to change were assessed. Results Mean age of the patients was 54.3 years (standard deviation, 8.9). The Cronbach α coefficient was satisfactory (α=0.84). Test-retest reliability as assessed by the intraclass correlation coefficient analysis was 0.95 (95% confidence interval, 0.92-0.98). The modified Japanese Orthopedic Association score correlated strongly with the CNFDS score, lending support to its good convergent validity (r=-0.80; p<0.001). Additionally, the correlation of each item with its hypothesized domain on the CNFDS was acceptable, suggesting that the items had a substantial relationship with their own domains. These results also indicate that the instrument was responsive to change (p<0.0001). Conclusions The findings suggest that the Iranian version of the CNFDS is a valid measure to assess functionality, social interaction, and pain among patients with cervical spondylotic myelopathy. PMID:26713123

  20. Comparison of the Japanese Orthopaedic Association Score and the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire Scores: Time-Dependent Changes in Patients with Cervical Spondylotic Myelopathy and Posterior Longitudinal Ligament

    PubMed Central

    Iwasaki, Motoki; Sakaura, Hironobu; Fujimori, Takahito; Nagamoto, Yukitaka; Yoshikawa, Hideki

    2015-01-01

    Study Design Prospective cohort study. Purpose To identify differences in time-dependent perioperative changes between the Japanese Orthopaedic Association (JOA) score and the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) score in patients with cervical spondylotic myelopathy (CSM) and posterior longitudinal ligament (OPLL) who underwent cervical laminoplasty. Overview of Literature The JOA score does not take into consideration patient satisfaction or quality of life. Accordingly, the JOACMEQ was designed in 2007 as a patient-centered assessment tool. Methods We studied 21 patients who underwent cervical laminoplasty. We objectively evaluated the time-dependent changes in JOACMEQ scores and JOA scores for all patients before surgery and at 2 weeks, 3 months, 6 months, and 1 year after surgery. Results The average total JOA score and the recovery rate improved significantly after surgery in both groups, with a slightly better recovery rate in the OPLL group. Cervical spine function improved significantly in the CSM group but not in the OPLL group. Upper- and lower-extremity functions were more stable in the CSM group than in the OPLL group. The effectiveness rate of the JOACMEQ for measuring quality of life was quite low in both groups. In both groups, the Spearman contingency coefficients were dispersed widely except for upper- and lower-extremity function. Conclusions Scores for upper- and lower-extremity function on the JOACMEQ correlated well with JOA scores. Because the JOACMEQ can also assess cervical spine function and quality of life, factors that cannot be assessed by the JOA score alone, the JOACMEQ is a more comprehensive evaluation tool. PMID:25705334

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

    PubMed Central

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

    2016-01-01

    Objectives Cervical disc arthroplasty (CDA) with Discover prosthesis or anterior cervical discectomy and fusion (ACDF) with Zero-P cage has been widely used in the treatment of cervical spondylotic myelopathy (CSM). However, little is known about the comparison of the 2 zero-profile implants in the treatment of single-level CSM. The aim was to compare the clinical outcomes and radiographic parameters of CDA with Discover prosthesis and ACDF with Zero-P cage for the treatment of single-level CSM. Methods A total of 128 consecutive patients who underwent 1-level CDA with Discover prosthesis or ACDF with Zero-P cage for single-level CSM between September 2009 and December 2012 were included in this study. Clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) score and Neck Disability Index (NDI). For radiographic assessment, the overall sagittal alignment (OSA), functional spinal unit (FSU) angle, and range of motion (ROM) at the index and adjacent levels were measured before and after surgery. Additionally, the complications were also recorded. Results Both treatments significantly improved all clinical parameters (P < 0.05), without statistically relevant differences between the 2 groups. The OSA and FSU angle increased significantly in both groups (P <0.05). Compared with Zero-P group, ROMs at the index levels were well maintained in the Discover group (P < 0.05). However, there were no statistical differences in the ROMs of adjacent levels between the 2 groups (P > 0.05). Besides, no significant differences existed in dysphagia, subsidence, or adjacent disc degeneration between the 2 groups (P > 0.05). However, significant differences occurred in prosthesis migration in CDA group. Conclusions The results of this study showed that clinical outcomes and radiographic parameters were satisfactory and comparable with the 2 techniques. However, more attention to prosthesis migration of artificial cervical disc should be paid in the

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

    PubMed Central

    Soufiani, Housain F.; Rahimizadeh, Saghayegh

    2016-01-01

    The dropped head syndrome (DHS) is a disabling condition caused by severe weakness of the neck extensor muscles causing progressive reducible kyphosis of the cervical spine and the inability to hold the head up. Weakness can occur in isolation or in association with a generalized neuromuscular disorder. Isolated cases are owed to the late onset of noninflammatory myopathy designated as INEM, where persistent chin to chest deformity may gradually cause or aggravate preexisting degenerative changes of the cervical spine and ultimately result in myelopathy. In review of the literature, we could find only 5 cases, with no unique guidelines to address the management of these two concomitant pathologies. Herein, a 69-year-old man who had developed cervical myelopathy 2 years after being affected by isolated dropped head syndrome is presented. Chin to chest deformity and cervical myelopathy were managed through three-level anterior cervical discectomy and fusion (ACDF) combined with decompressive cervical laminectomy and stabilization with C2 to C7 pedicle screw-rod construct. At 4-month follow-up, despite recovery in patient's neurological status, flexion deformity reappeared with recurrence of dropped head due to C7 pedicle screws pull-out. However, this was successfully managed with extension of the construct to the upper thoracic levels. PMID:27034870

  3. 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)

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

    2009-10-01

    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.

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

    PubMed

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

    2016-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

    Su, Nan; Fei, Qi; Wang, Bingqiang; Li, Dong; Li, Jinjun; Meng, Hai; Yang, Yong; Guo, Ai

    2016-01-01

    Objectives The purpose of the present study was to explore and analyze the long-term outcomes and factors that affect the prognosis of expansive open-door laminoplasty with lateral mass screw fusion in treatment of cervical spondylotic myelopathy (CSM). Methods We retrospectively reviewed 49 patients with multilevel CSM who had undergone expansive open-door laminoplasty with lateral mass screws fixation and fusion in our hospital between February 2008 and February 2012. The average follow-up period was 4.6 years. The clinical data of patients, including age, sex, operation records, pre- and postoperation Japanese Orthopedic Association (JOA) scores, cervical spine canal stenosis, and cervical curvature, were collected. Increased signal intensity (ISI) on T2-weighted magnetic resonance imaging and ossification of the posterior longitudinal ligament were also observed. Paired t-test was used to analyze the treatment effectiveness and recovery of neuronal function. The prognostic factors were analyzed with multivariable linear regression model. Results Forty-nine patients with CSM with a mean age of 59.44 years were enrolled in this study. The average of preoperative JOA score was 9.14±2.25, and postoperative JOA score was 15.31±1.73. There was significant difference between the pre- and postoperative JOA scores. The clinical improvement rate was 80.27%. On follow-up, five patients had complaints of neck and shoulder pain, but no evidence of C5 nerve palsy was found. Developmental cervical spine canal stenosis was present in all patients before surgery. Before surgery, ISI was observed in eight patients, while ossification of the posterior longitudinal ligament was found in 12 patients. The average of preoperative cervical curvature was 21.27°±8.37° and postoperative cervical curvature was 20.09°±1.29°, and there was no significant difference between the pre- and postoperative cervical curvatures. Multivariable linear regression analysis results showed that

  8. [Cervical Spondylotic Amyotrophy].

    PubMed

    Sonoo, Masahiro

    2016-05-01

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

  9. Psychometric analysis and critical appraisal of the original, revised, and modified versions of the Japanese Orthopaedic Association score in the assessment of patients with cervical spondylotic myelopathy.

    PubMed

    Furlan, Julio C; Catharine Craven, B

    2016-06-01

    OBJECTIVE Cervical spondylotic myelopathy (CSM) is the most common cause of nontraumatic spinal cord impairment and disability in the world. Given that the Japanese Orthopaedic Association (JOA) score is the most frequently used outcome measure in clinical research and practice for treating patients with CSM, this review was undertaken to comprehensively and critically evaluate the psychometric properties of the JOA score. METHODS The authors identified studies (published in the period of January 1975 to November 2015) on the psychometric properties of the original, revised, and modified versions of the JOA score in Medline, PsycINFO, Excerpta Medica dataBASE (EMBASE), American College of Physicians Journal Club, and Cochrane Database of Systematic Reviews. Additional publications were captured in a secondary search of the bibliographies in both original research articles and literature reviews identified in the original search. The JOA scores were evaluated for item generation and reduction, internal consistency, reliability, validity, and responsiveness. This review included all those versions of the JOA score whose psychometric properties had been reported in at least 2 published studies. RESULTS The primary search strategy identified 59 studies, of which 9 fulfilled the inclusion and exclusion criteria. An additional 18 publications were captured in the secondary search and included in the analysis. The key findings from the 27 studies analyzed indicated the following: 1) the original JOA score (1975) was the source for the revised JOA score (1994) and 3 modified versions (1991, 1993, and 1999 JOA scores) reported or used in at least 2 published studies; 2) the revised and modified versions of the JOA score are markedly different from each other; 3) only the revised JOA score (1994) was validated with the original JOA score; and 4) the 1975 JOA score is the most appropriate instrument for assessing patients in Asian populations (especially from Japan) because

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

    PubMed

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

    2016-06-01

    OBJECTIVE This study aimed to estimate the risk of spinal cord injury (SCI) in patients with cervical spondylotic myelopathy (CSM) with and without ossification of posterior longitudinal ligament (OPLL). Also, the study compared the incidence rates of SCI in patients who were managed surgically and conservatively. METHODS This retrospective cohort study covering 15 years analyzed the incidence of SCI in patients with CSM. All patients, identified from the National Health Insurance Research Database, were hospitalized with the diagnosis of CSM and followed up during the study period. These patients with CSM were categorized into 4 groups according to whether they had OPLL or not and whether they received surgery or not: 1) surgically managed CSM without OPLL; 2) conservatively managed CSM without OPLL; 3) surgically managed CSM with OPLL; and 4) conservatively managed CSM with OPLL. The incidence rates of subsequent SCI in each group during follow-up were then compared. Kaplan-Meier and Cox regression analyses were performed to compare the risk of SCI between the groups. RESULTS Between January 1, 1999, and December 31, 2013, there were 17,258 patients with CSM who were followed up for 89,003.78 person-years. The overall incidence of SCI in these patients with CSM was 2.022 per 1000 person-years. Patients who had CSM with OPLL and were conservatively managed had the highest incidence of SCI, at 4.11 per 1000 person-years. Patients who had CSM with OPLL and were surgically managed had a lower incidence of SCI, at 3.69 per 1000 person-years. Patients who had CSM without OPLL and were conservatively managed had an even lower incidence of SCI, at 2.41 per 1000 person-years. Patients who had CSM without OPLL and were surgically managed had the lowest incidence of SCI, at 1.31 per 1000 person-years. The Cox regression model demonstrated that SCIs are significantly more likely to happen in male patients and in those with OPLL (HR 2.00 and 2.24, p < 0.001 and p = 0

  11. Operative Outcomes for Cervical Myelopathy and Radiculopathy

    PubMed Central

    Galbraith, J. G.; Butler, J. S.; Dolan, A. M.; O'Byrne, J. M.

    2012-01-01

    Cervical spondylotic myelopathy and radiculopathy are common disorders which can lead to significant clinical morbidity. Conservative management, such as physical therapy, cervical immobilisation, or anti-inflammatory medications, is the preferred and often only required intervention. Surgical intervention is reserved for those patients who have intractable pain or progressive neurological symptoms. The goals of surgical treatment are decompression of the spinal cord and nerve roots and deformity prevention by maintaining or supplementing spinal stability and alleviating pain. Numerous surgical techniques exist to alleviate symptoms, which are achieved through anterior, posterior, or circumferential approaches. Under most circumstances, one approach will produce optimal results. It is important that the surgical plan is tailored to address each individual's unique clinical circumstance. The objective of this paper is to analyse the major surgical treatment options for cervical myelopathy and radiculopathy focusing on outcomes and complications. PMID:22046575

  12. Copper deficiency myelopathy in the setting of advanced degenerative cervical spondylosis.

    PubMed

    Page, Paul S; Nazar, Ryan G; Park, Michael C; James, Robert F

    2016-08-01

    When presenting conjointly, degenerative cervical spondylosis and copper deficiency myelopathy may be difficult to differentiate providing the potential for mismanagement and unnecessary surgery. We present a case of a 69-year-old female with copper deficiency myelopathy secondary to previous bowel resection in the setting of advanced degenerative cervical spondylotic disease. PMID:26337459

  13. Degenerative cervical myelopathy.

    PubMed

    Kato, So; Fehlings, Michael

    2016-09-01

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

  14. Prediction of Neurological Impairment in Cervical Spondylotic Myelopathy using a Combination of Diffusion MRI and Proton MR Spectroscopy

    PubMed Central

    Ellingson, Benjamin M.; Salamon, Noriko; Hardy, Anthony J.; Holly, Langston T.

    2015-01-01

    Purpose In the present study we investigated a combination of diffusion tensor imaging (DTI) and magnetic resonance spectroscopic (MRS) biomarkers in order to predict neurological impairment in patients with cervical spondylosis. Methods Twenty-seven patients with cervical spondylosis were evaluated. DTI and single voxel MRS were performed in the cervical cord. N-acetylaspartate (NAA) and choline (Cho) metabolite concentration ratios with respect to creatine were quantified, as well as the ratio of choline to NAA. The modified mJOA scale was used as a measure of neurologic deficit. Linear regression was performed between DTI and MRS parameters and mJOA scores. Significant predictors from linear regression were used in a multiple linear regression model in order to improve prediction of mJOA. Parameters that did not add value to model performance were removed, then an optimized multiparametric model was established to predict mJOA. Results Significant correlations were observed between the Torg-Pavlov ratio and FA (R2 = 0.2021, P = 0.019); DTI fiber tract density and FA, MD, Cho/NAA (R2 = 0.3412, P = 0.0014; R2 = 0.2112, P = 0.016; and R2 = 0.2352, P = 0.010 respectively); along with FA and Cho/NAA (R2 = 0.1695, P = 0.033). DTI fiber tract density, MD and FA at the site of compression, along with Cho/NAA at C2, were significantly correlated with mJOA score (R2 = 0.05939, P < 0.0001; R2 = 0.4739, P < 0.0001; R2 = 0.7034, P < 0.0001; R2 = 0.4649, P < 0.0001). A combination biomarker consisting of DTI fiber tract density, MD, and Cho/NAA showed the best prediction of mJOA (R2 = 0.8274, P<0.0001), with post-hoc tests suggesting fiber tract density, MD, and Cho/NAA were all significant contributors to predicting mJOA (P = 0.00053, P = 0.00085, and P = 0.0019, respectively). Conclusion A linear combination of DTI and MRS measurements within the cervical spinal cord may be useful for accurately predicting neurological deficits in patients with cervical spondylosis

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

    PubMed Central

    Tan, Bingyi; Wang, Haiyan; Dong, Jun; Yuan, Zenong; Wang, Dachuan; Wang, Feng

    2015-01-01

    Background Few studies have examined the efficacy of recombinant human bone morphogenetic protein-2 (rhBMP-2) in 2-level anterior cervical discectomy and fusion (ACDF). The purpose of this study was to compare the outcomes in a series of patients with CSM treated with 2-level ACDF with or without rhBMP-2. Material/Methods The retrospective study included a total of 146 patients with CSM. The rhBMP-2 group consisted of 73 patients who underwent 2-level ACDF with rhBMP-2. A total of 73 patients who also received 2-level ACDF with autogenous ICBG alone were included in the matched-pair ICBG group with a ratio of 1:1, based on age, sex, and BMI. All data, including fusion rate and time, VAS, JOA score, operative date, and complications, were assessed. Results With respect to the length of hospital stay, operative times, and blood loss, there were no significant difference between the 2 groups. However, the rhBMP-2 group presented a shorter fusion time (P<0.013) and higher fusion rate (P<0.036) than the ICBG group. In the rhBMP-2 group, 22% required additional treatment for complications compared to 18% of patients in the ICBG group, which showed no significant difference (P=0.543). Conclusions The application of rhBMP-2 in 2-level ACDF showed higher fusion rates, shorter fusion time, and similar function outcomes compared to those who received ACDF with ICBG alone. PMID:26479708

  16. Mechanical and cellular processes driving cervical myelopathy

    PubMed Central

    Dolan, Roisin T; Butler, Joseph S; O’Byrne, John M; Poynton, Ashley R

    2016-01-01

    Cervical myelopathy is a well-described clinical syndrome that may evolve from a combination of etiological mechanisms. It is traditionally classified by cervical spinal cord and/or nerve root compression which varies in severity and number of levels involved. The vast array of clinical manifestations of cervical myelopathy cannot fully be explained by the simple concept that a narrowed spinal canal causes compression of the cord, local tissue ischemia, injury and neurological impairment. Despite advances in surgical technology and treatment innovations, there are limited neuro-protective treatments for cervical myelopathy, which reflects an incomplete understanding of the pathophysiological processes involved in this disease. The aim of this review is to provide a comprehensive overview of the key pathophysiological processes at play in the development of cervical myelopathy. PMID:26807352

  17. Cervical myelopathy in rheumatoid arthritis.

    PubMed

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

    1984-01-01

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

  18. Posterior atlantoaxial ‘facetal’ instability associated with cervical spondylotic disease

    PubMed Central

    Goel, Atul

    2015-01-01

    Aim: The association of single or multiple level cervical spondylotic disease with atlantoaxial instability is assessed. The implications of identifying and treating atlantoaxial instability in such an association are highlighted. Materials and Methods: The analysis is based on an experience with 11 patients treated during the period June 2013-June 2014. All patients had single or multilevel cervical spondylotic disease. The spinal canal compromise and evidence of cord compression was evident on imaging in the cervical subaxial spine and was related to disc bulges and osteophytic bars. There was no or relatively insignificant compression of the cervicomedullary cord by the odontoid process. There was no evidence of odontoid process-related instability on dynamic imaging. Apart from presence of features of cervical spondylosis, investigations and surgical exploration and direct manual handling of the facets revealed evidence of Type B (posterior) atlantoaxial ‘facetal’ instability in all patients. Our 5-point clinical grading system and Japanese Orthopaedic Association (JOA) scores were used to monitor the patients both before and after surgery and at follow-up. Surgery involved both at lantoaxial and subaxial cervical fixation. During the average period of follow-up of 9 months (5-17 months), all patients showed remarkable and gratifying neurological recovery. Conclusion: We conclude that atlantoaxial facetal instability can be ‘frequently’ associated with cervical spondylosis and needs surgical stabilization. Our surgical outcome analysis suggests that missing or ignoring the presence of atlantoaxial facetal instability can be an important cause of suboptimal result or failure of surgery for cervical spondylotic myelopathy. PMID:25972708

  19. Anterior decompression and fusion versus posterior laminoplasty for multilevel cervical compressive myelopathy.

    PubMed

    Liu, Xuzhou; Wang, Hehui; Zhou, Zhilai; Jin, Anmin

    2014-02-01

    The optimal surgical strategy for anterior or posterior approaches remains controversial for multilevel cervical compressive myelopathy caused by multisegment cervical spondylotic myelopathy (MCSM) or ossification of the posterior longitudinal ligament (OPLL). A systematic review and meta-analysis was conducted evaluating the clinical results of anterior decompression and fusion (ADF) compared with posterior laminoplasty for patients with multilevel cervical compressive myelopathy. PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials and nonrandomized cohort studies conducted from 1990 to May 2013 comparing ADF with posterior laminoplasty for the treatment of multilevel cervical compressive myelopathy due to MCSM or OPLL. The following outcome measures were extracted: Japanese Orthopedic Association (JOA) score, recovery rate, complication rate, reoperation rate, blood loss, and operative time. Subgroup analysis was conducted according to the mean number of surgical segments. Eleven studies were included in the review, all of which were prospective or retrospective cohort studies with relatively low quality indicated by GRADE Working Group assessment. A definitive conclusion could not be reached regarding which surgical approach is more effective for the treatment of multilevel cervical compressive myelopathy. Although ADF was associated with better postoperative neural function than posterior laminoplasty in the treatment of multilevel cervical compressive myelopathy due to MCSM or OPLL, there was no apparent difference in the neural function recovery rate between the 2 approaches. Higher rates of surgery-related complication and reoperation should be taken into consideration when ADF is used for patients with multilevel cervical compressive myelopathy. The surgical trauma associated with corpectomy was significantly higher than that associated with posterior laminoplasty. PMID:24679196

  20. Cox Decompression Manipulation and Guided Rehabilitation of a Patient With a Post Surgical C6-C7 Fusion With Spondylotic Myelopathy and Concurrent L5-S1 Radiculopathy

    PubMed Central

    Joachim, George C.

    2014-01-01

    Objective The purpose of this case report is to describe combined treatment utilizing Cox distraction manipulation and guided rehabilitation for a patient with spine pain and post-surgical C6-7 fusion with spondylotic myelopathy and L5-S1 radiculopathy. Clinical features A 38-year-old man presented to a chiropractic clinic with neck pain and a history of an anterior cervical spine plate fusion at C6-7 after a work related accident 4 years earlier. He had signs and symptoms of spondolytic myelopathy and right lower back, right posterior thigh pain and numbness. Intervention and outcome The patient was treated with Cox technique and rehabilitation. The patient experienced a reduction of pain on a numeric pain scale from 8/10 to 3/10. The patient was seen a total of 12 visits over 3 months. No adverse effects were reported. Conclusions A patient with a prior C6-7 fusion with spondylotic myelopathy and concurrent L5-S1 radiculopathy improved after a course of rehabilitation and Cox distraction manipulation. Further research is needed to establish its efficiency. PMID:25685119

  1. Activ C cervical disc replacement for myelopathy

    PubMed Central

    McGonagle, L.; Cadman, S.; Chitgopkar, S. D.; Canavan, L.; O’Malley, M.; Shackleford, I. M.

    2011-01-01

    Background: Cervical disc replacement is becoming an increasingly popular treatment option for cervical myelopathy. It retains motion at the affected segment, unlike anterior cervical discectomy and fusion. The aim of this study is to assess the outcomes of a series of patients who underwent Activ C disc replacement for cervical myelopathy. Materials and Methods: A series of patients at the above Trust with clinical and radiological evidence of cervical myelopathy who were suitable for cervical disc replacement from 2007 to 2009 were included. Implants were inserted by one of two consultant surgeons {IMS, MO’M}. Patients were assessed preoperatively and at six, 12 and 24 months, postoperatively, with a visual analogue score (VAS) for neck and arm pain severity and frequency, the Neck Disability Index questionnaire (NDI) and the Centre for Epidemiologic Studies Depression questionnaire (CES-D). Results: Ten patients underwent surgery between May 2007 and July 2009, 6 women, and 4 men. Average age was 54 years (40-64). Disc levels replaced were: four at C4-5; eight at C5-6; seven at C6-7. Three patients had one disc replaced, five patients had two discs replaced, and two patients had three discs replaced. The VAS for neck pain improved from 5.9 pre-operatively to 1.4-24 months postoperatively and the VAS arm pain improved from 5.4 to 2.6. The NDI improved from 51% preoperatively to 26.8% at 24 months postoperatively. The CES-D showed a slight increase from 19.5 preoperatively to 21.7 at 24 months, postoperatively. Conclusion: Cervical decompression and disc replacement improves pain and function in patients with cervical myelopathy. This benefit is maintained at 24 months post op, with no cases requiring revision. PMID:23125494

  2. [Langerhans cell histiocytosis causing cervical myelopathy].

    PubMed

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

    2012-08-01

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

  3. The chiropractic management of two cases of cervical spondylotic radiculopathy

    PubMed Central

    Dufton, John A.; Giantomaso, Tony

    2003-01-01

    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.

  4. Cervical Stenosis, Myelopathy and Radiculopathy

    MedlinePlus

    ... between the vertebrae results in narrowing of the space for the spinal cord and its branches, known ... and cervical stenosis refers to narrowing of the space for the spinal cord or nerve branches in ...

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

    PubMed

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

    2015-10-01

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

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

    PubMed

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

    2016-06-01

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

  7. Cervical Myelopathy Caused by Injections into the Neck

    PubMed Central

    Ralph, Jeffrey W.; Layzer, Robert B.

    2015-01-01

    Three cases of longitudinally extensive cervical myelopathies temporally associated with neck injections are presented. The spinal cord injury was similar radiographically, despite a number of different needle approaches and substances injected. In recent years, there have been reports of an acute cervical myelopathy immediately following an injection procedure in the neck. Various explanations have been offered for this unfortunate complication, including (1) direct injection into the cord leading to traumatic injury, (2) injection of particulate matter into the arterial supply of the cord causing microvascular embolism and spinal cord infarction, and (3) intraneural injection of the chemical with centripetal spread of the injectant from the nerve trunk to the substance of the cord. The merits of each of these 3 mechanisms in explaining these cases are discussed. Albeit rare, acute cervical myelopathy should be considered a potential complication from any deep injection of chemicals into the neck. PMID:26425248

  8. Modified Open-Door Laminoplasty Using a Ceramic Spacer and Suture Fixation for Cervical Myelopathy

    PubMed Central

    Toyone, Tomoaki; Shiboi, Ryutaro; Inada, Kunimasa; Oikawa, Yasuhiro; Takahashi, Kazuhisa; Ohtori, Seiji; Inoue, Gen; Miyagi, Masayuki; Ishikawa, Tetsuhiro; Shirahata, Toshiyuki; Kudo, Yoshifumi; Inagaki, Katsunori

    2015-01-01

    Purpose To introduce a new simple technique using suture anchors and ceramic spacers to stabilize the elevated laminae in open-door cervical laminoplasty. Although ceramic spacers were placed in the opened laminae and fixed with nylon threads in this series, it was occasionally difficult to fix the nylon threads to the lateral mass. Materials and Methods Study 1: A preliminary study was conducted using a suture anchor system. Sixteen consecutive patients who underwent surgery for cervical myelopathy were prospectively examined. Study 2: The second study was performed prospectively to evaluate the feasibility of this new technique based on the result of the preliminary study. Clinical outcomes were examined in 45 consecutive patients [cervical spondylotic myelopathy (CSM)] and 43 consecutive patients (OPLL). The Japanese Orthopedic Association scoring system (JOA score), axial neck pain, and radiological findings were analyzed. Results 1) In one case, re-operation was necessary due to dislodgement of the ceramic spacer following rupture of the thread. 2) In all patients, postoperative CT scans showed that the anchors were securely inserted into the bone. In the CSM group, the average JOA score improved from 9.5 points preoperatively to 13.3 at follow-up (recovery 51%). In the OPLL group, the average JOA score improved from 10.1 (5-14) points preoperatively to 14.4 (11-16) at follow-up (recovery 62%). There were no serious complications. Conclusion The use of the suture anchor system made it unnecessary to create a hole in the lateral mass and enabled reliable and faster fixation of the HA spacers in open-door laminoplasty. PMID:26446650

  9. Myelopathy.

    PubMed

    Oyinkan Marquis, B; Capone, Patrick M

    2016-01-01

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

  10. Cervical Myelopathy Caused by Intracranial Dural Arteriovenous Fistula

    PubMed Central

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

    2016-01-01

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

  11. Cervical Myelopathy Caused by Intracranial Dural Arteriovenous Fistula.

    PubMed

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

    2016-06-01

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

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

    PubMed

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

    2010-06-01

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

  13. Langerhans Cell Histiocytosis Causing Cervical Myelopathy in a Child

    PubMed Central

    Jang, Kun Soo; Jung, Youn Young

    2010-01-01

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

  14. Cervical myelopathy associated with extradural synovial cysts in 4 dogs.

    PubMed

    Levitski, R E; Chauvet, A E; Lipsitz, D

    1999-01-01

    Three Mastiffs and 1 Great Dane were presented to the University of Wisconsin Veterinary Medical Teaching Hospital for cervical myelopathy based on history and neurologic examination. All dogs were males and had progressive ataxia and tetraparesis. Degenerative arthritis of the articular facet joints was noted on survey spinal radiographs. Myelography disclosed lateral axial compression of the cervical spinal cord medial to the articular facets. Extradural compressive cystic structures adjacent to articular facets were identified on magnetic resonance imaging (1 dog). High protein concentration was the most important finding on cerebrospinal fluid analysis. Dorsal laminectomies were performed in all dogs for spinal cord decompression and cyst removal. Findings on cytologic examination of the cystic fluid were consistent with synovial fluid, and histopathologic results supported the diagnosis of synovial cysts. All dogs are ambulatory and 3 are asymptomatic after surgery with a follow-up time ranging from 1 to 8 months. This is the 1st report of extradural synovial cysts in dogs, and synovial cysts should be a differential diagnosis for young giant breed dogs with cervical myelopathy. PMID:10357105

  15. Analysis of five specific scores for cervical spondylogenic myelopathy

    PubMed Central

    Dalitz, Kristina

    2007-01-01

    The ability to compare various results that measure clinical deficits and outcome is a necessity for successful worldwide discussion about cervical spondylogenic myelopathy (CSM) and its treatment. There is hardly any information in literature how to value and compare outcome assessed by different scores. In a retrospective study we objectively evaluated the Nurick-score, Japanese-orthopaedic-association-score (JOA-Score), Cooper-myelopathy-scale (CMS), Prolo-score and European-myelopathy-score (EMS) using the data of 43 patients, all of whom showed clinical and morphological signs of CSM and underwent operative decompression. The scores were assessed pre- and postoperatively. The correlation between the score-results, anamnesis, clinical and diagnostic data was investigated. All the scores show a statistically significant correlation and measure postoperative improvement. With exception of the Prolo-score all scores reflect clinical deficits of CSM. The Prolo-score rates the severity of CSM on the state of the economic situation above clinical symptoms. The main differences of the scores are shown in the number of patients showing postoperative improvement, varying between 33% (Nurick-score) and 81% (JOA-score). The recovery-rates, as a measure of the cumulative improvement of all the symptoms, show less variation (23–37%). The differences of the recovery-rate were only statistically significant between JOA-score, Nurick-score and EMS (P < 0.05), whereas all the other scores showed no significant differences. To assess the postoperative successes, the evaluation of the recovery-rate is essential. There is no significant difference in the recovery-rate amongst the majority of the scores, which allows a good comparison of the results from different studies. Nevertheless, it is always important to differentiate the therapy results of CSM published worldwide. PMID:17922150

  16. Laminoplasty versus laminectomy and fusion for multilevel cervical compressive myelopathy

    PubMed Central

    Liu, Feng-Yu; Yang, Si-Dong; Huo, Li-Shuang; Wang, Tao; Yang, Da-Long; Ding, Wen-Yuan

    2016-01-01

    Abstract This is a meta-analysis to compare the results between laminoplasty and laminectomy followed by fusion for the patients with multilevel cervical compressive myelopathy. An extensive search of literature was performed in MEDLINE, Embase, the Cochrane library, CNKI, and WANFANG. The following outcome measures were extracted: the Japanese Orthopaedic Association (JOA) scores, cervical curvature index (CCI), visual analog scale (VAS), cervical lordosis (C2–7), complications, blood loss, and operation time. Data analysis was conducted with RevMan 5.3 and STATA 12.0. A total of 23 studies comprising 774 and 743 patients treated with laminoplasty and laminectomy followed by fusion, respectively, were included in the final analysis. The pooled analysis showed that there was no significant difference in preoperative JOA scores [P = 0.89], postoperative JOA scores [P = 0.13], JOA scores improvement rate [P = 0.27], preoperative CCI [P = 0.15], postoperative CCI [P = 0.14], preoperative VAS [P = 0.41], postoperative VAS [P = 0.52], preoperative cervical lordosis (C2–7) [P = 0.46], postoperative cervical lordosis (C2–7) [P = 0.67], total complications [P = 0.07], axial pain [P = 0.94], and blood loss [P = 0.51]. However, there were significant difference in operation time (WMD = −19.57 [−32.11, −7.02], P = 0.002) and C5 palsy (OR = 0.26 [0.15, 0.44], P < 0.001). As compared with laminectomy followed by fusion, expansive laminoplasty showed no significant differences in JOA scores, CCI, ROM, VAS, cervical lordosis (C2–7), axial pain, total complications, and blood loss, but shorter operation time and fewer C5 palsy. PMID:27281067

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

    SciTech Connect

    Modi, Manish; Bapuraj, J. Rajiv; Lal, Anupam; Prabhakar, S.; Khandelwal, N.

    2010-12-15

    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.

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

    PubMed

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

    2015-06-01

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

  19. Reported Outcome Measures in Degenerative Cervical Myelopathy: A Systematic Review

    PubMed Central

    McHugh, Maire; Elgheriani, Ali; Kolias, Angelos G.; Tetreault, Lindsay A.; Hutchinson, Peter J. A.; Fehlings, Michael G.; Kotter, Mark R. N.

    2016-01-01

    Objective Degenerative cervical myelopathy [DCM] is a disabling and increasingly prevalent group of diseases. Heterogeneous reporting of trial outcomes limits effective inter-study comparison and optimisation of treatment. This is recognised in many fields of healthcare research. The present study aims to assess the heterogeneity of outcome reporting in DCM as the premise for the development of a standardised reporting set. Methods A systematic review of MEDLINE and EMBASE databases, registered with PROSPERO (CRD42015025497) was conducted in accordance with PRISMA guidelines. Full text articles in English, with >50 patients (prospective) or >200 patients (retrospective), reporting outcomes of DCM were eligible. Results 108 studies, assessing 23,876 patients, conducted world-wide, were identified. Reported outcome themes included function (reported by 97, 90% of studies), complications (reported by 56, 52% of studies), quality of life (reported by 31, 29% of studies), pain (reported by 29, 27% of studies) and imaging (reported by 59, 55% of studies). Only 7 (6%) studies considered all of domains in a single publication. All domains showed variability in reporting. Conclusions Significant heterogeneity exists in the reporting of outcomes in DCM. The development of a consensus minimum dataset will facilitate future research synthesis. PMID:27482710

  20. Magnetic resonance imaging assessment of degenerative cervical myelopathy: a review of structural changes and measurement techniques.

    PubMed

    Nouri, Aria; Martin, Allan R; Mikulis, David; Fehlings, Michael G

    2016-06-01

    Degenerative cervical myelopathy encompasses a spectrum of age-related structural changes of the cervical spine that result in static and dynamic injury to the spinal cord and collectively represent the most common cause of myelopathy in adults. Although cervical myelopathy is determined clinically, the diagnosis requires confirmation via imaging, and MRI is the preferred modality. Because of the heterogeneity of the condition and evolution of MRI technology, multiple techniques have been developed over the years in an attempt to quantify the degree of baseline severity and potential for neurological recovery. In this review, these techniques are categorized anatomically into those that focus on bone, ligaments, discs, and the spinal cord. In addition, measurements for the cervical spine canal size and sagittal alignment are also described briefly. These tools have resulted collectively in the identification of numerous useful parameters. However, the development of multiple techniques for assessing the same feature, such as cord compression, has also resulted in a number of challenges, including introducing ambiguity in terms of which methods to use and hindering effective comparisons of analysis in the literature. In addition, newer techniques that use advanced MRI are emerging and providing exciting new tools for assessing the spinal cord in patients with degenerative cervical myelopathy. PMID:27246488

  1. Phosphorylated neurofilament subunit levels in the serum of cervical compressive myelopathy patients.

    PubMed

    Kato, So; Chikuda, Hirotaka; Ohya, Junichi; Hayakawa, Kentaro; Takeshita, Katsushi; Tanaka, Sakae; Ogata, Toru

    2015-10-01

    We investigated the serum levels of the phosphorylated form of the high molecular weight neurofilament subunit (pNF-H) in patients with cervical compressive myelopathy. pNF-H is becoming increasingly recognized as a biomarker for axonal injury, however, it remains unclear whether serum pNF-H is elevated in chronic spinal cord compression. We examined 26 patients who underwent surgery for cervical compressive myelopathy. Peripheral blood samples were obtained both preoperatively and 1 week after surgery to evaluate the serum pNF-H levels using an enzyme-linked immunosorbent assay. A history of recent aggravation of myelopathy was also investigated. Of the 26 myelopathy patients, the preoperative serum pNF-H level was negative in 20 patients and moderately elevated in six. Patients who were positive for pNF-H were more likely to have had a recent aggravation of myelopathy compared with the pNF-H negative patients (83 versus 25%; p=0.02). All patients who were positive for pNF-H before surgery remained positive after surgery. Two patients who became positive after surgery demonstrated a neurologic deterioration associated with the surgery. In conclusion, the serum pNF-H level was negative in the majority of patients with cervical compressive myelopathy. Our results suggest that an elevated serum level of pNF-H is associated with an acute worsening of myelopathy and that a positive conversion of pNF-H after surgery is a marker of perioperative neural damage. PMID:26195334

  2. Myelopathy Caused by Soft Cervical Disc Herniation : Surgical Results and Prognostic Factors

    PubMed Central

    Kim, Young-Jin; Yi, Hyeong-Joong; Kim, Young-Soo; Ko, Yong; Oh, Suck Jun

    2007-01-01

    Objective The purpose of this study was to investigate the surgical results and prognostic factors for patients with soft cervical disc herniation with myelopathy. Methods During the last 7 years, 26 patients with cervical discogenic myelopathy were undertaken anterior discectomy and fusion. Clinical and radiographic features were reviewed to evaluate the surgical results and prognostic factors. The clinical outcome was judged using two grading systems (Herkowitz's scale and Nurick's grade). Results Male were predominant (4:1), and C5-6 was the most frequently involved level. Gait disturbance, variable degree of spasticity, discomfort in chest and abdomen, hand numbness were the most obvious signs. Magnetic resonance(MR) images showed that central disc herniation was revealed in 16 cases, and accompanying cord signal changes in 4. Postoperatively, 23 patients showed favorable results (excellent, good and fair) according to Herkowitz's scale. Conclusion Anterior cervical discectomy and fusion effectively reduced myelopathic symptoms due to soft cervical disc herniation. The authors assured that the shorter duration of clinical attention, the lesser the degree of myelopathy and better outcome in discogenic myelopathy. PMID:19096586

  3. Development of a functional scoring system for rheumatoid arthritis patients with cervical myelopathy.

    PubMed Central

    Casey, A T; Bland, J M; Crockard, H A

    1996-01-01

    OBJECTIVE: To be able to measure disability objectively in rheumatoid arthritis complicated by cervical myelopathy. METHODS: The responses to the Stanford health assessment questionnaire disability index were recorded from 250 consecutive patients (group 1) referred to our unit for spinal surgery. Using principal components analysis the questionnaire was reduced from 20 questions to 10 questions. In the second part of the study, the results of the questionnaire for those patients undergoing surgery from the original group of 250 patients were analysed with respect to outcome. RESULTS: The reduction in the number of questions results in no significant loss of information, reliability (internal consistency Cronbach's alpha = 0.968) or sensitivity. The new scale, the myelopathy disability index, measures only one dimension (Eigen value 6.97) and may be more finely tuned to the measurement of disability in these myelopathic patients. When administered to the 194 patients undergoing cervical spine (group 2) surgery the myelopathy disability index was an accurate predictor of neurological and functional outcome, as well as survival following surgery (P < 0.0001). CONCLUSIONS: The myelopathy disability index provides a much needed objective and reliable means of assessing disability in patients with rheumatoid involvement of the cervical spine and also in predicting outcome following surgical intervention. It also provides information for both the patient and surgeon alike, on what to realistically expect from surgery. Its adoption should facilitate comparisons between different forms of surgical intervention. PMID:9014584

  4. One stage laminoplasty and posterior herniotomy for the treatment of myelopathy caused by cervical stenosis with cervical disc herniation

    PubMed Central

    Yue, Bin; Chen, Bohua; Ma, Xue-Xiao; Xi, Yong-Ming; Xiang, Hong-Fei; Hu, You-Gu; Zhang, Guoqing

    2015-01-01

    The aim of the study was to introduce a method of one stage laminoplasty and posterior herniotomy for myelopathy caused by cervical stenosis with cervical disc herniation and to evaluate the clinical efficacy of this surgery. From 1999 to 2008, 18 patients with myelopathy caused by cervical stenosis with cervical disc herniation who underwent this procedure were included. The average age was 63 years (range 48-74 years), and the average follow-up period was 46 months (range 3-108 months). Neurologic status was evaluated using the JOA scoring system. Neurological symptoms improvement was seen in all patients after surgery. The average JOA score was 14.22±1.86 by final follow-up, which was higher than preoperative values (P<0.01), and the average improvement in neurological function was 76.63%. Neurologic examination showed that excellent results had been obtained by 10 patients, good results by 8 patients, with no fair or poor results. 2 patients developed cerebrospinal fluid leakage after surgery and recovered during the follow-up period. One patient with cervical disc herniation developed postoperative C5 palsy on the axle side on the third day after surgery. She completely recovered by 1 month after surgery. No other patients experienced postoperative neurologic complications. Complete anterior and posterior decompression of the spinal cord was achieved after surgery. We concluded that one stage laminoplasty and posterior herniotomy is an effective, reliable, and safe procedure for the treatment of myelopathy caused by cervical stenosis with cervical disc herniation. PMID:26309625

  5. Compressive myelopathy of the cervical spine in Komodo dragons (Varanus komodoensis).

    PubMed

    Zimmerman, Dawn M; Douglass, Michael; Sutherland-Smith, Meg; Aguilar, Roberto; Schaftenaar, Willem; Shores, Andy

    2009-03-01

    Cervical subluxation and compressive myelopathy appears to be a cause of morbidity and mortality in captive Komodo dragons (Varanus komodoensis). Four cases of cervical subluxation resulting in nerve root compression or spinal cord compression were identified. Three were presumptively induced by trauma, and one had an unknown inciting cause. Two dragons exhibited signs of chronic instability. Cervical vertebrae affected included C1-C4. Clinical signs on presentation included ataxia, ambulatory paraparesis or tetraparesis to tetraplegia, depression to stupor, cervical scoliosis, and anorexia. Antemortem diagnosis of compression was only confirmed with magnetic resonance imaging or computed tomography. Treatment ranged from supportive care to attempted surgical decompression. All dragons died or were euthanatized, at 4 days to 12 mo postpresentation. Studies to define normal vertebral anatomy in the species are necessary to determine whether the pathology is linked to cervical malformation, resulting in ligament laxity, subsequent instability, and subluxation. PMID:19368265

  6. MRI findings in Hirayama's disease: flexion-induced cervical myelopathy or intrinsic motor neuron disease?

    PubMed

    Schröder, R; Keller, E; Flacke, S; Schmidt, S; Pohl, C; Klockgether, T; Schlegel, U

    1999-11-01

    Hirayama's disease is a benign juvenile form of focal amyotrophy affecting the upper limbs. Previous studies have suggested that the disorder is a neck flexion induced cervical myelopathy. We report clinical and magnetic resonance imaging findings in nine patients with Hirayama's disease. Cervical imaging of seven patients revealed spinal cord changes consisting of focal atrophy and foci of signal alterations. On neck flexion a forward movement and mild reduction in the anteroposterior diameter of the lower cervical cord against the vertebral bodies was noted in affected individuals as well as in five normal controls. In contrast to earlier reports, none of our patients showed complete obliteration of the posterior subarachnoid space. Measurement of the anteroposterior spinal cord diameter in each vertebral segment (C4-C7) revealed no significant differences in the degree of spinal cord flattening between the two groups. Furthermore, two of our patients had significant degenerative changes in the cervical spine (disc herniation, retrospondylosis) contralateral to the clinically affected side. These degenerative changes resulted in a marked cord compression on neck flexion but were not associated with ipsilateral clinical abnormalities or spinal cord alterations. Our results argue against a flexion-induced cervical myelopathy and support the view that Hirayama's disease is an intrinsic motor neuron disease. PMID:10631640

  7. Clinical Case Report of Expansive Laminoplasty for Cervical Myelopathy Due to Both Disc Herniation and Developmental Cervical Spinal Canal Stenosis in Older Adolescents

    PubMed Central

    Zhou, Hua; Sun, Yu; Zhang, Fengshan; Dang, Gengting; Liu, Zhongjun

    2016-01-01

    Abstract Reports on adolescent patients with cervical myelopathy who underwent anterior cervical discectomy and fusion are scarce. However, to our knowledge, no cases of expansive laminoplasty for cervical myelopathy associated with progressive neurological deficit after a series of conservative treatment, caused by both disc herniation and developmental cervical spinal canal stenosis, have been reported. From January 2006 to July 2012, we retrospectively studied 3 patients in late adolescence presenting with cervical myelopathy who underwent expansive unilateral open-door laminoplasty at our hospital. The outcomes after the surgery were evaluated according to the Japanese Orthopedic Association scores. Symptoms presented by these patients were due to both disc herniation and developmental cervical spinal canal stenosis. No major complications occurred after the surgical procedures. The median follow-up time was 66 months (range 36–112 months). The Japanese Orthopedic Association scores after surgery showed a significant increase. Long-term outcomes after surgery were satisfactory according to the evaluation criteria for the Japanese Orthopedic Association scores. However, the ranges of motion of the cervical spine decreased, especially the ranges of motion on flexion after surgery showed a significant decrease. Expansive laminoplasty is helpful for older adolescent patients with cervical myelopathy due to both disc herniation and developmental cervical spinal canal stenosis, presenting with progressive neurological deficit after long conservative treatment. PMID:26937923

  8. Clinical Case Report of Expansive Laminoplasty for Cervical Myelopathy Due to Both Disc Herniation and Developmental Cervical Spinal Canal Stenosis in Older Adolescents.

    PubMed

    Zhou, Hua; Sun, Yu; Zhang, Fengshan; Dang, Gengting; Liu, Zhongjun

    2016-02-01

    Reports on adolescent patients with cervical myelopathy who underwent anterior cervical discectomy and fusion are scarce. However, to our knowledge, no cases of expansive laminoplasty for cervical myelopathy associated with progressive neurological deficit after a series of conservative treatment, caused by both disc herniation and developmental cervical spinal canal stenosis, have been reported.From January 2006 to July 2012, we retrospectively studied 3 patients in late adolescence presenting with cervical myelopathy who underwent expansive unilateral open-door laminoplasty at our hospital. The outcomes after the surgery were evaluated according to the Japanese Orthopedic Association scores.Symptoms presented by these patients were due to both disc herniation and developmental cervical spinal canal stenosis. No major complications occurred after the surgical procedures. The median follow-up time was 66 months (range 36-112 months). The Japanese Orthopedic Association scores after surgery showed a significant increase. Long-term outcomes after surgery were satisfactory according to the evaluation criteria for the Japanese Orthopedic Association scores. However, the ranges of motion of the cervical spine decreased, especially the ranges of motion on flexion after surgery showed a significant decrease.Expansive laminoplasty is helpful for older adolescent patients with cervical myelopathy due to both disc herniation and developmental cervical spinal canal stenosis, presenting with progressive neurological deficit after long conservative treatment. PMID:26937923

  9. Laminoplasty Techniques for the Treatment of Multilevel Cervical Stenosis

    PubMed Central

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

    2012-01-01

    Laminoplasty is one surgical option for cervical spondylotic myelopathy. It was developed to avoid the significant risk of complications associated with alternative surgical options such as anterior decompression and fusion and laminectomy with or without posterior fusion. Various laminoplasty techniques have been described. All of these variations are designed to reposition the laminae and expand the spinal canal while retaining the dorsal elements to protect the dura from scar formation 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. PMID:22496982

  10. Magnetic resonance imaging features of cervical stenotic myelopathy in 21 dogs.

    PubMed

    Lipsitz, D; Levitski, R E; Chauvet, A E; Berry, W L

    2001-01-01

    The cervical spine of 21 dogs with clinical signs of cervical stenotic myelopathy was evaluated using magnetic resonance (MR) imaging. Spin echo T1, T2 and gradient echo T2 weighted images were obtained with a 1.5 Tesla magnet in 12 dogs and a 1.0 Tesla magnet in 9 dogs. Sagittal or parasagittal T1W and T2W images were helpful in determining the presence of spinal cord compression or degenerative disease of the articular processes. Transverse T1W and T2W images were the most useful for the identification of dorsolateral spinal cord compression secondary to soft tissue and ligament hypertrophy, as well as synovial cysts, associated with the articular processes. The MR imaging findings were consistent with the surgical findings in all 14 dogs that underwent surgery. Magnetic resonance imaging provided a safe, non-invasive method of evaluating the cervical spine in dogs suspected of having cervical stenotic myelopathy. Veterinary PMID:11245233

  11. Angiographically proven cervical venous engorgement: a possible concurrent cause in the pathophysiology of Hirayama's myelopathy.

    PubMed

    Ciceri, Elisa F; Chiapparini, Luisa; Erbetta, Alessandra; Longhi, Laura; Cicardi, Benedetta; Milani, Nicoletta; Solero, Carlo Lazzaro; Savoiardo, Mario

    2010-12-01

    The objective of this study is to discuss the possible role of cervical posterior epidural plexus engorgement during cervical flexion in the pathogenesis of Hirayama myelopathy. In Hirayama disease, MRI during neck flexion often shows that the posterior dura detaches from the posterior arches compressing the spinal cord. Autopsies demonstrated asymmetric changes in the anterior horns consistent with chronic ischemic damage, attributed to arterial insufficiency during flexion or to microcirculatory changes due to compression by the tight dura. In a 15-year-old patient with 5-year history of distal upper limbs weakness, MRI demonstrated marked venous engorgement of the posterior epidural plexus in cervical flexion, confirmed by angiography. Laminectomy from C3 to C6 with duraplasty was performed. At one-year follow-up, the clinical condition of the patient remained stable. In Hirayama myelopathy, compression of the spinal cord by the tight dura is probably the most important pathogenetic factor. However, venous congestion in flexion might play an additional role in determining spinal cord ischemic changes. PMID:20857161

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

    PubMed Central

    2013-01-01

    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 < 0.01) and surgical time (CA, 95.1 min; MELF, 24.0 min; P < 0.01) were significantly longer in the CA cases. Shorter hospitalized days (CA, 1.1 days; MELF, 0.13 days; P < 0.01) and less estimated blood loss (EBL; CA, 75.8 ml; MELF, 31.9 ml; P < 0.01) were observed in the MELF group. Both CA and MELF groups showed significant improvement in NDI, VAS of neck pain and arm pain, and SF-36 (P < 0.05 for each) at 1.5, 3, 6, 12, and 24 months after surgery, but there was no significant difference between them (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. PMID:24341633

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

    PubMed Central

    Aggarwal, Rishi Anil; Srivastava, Sudhir Kumar; Bhosale, Sunil Krishna; Nemade, Pradip Sharad

    2016-01-01

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

  14. Cervicothoracic Arachnoid Cyst Causing Cervical Myelopathy: A Case Report

    PubMed Central

    Kizilay, Zahir; Yilmaz, Ali; Ozkul, Ayca; Ismailoglu, Ozgur

    2015-01-01

    Several types of intraspinal cyst develop within the spinal canal from the craniovertebral junction to the sacrum. These lesions occur in both children and adults. Arachnoid cysts are one of them and are more frequent in the paediatric population, being a relatively uncommon lesion in adults. The arachnoid cyst may be located intradurally or extradurally. The intradural type may be congenital or from spinal trauma, infection or spondylosis. Although intradural arachnoid cysts are often asymptomatic, they may give early symptoms when they exist with synchronous pathologies constricting the spinal canal gradually as in cervical spondylosis. In this report, a 60-year-old man with an arachnoid cyst of the cervicothoracic spine is presented. His cyst remained undiagnosed because of the nonspecific nature of the symptoms. It was only when he developed right hemiparesis that a posterior fluid collection compressing the spinal cord was found in Magnetic resonance imaginig. An intradural extramedullary cyst was removed with successful surgery and cord compression and symptoms were reversed. We discuss radiological diagnosis and surgical treatment of an arachnoid cyst in this report. PMID:27275210

  15. Laminoplasty versus laminectomy and fusion for multilevel cervical compressive myelopathy: A meta-analysis.

    PubMed

    Liu, Feng-Yu; Yang, Si-Dong; Huo, Li-Shuang; Wang, Tao; Yang, Da-Long; Ding, Wen-Yuan

    2016-06-01

    This is a meta-analysis to compare the results between laminoplasty and laminectomy followed by fusion for the patients with multilevel cervical compressive myelopathy. An extensive search of literature was performed in MEDLINE, Embase, the Cochrane library, CNKI, and WANFANG. The following outcome measures were extracted: the Japanese Orthopaedic Association (JOA) scores, cervical curvature index (CCI), visual analog scale (VAS), cervical lordosis (C2-7), complications, blood loss, and operation time. Data analysis was conducted with RevMan 5.3 and STATA 12.0. A total of 23 studies comprising 774 and 743 patients treated with laminoplasty and laminectomy followed by fusion, respectively, were included in the final analysis. The pooled analysis showed that there was no significant difference in preoperative JOA scores [P = 0.89], postoperative JOA scores [P = 0.13], JOA scores improvement rate [P = 0.27], preoperative CCI [P = 0.15], postoperative CCI [P = 0.14], preoperative VAS [P = 0.41], postoperative VAS [P = 0.52], preoperative cervical lordosis (C2-7) [P = 0.46], postoperative cervical lordosis (C2-7) [P = 0.67], total complications [P = 0.07], axial pain [P = 0.94], and blood loss [P = 0.51]. However, there were significant difference in operation time (WMD = -19.57 [-32.11, -7.02], P = 0.002) and C5 palsy (OR = 0.26 [0.15, 0.44], P < 0.001). As compared with laminectomy followed by fusion, expansive laminoplasty showed no significant differences in JOA scores, CCI, ROM, VAS, cervical lordosis (C2-7), axial pain, total complications, and blood loss, but shorter operation time and fewer C5 palsy. PMID:27281067

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

    PubMed

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

    2015-08-01

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

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

    PubMed Central

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

    2016-01-01

    Study Design Single-center retrospective study. Purpose To clarify the clinical features of cervical myelopathy at the C1–2 level. Overview of Literature Methods for distinguishing the affected level based on myelomere symptoms or dysfunction of the conducting pathway were established. However, no symptoms have been identified as being specific to the C1–2 level segment. Methods We evaluated 24 patients with cervical myelopathy due to spinal cord compression at the C1–2 level. Preoperative neurological assessment were investigated and compared with the rate and site of compression of the spinal cord using computed tomography-myelography. Results Impaired temperature and pain sensation were confirmed in 18 of the 24 patients with that localized to the upper arms (n=3), forearm (n=9), both (n=2), and whole body (n=4). Muscle weakness was observed in 18 patients, muscle weakness extended from the biceps brachii to the abductor digiti minimi in 10 patients, and in the whole body in 8 patients. Deep tendon reflexes were normal in 10 patients, whereas hyperactive deep tendon reflexes were noted in 14 patients. The rate of spinal cord compression was significantly higher in patients with perceptual dysfunction and muscle weakness compared with those with no dysfunction. However, no significant difference in the rate and site of compression was identified in those with dysfunction. Conclusions Perceptual dysfunction and muscle weakness localized to the upper limbs was observed in 58% and 42% of patients, respectively. Neurological abnormalities, such as perceptual dysfunction and muscle weakness, were visualized in patients with marked compression. PMID:27559458

  18. Cervical anterior hybrid technique with bi-level Bryan artificial disc replacement and adjacent segment fusion for cervical myelopathy over three consecutive segments.

    PubMed

    Chen, Jiang; Xu, Lin; Jia, Yu-Song; Sun, Qi; Li, Jin-Yu; Zheng, Chen-Ying; Bai, Chun-Xiao; Yu, Qin-Sheng

    2016-05-01

    This study aimed to assess the preliminary clinical efficacy and feasibility of the hybrid technique for multilevel cervical myelopathy. Considering the many shortcomings of traditional treatment methods for multilevel cervical degenerative myelopathy, hybrid surgery (bi-level Bryan artificial disc [Medtronic Sofamor Danek, Memphis, TN, USA] replacement and anterior cervical discectomy and fusion) should be considered. Between March 2006 and November 2012, 108 patients (68 men and 40 women, average age 45years) underwent hybrid surgery. Based on the Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), and Odom's criteria, the clinical symptoms and neurological function before and after surgery were evaluated. Mean surgery duration was 90minutes, with average blood loss of 30mL. Mean follow-up duration was 36months. At the final follow-up, the mean JOA (± standard deviation) scores were significantly higher compared with preoperative values (15.08±1.47 versus 9.18±1.22; P<0.01); meanwhile, NDI values were markedly decreased (12.32±1.03 versus 42.68±1.83; P<0.01). Using Odom's criteria, the clinical outcomes were rated as excellent (76 patients), good (22 patients), fair (six patients), and poor (four patients). These findings indicate that the hybrid method provides an effective treatment for cervical myelopathy over three consecutive segments, ensuring a good clinical outcome. PMID:26758702

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

    PubMed

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

    2016-09-01

    Background A considerable number of patients with cervical spondylosis complain about one or multiple atypical symptoms such as vertigo, palpitations, headache, blurred vision, hypomnesia, and/or nausea. It remains unclear whether surgical intervention for cervical spondylosis can also effectively alleviate those symptoms. The current study was performed to see if anterior cervical diskectomy and fusion (ACDF) offers such an extra benefit for patients with cervical spondylosis. Objective To investigate if patients who received ACDF for the treatment of cervical spondylotic myelopathy and/or radiculopathy can also achieve alleviation of certain atypical symptoms associated with cervical spondylosis after the surgery in the long run. Methods Sixty-seven patients who underwent ACDF for the treatment of cervical spondylotic myelopathy and/or radiculopathy were involved in this study. All these patients also complained about various associated atypical symptoms. They were followed up for 26 to 145 months after the surgery. Severity and frequency scores of the atypical symptoms before the surgery and at last follow-up were compared by paired t tests. Results Most patients reported significantly alleviated symptoms at the last follow-up compared with before the surgery. The severity of vertigo, headache, nausea, and palpitations were significantly alleviated at the last follow-up (with p values of p < 0.001, p = 0.001, p = 0.022, p = 0.004, respectively). There were no significant changes in the severity of tinnitus (p = 0.182), blurred vision (p = 0.260), and hypomnesia (p = 0.821). Conclusion ACDF can significantly alleviate vertigo, headache, nausea, and palpitations in most patients with cervical spondylotic myelopathy and/or radiculopathy, but it is not effective in alleviating symptoms such as tinnitus, blurred vision, and hypomnesia. It can be considered for alleviating atypical symptoms when other treatment options prove

  20. Our technique of midsagittal splitting laminoplasty for compressive cervical myelopathy and its short-term results

    PubMed Central

    Srivastava, Niraj Kumar; Singh, Sunita; Chauhan, Shishu Pal Singh; Gopal, Nitya Nand

    2016-01-01

    Objective: The aim of this study was to discuss the technique of midsagittal splitting laminoplasty and to compare its short-term follow-up results with laminectomy in cases of compressive cervical spinal cord myelopathy. Materials and Methods: Exclusion criteria were as follows: Intramedullary compressive lesions, kyphotic cervical spine, previous spinal surgeries, and defective anterior vertebral column. Twenty patients (10 each of laminoplasty and laminectomy groups) were prospectively studied from 2005 to 2008. After clinico-radiological assessment, laminoplasty or laminectomy was performed in patients aged <50 years and >50 years, respectively. The laminoplasty was performed by splitting the excised lamina in midline up to the tip of spinous process. Follow-up was done by neurosurgical cervical spine scoring, Nurick's grading, and the final outcome was determined by Odom's criteria. Results: The mean operative time and blood loss in laminoplasty and laminectomy was 100 ± 0.87 (range 90-140 min), 80 ± 0.67 (range 75-100 min) P = 0.04; and 65 ± 0.07 (range 60-90 ml) and 68 ± 0.61 (range 65-80 ml) P = 0.09, respectively. There were no intraoperative accidents, and no postoperative neurological deterioration/recurrence of symptoms. One patient who underwent laminectomy alone developed progressive kyphosis of the spine, whereas one having rheumatoid arthritis and long symptom duration didn’t improve. 85% (17/20 patients) had sustained excellent to fair outcome (improvement by at least one Nurick's grade). Conclusions: The technique used by us was simple, effective, and inexpensive. There was no minimal postoperative morbidity, although long-term results are awaited. PMID:27366246

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

    PubMed

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

    2015-09-01

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

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

    PubMed Central

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

    2015-01-01

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

  3. Prognostic Value of Preoperative Coping Strategies for Pain in Patients with Residual Neuropathic Pain after Laminoplasty for Compressive Cervical Myelopathy

    PubMed Central

    2015-01-01

    Study Design Single-center retrospective cohort study. Purpose To clarify the prognostic value of preoperative coping strategies for pain due to compressive cervical myelopathy. Overview of Literature Preoperative physical function, imaging and electrophysiological findings are known predictors of surgical outcomes. However, coping strategies for pain have not been considered. Methods Postoperative questionnaires, concerning health-related quality of life (HRQOL) and daily living activities, were sent to 78 patients with compressive cervical myelopathy who had suffered from neuropathic pain before laminoplasty, and been preoperatively assessed with respect to their physical and mental status and coping strategies for pain. Hierarchical multiple regression analysis was performed to clarify the extent to which the patient's preoperative coping strategies could explain the variance in postoperative HRQOL and activity levels. Results Forty-two patients with residual neuropathic pain after laminoplasty were analyzed by questionnaires (28 men, 14 women; mean age, 62.7±10.2 years; symptom duration, 48.0±66.0 months). The valid response rate was 53.8%. Hierarchical multiple regression analysis showed that preoperative coping strategies, which involved coping self-statements, diverting attention, and catastrophizing, were independently associated with postoperative HRQOL and activity level, and could explain 7% to 11% of their variance. Combinations of the coping strategies for pain and upper/lower motor functions could explain 26% to 36% of the variance in postoperative HRQOL and activity level. Conclusions Preoperative coping strategies for pain are good predictors of postoperative HRQOL and activities of daily living in patients with postoperative residual neuropathic pain due to compressive cervical myelopathy. PMID:26435783

  4. [Syringomyelobulbia associated with cervical spondylosis. Pathophysiology and therapeutic implications].

    PubMed

    Rebai, R; Boudawara, M Z; Ben Yahia, M; Mhiri, C; Ben Mansour, H

    2002-05-01

    Spinal spondylosis is rarely implicated in syringomyelia. We report the case of a 70-year-old patient with a 10-year history of gait disturbance; constrictive pain of lower limbs and urinary incontinance. Physical examination disclosed spastic tetraparesis. In the upper limbs, deep tendon reflexes were abolished, with hyposthesia and hands amyotrophy. Brain and cervical MRI showed syringomyelobulbia with cervical spondylotic myelopathy. Extensive cervical laminectomy induced a mild clinical improvement. A second MRI performed 6 months after surgery depicted a complete disappearance of the bulbo-medullar cavitation with secondary atrophy. Extradural spondylotic compression of the spinal cord should be firmly considered as an etiology of syringomyelia. A purely extradural decompression could be sufficient to induce regression of the medullary cavitation. PMID:12053170

  5. 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

    PubMed Central

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

    1999-01-01

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

 Keywords: rheumatoid arthrits; rheumatoid subaxial subluxation PMID:10343530

  6. Scheie syndrome: enzyme replacement therapy does not prevent progression of cervical myelopathy due to spinal cord compression.

    PubMed

    Illsinger, S; Lücke, T; Hartmann, H; Mengel, E; Müller-Forell, W; Donnerstag, F; Das, A M

    2009-12-01

    Hurler-Scheie syndrome is caused by alpha-l-iduronidase deficiency. Enzyme replacement therapy (ERT) can improve physical capacity and reduces organomegaly. However, the effect on bradytrophic connective tissue is limited. As intravenously administered enzyme cannot cross the blood-brain barrier, the therapy of choice for the more severe Hurler syndrome is haematopoietic stem cell transplantation (HCT). In the more attenuated Scheie syndrome, neurological impairment is less severe; therefore, ERT may be appropriate to treat these patients. Information on long-term outcome in Scheie patients undergoing ERT is scarce. We report a 38-year-old female Scheie patient who has been on ERT for 8 years. While non-neurological symptoms improved, she developed paresthesias in her hands and feet and progressive pain in her legs. Somatosensory evoked potentials were abnormal, suggesting dysfunction of the dorsal funiculus and lemniscus medialis. After 6 years of ERT, a spinal MRI showed dural thickening at the upper cervical spine. These soft-tissue deposits are presumably due to the accumulation of mucopolysaccharides. Intramedullary hyperintensities at the level of C1/2 revealed cervical myelopathy. An MRI before the start of ERT had shown milder spinal lesions. Cystic lesions in the white matter of the centrum semiovale due to dilated Virchow-Robin spaces were essentially unchanged compared with the MRI scan before ERT. Decompression of the spinal cord resulted in clinical improvement. In an adult patient with Scheie syndrome, ERT failed to prevent progression of cervical myelopathy. Clinical significance of cerebral changes is unclear. Whether early HCT or intrathecal ERT could have prevented these lesions remains speculative. PMID:19894140

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

    PubMed

    Evans, Linton T; Lollis, S Scott

    2015-01-01

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

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

    PubMed Central

    Evans, Linton T.; Lollis, S. Scott

    2015-01-01

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

  9. A comparison of minimally invasive posterior cervical decompression and open anterior cervical decompression and instrumented fusion in the surgical management of degenerative cervical myelopathy.

    PubMed

    Abbas, Syed F; Spurgas, Morgan P; Szewczyk, Benjamin S; Yim, Benjamin; Ata, Ashar; German, John W

    2016-06-01

    OBJECTIVE Minimally invasive posterior cervical decompression (miPCD) has been described in several case series with promising preliminary results. The object of the current study was to compare the clinical outcomes between patients undergoing miPCD with anterior cervical discectomy and instrumented fusion (ACDFi). METHODS A retrospective study of 74 patients undergoing surgery (45 using miPCD and 29 using ACDFi) for myelopathy was performed. Outcomes were categorized into short-term, intermediate, and long-term follow-up, corresponding to averages of 1.7, 7.7, and 30.9 months, respectively. Mean scores for the Neck Disability Index (NDI), neck visual analog scale (VAS) score, SF-12 Physical Component Summary (PCS), and SF-12 Mental Component Summary (MCS) were compared for each follow-up period. The percentage of patients meeting substantial clinical benefit (SCB) was also compared for each outcome measure. RESULTS Baseline patient characteristics were well-matched, with the exception that patients undergoing miPCD were older (mean age 57.6 ± 10.0 years [miPCD] vs 51.1 ± 9.2 years [ACDFi]; p = 0.006) and underwent surgery at more levels (mean 2.8 ± 0.9 levels [miPCD] vs 1.5 ± 0.7 levels [ACDFi]; p < 0.0001) while the ACDFi patients reported higher preoperative neck VAS scores (mean 3.8 ± 3.0 [miPCD] vs 5.4 ± 2.6 [ACDFi]; p = 0.047). The mean PCS, NDI, neck VAS, and MCS scores were not significantly different with the exception of the MCS score at the short-term follow-up period (mean 46.8 ± 10.6 [miPCD] vs 41.3 ± 10.7 [ACDFi]; p = 0.033). The percentage of patients reporting SCB based on thresholds derived for PCS, NDI, neck VAS, and MCS scores were not significantly different, with the exception of the PCS score at the intermediate follow-up period (52% [miPCD] vs 80% [ACDFi]; p = 0.011). CONCLUSIONS The current report suggests that the optimal surgical strategy in patients requiring dorsal surgery may be enhanced by the adoption of a minimally invasive

  10. The value of preoperative magnetic resonance imaging in predicting postoperative recovery in patients with cervical spondylosis myelopathy: a meta-analysis

    PubMed Central

    Chen, Hui; Pan, Jun; Nisar, Majid; Zeng, Huan Bei; Dai, Li Fang; Lou, Chao; Zhu, Si Pin; Dai, Bing; Xiang, Guang Heng

    2016-01-01

    This meta-analysis was designed to elucidate whether preoperative signal intensity changes could predict the surgical outcomes of patients with cervical spondylosis myelopathy on the basis of T1-weighted and T2-weighted magnetic resonance imaging images. We searched the Medline database and the Cochrane Central Register of Controlled Trials for this purpose and 10 studies meeting our inclusion criteria were identified. In total, 650 cervical spondylosis myelopathy patients with (+) or without (-) intramedullary signal changes on their T2-weighted images were examined. Weighted mean differences and 95% confidence intervals were used to summarize the data. Patients with focal and faint border changes in the intramedullary signal on T2 magnetic resonance imaging had similar Japanese Orthopaedic Association recovery ratios as those with no signal changes on the magnetic resonance imaging images of the spinal cord did. The surgical outcomes were poorer in the patients with both T2 intramedullary signal changes, especially when the signal changes were multisegmental and had a well-defined border and T1 intramedullary signal changes compared with those without intramedullary signal changes. Preoperative magnetic resonance imaging including T1 and T2 imaging can thus be used to predict postoperative recovery in cervical spondylosis myelopathy patients. PMID:27074180

  11. Comparison of two anterior fusion methods in two-level cervical spondylosis myelopathy: a meta-analysis

    PubMed Central

    Huang, Zhe-Yu; Wu, Ai-Min; Li, Qing-Long; Lei, Tao; Wang, Kang-Yi; Xu, Hua-Zi; Ni, Wen-Fei

    2014-01-01

    Objective The aim of this study was to evaluate the efficacy and safety of anterior cervical corpectomy and fusion (ACCF) and anterior cervical discectomy and fusion (ACDF) for treating two-adjacent-level cervical spondylosis myelopathy (CSM). Design A meta-analysis of the two anterior fusion methods was conducted. The electronic databases of PubMed, the Cochrane Central Register of Controlled Trials, ScienceDirect, CNKI, WANFANG DATA and CQVIP were searched. Quality assessment of the included studies was evaluated using the Cochrane Risk of Bias Tool and the Methodological Index for Non-Randomised Studies criteria. Pooled risk ratios of dichotomous outcomes and standardised mean differences (SMDs) of continuous outcomes were generated. Using the χ2 and I2 tests, the statistical heterogeneity was assessed. Subgroup and sensitivity analyses were also performed. Participants Nine eligible trials with a total of 631 patients and a male-to-female ratio of 1.38:1 were included in this meta-analysis. Inclusion criteria Randomised controlled trials (RCTs) and non-randomised controlled trials that adopted ACCF and ACDF to treat two-adjacent-level CSM were included. Results No significant differences were identified between the two groups regarding hospital stay, the Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) scores for neck and arm pain, total cervical range of motion (ROM), fusion ROM, fusion rate, adjacent-level ossification and complications, while ACDF had significantly less bleeding (SMD=1.14, 95% CI (0.74 to 1.53)); a shorter operation time (SMD=1.13, 95% CI (0.82 to 1.45)); greater cervical lordosis, total cervical (SMD=−2.95, 95% CI (−4.79 to −1.12)) and fused segment (SMD=−2.24, 95% CI (−3.31 to −1.17)); higher segmental height (SMD=−0.68, 95% CI (−1.03 to −0.34)) and less graft subsidence (SMD=0.40, 95% CI (0.06 to 0.75)) compared to ACCF. Conclusions The results suggested that ACDF has more advantages compared to

  12. Prediction of the efficacy of surgical intervention in patients with cervical myelopathy by using diffusion tensor 3T-magnetic resonance imaging parameters

    PubMed Central

    Arima, Hironori; Sakamoto, Shinichi; Naito, Kentaro; Yamagata, Toru; Uda, Takehiro; Ohata, Kenji; Takami, Toshihiro

    2015-01-01

    Background: The clinical significance of diffusion tensor (DT) magnetic resonance imaging (MRI) parameters was analyzed to predict postoperative functional recovery in patients with cervical myelopathy. Materials and Methods: Sixteen patients with cervical myelopathy caused by cervical spondylosis, disk herniation or ossification of the posterior longitudinal ligament who underwent surgical intervention in our institute were enrolled in this retrospective study. There were 7 men and 9 women, with a mean age of 62.8 years. Clinical assessment was done before surgery and at least 3 months after surgery. All patients underwent whole-body 3.0-Tesla MRI before surgery. DT images (DTIs) were obtained using a single-shot fast spin-echo-based sequence. Mean values of mean diffusivity (MD) and fractional anisotropy (FA) at 6 disk levels of the cervical spine were measured using manual setting of regions of interest. The MD and FA values at the most compressed part were analyzed. Absolute MD and FA values at the most compressed spinal level in patients were transformed into the normalized values with a z-score analysis. Results: MD-z may decrease with the severity of cervical myelopathy. Receiver operating characteristic analysis of MD-z and FA-z suggested that both MD-z and FA-z have clinical validity for predicting the efficacy of surgical intervention, but MD-z was considered to be the most appropriate value to predict the efficacy of surgery. Conclusions: DTIs may be a promising modality to predict functional recovery after surgery. MD changes may reflect spinal cord condition and its reversibility. PMID:26288547

  13. The Practical Application of Clinical Prediction Rules: A Commentary Using Case Examples in Surgical Patients with Degenerative Cervical Myelopathy

    PubMed Central

    Tetreault, Lindsay; Le, David; Côté, Pierre; Fehlings, Michael

    2015-01-01

    Study Design Commentary. Objective This commentary aims to discuss the practical applications of a clinical prediction rule (CPR) developed to predict functional status in patients undergoing surgery for the treatment of degenerative cervical myelopathy. Methods Clinical cases from the AOSpine CSM-North America study were used to illustrate the application of a prediction rule in a surgical setting and to highlight how this CPR can be used to ultimately enhance patient care. Results A CPR combines signs and symptoms, patient characteristics, and other predictive factors to estimate disease probability, treatment prognosis, or risk of complications. These tools can influence allocation of health care resources, inform clinical decision making, and guide the design of future research studies. In a surgical setting, CPRs can be used to (1) manage patients' expectations of outcome and, in turn, improve overall satisfaction; (2) facilitate shared decision making between patient and physician; (3) identify strategies to optimize surgical results; and (4) reduce heterogeneity of care and align surgeons' perceptions of outcome with objective evidence. Conclusions Valid and clinically-relevant CPRs have tremendous value in a surgical setting. PMID:26682095

  14. [Anesthetic Management Using Frontal Nerve, Greater Occipital Nerve, and Superficial Cervical Plexus Block for Posterior Cervical Spinal Fusion in a Patient with Athetoid Cerebral Palsy].

    PubMed

    Matsunami, Sayuri; Komasawa, Nobuyasu; Fujiwara, Shunsuke; Fujitate, Yasutaka; Soen, Masako; Minami, Toshiaki

    2015-05-01

    Here, we report successful anesthetic management of posterior cervical spinal fusion utilizing block of the frontal nerve, the greater occipital nerve, and the superficial cervical plexus in a patient with athetoid cerebral palsy. A 69-year-old woman (height 157 cm; weight 33 kg) with athetoid cerebral palsy was scheduled to undergo posterior cervical spinal fusion for cervical spondylotic myelopathy. After induction of general anesthesia, we performed tracheal intubation using the Pentax-AWS Airwayscope with a thin Intlock. After tracheal intubation, we used ropivacaine for the frontal nerve, greater occipital nerve, and superficial cervical plexus block. Anesthetic maintenance was performed with total intravenous anesthesia utilizing propofol and remifentanil. Continuous administration of dexmedetomidine was started during operation. Following surgery, smooth spontaneous ventilation was observed following uneventful extubation. No significant pain and no athetoid movement were observed under continuous administration of dexmedetomidine. PMID:26422967

  15. Postural hypotension in a patient with cervical myelopathy due to craniovertebral anomaly.

    PubMed

    Misra, U K; Kalita, J; Kapoor, R

    1997-10-01

    We report a patient with craniovertebral anomaly leading to cervical cord compression who presented with disabling postural hypotension. A 60-year-old electrician presented with progressive weakness of the upper and lower limbs, which had started 7 years previously. He had difficulty in holding urine for the previous year and had blacked out on standing for the past 3 months. He had upper limb wasting and lower limb spasticity, with impaired joint position sense. Autonomic dysfunctions included postural hypotension, absence of sinus arrhythmia, impaired Valsalva ratio, and lack of increase in blood pressure on cold immersion and isometric contraction. Cervical spine radiograph and magnetic resonance imaging revealed atlantoaxial dislocation, Klippel-Feil syndrome and osteophytes, resulting in cord compression at C2-C4. Partial and selective damage to the descending autonomic fibres may be responsible for postural hypotension in this patient. PMID:9370068

  16. Cervical spondylosis. An update.

    PubMed Central

    McCormack, B M; Weinstein, P R

    1996-01-01

    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. PMID:8855684

  17. Autoimmune myelopathies.

    PubMed

    Flanagan, Eoin P

    2016-01-01

    Autoimmune myelopathies are a heterogeneous group of immune-mediated spinal cord disorders with a broad differential diagnosis. They encompass myelopathies with an immune attack on the spinal cord (e.g., aquaporin-4-IgG (AQP4-IgG) seropositive neuromyelitis optica (NMO) and its spectrum disorders (NMOSD)), myelopathies occurring with systemic autoimmune disorders (which may also be due to coexisting NMO/NMOSD), paraneoplastic autoimmune myelopathies, postinfectious autoimmune myelopathies (e.g., acute disseminated encephalomyelitis), and myelopathies thought to be immune-related (e.g., multiple sclerosis and spinal cord sarcoidosis). Spine magnetic resonance imaging is extremely useful in the evaluation of autoimmune myelopathies as the location of signal change, length of the lesion, gadolinium enhancement pattern, and evolution over time narrow the differential diagnosis considerably. The recent discovery of multiple novel neural-specific autoantibodies accompanying autoimmune myelopathies has improved their classification. These autoantibodies may be pathogenic (e.g., AQP4-IgG) or nonpathogenic and more reflective of a cytotoxic T-cell-mediated autoimmune response (collapsin response mediator protein-5(CRMP5)-IgG). The presence of an autoantibody may help guide cancer search, assist treatment decisions, and predict outcome/relapse. With paraneoplastic myelopathies the initial goal is detection and treatment of the underlying cancer. The aim of immunotherapy in all autoimmune myelopathies is to maximize reversibility, maintain benefits (while preventing relapse), and minimize side effects. PMID:27112686

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

    PubMed

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

    2016-06-01

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

  19. Radiological study of C3–C4 level surgical cases of cervical spondylosis

    PubMed Central

    Tomii, Masato; Mizuno, Junichi; Watanabe, Kazuo

    2016-01-01

    Objective: The purpose of this study was to elucidate the pathological characteristics of C3-C4 cervical spondylotic myelopathy (CSM) from the radiological study. Materials and Methods: A total of 31 patients with single level anterior cervical discectomy and fusion (ACDF) at C3-C4 and 46 patients with single level ACDF at C5-C6 were included in this study. We selected C5-C6 level as a representative of the lower cervical level. The C3-C4 and C5-C6 levels were routinely examined to investigate the areas of the vertebral canal, subarachnoid space, and spinal cord in the cervical canal. Results: The clinical study of C3-C4 ACDF patients showed that as for the C3-C4 area, the area of the cervical vertebral canal, the area of the subarachnoid space, and he transverse surface area of the spinal cord were all significantly smaller in C3-C4 ACDF patients than in C5-C6 ACDF patients. Moreover, as for the C5-C6 area, only the area of the subarachnoid space was significantly smaller in C5-C6 ACDF patients than in C3-C4 ACDF patients. Spondylotic changes predominated at both the C3-C4 and C5-C6 levels. However, in the C5-C6 ACDF patients, spondylotic changes tended to predominate only at the operation level at C5-C6. Conclusions: Aging process develops from lower cervical to upper cervical level. Moreover, this static factor in conjunction with dynamic factor (instability) was the causative factors for the CSM in C3-C4 ACDF patients. PMID:27366255

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

    PubMed

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

    2011-09-01

    Some controversy still exists over the optimal treatment time and the surgical approach for cervical myelopathy due to ossification of the posterior longitudinal ligament (OPLL). The aim of the current study was first to analyze the effect of intramedullary spinal cord changes in signal intensity (hyperintensity on T2-weighted imaging and hypointensity on T1-weighted imaging) on magnetic resonance imaging (MRI) on surgical opportunity and approach for cervical myelopathy due to OPLL. This was a prospective randomized controlled study. Fifty-six patients with cervical myelopathy due to OPLL were enrolled and assigned to either group A (receiving anterior decompression and fusion, n = 27) or group P (receiving posterior laminectomy, n = 29). All the patients were followed up for an average 20.3 months (12-34 months). The clinical outcomes were assessed by the average operative time, blood loss, Japanese Orthopedic Association (JOA) score, improvement rate (IR) and complication. To determine the relevant statistics, we made two factorial designs and regrouped the data of all patients to group H (with hyperintensity on MRI, n = 31), group L (with hypointensity on MRI, n = 19) and group N (no signal on MRI, n = 25), and then to further six subgroups as well: AH (with hyperintensity on MRI from group A, n = 15), PH (with hyperintensity on MRI from group P, n = 16), AL (with hypointensity on MRI from group A, n = 10), PL (with hypointensity on MRI from group P, n = 9), AN (no signal intensity on MRI from group A, n = 12) and PN (no signal intensity on MRI from group P, n = 13). Both hyperintensity on T2-weighted imaging and hypointensity on T1-weighted imaging had a close relationship with the JOA score and IR. The pre- and postoperative JOA score and postoperative IR of either group H or group L was significantly lower than that of group N (P < 0.05), regardless of whether the patients had received anterior or posterior surgery. On the other hand, both the JOA score and

  1. [Cervical myelopathy after low grade distortion of the cervical spine. Possible association with pre-existing spondylosis of the cervical spine].

    PubMed

    Aurich, M; Hofmann, G O; Gras, F M

    2015-04-01

    A patient with spondylosis deformans of the cervical spine with no neurological deficits developed rapidly progressive tetraparesis 1 day after a whiplash injury due to a car accident (rear end collision), although initially there were no clinical symptoms. Surgical decompression and spondylodesis led to relief of the neurological deficits. This case demonstrates that even a low grade whiplash injury (grade 1) can cause severe neurological symptoms later and that a degenerative disease of the spine is a predisposing factor. PMID:25336350

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

    PubMed

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

    2016-09-01

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

  3. Syphilitic myelopathy

    MedlinePlus

    Syphilitic myelopathy is a complication of untreated syphilis that involves muscle weakness and abnormal sensations . ... which is a complication of late or tertiary syphilis infection. Syphilis is a sexually transmitted infection. A ...

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

    PubMed

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

    2016-07-01

    The anatomy of the cervical spine musculature visible on magnetic resonance (MR) images is poorly described in the literature. However, the correct identification of individual muscles is clinically important because certain conditions of the cervical spine, for example whiplash associated disorders, idiopathic neck pain, cervical nerve root avulsion and cervical spondylotic myelopathy, are associated with different morphological changes in specific muscles visible on MR images. Knowledge of the precise structure of different cervical spine muscles is crucial when comparisons with the contralateral side or with normal are required for accurate description of imaging pathology, management and assessment of treatment efficacy. However, learning the intricate arrangement of 27 muscles is challenging. A multi-level cross-sectional depiction combined with three-dimensional reconstructions could facilitate the understanding of this anatomically complex area. This paper presents a comprehensive series of labeled axial MR images from one individual and serves as a reference atlas of the cervical spine musculature to guide clinicians, researchers, and anatomists in the accurate identification of these muscles on MR imaging. Clin. Anat. 29:643-659, 2016. © 2016 Wiley Periodicals, Inc. PMID:27106787

  5. Pulmonary function after surgery for congenital atlantoaxial dislocation: a comparison with surgery for compressive cervical myelopathy and craniotomy.

    PubMed

    Reddy, Kotipi R Madhusudan; Rao, Ganne S Umamaheswara; Devi, Bhagavathula Indira; Prasad, Pilla V S; Ramesh, Venkatapura J

    2009-07-01

    Deterioration of pulmonary function after surgery for congenital atlantoaxial dislocation (AAD) has been documented in a few studies. We proposed that this deterioration in AAD is much higher than what can be expected after a surgical procedure under general anesthesia or what occurs after any surgery on the cervical spine. To test this hypothesis, we recorded forced vital capacity (FVC), forced expiratory ratio (FEV 1.0), forced expiratory flow (FEF 25%-75%) and muscle power in the extremities in 25 patients undergoing surgical correction of AAD (AAD group), 29 patients undergoing surgery for compressive cervical spine lesions (cervical spine group) and 20 patients undergoing craniotomy for an intracranial lesion (craniotomy group). The observations were made before surgery and on postoperative days 1 and 7. The demographic characters were comparable among the 3 groups. All patients underwent an uneventful surgery and their trachea was extubated in the operating room. There was no decrease in the muscle power in the postoperative period in any of the groups. A significant decrease in FVC (expressed as percentage of the predicted value) was seen postoperatively in all the 3 groups. The reduction of FVC was significantly different among the groups, with the AAD group having the lowest values (P<0.001). The FVC values in the AAD group were 74.6+/-19.6%, 49.6+/-17.7%, 64.0+/-20.8% at baseline, on postoperative days 1 and 7, respectively (P<0.001). Postoperative change in forced expiratory ratio was also significantly different among the groups (P=0.03). A significant difference was found between the AAD and cervical spine group (89.8+/-8.3%, 88.2+/-17.6%, 89.3+/-9.8% in the AAD group and 95.5+/-20.5%, 78.4+/-13.4%, 72.7+/-19.1% in the cervical spine group at baseline and on postoperative days 1 and 7, respectively, P<0.05). FEF 25%-75% changes were also significantly different among the groups (P<0.001). The decrease in the AAD and cervical spine groups was

  6. Acute myelopathy with normal imaging.

    PubMed

    Holland, Neil R

    2013-05-01

    A 17-year-old girl presented with rapidly progressive quadriparesis and ventilatory failure. The clinical findings indicated a spinal level, but the diagnosis of myelopathy was not supported by her initial spinal imaging and cerebrospinal fluid studies. She had completed treatment for Guillain-Barré syndrome before a follow-up spinal imaging study showed interval expansion and enhancement of the cervical cord. PMID:22752484

  7. A Case Report of Reiter's Syndrome with Progressive Myelopathy.

    PubMed

    Kim, Soo Kyoung; An, Jae Young; Park, Min Soo; Kim, Byoung Joon

    2007-12-01

    Reiter's syndrome belongs to the family of spondyloarthropathies that usually present with a triad of arthritis, urethritis, and uveitis. The diagnostic criteria include clinical, radiological, and genetic findings, and the response to treatment. Nervous system involvement in Reiter's syndrome is extremely rare. We report here on a 36-year-old man who initially presented with progressive cervical myelopathy and was diagnosed as Reiter's syndrome 2 years later. The myelopathy was stable after treatment with methotrexate and sulfasalazine. This case suggests that Reiter's syndrome can present as progressive myelopathy and should be considered in the differential diagnosis of treatable myelopathies. PMID:19513137

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

    PubMed Central

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

    2016-01-01

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

  9. Clinical and radiologic comparison of dynamic cervical implant arthroplasty and cervical total disc replacement for single-level cervical degenerative disc disease.

    PubMed

    Shichang, Liu; Yueming, Song; Limin, Liu; Lei, Wang; Zhongjie, Zhou; Chunguang, Zhou; Xi, Yang

    2016-05-01

    Anterior cervical discectomy and fusion, to date the most successful spine procedure for the surgical treatment of cervical radiculopathy, has limitations that have led to the development of non-fusion cervical procedures, such as cervical total disc replacement (TDR) and dynamic cervical implant (DCI) arthroplasty. We compared the clinical and radiological results of DCI and cervical TDR for the treatment of single-level cervical degenerative disc disease in Chinese patients. A retrospective review of 179 patients with cervical spondylotic myelopathy who underwent DCI or TDR between April 2010 and October 2012 was conducted, and 152 consecutive patients (67 patients single-level DCI and 85 single-level TDR) who completed at least 2years of follow-up were included. Clinical and radiological assessments were performed preoperatively and at 1week and 3, 6, 12, and 24months postoperatively. The most common operative level was C5/C6 (49.3%). The differences in blood loss, duration of surgery, and duration of hospitalization were not statistically significant. The Japanese Orthopaedic Association scale, Visual Analog Scale, Neck Disability Index, and Short Form-36 scores improved significantly after surgery in both the DCI and TDR groups (P<0.05), but the differences were not statistically significant at the final follow-up. The rate of occurrence of heterotopic ossification was 22.4% and 28.2% in the DCI and TDR groups, respectively. As an effective non-fusion technique, DCI is a more economical procedure. Further prospective, randomized studies with long-term follow-up periods are needed to determine the long-term effects. PMID:26928156

  10. Diffusion tensor imaging in the cervical spinal cord.

    PubMed

    Song, Ting; Chen, Wen-Jun; Yang, Bo; Zhao, Hong-Pu; Huang, Jian-Wei; Cai, Ming-Jin; Dong, Tian-Fa; Li, Tang-Sheng

    2011-03-01

    There are discrepancy between MR findings and clinical presentations. The compressed cervical cord in patients of the spondylotic myelopathy may be normal on conventional MRI when it is at the earlier stage or even if patients had severe symptoms. Therefore, it is necessary to take a developed MR technique--diffusion tensor imaging (DTI)--to detect the intramedullary lesions. Prospective MR and DTI were performed in 53 patients with cervical compressive myelopathy and twenty healthy volunteers. DTI was performed along six non-collinear directions with single-shot spin echo echo-planar imaging (EPI) sequence. Intramedullary apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values were measured in four segments (C2/3, C3/4, C4/5, C5/6) for volunteers, in lesions (or the compressed cord) and normal cord for patients. DTI original images were processed to produce color DTI maps. In the volunteers' group, cervical cord exhibited blue on the color DTI map. FA values between four segments had a significant difference (P < 0.01), with the highest FA value (0.85 ± 0.03) at C2/3 level. However, ADC value between them had no significant difference (P > 0.05). For patients, only 24 cases showed hyperintense on T2-weighted image, while 39 cases shown patchy green signal on color DTI maps. ADC and FA values between lesions or the compressed cord and normal spinal cord of patients had a significant difference (both P < 0.01). FA value at C2/3 cord is the highest of other segments and it gradually decreases towards the caudal direction. Using single-shot spin echo EPI sequence and six non-collinear diffusion directions with b value of 400 s mm(-2), DTI can clearly show the intramedullary microstructure and more lesions than conventional MRI. PMID:20938788

  11. Reflex sympathetic dystrophy following traumatic myelopathy.

    PubMed

    Wainapel, S F

    1984-04-01

    Two cases of reflex sympathetic dystrophy in the upper extremity of patients with traumatic cervical spinal cord injuries are reported. Both patients had very incomplete lesions with early neurological recovery, suggesting an underlying central cord syndrome. Although reflex sympathetic dystrophy is often seen following stroke, it has only rarely been documented in traumatic myelopathy, and it should be considered in the differential diagnosis of unexplained pain syndromes in the extremities of paraplegic or quadriplegic patients. PMID:6728500

  12. Preliminary Experiences of the Combined Midline-Splitting French Door Laminoplasty with Polyether Ether Ketone (PEEK) Plate for Cervical Spondylosis and OPLL

    PubMed Central

    Oh, Chang Hyun; Ji, Gyu Yeul; Hur, Junseok W.; Choi, Won-Seok; Shin, Dong Ah

    2015-01-01

    Objective The purpose of this study was to evaluate the safety and efficacy of cervical midline-splitting French-door laminoplasty with a polyether ether ketone (PEEK) plate. The authors retrospectively analyzed the results of patients with cervical laminoplasty miniplate (MAXPACER®) without bone grafts in multilevel cervical stenosis. Methods Fifteen patients (13 males and 2 females, mean age 50.0 years (range 35-72)) with multilevel cervical stenosis (ossification of the posterior longitudinal ligament and cervical spondylotic myelopathy) underwent a combined surgery of midline-splitting French-door laminoplasty with or without mini plate. All 15 patients were followed for at least 12 months (mean follow-up 13.3 months) after surgery, and a retrospective review of the clinical, radiological and surgical data was conducted. Results The radiographic results showed a significant increase over the postoperative period in anterior-posterior diameter (9.4±2.2 cm to 16.2±1.1 cm), open angles in cervical lamina (46.5±16.0° to 77.2±13.1°), and sectional volume of cervical central canal (100.5±0.7 cm2 to 146.5±4.9 cm2) (p<0.001). The sagittal alignment of the cervical spine was well preserved (31.7±10.0° to 31.2±7.6°, p=0.877) during the follow-up period. The clinical results were successful, and there were no significant intraoperative complications except for screw displacement in two cases. The mini plate constructs did not fail during the 12 month follow-up period, and the decompression was maintained. Conclusion Despite the small cohort and short follow-up duration, the present study demonstrated that combined cervical expansive laminoplasty using the mini plate is an effective treatment for multilevel cervical stenosis. PMID:26217382

  13. Hereditary and metabolic myelopathies.

    PubMed

    Hedera, Peter

    2016-01-01

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

  14. Toxic and Metabolic Myelopathies.

    PubMed

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

    2016-10-01

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

  15. Multivariate Analysis of Factors Associated With Axial Symptoms in Unilateral Expansive Open-Door Cervical Laminoplasty With Miniplate Fixation.

    PubMed

    Chen, Hua; Liu, Hao; Deng, Yuxiao; Gong, Quan; Li, Tao; Song, Yueming

    2016-01-01

    Retrospective case-control study.Unilateral expansive open-door cervical laminoplasty with miniplate fixation is an efficient and increasing popular surgery for multilevel cervical spondylotic myelopathy. Axial symptoms are the most frequent complaints after cervical laminoplasty. But the mechanisms have not been fully clarified yet.The objective of this study is to compare the clinical and radiologic data between patients with or without axial symptoms and to investigate the factors associated with axial symptoms by multivariate analysis in cervical laminoplasty with miniplate fixation.A total of 129 patients who underwent cervical laminoplasty with miniplate fixation were comprised from August 2009 to March 2014. Patients were grouped according to whether they suffered from postoperative axial symptoms (PA) or not (NA). The clinical data including gender, age, duration of symptoms, diagnosis type, medical comorbidity, operative level, blood loss, operative time, pre- and post-Japanese Orthopedic Association (JOA) score, JOA recovery rates, and other complications were recorded. The radiologic data including cervical canal diameter, C2-7 Cobb angle, cervical range of motion (ROM), cross-sectional area, open angle, hinge union, and facet joint destroyed would be measured according to X-ray plain and CT scan images. The univariate analysis and multivariate logistic regression analysis were performed.There were 39 patients in PA group and 90 patients in NA group. Both groups gained significant JOA improvement postoperatively (P < 0.05). The preoperative neck pain (P = 0.048), negative change of cervical ROM (P = 0.018), and facet joints destroyed (P = 0.022) were significant different between the 2 groups. There were no significant differences for other clinical and radiography parameters between the groups (P > 0.05). The multivariate analysis showed that the negative change of cervical ROM (OR = 1.062, P = 0.047) and facet joints

  16. Multivariate Analysis of Factors Associated With Axial Symptoms in Unilateral Expansive Open-Door Cervical Laminoplasty With Miniplate Fixation

    PubMed Central

    Chen, Hua; Liu, Hao; Deng, Yuxiao; Gong, Quan; Li, Tao; Song, Yueming

    2016-01-01

    Abstract Retrospective case–control study. Unilateral expansive open-door cervical laminoplasty with miniplate fixation is an efficient and increasing popular surgery for multilevel cervical spondylotic myelopathy. Axial symptoms are the most frequent complaints after cervical laminoplasty. But the mechanisms have not been fully clarified yet. The objective of this study is to compare the clinical and radiologic data between patients with or without axial symptoms and to investigate the factors associated with axial symptoms by multivariate analysis in cervical laminoplasty with miniplate fixation. A total of 129 patients who underwent cervical laminoplasty with miniplate fixation were comprised from August 2009 to March 2014. Patients were grouped according to whether they suffered from postoperative axial symptoms (PA) or not (NA). The clinical data including gender, age, duration of symptoms, diagnosis type, medical comorbidity, operative level, blood loss, operative time, pre- and post-Japanese Orthopedic Association (JOA) score, JOA recovery rates, and other complications were recorded. The radiologic data including cervical canal diameter, C2–7 Cobb angle, cervical range of motion (ROM), cross-sectional area, open angle, hinge union, and facet joint destroyed would be measured according to X-ray plain and CT scan images. The univariate analysis and multivariate logistic regression analysis were performed. There were 39 patients in PA group and 90 patients in NA group. Both groups gained significant JOA improvement postoperatively (P < 0.05). The preoperative neck pain (P = 0.048), negative change of cervical ROM (P = 0.018), and facet joints destroyed (P = 0.022) were significant different between the 2 groups. There were no significant differences for other clinical and radiography parameters between the groups (P > 0.05). The multivariate analysis showed that the negative change of cervical ROM (OR = 1.062, P = 0.047) and

  17. Proteomic Analysis of Cerebrospinal Fluid in Canine Cervical Spondylomyelopathy

    PubMed Central

    Martin-Vaquero, Paula; da Costa, Ronaldo C.; Allen, Matthew J.; Moore, Sarah A.; Keirsey, Jeremy K.; Green, Kari B.

    2015-01-01

    Study Design Prospective study. Objective To identify proteins with differential expression in the cerebrospinal fluid (CSF) from 15 clinically normal (control) dogs and 15 dogs with cervical spondylomyelopathy (CSM). Summary of Background Data Canine CSM is a spontaneous, chronic, compressive cervical myelopathy similar to human cervical spondylotic myelopathy. There is a limited knowledge of the molecular mechanisms underlying these conditions. Differentially expressed CSF proteins may contribute with novel information about the disease pathogenesis in both dogs and humans. Methods Protein separation was performed with two-dimensional electrophoresis. A Student’s t-test was used to detect significant differences between groups (P < 0.05). Three comparisons were made: 1) control versus CSM-affected dogs, 2) control versus non-corticosteroid treated CSM-affected dogs, and 3) non-corticosteroid treated CSM-affected versus corticosteroid treated CSM-affected dogs. Protein spots exhibiting at least a statistically significant 1.25-fold change between groups were selected for subsequent identification with capillary-liquid chromatography tandem mass spectrometry. Results A total of 96 spots had a significant average change of at least 1.25-fold in one of the three comparisons. Compared to the CSF of control dogs, CSM-affected dogs demonstrated increased CSF expression of eight proteins including vitamin D-binding protein, gelsolin, creatine kinase B-type, angiotensinogen, alpha-2-HS-glycoprotein, SPARC, calsyntenin-1, and complement C3, and decreased expression of pigment epithelium-derived factor, prostaglandin-H2 D-isomerase, apolipoprotein E, and clusterin. In the CSF of CSM-affected dogs, corticosteroid treatment increased the expression of haptoglobin, transthyretin isoform 2, cystatin C-like, apolipoprotein E, and clusterin, and decreased the expression of angiotensinogen, alpha-2-HS-glycoprotein, and gelsolin. Conclusions Many of the differentially expressed

  18. ACR Appropriateness Criteria Myelopathy.

    PubMed

    Roth, Christopher J; Angevine, Peter D; Aulino, Joseph M; Berger, Kevin L; Choudhri, Asim F; Fries, Ian Blair; Holly, Langston T; Kendi, Ayse Tuba Karaqulle; Kessler, Marcus M; Kirsch, Claudia F; Luttrull, Michael D; Mechtler, Laszlo L; O'Toole, John E; Sharma, Aseem; Shetty, Vilaas S; West, O Clark; Cornelius, Rebecca S; Bykowski, Julie

    2016-01-01

    Patients presenting with myelopathic symptoms may have a number of causative intradural and extradural etiologies, including disc degenerative diseases, spinal masses, infectious or inflammatory processes, vascular compromise, and vertebral fracture. Patients may present acutely or insidiously and may progress toward long-term paralysis if not treated promptly and effectively. Noncontrast CT is the most appropriate first examination in acute trauma cases to diagnose vertebral fracture as the cause of acute myelopathy. In most nontraumatic cases, MRI is the modality of choice to evaluate the location, severity, and causative etiology of spinal cord myelopathy, and predicts which patients may benefit from surgery. Myelopathy from spinal stenosis and spinal osteoarthritis is best confirmed without MRI intravenous contrast. Many other myelopathic conditions are more easily visualized after contrast administration. Imaging performed should be limited to the appropriate spinal levels, based on history, physical examination, and clinical judgment. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals, and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:26653797

  19. The evidence and the possible significance of autophagy in degeneration model of human cervical end-plate cartilage

    PubMed Central

    XU, HONGGUANG; XIONG, SHOULIANG; WANG, HONG; ZHANG, MIN; YU, YUNFEI

    2014-01-01

    The aim of this study was to observe autophagy in chondrocytes from degenerative human cervical vertebral end-plates and to investigate the significance of variations in autophagy in the degeneration of cervical vertebral end-plate chondrocytes. Cartilage end-plates were obtained from 48 inpatients admitted to hospital between February 2011 and August 2012. The patients were divided into the control group (n=17) with cervical vertebral fracture or dislocation and the cervical spondylosis group (n=31) with cervical spondylotic myelopathy. End-plate chondrocytes were isolated via enzyme digestion and then cultured in vitro. The cells were stained with toluidine blue and hematoxylin-eosin (H&E). A laser scanning confocal microscope and monodansylcadaverine (MDC) were used to reveal autophagy in the end-plate chondrocytes. Reverse transcription polymerase chain reaction (RT-PCR) was used to detect mRNA expression of type II collagen and aggrecan. Western blotting was conducted to detect LC3 proteins. The chondrocytes isolated from the degenerative human cervical end-plates were cultured successfully in vitro. The morphology of the cells from the cervical spondylosis group tended to exhibit changes in spindle morphology compared with the control group. Autophagic bodies were stained with MDC. LC3 proteins were visible in the intracellular and perinuclear regions under the laser scanning confocal microscope. The mRNA expression levels (relative to those of β-actin) of aggrecan (0.715±0.194) and type II collagen (0.628±0.254) in the cervical spondylosis group were markedly decreased compared with those in the control group (0.913±0.254 and 0.845±0.186, respectively; both P<0.05). The LC3-II/LC3-I ratio was observed to be significantly reduced in the cervical spondylosis group by Western blot analysis. Autophagy has an important role in human cervical disc degeneration. The regulation of autophagy may prevent disc degeneration in cartilage end-plate cells. PMID

  20. Preliminary documentation of the comparable efficacy of vitoss versus NanOss bioactive as bone graft expanders for posterior cervical fusion

    PubMed Central

    Epstein, Nancy E.

    2015-01-01

    Background: Laminectomies with posterior cervical instrumented fusions often utilize bone graft expanders to supplement cervical lamina/iliac crest autograft/bone marrow aspirate (BMA). Here we compared posterior fusion rates utilizing two graft expanders; Vitoss (Orthovita, Malvern, PA, USA) vs. NanOss Bioactive (Regeneration Technologies Corporation [RTI: Alachua, FL, USA]). Methods: Two successive prospective cohorts of patients underwent 1-3 level laminectomies with 5-9 level posterior cervical fusions to address cervical spondylotic myelopathy (CSM) and/or ossification of the posterior longitudinal ligament (OPLL). The first cohort of 72 patients received Vitoss, while the second cohort or 20 patients received NanOss. Fusions were performed utilizing the Vertex/Rod/Eyelet System (Medtronic, Memphis, TN, USA) with braided titanium cables through the base of intact spinous processes (not lateral mass screws) cephalad and caudad to laminectomy defects. Fusion was documented by an independent neuroradiologist blinded to the study design, utilizing dynamic X-rays and two dimensional computed tomography (2D-CT) studies up to 6 months postoperatively, or until fusion or pseudarthrosis was confirmed at 1 year. Results: Vitoss and NanOss resulted in comparable times to fusion: 5.65 vs. 5.35 months. Dynamic X-ray and CT-documented pseudarthrosis developed in 2 of 72 Vitoss patients at one postoperative year (e.g. bone graft resorbed secondary to early deep wound infections), while none occurred in the 20 patients receiving NanOss. Conclusion: In this preliminary study combining cervical laminectomy/fusions, the time to fusion (5.65 vs. 5.35 months), pseudarthrosis (2.7% vs. 0%), and infection rates (2.7% vs. 0%) were nearly comparable sequentially utilizing Vitoss (72 patients) vs. NanOss (20 patients) as bone graft expanders. PMID:26005578

  1. Cytokine Concentrations in the Cerebrospinal Fluid of Great Danes with Cervical Spondylomyelopathy

    PubMed Central

    Martin-Vaquero, P.; da Costa, R.C.; Moore, S.A.; Gross, A.C.; Eubank, T.D.

    2014-01-01

    Background Chronic inflammation is involved in the pathogenesis of human cervical spondylotic myelopathy and could also play a role in cervical spondylomyelopathy (CSM) in dogs. Hypothesis/Objectives That cerebrospinal fluid (CSF) cytokine concentrations would differ between clinically normal (control) and CSM-affected Great Danes (GDs), with affected GDs showing higher levels of inflammatory cytokines, such as interleukin (IL)-6 and monocyte chemoattractant protein-1/chemokine ligand 2 (MCP-1/CCL2). Animals Client-owned GDs: 15 control, 15 CSM-affected. Methods Prospective study. Dogs underwent cervical vertebral column magnetic resonance imaging and collection of CSF from the cerebellomedullary cistern. Cytokine concentrations were measured using a commercially available canine multiplex immunoassay. Cytokine concentrations were compared between groups. Associations with the administration of anti-inflammatory medications, disease duration and severity, severity of spinal cord (SC) compression, and SC signal changes were investigated in affected GDs. Results Affected GDs had significantly lower MCP-1/CCL2 (mean 138.03 pg/mL, 95% confidence interval [CI] = 114.85–161.20) than control GDs (212.89 pg/mL, 95% CI = 165.68–260.11, P = .028). In affected GDs, MCP-1/CCL2 concentrations correlated inversely with the severity of SC compression. There were no associations with administration of anti-inflammatory medications, disease duration, or disease severity. IL-6 concentrations were significantly higher (2.20 pg/mL, 95% CI = 1.92–2.47, P < .001) in GDs with SC signal changes. Conclusions and Clinical Importance Lower MCP-1/CCL2 in CSM-affected GDs might compromise clearance of axonal and myelin debris, delay axon regeneration, and affect recovery. Higher IL-6 in CSM-affected GDs with SC signal changes suggests more severe inflammation in this group. PMID:24965833

  2. Canine degenerative myelopathy.

    PubMed

    Coates, Joan R; Wininger, Fred A

    2010-09-01

    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

  3. Dorsal column myelopathy following intrathecal chemotherapy for acute lymphoblastic leukemia

    PubMed Central

    Joseph, Prathap Jacob; Reyes, Maria Regina

    2014-01-01

    Objective/context To describe a distinctive clinical and radiographic pattern of myelopathy following intrathecal chemotherapy. Myelopathy is a rare complication of intrathecal chemotherapy used in the treatment of acute lymphoblastic leukemia (ALL). We present a 42-year-old female with T-cell ALL who developed a myelopathy primarily involving the dorsal columns. Method Case report and literature review. Findings Within 24 hours of an injection of intrathecal methotrexate, cytarabine, and hydrocortisone, the patient developed ascending lower limb numbness and balance difficulties progressing to the inability to ambulate. Clinical examination showed profound loss of lower limb proprioception and light touch sensation below T5, mild proximal limb weakness, but preserved pinprick and temperature sensation with intact bowel and bladder function. Initial thoracic and lumbar spine magnetic resonance imaging (MRI) at 1 week revealed no abnormalities. However, repeat imaging at 6 weeks showed abnormal signal in the posterior cord with sparing of the anterior and lateral columns, diffusely involving the lower cervical cord through the conus medullaris. Dermatomal somatosensory-evoked potential (DSEP) conduction abnormalities were consistent with thoracic myelopathy. An empiric trial of high-dose intravenous corticosteroids during inpatient rehabilitation more than 6 weeks later produced no significant clinical improvement. Conclusion/clinical relevance Preferential and persistent dorsal column myelopathy is a distinctive clinical and radiographic presentation of a rare complication of intrathecal chemotherapy. The MRI abnormalities were initially absent, but evolved to consist of multi-level spinal cord T2 and STIR hyperintensity with regional gadolinium enhancement. DSEPs more accurately reflected the clinical level of spinal cord dysfunction. PMID:24090227

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

    PubMed

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

    1989-10-01

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

  5. Cervical cord injury after massage.

    PubMed

    Lee, Tzu-Han; Chiu, Jan-Wei; Chan, Rai-Chi

    2011-10-01

    We present the case of a 47-yr-old gentleman with cervical cord injury after he received massage in the neck area. Magnetic resonance imaging of the cervical spine showed a herniation of the nucleus pulposus and compressive myelopathy. The patient required surgical intervention and rehabilitation. Despite 6 mos of rehabilitation, residual hand dysfunction and minor ambulation problems persisted. Although massage has many benefits, this case reminds us that there is potential danger in performing neck massage. PMID:21862908

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

    PubMed

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

    2016-06-01

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

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

    PubMed Central

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

    2016-01-01

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

  8. Difference in canal encroachment by the fusion mass between anterior cervical discectomy and fusion with bone autograft and anterior plating, and stand-alone cage.

    PubMed

    Lee, Soo Eon; Chung, Chun Kee; Kim, Chi Heon

    2016-07-01

    We conducted a prospective randomized study comparing stand-alone cage and bone autograft and plate implants in anterior cervical discectomy and fusion (www.clinicaltrials.gov, NCT01011569). Our interim analysis showed autologous bone graft with plating was superior to a stand-alone cage for segmental lordosis. During this analysis, we noted a difference in canal encroachment by the fusion mass between the two fusion groups. A narrow cervical spinal canal is an important factor in the development of cervical spondylotic myelopathy, therefore this unexpected potential risk of spinal cord compression necessitated another interim analysis to investigate whether there was a difference in canal encroachment by the fusion mass between the two groups. Patients had a minimum 1year of follow-up. The Neck Disability Index, neck and arm pain Visual Analog Scales and lateral radiographs, including bone fusion patterns, were evaluated. Twenty-seven (16 males, 11 females, mean age 54.8years) and 31 (24 males, seven females, mean age 54.5years) patients were in the cage and plate group, respectively. Both groups improved after surgery. Fusion began at 2.6months and 1.3months and finished at 6.7months and 4.0months in 24 (88.9%) and 28 (90.3%) patients in the cage and plate group, respectively. Encroachment into the spinal canal by the fusion mass was significantly different between the fusion types, occuring in 21 (77.8%) patients in the cage group versus six (19.4%) in the plate group (p=0.003). There was a high incidence of spinal canal encroachment by the fusion mass in the stand-alone cage group, possibly limiting use in narrow spinal canals. PMID:27234609

  9. 4- and 5-level anterior fusions of the cervical spine: review of literature and clinical results

    PubMed Central

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

    2007-01-01

    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

  10. Outcome of cervical spine surgery in patients with rheumatoid arthritis

    PubMed Central

    van Asselt, K M; Lems, W; Bongartz, E; Hamburger, H; Drossaers-Bakker, K; Dijkmans, B; van Soesbergen, R M

    2001-01-01

    OBJECTIVES—Cervical spine instability in patients with rheumatoid arthritis (RA) may lead to cervical myelopathy or occipital neuralgia, or both. Morbidity and mortality in patients with RA treated with cervical spine surgery during two years of follow up were evaluated.
METHODS—Between 1992 and 1996 55 patients with RA underwent cervical spine surgery because of occipital neuralgia or cervical myelopathy, or both. Patients were classified according to the Ranawat criteria for pain and neurological assessment before operation and three months and two years postoperatively. For occipital neuralgia a successful operation was defined as complete relief of pain and for cervical myelopathy as neurological improvement.
RESULTS—Occipital neuralgia was present in 17 patients, cervical myelopathy in 14 patients, and 24 had both. Surgical treatment in the patients with symptoms of occipital neuralgia who were still alive two years after surgery was successful in 18/29 (62%). In the surviving patients with cervical myelopathy neurological improvement of at least one Ranawat class was seen in 16/24 (67%). Postoperative mortality within six weeks was 3/51 (6%). Within two years after the operation 14 /51 (27%) of the patients had died; in most patients the cause of death was not related to surgery. The highest mortality (50%) was found in the group of six patients with quadriparesis and very poor functional capacity (Ranawat IIIB).
CONCLUSION—Cervical spine surgery in patients with RA performed because of occipital neuralgia or cervical myelopathy, or both, is successful in most patients who are alive two years after surgery. However, the mortality rate during these two years is relatively high, which seems to be largely related to the severity of the underlying disease and not to the surgery itself.

 PMID:11302865

  11. Nontraumatic Myelopathy Associated With Surfing

    PubMed Central

    Avilés-Hernández, Israel; García-Zozaya, Inigo; DeVillasante, Jorge M

    2007-01-01

    Background/Objective: Ischemic nontraumatic spinal cord injury associated with surfing is a novel diagnosis believed to be related to prolonged spine hyperextension while lying prone on the surfboard. Only 9 cases have been documented. This report features possible risk factors, etiology, diagnostic imaging, and outcomes of surfer's myelopathy. Design: Case report. Results: A 37-year-old man developed T11 American Spinal Injury Association (ASIA) A paraplegia shortly after surfing. The clinical history and magnetic resonance imaging findings were compatible with an ischemic insult to the distal thoracic spinal cord. Our patient did not have any of the proposed risk factors associated with this condition, and, contrary to most reports, he sustained a complete spinal cord lesion without neurological recovery by 8 weeks post injury. Conclusions: Surfer's myelopathy, because of its proposed mechanism of injury, is amenable to medical intervention. Increased awareness of this condition may lead to early recognition and treatment, which should contribute to improved neurological outcomes. PMID:17684897

  12. Airway management for cervical spine surgery.

    PubMed

    Farag, Ehab

    2016-03-01

    Cervical spine surgery is one of the most commonly performed spine surgeries in the United States, and 90% of the cases are related to degenerative cervical spine disease (the rest to cervical spine trauma and/or instability). The airway management for cervical spine surgery represents a crucial step in the anesthetic management to avoid injury to the cervical cord. The crux for upper airway management for cervical spine surgery is maintaining the neck in a neutral position with minimal neck movement during endotracheal intubation. Therefore, the conventional direct laryngoscopy (DL) can be unsuitable for securing the upper airway in cervical spine surgery, especially in cases of cervical spine instability and myelopathy. This review discusses the most recent evidence-based facts of the main advantages and limitations of different techniques available for upper airway management for cervical spine surgery. PMID:27036600

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

    PubMed Central

    Leven, Dante

    2016-01-01

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

  14. Expansive open-door laminoplasty secured with titanium miniplates is a good surgical method for multiple-level cervical stenosis

    PubMed Central

    2014-01-01

    Background Laminoplasty is an effective procedure for treating cervical spondylotic myelopathy (CSM). Little information is available regarding the surgical outcomes of expansive open-door laminoplasty (EOLP) when securing with titanium miniplates without bone grafting. This study is aimed to elucidate the efficacy of and problems associated with EOLP secured with titanium miniplates without bone grafting, thereby enhancing future surgical outcomes. Methods This is a retrospective study. The study participants comprised 104 patients who underwent cervical EOLP secured with titanium miniplates without bone graft for CSM treatment between August 2005 and March 2011. The clinical results were evaluated based on the Japanese Orthopedic Association (JOA) and Nurick scores. The radiographic outcomes were determined based on plain film and magnetic resonance imaging findings, which were assessed and compared. Results Lateral cervical spine X-rays exhibited improvement in the Pavlov ratio of the spinal canal at 1 day postoperation, and this ratio did not change at 1 year postoperation. The mean cervical curvature from C2 to C7 decreased 0.21° ± 10.09° and the mean cervical range of motion was deteriorated by 35% at 12 months (P < 0.05). The Nurick score improved from 3.19 ± 1.06 to 0.92 ± 1.32 (P < 0.05). The mean JOA recovery rate was 75% ± 21.1% at 1 year. The mean level of postoperative neck pain at 3 months was 3.09 ± 2.31, as determined using the visual analogue scale (VAS). Increased age, concomitant thoracolumbar stenosis, depression disorder, and preexisting myelomalacia negatively affected the JOA recovery rate (P < 0.05). A decreased preoperative Nurick score and superior sensory function in the upper extremities were powerful predictors of an enhanced JOA recovery rate. The postoperative complications involved hematoma formation 0.9%, reversible C5 nerve palsy 2.8%, and moderate to severe neck pain (VAS ≥ 4) 42%. No

  15. Acute transverse myelopathy complicating systemic lupus erythematosus.

    PubMed Central

    Propper, D J; Bucknall, R C

    1989-01-01

    A sixteen year old girl with systemic lupus erythematosus developed acute transverse myelopathy. She was treated with high dose steroids, cyclophosphamide, and plasma exchange and regained partial neurological function. Previous descriptions of transverse myelopathy complicating systemic lupus erythematosus are reviewed, with particular reference to the efficacy of high dose steroid treatment. PMID:2662918

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

    PubMed

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

    2014-05-01

    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

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

    PubMed

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

    2016-09-01

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

  18. Subclinical respiratory dysfunction in chronic cervical cord compression: a pulmonary function test correlation.

    PubMed

    Bhagavatula, Indira Devi; Bhat, Dhananjaya I; Sasidharan, Gopalakrishnan M; Mishra, Rakesh Kumar; Maste, Praful Suresh; Vilanilam, George C; Sathyaprabha, Talakkad N

    2016-06-01

    OBJECTIVE Respiratory abnormalities are well documented in acute spinal cord injury; however, the literature available for respiratory dysfunction in chronic compressive myelopathy (CCM) is limited. Respiratory dysfunction in CCM is often subtle and subclinical. The authors studied the pattern of respiratory dysfunction in patients with chronic cord compression by using spirometry, and the clinical and surgical implications of this dysfunction. In this study they also attempted to address the postoperative respiratory function in these patients. METHODS A prospective study was done in 30 patients in whom cervical CCM due to either cervical spondylosis or ossification of the posterior longitudinal ligament (OPLL) was diagnosed. Thirty age-matched healthy volunteers were recruited as controls. None of the patients included in the study had any symptoms or signs of respiratory dysfunction. After clinical and radiological diagnosis, all patients underwent pulmonary function tests (PFTs) performed using a standardized Spirometry Kit Micro before and after surgery. The data were analyzed using Statistical Software SPSS version 13.0. Comparison between the 2 groups was done using the Student t-test. The Pearson correlation coefficient was used for PFT results and Nurick classification scores. A p value < 0.05 was considered significant. RESULTS Cervical spondylotic myelopathy (prolapsed intervertebral disc) was the predominant cause of compression (n = 21, 70%) followed by OPLL (n = 9, 30%). The average patient age was 45.06 years. Degenerative cervical spine disease has a relatively younger onset in the Indian population. The majority of the patients (n = 28, 93.3%) had compression at or above the C-5 level. Ten patients (33.3%) underwent an anterior approach and discectomy, 11 patients (36.7%) underwent decompressive laminectomy, and the remaining 9 underwent either corpectomy with fusion or laminoplasty. The mean preoperative forced vital capacity (FVC) (65%) of the

  19. [Cervical disc herniation].

    PubMed

    Schnake, K J; Hoffmann, C-H; Kandziora, F

    2012-12-01

    The cervical disc herniation is characterized by prolapsed nucleus pulposus material through the annulus into the spinal canal. The local mechanical or chemical irritation of neural structures typically leads to symptoms of radiculopathy, cervicocephalgia or myelopathy. Pronounced sensorimotor deficits or intractable pain constitute surgical treatment. In all other cases conservative treatment is indicated, including pain medication, active and passive physiotherapy, and local injections, respectively. Anterior cervical discectomy and interbody fusion (ACDF) is still the surgical treatment of choice. Predominantly, cages with or without plates are in use to obtain solid fusion. The implantation of a total disc replacement is a viable alternative, if no contraindications exist. Other surgical techniques may be performed in proper selected cases. The overall clinical and radiological results of both surgical and conservative treatment are good. PMID:23296562

  20. Imaging features of copper deficiency myelopathy: a study of 25 cases.

    PubMed

    Kumar, Neeraj; Ahlskog, J Eric; Klein, Christopher J; Port, John D

    2006-02-01

    Acquired copper deficiency presents with a spastic gait and sensory ataxia. Spinal cord magnetic resonance imaging (MRI) in patients with copper deficiency myelopathy may show increased T2 signal, most commonly in the dorsal midline cervical and thoracic cord. These imaging findings may be reversible with normalization of serum copper. The clinical and imaging picture is very similar to the subacute combined degeneration seen in patients with vitamin B12 deficiency. Neuroradiologists should consider this possibility when a long segment of symmetric dorsal spinal cord T2-hyperintensity is identified. PMID:16261334

  1. Subacute myelopathy caused by spinal venous infarction.

    PubMed Central

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

    1987-01-01

    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 PMID:3422870

  2. [Cervical disc herniation--diagnosis and treatment].

    PubMed

    Corniola, M-V; Tessitore, E; Schaller, K; Gautschi, O P

    2015-10-28

    A cervical disc herniation (CDH) is a frequently encountered pathology in primary care medicine. It may give rise to a compression of a nerve root (a radiculopathy, with or without sensory-motor deficit) or of the spinal cord (myelopathy). The majority of CDHs can be supported by means of a conservative treatment. When a radiculopathy is found and a clinico-radiological correlation is present, a moderate neurological deficit appears suddenly, or if it is progressive under conservative treatment or if pain is poorly controlled by well-conducted conservative treatment performed during 6 to 8 months, surgery is then recommended. A symptomatic cervical myelopathy is, by itself, an indication for a surgical treatment. PMID:26672182

  3. Management of delayed posttraumatic cervical kyphosis.

    PubMed

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

    2016-01-01

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

  4. Microsurgical anterior cervical foraminotomy for radiculopathy: a new approach to cervical disc herniation.

    PubMed

    Jho, H D

    1996-02-01

    A new technique of microsurgical anterior foraminotomy was developed to improve the treatment of cervical radiculopathy. This technique provides direct anatomical decompression of the compressed nerve root by removing the compressive spondylotic spur or disc fragment. The nerve root is decompressed from its origin in the spinal cord to the point at which it passes behind the vertebral artery laterally. Because most of the disc within the intervertebral space is undisturbed, a functioning motion segment of the disc remains intact. This technique differs from that of Verbiest in that it does not directly transpose the vertebral artery. Unlike Hakuba's technique, the disc within the intervertebral disc space is not removed. PMID:8592215

  5. Complications following central corpectomy in 468 consecutive patients with degenerative cervical spine disease.

    PubMed

    Sarkar, Sauradeep; Nair, Bijesh R; Rajshekhar, Vedantam

    2016-06-01

    OBJECTIVE This study was performed to describe the incidence and predictors of perioperative complications following central corpectomy (CC) in 468 consecutive patients with cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament (OPLL). METHODS The authors performed a retrospective review of a cohort of patients who had undergone surgery for CSM (n = 338) or OPLL (n = 130) performed by a single surgeon over a 15-year period. All patients underwent uninstrumented CC with autologous iliac crest or fibular strut grafting. Preoperative clinical and imaging details were collected, and the type and incidence of complications were studied. Univariate and multivariate analyses were performed to establish risk factors for the development of perioperative complications. RESULTS Overall, 12.4% of patients suffered at least 1 complication following CC. The incidence of major complications was as follows: C-5 radiculopathy, 1.3%; recurrent laryngeal nerve injury, 0.4%; dysphagia, 0.8%; surgical-site infection, 3.4%; and dural tear, 4.3%. There was 1 postoperative death (0.2%). On multivariate analysis, patients in whom the corpectomy involved the C-4 vertebral body (alone or as part of multilevel CC) were significantly more likely to suffer complications (p = 0.004). OPLL and skip corpectomy were risk factors for dural tear (p = 0.015 and p = 0.001, respectively). No factors were found to be significantly associated with postoperative C-5 palsy, dysphagia, or acute graft extrusion on univariate or multivariate analysis. Patients who underwent multilevel CC were predisposed to surgical-site infections, with a slight trend toward statistical significance (p = 0.094). The occurrence of a complication after surgery significantly increased the mean duration of postoperative hospital stay from 5.0 ± 2.3 days to 8.9 ± 6 days (p < 0.001). CONCLUSIONS Complications following CC for CSM or OPLL are infrequent, but they significantly prolong

  6. Degenerative myelopathy in two Boxer dogs.

    PubMed

    Miller, A D; Barber, R; Porter, B F; Peters, R M; Kent, M; Platt, S R; Schatzberg, S J

    2009-07-01

    Degenerative myelopathy (DM) is a common, slowly progressive, debilitating disease reported in several dog breeds, including the German Shepherd Dog and Pembroke Welsh Corgi. Boxer dogs present occasionally for a thoracolumbar myelopathy for which no cause is identified on MRI or cerebrospinal fluid analysis. Despite a lack of a histologic description of DM in the Boxer in the veterinary literature, such dogs are presumed to have DM. Here we report 2 histologically confirmed cases of DM in the Boxer breed in which histologic studies disclosed marked degenerative changes in the spinal cord that were most prominent in the thoracic and cranial lumbar segments. Lesions consisted of myelin vacuolation and degeneration, myelophagocytosis, reactive astrocytosis, and ellipsoid formation most prominent in the lateral and ventral funiculi. We present a detailed histologic description of DM in the Boxer dog and compare it to DM in other purebred dogs. PMID:19276068

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

    PubMed

    Dvorak, J

    1996-11-01

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

  8. [Meningeal seeding of spinal cord glioblastoma multiforme without any signs of myelopathy].

    PubMed

    Chida, K; Konno, H; Sahara, M; Takase, S

    1995-11-01

    An autopsy case of meningeal spreading of glioblastoma multiforme (GBM) probably originating in the cervical cord was reported. In contrast to autopsy findings, main symptoms were similar to subacute meningitis, and any signs of myelopathy could not be detected during the clinical course. The patient was a 22-year-old man who was hospitalized because of a 2-week history of progressive headache following cough and slight fever. Vomiting and somnolence, developing 5 days before admission, were improved the day after a lumbar puncture performed at another hospital. On admission, meningeal signs, mild right abducens palsy, and depressed deep tendon reflexes were detected. There was no muscle weakness, sensory loss, or Babinski sign. Lumbar puncture yielded CSF with an opening pressure of 280 mmH2O, 21 mononuclear cells/mm3, a protein level of 645 mg/dl, and a glucose level of 7 mg/dl. Cytology for malignancy and multiple cultures were negative. Brain CT scan showed mild hydrocephalus and swelling of the brainstem and cerebellum. Intravenous administration of antimicrobial drugs was started and ventriculoperitoneal shunt surgery was performed. During the third hospital week, however, meningeal signs progressed and somnolence reappeared, followed by progressive multiple cranial neuropathy and polyradiculopathy characterized by flaccid tetraparesis, muscle atrophy, and sensory impairment without a level. Babinski sign could not be detected. MRI revealed an intramedullary lesion in the lower cervical cord, swelling of the brainstem, cerebellum, spinal cord and nerve roots, and a diffuse or nodular thickning of leptomeninges. Repeated CSF cytology disclosed atypical cells. Examinations for extraneural malignancies were negative. During the 9th hospital week, flaccid tetraplegia progressed and stupor developed, and the patient died 2 weeks later. The pathological study was limited to the brain. The brain showed a diffuse opalescent thickening of the leptomeninges, especially

  9. Differential Diagnosis of Acute Myelopathies: An Update.

    PubMed

    Nichtweiß, M; Weidauer, S

    2015-10-01

    Appropriate description may lead to adequate diagnostic and therapeutic measures, and therefore, a simple scheme to categorize and term the imaging findings of acute myelopathy is suggested based on current literature. Assigning imaging findings to five groups, that is (a) "segmental with rash," (b) "poliolike," (c) "granulomatous-nodular," (d) "longitudinally extensive transverse myelitis," (e) "short-segment ovoid or peripherally located," provides a rationale to lessen differential diagnoses. The key for understanding, proper description and differential diagnosis is the correlation of two time points: When did the first symptoms appear and when did imaging take place? Early infarction within the first 24 h will show neither swelling nor enhancement. PMID:26031429

  10. MR imaging in nelarabine-induced myelopathy.

    PubMed

    Dua, Sumeet G; Jhaveri, Miral D

    2016-07-01

    Nelarabine is one of the newer and novel drugs approved by the USA Food and Drug Administration for treatment of relapsed and resistant acute lymphoblastic leukemia. Although there are a few accounts of the neurologic toxicity of nelarabine in the oncological literature, it has never been discussed from a radiologic stand point to our knowledge. We describe a case of nelarabine-induced myelopathy and review the existing literature in an attempt to characterize the MRI features helpful in making an early diagnosis of this elusive entity. PMID:26899359

  11. The post-syrinx syndrome: stable central myelopathy and collapsed or absent syrinx.

    PubMed

    Bogdanov, E I; Heiss, John D; Mendelevich, E G

    2006-06-01

    Among 168 cases with neurologic findings of cervicothoracic syringomyelia and MRI findings of Chiari 1 malformation and/or underdevelopment of the posterior cranial fossa, 15 patients (9.1 %) had collapsed, flat syrinxes and 14 patients (8.3 %) did not have syrinxes. Both groups of patients had clinical findings of central myelopathy that had been stable for at least 3 years. Magnetic resonance imaging detected atrophy of the cervical spinal cord in both groups and spontaneous communications between the syrinx and the subarachnoid space in 3 patients of the group with collapsed syrinxes. Analysis of these results and review of the literature suggest that patients with clinical signs of syringomyelia and Chiari 1 malformation or underdeveloped posterior fossa, but with small or absent syringomyelitic cavities, have the "postsyrinx" state as a result of spontaneous collapse of distended syrinxes. PMID:16511636

  12. Cervical Laminoplasty

    MedlinePlus

    ... Treatments for Spinal Pain Surgical Options Anterior Cervical Fusion Artificial Disc Replacement Bone Graft Alternatives Bone Morphogenetic ... Discectomy Percutaneous Vertebral Augmentation Posterior Cervical Foraminotomy Spinal Fusion ... Medicine Cervical Laminoplasty What is ...

  13. Neurological complications of cervical spine manipulation.

    PubMed

    Stevinson, C; Honan, W; Cooke, B; Ernst, E

    2001-03-01

    To obtain preliminary data on neurological complications of spinal manipulation in the UK all members of the Association of British Neurologists were asked to report cases referred to them of neurological complications occurring within 24 hours of cervical spine manipulation over a 12-month period. The response rate was 74%. 24 respondents reported at least one case each, contributing to a total of about 35 cases. These included 7 cases of stroke in brainstem territory (4 with confirmation of vertebral artery dissection), 2 cases of stroke in carotid territory and 1 case of acute subdural haematoma. There were 3 cases of myelopathy and 3 of cervical radiculopathy. Concern about neurological complications following cervical spine manipulation appears to be justified. A large long-term prospective study is required to determine the scale of the hazard. PMID:11285788

  14. Neurological complications of cervical spine manipulation.

    PubMed Central

    Stevinson, C; Honan, W; Cooke, B; Ernst, E

    2001-01-01

    To obtain preliminary data on neurological complications of spinal manipulation in the UK all members of the Association of British Neurologists were asked to report cases referred to them of neurological complications occurring within 24 hours of cervical spine manipulation over a 12-month period. The response rate was 74%. 24 respondents reported at least one case each, contributing to a total of about 35 cases. These included 7 cases of stroke in brainstem territory (4 with confirmation of vertebral artery dissection), 2 cases of stroke in carotid territory and 1 case of acute subdural haematoma. There were 3 cases of myelopathy and 3 of cervical radiculopathy. Concern about neurological complications following cervical spine manipulation appears to be justified. A large long-term prospective study is required to determine the scale of the hazard. PMID:11285788

  15. Nonoperative Management of Cervical Radiculopathy.

    PubMed

    Childress, Marc A; Becker, Blair A

    2016-05-01

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

  16. Median Nerve Somatosensory Evoked Potential in HTLV-I Associated Myelopathy

    PubMed Central

    Boostani, Reza; Poorzahed, Ali; Ahmadi, Zahra; Mellat, Ali

    2016-01-01

    Introduction HTLV-I Associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP) is a progressive Myelopathy that mainly involves the corticospinal tract. Despite pronounced involvement of the lower limbs, patients also have abnormalities in their upper limbs. So, we studied somatosensory-evoked potentials (SSEPs) of the median nerve in HAM/TSP patients to determine the extent of the involvement of the pathway of the central nervous system, especially the cervical spinal cord. Methods In this cross sectional study, 48 patients with HAM/TSP who were referred to Qaem Hospital in Mashhad from October 2010 to October 2011 were evaluated for various indices, including SSEPs of the median nerve for N9, N11, N13, and N20 waveforms and also N11–13 and N13–20 Inter Peak Latency (IPL), severity of disease (based on Osama criteria), disease duration (less or more than 2 years), age, and gender. SPSS software was used for data analysis. The t-test was used for quantitative data, and the chi-squared test was used for the qualitative variables. Results Thirty-four patients (70.2%) were females. The mean age was 45.6 ± 14.2 years. About SSEPs indices of the median nerve, N9 and N11 were normal in all patients, but N13 (50%), N20 (16.7%), IPL11–13 (58.3%), and IPL13–20 (22.9%) were abnormal. No significant relationships were found between age, gender, disease duration, and SSEPs indices (p > 0.05), but IPL11–13 and IPL13–20 had significant relationships with disease disability (p = 0.017 and p = 0.01, respectively). Conclusion Despite the lack of obvious complaints of upper limbs, SSEPs indices of the median nerve from the cervical spinal cord to the cortex were abnormal, which indicated extension of the lesion from the thoracic spinal cord up to the cervical spinal cord and thalamocortical pathways. Also, abnormalities in the cervical spinal cord had a direct correlation with the severity of disability in patients with HAM/TSP. PMID:27382445

  17. Acute compressive myelopathy due to vertebral haemangioma

    PubMed Central

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

    2014-01-01

    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

  18. Nonoperative Modalities to Treat Symptomatic Cervical Spondylosis

    PubMed Central

    Hirpara, Kieran Michael; Butler, Joseph S.; Dolan, Roisin T.; O'Byrne, John M.; Poynton, Ashley R.

    2012-01-01

    Cervical spondylosis is a common and disabling condition. It is generally felt that the initial management should be nonoperative, and these modalities include physiotherapy, analgesia and selective nerve root injections. Surgery should be reserved for moderate to severe myelopathy patients who have failed a period of conservative treatment and patients whose symptoms are not adequately controlled by nonoperative means. A review of the literature supporting various modalities of conservative management is presented, and it is concluded that although effective, nonoperative treatment is labour intensive, requiring regular review and careful selection of medications and physical therapy on a case by case basis. PMID:21991426

  19. Cervical radiculopathy: epidemiology, etiology, diagnosis, and treatment.

    PubMed

    Woods, Barrett I; Hilibrand, Alan S

    2015-06-01

    Cervical radiculopathy is a relatively common neurological disorder resulting from nerve root dysfunction, which is often due to mechanical compression; however, inflammatory cytokines released from damaged intervertebral disks can also result in symptoms. Cervical radiculopathy can often be diagnosed with a thorough history and physical examination, but an magnetic resonance imaging or computed tomographic myelogram should be used to confirm the diagnosis. Because of the ubiquity of degenerative changes found on these imaging modalities, the patient's symptoms must correlate with pathology for a successful diagnosis. In the absence of myelopathy or significant muscle weakness all patients should be treated conservatively for at least 6 weeks. Conservative treatments consist of immobilization, anti-inflammatory medications, physical therapy, cervical traction, and epidural steroid injections. Cervical radiculopathy typically is self-limiting with 75%-90% of patients achieving symptomatic improvement with nonoperative care. For patients who are persistently symptomatic despite conservative treatment, or those who have a significant functional deficit surgical treatment is appropriate. Surgical options include anterior cervical decompression and fusion, cervical disk arthroplasty, and posterior foraminotomy. Patient selection is critical to optimize outcome. PMID:25985461

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

    PubMed

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

    2005-10-01

    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

  1. Etiological, clinical, and radiological features of longitudinally extensive myelopathy in Chinese patients.

    PubMed

    Zhang, Weihe; Jiao, Yujuan; Cui, Lei; Liu, Lei; Zhang, Linwei; Jiao, Jinsong

    2016-10-01

    Longitudinally extensive myelopathy (LEM) is a rare spinal syndrome, and was mostly assessed in western populations. In order to investigate the etiological, clinical, and radiological features of LEM in Chinese patients, we retrospectively analyzed eighty-nine (40 men and 49 women, median age 45.9±15.7years) patients with LEM hospitalized in China-Japan Friendship Hospital. LEM comprised autoimmune inflammatory myelitis (n=53), metabolic and compressive disorders (n=13), vascular diseases (n=10), neoplastic diseases (n=7), infectious diseases (n=4), and syringomyelia (n=2). Neuromyelitis optica spectrum disorders (NMOSD) was the most common cause of transverse myelopathy identified in LEM (38/89 [42.7%]) characterized by intractable vomiting and hiccups and painful tonic spasms. Subacute combined degeneration and anterior spinal artery syndrome accounted for the largest non-transverse LEM, which selectively affected the spinal dorsal and/or lateral columns and the spinal anterior region, respectively. Radicular pain was common in anterior spinal artery syndrome. Postrema (n=15, 39.5%) and cervical (n=31, 81.6%) lesions were significantly increased in NMOSD versus non-NMOSD (n=7, 13.7% and n=34, 66.7%, respectively, p<0.05]. Axial T2-weighted MRI indicated that 46 (51.7%) patients exhibited complete lesions; 43 (48.3%) patients exhibited non-transverse lesions, mainly unilateral or symmetrical tract lesions. Twenty-four (51.1%) LEM patients exhibited distinct gadolinium contrast enhancement. In this Chinese cohort, LEM was primarily attributed to NMOSD. While the etiological distribution in the non-NMOSD group was different from western populations, clinical and imaging features may facilitate a differential diagnosis. PMID:27526974

  2. Cervical spondylosis

    MedlinePlus

    ... cartilage (disks) and bones of the neck (cervical vertebrae). It is a common cause of chronic neck ... by aging and chronic wear on the cervical spine. This includes the disks or cushions between the ...

  3. Cervical dysplasia

    MedlinePlus

    ... cervical dysplasia is caused by the human papillomavirus (HPV). HPV is a common virus that is spread through sexual contact. There are many types of HPV. Some types lead to cervical dysplasia or cancer. ...

  4. Cervical Cancer

    MedlinePlus

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

  5. Cervical cancer

    MedlinePlus

    ... and cervical cancer cannot be seen with the naked eye. Special tests and tools are needed to ... Pap smears and cervical cancer References Committee on Adolescent Health Care of the American College of Obstetricians ...

  6. Cervical dysplasia

    MedlinePlus

    Cervical intraepithelial neoplasia (CIN); Precancerous changes of the cervix; Cervical cancer - dysplasia ... lesion (SIL). On the Pap smear report, these changes will be described as: Low-grade (LSIL) High- ...

  7. Somatosensory evoked potentials in cervical spondylosis. Correlation of median, ulnar and posterior tibial nerve responses with clinical and radiological findings.

    PubMed

    Yu, Y L; Jones, S J

    1985-06-01

    Somatosensory evoked potentials (SEPs) following median, ulnar and tibial nerve stimulation were recorded from sites over the shoulders, neck and scalp in 34 patients with cervical spondylosis. Twenty control subjects were matched for sex and age. Detailed clinical and radiological data were assembled, with particular attention to the sensory modalities impaired and the locus and severity of cord compression. The patients were divided clinically into 4 groups: combined myelopathy and radiculopathy (6 cases), myelopathy alone (15), radiculopathy (6) and neck pain (7). Four cases are described in detail. SEP abnormalities were strongly correlated with clinical myelopathy, but not with radiculopathy. Median and ulnar nerve responses were less often affected than tibial, even with myelopathy above C6 level. Tibial nerve SEP abnormalities were strongly correlated with posterior column signs on the same side of the body, but not with anterolateral column sensory signs. In myelopathy cases, the SEP examination appeared to be more sensitive to sensory pathway involvement than clinical sensory testing. SEP abnormalities were infrequent in cases of radiculopathy and neck pain, bearing no relation to the clinical locus of root lesions. Abnormal SEPs consistent with subclinical posterior column involvement, however, were recorded in 1 patient with radiculopathy and 2 with neck pain. Follow-up recordings made postoperatively in 7 myelopathy cases reflected the clinical course (improvement, deterioration or no change) in 4, but failed to reflect improvement in 3. The correlation of SEP findings with radiological data was generally poor. SEP abnormalities were detected in 6 out of 8 patients with clinical myelopathy but no radiological evidence of posterior cord compression, suggesting that impairment of the blood supply may be an important factor contributing to cord damage. An application for SEPs in the clinical management of cervical spondylosis may lie in the detection of

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

    PubMed

    Arroyo, Hugo A

    2013-09-01

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

  9. Cervical Laminoplasty: The History and the Future

    PubMed Central

    KUROKAWA, Ryu; KIM, Phyo

    Cervical laminoplasty was developed as an alternative to cervical laminectomy for treatment of cervical myelopathy, in which hinges are created to lift the lamina. Various techniques of laminoplasty have since been developed after two prototype techniques: Hirabayashi’s open-door laminoplasty and Kurokawa’s spinous process splitting (double-door) laminoplasty. Several in vitro studies report superior biomechanical stability of the cervical spine after laminoplasty compared with laminectomy. In clinical situation, randomized control studies are scarce and superiority of one procedure over another is not uniformly shown. Lack of hard evidence supporting the purported advantages of laminoplasty over laminectomy, that is, reduced rate of postoperative instability and kyphosis development, while preserving range of motion (ROM), has been a weak selling point. Currently, laminoplasty is performed by majority of spine surgeons in Japan, but is rarely performed in the United States and Europe. Recent development in laminoplasty is preservation of muscle attachment, which enabled dynamic stabilization of the cervical spine by neck extensor muscles. After treatment with new laminoplasty techniques with active postoperative neck ROM exercises, postoperative instability, kyphosis, axial neck pain, and loss of ROM seems minimal. Well-designed clinical trials to show the effectiveness and long-term outcome of this surgical procedure are warranted. PMID:26119898

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

    PubMed Central

    Zhang, Jing; Li, Lian-Bing; Qiu, Zhu; Ren, Hong-Bo; Wu, Jia-Yan; Wang, Tao; Bao, Zhong-Hui; Yang, Ji-Fan; Zheng, Ke; Li, Shao-Lin; Wei, Li; You, Hua

    2015-01-01

    The main aim of the present study was to assess the antioxidative effects of human umbilical cord-derived mesenchymal stromal cells (UC-MSCs) in a rat model of radiation myelopathy. UC-MSCs were isolated from Wharton's jelly (WJ) of umbilical cords. An irradiated cervical spinal cord rat model (C2-T2 segment) was generated using a 60Co irradiator to deliver 30 Gy of radiation. UC-MSCs were injected through the tail vein at 90 days, 97 days, 104 days, and 111 days after-irradiation. Histological damage was examined by cresyl violet/Nissl staining. The activities of two antioxidant enzymes catalase (CAT) and glutathione peroxidase (GPX) in the spinal cord were measured by the biomedical assay. In addition, the levels of vascular endothelial growth factor (VEGF) and angiopoietin-2 (Ang-2) in the spinal cord were determined by ELISA methods. Multiple injections of UC-MSCs through the tail vein ameliorated neuronal damage in the spinal cord, increased the activities of the antioxidant enzymes CAT and GPX, and increased the levels of VEGF and Ang-2 in the spinal cord. Our results suggest that multiple injections of UC-MSCs via the tail vein in the rat model of radiation myelopathy could significantly improve the antioxidative microenvironment in vivo. PMID:26366180

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

    PubMed

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

    2016-02-01

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

  12. Cervical radiculopathy.

    PubMed

    Iyer, Sravisht; Kim, Han Jo

    2016-09-01

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

  13. Cervical spinal intradural arachnoid cysts in related, young pugs.

    PubMed

    Rohdin, C; Nyman, H T; Wohlsein, P; Hultin Jäderlund, K

    2014-04-01

    Seven related young pugs were diagnosed with cervical spinal intradural arachnoid cysts by magnetic resonance imaging (n = 6) and myelography (n = 1). All dogs were presented with skin abrasions on their thoracic limbs and non-painful neurological deficits, indicating a C1-T2 myelopathy. In all six dogs examined by magnetic resonance imaging not only the spinal arachnoid cyst but also a concomitant, most likely secondary, syringohydromyelia was confirmed. Pedigree analysis suggested a genetic predisposition for spinal arachnoid cysts in this family of pugs. Generalised proprioceptive deficits more pronounced in the thoracic limbs suggesting a focal cervical spinal cord lesion, with concomitant skin abrasions on the dorsal aspect of the thoracic limbs in a young pug, should alert veterinarians to the possibility of cervical spinal arachnoid cysts. PMID:24372140

  14. Cervical spondylosis

    MedlinePlus

    Cervical osteoarthritis; Arthritis - neck; Neck arthritis; Chronic neck pain; Degenerative disk disease ... Past spine surgery Ruptured or slipped disk Severe arthritis Small fractures to the spine from osteoporosis

  15. Cervical canal stenosis caused by progressive fusion and enlargement of cervical vertebrae with features of Proteus syndrome and Klippel-Feil syndrome.

    PubMed

    Sugita, Shurei; Chikuda, Hirotaka; Ohya, Junichi; Taniguchi, Yuki; Takeshita, Katsushi; Haga, Nobuhiko; Ushiku, Tetsuo; Tanaka, Sakae

    2013-12-01

    We report the case of a female who presented with progressive fusion and an enlargement of the cervical vertebrae. Her cervical deformity gradually progressed with age, and the abnormal bony protrusion into the spinal canal caused myelopathy. We resected the affected vertebrae to decompress the spinal cord and performed combined anterior-posterior spinal fusion. The progression of the spinal deformity and enlargement of vertebrae stopped after surgery. The enlargement of vertebrae in the present case resembled that observed in Proteus syndrome; however, autonomous vertebral fusion has not been reported previously in patients with this condition. Our report may help expand the knowledge on developmental spine disorders. PMID:23760594

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

    PubMed

    Ibrahim, Wanis H; Elalamy, Osama R; Doiphode, Sanjay H; Mobyaed, Hassan; Darweesh, Adham

    2010-01-01

    Acute myelopathy with sudden paraplegia is a very rare manifestation of meningococcal meningitis, with only a few cases reported in the literature. In almost all previously reported cases, other clinical manifestations of meningitis, such as fever, headache, and neck stiffness preceded acute myelopathy. In this paper, we report a case of acute myelopathy with sudden paraplegia as the sole manifestation of meningococcal meningitis, in the absence of other clinical manifestations of meningitis. PMID:21483588

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

    PubMed Central

    Ibrahim, Wanis H.; Elalamy, Osama R.; Doiphode, Sanjay H.; Mobyaed, Hassan; Darweesh, Adham

    2010-01-01

    Acute myelopathy with sudden paraplegia is a very rare manifestation of meningococcal meningitis, with only a few cases reported in the literature. In almost all previously reported cases, other clinical manifestations of meningitis, such as fever, headache, and neck stiffness preceded acute myelopathy. In this paper, we report a case of acute myelopathy with sudden paraplegia as the sole manifestation of meningococcal meningitis, in the absence of other clinical manifestations of meningitis. PMID:21483588

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

    SciTech Connect

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

    2013-08-01

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

  19. Cervical Cancer

    MedlinePlus

    ... dysplasia of the cervix, vagina, or vulva • A family history of cervical cancer •Smoking •Certain sexually transmitted infections , such as chlamydia • ... to treat your cancer, you still need cervical cancer screening. Cells are taken from the upper vagina ... smallest units of a structure in the body; the building blocks for all ...

  20. Arachnoiditis Ossificans – A Rare Cause of Progressive Myelopathy

    PubMed Central

    Steel, Christopher J; Abrames, Erik L; O’Brien, William T

    2015-01-01

    Arachnoiditis ossificans is a rare cause of chronic, progressive myelopathy. In contrast to the more common benign causes of meningeal calcification, arachnoiditis ossificans results in replacement of portions of the spinal arachnoid by bone as an end-stage complication of adhesive arachnoiditis. It is usually the sequela of prior trauma or interventional procedures. Prognosis and treatment options depend upon the location and degree of spinal stenosis with thoracic involvement being more common and more severe than lumbar spine involvement. The imaging findings on magnetic resonance imaging may be confusing; however, the findings of intraspinal ossification on computed tomography are characteristics and diagnostic. We present a classic case of arachnoiditis ossificans in an elderly man who presented with progressive myelopathy and a recent fall, along with a review of the literature. The imaging in this case not only identified the characteristic findings of arachnoiditis ossificans but also identified secondary findings of the underlying causative etiology. PMID:26401174

  1. Arachnoiditis Ossificans - A Rare Cause of Progressive Myelopathy.

    PubMed

    Steel, Christopher J; Abrames, Erik L; O'Brien, William T

    2015-01-01

    Arachnoiditis ossificans is a rare cause of chronic, progressive myelopathy. In contrast to the more common benign causes of meningeal calcification, arachnoiditis ossificans results in replacement of portions of the spinal arachnoid by bone as an end-stage complication of adhesive arachnoiditis. It is usually the sequela of prior trauma or interventional procedures. Prognosis and treatment options depend upon the location and degree of spinal stenosis with thoracic involvement being more common and more severe than lumbar spine involvement. The imaging findings on magnetic resonance imaging may be confusing; however, the findings of intraspinal ossification on computed tomography are characteristics and diagnostic. We present a classic case of arachnoiditis ossificans in an elderly man who presented with progressive myelopathy and a recent fall, along with a review of the literature. The imaging in this case not only identified the characteristic findings of arachnoiditis ossificans but also identified secondary findings of the underlying causative etiology. PMID:26401174

  2. HTLV-1-associated myelopathy in a solid organ transplant recipient.

    PubMed

    Montesdeoca Andrade, Maria Jose; Correa Diaz, Edgar Patricio; Buestán, Maria Eugenia

    2016-01-01

    Human T-cell lymphotropic virus type-1 (HTLV-1) is endemic in Japan, the Caribbean and in South American countries such as Ecuador. This virus is the cause of HTLV-1-associated myelopathy or tropical spastic paraparesis (HAM/TSP), a myelopathy characterised by chronic progressive paraparesis, spasticity and urinary symptoms. We report the case of a 40-year-old man who received a kidney transplant from a living donor and developed HAM/TSP, 24 months after transplant. The diagnosis was confirmed by detection of HTLV-1 in blood and cerebrospinal fluid by the ELISA and Western Blot tests. For myelopathy, the patient was treated with pulse methylprednisolone, but had poor response to treatment. We recommend that all patients receiving transplants and their donors who come from endemic countries be given a mandatory screening for HTLV-1 through an ELISA test, in an effort to inform candidates for renal transplantation of the potential risk of infection and the development of this disease. PMID:27268291

  3. Cytokine expression of macrophages in HIV-1-associated vacuolar myelopathy.

    PubMed

    Tyor, W R; Glass, J D; Baumrind, N; McArthur, J C; Griffin, J W; Becker, P S; Griffin, D E

    1993-05-01

    Macrophages are frequently present within the periaxonal and intramyelinic vacuoles that are located primarily in the posterior and lateral funiculi of the thoracic spinal cord in HIV-associated vacuolar myelopathy. But the role of these macrophages in the formation of the vacuoles is unclear. One hypothesis is that cytokines, such as interleukin-1 (IL-1) and tumor necrosis factor (TNF)-alpha, are produced locally by macrophages and have toxic effects on myelin or oligodendrocytes. The resulting myelin damage eventually culminates in the removal of myelin by macrophages and vacuole formation. We studied thoracic spinal cord specimens taken at autopsy from HIV-positive (+) and HIV-negative individuals. The predominant mononuclear cells present in HIV+ spinal cords are macrophages. They are located primarily in the posterior and lateral funiculi regardless of the presence or absence of vacuolar myelopathy. Macrophages and microglia are more frequent in HIV+ than HIV-negative individuals and these cells frequently stain for class I and class II antigens, IL-1, and TNF-alpha. Activated macrophages positive for IL-1 and TNF-alpha are great increased in the posterior and lateral funiculi of HIV+ individuals with and without vacuolar myelopathy, suggesting they are present prior to the development of vacuoles. Cytokines, such as TNF-alpha, may be toxic for myelin or oligodendrocytes, leading to myelin damage and removal by macrophages and vacuole formation. PMID:8492917

  4. Degenerative myelopathy in 18 Pembroke Welsh Corgi dogs.

    PubMed

    March, P A; Coates, J R; Abyad, R J; Williams, D A; O'Brien, D P; Olby, N J; Keating, J H; Oglesbee, M

    2009-03-01

    Postmortem examination was performed on 18 Pembroke Welsh Corgi dogs (mean age 12.7 years) with clinical signs and antemortem diagnostic tests compatible with a diagnosis of degenerative myelopathy. Tissue sections from specific spinal cord and brain regions were systematically evaluated in all dogs. Axonal degeneration and loss were graded according to severity and subsequently compared across different spinal cord segments and funiculi. White matter lesions were identified in defined regions of the dorsal, lateral, and ventral funiculi. The dorsolateral portion of the lateral funiculus was the most severely affected region in all cord segments. Spinal cord segment T12 exhibited the most severe axonal loss. Spinal nerve roots, peripheral nerves, and brain sections were within normal limits, with the exception of areas of mild astrogliosis in gray matter of the caudal medulla. Dogs with more severe lesions showed significant progression of axonal degeneration and loss at T12 and at cord segments cranial and caudal to T12. Severity of axonal loss in individual dogs positively correlated with the duration of clinical signs. The distribution of axonal degeneration resembled that reported in German Shepherd Dog degenerative myelopathy but differed with respect to the transverse and longitudinal extent of the lesions within more clearly defined funicular areas. Although these lesion differences might reflect disease longevity, they could also indicate a form of degenerative myelopathy unique to the Pembroke Welsh Corgi dog. PMID:19261635

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

    PubMed

    Prabhakar, S; Syal, P; Singh, P; Lal, V; Khandelwal, N; Das, C P

    1999-12-01

    Fifty seven patients (42 males and 15 females) with non-compressive myelopathy were studied from 1997 to 1999. Acute transverse myelitis (ATM) was the commonest (31) followed by Vit B12 deficiency myelopathy (8), primary progressive multiple sclerosis (5), hereditary spastic paraplegia (3), tropical spastic paraplegia (2), subacute necrotising myelitis (1), radiation myelitis (1), syphilitic myelitis (1) and herpes zoster myelitis (1). 4 cases remained unclassified. In the ATM group, mean age was 30.35 years, antecedent event was observed in 41.9% case, 25 cases had symmetrical involvement and most of the cases had severe deficit at onset. CSF study carried out in 23 patients of ATM revealed rise in proteins (mean 147.95mg%, range 20-1200 mg/dL) and pleocytosis (mean 20.78/cumm, range 0-200 mm3). Oligoclonal band (OCB) was present in 28% of cases of ATM. The most common abnormality detected was a multisegment hyperintense lesion on T2W images, that occupied the central area on cross section. In 6 patients hyperintense signal was eccentric in location. MRI was normal in 4 cases of ATM. Thus ATM is the leading cause of non-compressive myelopathy. Clinical features combined with MRI findings are helpful in defining the cause of ATM. PMID:10625902

  6. Asymptomatic Stenosis in the Cervical and Thoracic Spines of Patients with Symptomatic Lumbar Stenosis

    PubMed Central

    Park, Moon Soo; Moon, Seong-Hwan; Kim, Tae-Hwan; Oh, Jae Keun; Lyu, Ho Dong; Lee, Jae-Hoo; Riew, K. Daniel

    2015-01-01

    Study Design Retrospective study. Objective Studies on age-related degenerative changes causing concurrent stenoses in the cervical, thoracic, and lumbar spines (triple stenosis) are rare in the literature. Our objectives were to determine: (1) the incidence of asymptomatic radiologic cervical and thoracic stenosis in elderly patients with symptomatic lumbar stenosis, (2) the incidence of concurrent radiologic spinal stenosis in the cervical and thoracic spines, and (3) the radiologic features of cervical stenosis that might predict concurrent thoracic stenosis. Methods Whole-spine T2 sagittal magnetic resonance images of patients older than 80 and diagnosed with lumbar spinal stenosis between January 2003 and January 2012 were evaluated retrospectively. We included patients with asymptomatic spondylotic cervical and thoracic stenosis. We measured the anteroposterior diameters of the vertebral body, bony spinal canal, and spinal cord, along with the Pavlov ratio and anterior or posterior epidural stenosis at the level of the disk for each cervical and thoracic level. We compared the radiologic parameters between the subgroups of cervical stenosis with and without thoracic stenosis. Results Among the 460 patients with lumbar stenosis, 110 (23.9%) had concurrent radiologic cervical stenosis and 112 (24.3%) had concurrent radiologic thoracic stenosis. Fifty-six patients (12.1%) had combined radiologic cervical and thoracic stenosis in addition to their symptomatic lumbar stenosis (triple stenosis). Anterior epidural stenosis at C7–T1 was associated with a high prevalence of thoracic stenosis. Conclusions It appears that asymptomatic radiologic cervical and thoracic stenosis is common in elderly patients with symptomatic lumbar stenosis. PMID:26430589

  7. [Cervical laminoplasty--review of surgical techniques, indications, methods of efficacy evaluation, and complications].

    PubMed

    Derenda, Marek; Kowalina, Ireneusz

    2006-01-01

    Techniques of expansive cervical laminoplasty evolved in the 1970s in Japan as an alternative to laminectomy connected with many complications. They were developed and modified in the following years. Nowadays cervical laminoplasty is the standard method of posterior decompression of the cervical spine which reflects the aspiration to preserve the spine stabilising structures. Indications for laminoplasty are multilevel cervical pathological changes leading to spinal canal stenosis and myelopathy as a consequence. Historical background is discussed. Technical details of Z-type laminoplasty (Oyama), open-door laminoplasty (Hirabayashi), spinous process-splitting laminoplasty (Kurokawa), hardware-augmented laminoplasty (O'Brien with Shaffrey's modification) and dorso-lateral decompression (Ohtsuka) are described. The Japanese Orthopaedic Association scale is widely accepted for the clinical evaluation of cervical myelopathy. Effectiveness of surgical treatment is evaluated using the Hirabayashi recovery rate. Postoperative complications are: diminution of neck motion range, kyphotic deformity, axial neck pain, C5 nerve root palsy, restenosis and late deterioration of neurological postoperative outcome. Contemporary theories explaining problems connected with the complications are described. The subject is discussed based on a review of literature and own practice. PMID:17103356

  8. Increased seroreactivity to HERV-K10 peptides in patients with HTLV myelopathy

    PubMed Central

    2013-01-01

    Background Previously, we had shown that persons infected with human T-cell lymphoma leukemia virus 1 or 2 (HTLV-1 or 2) had an increased prevalence of antibodies to a peptide in the Pol protein of the retrovirus HERV-K10, homologous to a peptide in HTLV gp21 envelope protein. The prevalence rate was higher in those with myelopathy vs. non-myelopathy. We have now extended our observations to a cohort restricted to North America in whom the diagnosis of HTLV myelopathy was rigorously confirmed to also test for reactivity to another HERV-K10 peptide homologous to the HTLV p24 Gag protein. Methods Sera from 100 volunteer blood donors (VBD), 53 patients with large granular lymphocytic leukemia (LGLL), 74 subjects with HTLV-1 or 2 infection (58 non-myelopathy and 16 myelopathy) and 83 patients with multiple sclerosis (MS) were evaluated in ELISA assays using the above peptides. Results The HTLV myelopathy patients had a statistically significant increased prevalence of antibodies to both HERV-K10 peptides (87.5%) vs. the VBD (0%), LGLL patients (0%), MS patients (4.8%), and the HTLV positive non-myelopathy subjects (5.2%). Conclusion The data suggest that immuno-cross-reactivity to HERV-K10 peptides and/or transactivation of HERV-K10 expression by the HTLV Tax protein may be involved in the pathogenesis of HTLV-associated myelopathy/tropical spastic paraparesis and spastic ataxia. PMID:24365054

  9. Cervical Cap

    MedlinePlus

    ... and remove the cap. How Much Does It Cost? A cervical cap costs about $70 and should be replaced every year. In addition, there is also the cost of the doctor's visit. Many health insurance plans ...

  10. [Cervical cerclage].

    PubMed

    Akladios, C Y; Sananes, N; Gaudineau, A; Boudier, E; Langer, B

    2015-10-01

    Cervical cerclage aims to strengthen not only the mechanical properties of the cervix, but also its immunological and anti-infectious functions. The demonstration of a strong interrelation between cervical insufficiency as well as decreased cervical length at endo-vaginal ultrasonography and infection has changed the indications cerclage. Actually we can distinguish three indications for cerclage: prophylactic, for obstetrical history; therapeutic, for shortened cervical length at ultrasonography in patients at risk and; emergency cerclage in case of threatening cervix at physical examination. The McDonald's technique is the most recommended. In case of failure, it is proposed to realize cerclage at a higher level on the cervix either by vaginal or abdominal route. PMID:26144289

  11. Paravertebral muscles in disease of the cervical spine.

    PubMed Central

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

    1996-01-01

    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 PMID:8937338

  12. Posterior Cervical Microscopic Foraminotomy and Discectomy with Laser for Unilateral Radiculopathy

    PubMed Central

    Jeon, Hyo-Cheol; Kim, Cheol-Soo; Kim, Suk-Cheol; Kim, Tae-Ho; Jang, Jae-Won; Choi, Ki-Young; Moon, Bong Ju

    2015-01-01

    Surgical decompression for cervical radiculopathy includes anterior cervical discectomy and fusion, anterior or posterior cervical foraminotomy, and cervical arthroplasty after decompression. The aim of this study was to evaluate the usefulness of a CO2 laser in posterior-approach surgery for unilateral cervical radiculopathy. From January 2006 to December 2008, 12 consecutive patients with unilateral cervical radiculopathy from either foraminal stenosis or disc herniation, which was confirmed with imaging studies, underwent posterior foraminotomy and discectomy with the use of a microscope and CO2 laser. For annulotomy and discectomy, we used about 300 joules of CO2 laser energy. Magnetic resonance imaging (MRI) was used to evaluate the extent of disc removal or foraminal decompression. Clinical outcome was evaluated by using visual analogue scale scores for radicular pain and Odom's criteria. For evaluation of spinal stability, cervical flexion and extension radiographs were obtained. Single-level foraminotomy was performed in 10 patients and two-level foraminotomies were performed in 2 patients. Preoperative radicular symptoms were improved immediately after surgery in all patients. No surgery-related complications developed in our cases. Postoperative MRI demonstrated effective decompression of ventral lesions and widened foraminal spaces in all cases. There was no development of cervical instability during the follow-up period. Posterior foraminotomy and discectomy using a microscope and CO2 laser is an effective surgical tool for unilateral cervical radiculopathy caused by lateral or foraminal disc herniations or spondylotic stenosis. Long-term follow-up with radiographs showed no significant kyphotic changes or spinal instability. PMID:26730364

  13. Posterior Cervical Microscopic Foraminotomy and Discectomy with Laser for Unilateral Radiculopathy.

    PubMed

    Jeon, Hyo-Cheol; Kim, Cheol-Soo; Kim, Suk-Cheol; Kim, Tae-Ho; Jang, Jae-Won; Choi, Ki-Young; Moon, Bong Ju; Lee, Jung-Kil

    2015-12-01

    Surgical decompression for cervical radiculopathy includes anterior cervical discectomy and fusion, anterior or posterior cervical foraminotomy, and cervical arthroplasty after decompression. The aim of this study was to evaluate the usefulness of a CO2 laser in posterior-approach surgery for unilateral cervical radiculopathy. From January 2006 to December 2008, 12 consecutive patients with unilateral cervical radiculopathy from either foraminal stenosis or disc herniation, which was confirmed with imaging studies, underwent posterior foraminotomy and discectomy with the use of a microscope and CO2 laser. For annulotomy and discectomy, we used about 300 joules of CO2 laser energy. Magnetic resonance imaging (MRI) was used to evaluate the extent of disc removal or foraminal decompression. Clinical outcome was evaluated by using visual analogue scale scores for radicular pain and Odom's criteria. For evaluation of spinal stability, cervical flexion and extension radiographs were obtained. Single-level foraminotomy was performed in 10 patients and two-level foraminotomies were performed in 2 patients. Preoperative radicular symptoms were improved immediately after surgery in all patients. No surgery-related complications developed in our cases. Postoperative MRI demonstrated effective decompression of ventral lesions and widened foraminal spaces in all cases. There was no development of cervical instability during the follow-up period. Posterior foraminotomy and discectomy using a microscope and CO2 laser is an effective surgical tool for unilateral cervical radiculopathy caused by lateral or foraminal disc herniations or spondylotic stenosis. Long-term follow-up with radiographs showed no significant kyphotic changes or spinal instability. PMID:26730364

  14. Congenital variations of the upper cervical spine and their importance in preoperative diagnosis. A case report and a review of the literature.

    PubMed

    Lampropoulou-Adamidou, Kalliopi; Athanassacopoulos, Michael; Karampinas, Panagiotis K; Vlamis, John; Korres, Demetrios S; Pneumaticos, Spiros G

    2013-07-01

    Several variations of the bony and vascular anatomy around the first and second cervical vertebrae have been reported. Failure to recognise these variations can complicate operations on the upper cervical spine. We present a patient with recent onset of cervical myelopathy due to stenosis at the C3-4 level. Preoperative evaluation identified Klippel-Feil syndrome with cervical fusion of C2-3, aplasia of posterior arch of C1, anomalous vertebral artery course and a "ponticulus posticus" of C2. The combination of these variations in a Klippel-Feil syndrome patient has never been reported. Thus, we recommend a thorough preoperative imaging evaluation, with CT scan and CT angiography or DSA, in addition to plain radiographs. This evaluation is imperative, before a cervical spine surgery, allowing a better understanding of the anatomy, in order to minimise the risks of misplacement of cervical instrumentation especially in such patients. PMID:23563588

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

    PubMed

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

    2014-11-01

    A 2-year-old Thoroughbred gelding with clinical signs localized to the first 6 spinal cord segments (C1 to C6) had complete fusion of the atlanto-occipital bones which precluded performing a routine myelogram. An ultrasound-assisted myelogram at the intervertebral space between the atlas and axis was successfully done and identified a marked extradural compressive myelopathy at the level of the atlas and axis, and axis and third cervical vertebrae. PMID:25392550

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

    PubMed Central

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

    2014-01-01

    A 2-year-old Thoroughbred gelding with clinical signs localized to the first 6 spinal cord segments (C1 to C6) had complete fusion of the atlanto-occipital bones which precluded performing a routine myelogram. An ultrasound-assisted myelogram at the intervertebral space between the atlas and axis was successfully done and identified a marked extradural compressive myelopathy at the level of the atlas and axis, and axis and third cervical vertebrae. PMID:25392550

  17. Anti-venom-induced myelopathy in a semipoisonous snakebite.

    PubMed

    Biswas, R; Irodi, A; Paul, A; Ghimere, G; Joshi, K R; Alurkar, V M; Shetty, K J

    2004-06-01

    A 40-year-old woman developed myelopathy manifesting as Brown Sequard syndrome after administration of Anti-venom (polyvalent enzyme-refined equine globulin supposed to neutralise 0.6 mg of standard cobra venom, 0.45 mg of standard krait venom, 0.6 mg of standard Russel's viper venom and 0.45 mg of saw scaled viper venom, manufactured by Serum Institute of India, Pune, India). It was concluded to be an immunological inflammation of the spinal cord after ruling out hematomyelia on imaging. The necessity of antivenom in semipoisonous snake bites have been addressed further in the article. PMID:15311570

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

    PubMed

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

    2016-08-01

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

  19. Cervical Dysplasia

    PubMed Central

    Carmichael, John A.

    1983-01-01

    Invasive squamous carcinoma of the cervix is preceded by a series of premalignant changes described as mild, moderate, or severe dysplasia, and carcinoma in situ. These premalignant states are identified by cervical cytology, diagnosed by colposcopy and if effectively treated, can prevent invasive squamous carcinoma of the cervix. Because of the apparent biological variation of the premalignant states, even the most aggressive cervical screening program cannot be expected to eliminate all invasive squamous cancer of the cervix. Optimal results of a cervical screening program will be achieved when all women under 35 years of age and sexually active have an annual cytological smear; the cytology is screened by a laboratory with high quality control; the patient's positive cytology is accurately assessed by an experienced colposcopist, and the premalignant lesion is effectively treated. PMID:21283455

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

    PubMed Central

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

    2016-01-01

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

  1. Cervical cancer.

    PubMed

    Koh, Wui-Jin; Greer, Benjamin E; Abu-Rustum, Nadeem R; Apte, Sachin M; Campos, Susana M; Chan, John; Cho, Kathleen R; Cohn, David; Crispens, Marta Ann; DuPont, Nefertiti; Eifel, Patricia J; Gaffney, David K; Giuntoli, Robert L; Han, Ernest; Huh, Warner K; Lurain, John R; Martin, Lainie; Morgan, Mark A; Mutch, David; Remmenga, Steven W; Reynolds, R Kevin; Small, William; Teng, Nelson; Tillmanns, Todd; Valea, Fidel A; McMillian, Nicole R; Hughes, Miranda

    2013-03-01

    These NCCN Clinical Practice Guidelines in Oncology for Cervical Cancer focus on early-stage disease, because it occurs more frequently in the United States. After careful clinical evaluation and staging, the primary treatment of early-stage cervical cancer is either surgery or radiotherapy. These guidelines include fertility-sparing and non-fertility-sparing treatment for those with early-stage disease, which is disease confined to the uterus. A new fertility-sparing algorithm was added for select patients with stage IA and IB1 disease.. PMID:23486458

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

    PubMed

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

    1989-11-01

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

  3. Clinical analysis of cervical radiculopathy causing deltoid paralysis.

    PubMed

    Chang, Han; Park, Jong-Beom; Hwang, Jin-Yeun; Song, Kyung-Jin

    2003-10-01

    In general, deltoid paralysis develops in patients with cervical disc herniation (CDH) or cervical spondylotic radiculopathy (CSR) at the level of C4/5, resulting in compression of the C5 nerve root. Therefore, little attention has been paid to CDH or CSR at other levels as the possible cause of deltoid paralysis. In addition, the surgical outcomes for deltoid paralysis have not been fully described. Fourteen patients with single-level CDH or CSR, who had undergone anterior cervical decompression and fusion for deltoid paralysis, were included in this study. The severity of deltoid paralysis was classified into five grades according to manual motor power test, and the severity of radiculopathy was recorded on a visual analog scale (zero to ten points). The degree of improvement in both the severity of deltoid paralysis and radiculopathy following surgery was evaluated. Of 14 patients, one had C3/4 CDH, four had C4/5 CDH, three had C4/5 CSR, one had C5/6 CDH, and five had C5/6 CSR. Both deltoid paralysis and radiculopathy improved significantly with surgery (2.57+/-0.51 grades vs 4.14+/-0.66, P=0.001, and 7.64+/-1.65 points vs 3.21+/-0.58, P=0.001, respectively). In conclusion, the current study demonstrates that deltoid paralysis can develop due to CDH or CSR not only C4/5, but also at the levels of C3/4 and C5/6, and that surgical decompression significantly improves the degree of deltoid paralysis due to cervical radiculopathy. PMID:12734743

  4. General Information about Cervical Cancer

    MedlinePlus

    ... Research Cervical Cancer Treatment (PDQ®)–Patient Version General Information About Cervical Cancer Go to Health Professional Version ... the NCI website . Cervical Cancer During Pregnancy General Information About Cervical Cancer During Pregnancy Treatment of cervical ...

  5. Cervical Spondylosis and Hypertension

    PubMed Central

    Peng, Baogan; Pang, Xiaodong; Li, Duanming; Yang, Hong

    2015-01-01

    Abstract Cervical spondylosis and hypertension are all common diseases, but the relationship between them has never been studied. Patients with cervical spondylosis are often accompanied with vertigo. Anterior cervical discectomy and fusion is an effective method of treatment for cervical spondylosis with cervical vertigo that is unresponsive to conservative therapy. We report 2 patients of cervical spondylosis with concomitant cervical vertigo and hypertension who were treated successfully with anterior cervical discectomy and fusion. Stimulation of sympathetic nerve fibers in pathologically degenerative disc could produce sympathetic excitation, and induce a sympathetic reflex to cause cervical vertigo and hypertension. In addition, chronic neck pain could contribute to hypertension development through sympathetic arousal and failure of normal homeostatic pain regulatory mechanisms. Cervical spondylosis may be one of the causes of secondary hypertension. Early treatment for resolution of symptoms of cervical spondylosis may have a beneficial impact on cardiovascular disease risk in patients with cervical spondylosis. PMID:25761188

  6. Solitary osteochondroma of the thoracic spine causing myelopathy.

    PubMed

    Song, K-J; Lee, K-B

    2007-06-01

    We evaluate the clinical presentation and radiographic findings of a patient with solitary osteochondroma and compressive myelopathy and review the relevant English-language medical literature. The involvement of the spine with a solitary osteochondroma is rare. The addition of the current case to those already reported makes a total of 51 published cases of solitary vertebral osteochondromas with spinal cord compression. The clinical history, computed tomogram, magnetic resonance image, and plain radiograms were reviewed. A review of the literature was also done. The patient gradually improved and symptoms stopped progressing after surgical removal of the lesion. Magnetic resonance imaging and computed tomography are useful for evaluating the size and extent of a spinal osteochondroma causing spinal cord compression. PMID:17638163

  7. Cervical cancer.

    PubMed

    Shepherd, John H

    2012-06-01

    Standard treatment for invasive cervical cancer involves either radical surgery or radiotherapy. Childbearing is therefore impossible after either of these treatments. A fertility-sparing option, however, by radical trachelectomy has been shown to be effective, provided that strict criteria for selection are followed. Fertility rates are high, whereas recurrence is low, indicating that a more conservative approach to dealing with early small cervical tumours is feasible. Careful preoperative assessment by magnetic resonance imaging scans allows accurate measurement of the tumour with precise definition to plan surgery. This will ensure an adequate clear margin by wide excision of the tumour excising the cervix by radical vaginal trachelectomy with surrounding para-cervical and upper vaginal tissues. An isthmic cerclage is inserted to provide competence at the level of the internal orifice. A primary vagino-isthmic anastomosis is conducted to restore continuity of the lower genital tract. Subsequent pregnancies require careful monitoring in view of the high risk of spontaneous premature rupture of the membranes. Delivery by classical caesarean section is necessary at the onset of labour or electively before term. Over 1100 such procedures have been carried out vaginally or abdominally, resulting in 240 live births. Radical vaginal trachelectomy with a laparoscopic pelvic-node dissection offers the least morbid and invasive route for surgery, provided that adequate surgical skills have been obtained. PMID:22353492

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

    PubMed

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

    2014-07-01

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

  9. Biomarkers in Cervical Cancer

    PubMed Central

    Yim, Eun-Kyoung; Park, Jong-Sup

    2006-01-01

    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. PMID:19690652

  10. Long-Term Outcome of Posterior Cervical Inclinatory Foraminotomy

    PubMed Central

    Heo, Juneyoung; Park, Hyung-Ki

    2016-01-01

    Objective A modified surgical technique of posterior cervical foramintomy called posterior cervical inclinatory foraminotomy (PCIF) was introduced in previous preliminary article. PCIF allows better preservation of facet joint and capsule than conventional techniques. The authors conducted a study to investigate long-term outcomes of PCIF. Methods We retrospectively reviewed demographic, radiologic, and clinical data from the patients who underwent PCIFs at our institution. Criteria included a minimum of 48 month follow-up and PCIFs for patients with radiculopathy from foraminal stenosis (C2–T1; single or multilevel) with persistent or recurrent root symptoms despite conservative treatment for more than 3 months. Patients who had undergone previous cervical operation were excluded. The visual analogue scale (VAS) score was used for clinical follow-up, and radiologic follow-up was performed to compare the changes of cervical sagittal alignment, focal angle and disc-space height of treated segment. Results The PCIFs were performed between April 2007 and March 2011 on 46 patients (32 males and 14 females) with a total of 73 levels affected. The average duration of follow-up was 74.4 months. Improvements in radiculopathic pain were seen in 39 patients (84.7%), and VAS score decreased from 6.82±1.9 to 2.19±1.9. Posterior neck pain also improved in 25 patients (71.4%) among 35 patients, and VAS score decreased from 4.97±2.0 to 2.71±1.9. The mean disc-space heights of treated segment were 5.41±1.03 mm preoperatively and decreased to 5.17±1.12 mm postoperatively. No statistically significant changes in cervical sagittal alignment, focal angle were seen during the follow-up period (Cox proportional hazards analysis and Student t-test, p>0.05). Conclusion The PCIF is highly effective in treating patients with cervical spondylotic radiculopathy, leading to long-lasting relief in pain. Long-term radiologic follow-up showed no significant spinal angular imbalance. PMID

  11. New titanium spacer for cervical laminoplasty: initial clinical experience. Technical note.

    PubMed

    Tani, Satoshi; Suetsua, Futoshi; Mizuno, Junichi; Uchikado, Hisaaki; Nagashima, Hiroyasu; Akiyama, Masahiko; Isoshima, Akira; Ohashi, Hiroki; Hirano, Yoshitaka; Abe, Toshiaki

    2010-01-01

    Many commercially available hydroxyapatite (HA) spacers for cervical laminoplasty have been introduced but have disadvantages such as lack of plasticity, easy cracking, and occasional difficulty in fixation by sutures. Here we present the short-term results of a newly designed titanium spacer (Laminoplasty Basket) in open-door cervical laminoplasty, and evaluated clinically and radiologically. The titanium box-shaped spacer with two arms for fixation was easily inserted and fixed into the laminoplasty space with 4-mm or 5-mm length screws after the posterior cervical arch was repositioned for the canal expansion. Twenty-one patients with cervical myelopathy due to spondylosis or ossification of the longitudinal ligament or developmental narrow canal observed for more than 6 months postoperatively were enrolled in this study. The neurological condition of these patients improved from 9.4 points on the Japanese Orthopaedic Association scale preoperatively to 13.5 points at 6 months after surgery. Postoperative radiological evaluation showed no laminar closure or implant failure and cervical spine curvature was maintained. These results seemed to have no significant difference compared with those using HA spacers. This titanium spacer is a potential substitute for conventional HA or other similar devices in cervical laminoplasty. PMID:21206196

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

    PubMed Central

    Haghnegahdar, Ali

    2016-01-01

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

  13. Canine degenerative myelopathy: a model of human amyotrophic lateral sclerosis.

    PubMed

    Nardone, Raffaele; Höller, Yvonne; Taylor, Alexandra C; Lochner, Piergiorgio; Tezzon, Frediano; Golaszewski, Stefan; Brigo, Francesco; Trinka, Eugen

    2016-02-01

    Canine degenerative myelopathy (CDM) represents a unique naturally occurring animal model for human amyotrophic lateral sclerosis (ALS) because of similar clinical signs, neuropathologic findings, and involvement of the superoxide dismutase 1 (SOD1) mutation. A definitive diagnosis can only be made postmortem through microscopic detection of axonal degeneration, demyelination and astroglial proliferation, which is more severe in the dorsal columns of the thoracic spinal cord and in the dorsal portion of the lateral funiculus. Interestingly, the muscle acetylcholine receptor complexes are intact in CDM prior to functional impairment, thus suggesting that muscle atrophy in CDM does not result from physical denervation. Moreover, since sensory involvement seems to play an important role in CDM progression, a more careful investigation of the sensory pathology in ALS is also warranted. The importance of SOD1 expression remains unclear, while oxidative stress and denatured ubiquinated proteins appear to play a crucial role in the pathogenesis of CDM. In this updated narrative review we performed a systematic search of the published studies on CDM that may shed light on the pathophysiological mechanisms of human ALS. A better understanding of the factors that determine the disease progression in CDM may be beneficial for the development of effective treatments for ALS. PMID:26432396

  14. Neuroimaging of Spinal Canal Stenosis.

    PubMed

    Cowley, Peter

    2016-08-01

    Spinal stenosis is common and presents in a variety of forms. Symptomatic lumbar stenosis occurs in approximately 10% of the population and cervical stenosis in 9% over age 70. Imaging is central to the management decision process and first-choice MR imaging may be substituted with CT and CT myelography. A review of the literature is presented with particular emphasis on the clinical-radiologic correlation in both neurogenic intermittent claudication and cervical spondylotic myelopathy. Advanced techniques promise improvements, particularly with radicular compressive lesions, but remain underutilized in routine clinical practice. PMID:27417399

  15. Cervical Synovial Cyst Causing Cervical Radiculomyelopathy: Case Report and Review of the Literature.

    PubMed

    Corredor, José A; Quan, Gerald

    2015-08-01

    Study Design Case report. Objective Synovial cysts in the subaxial cervical spine are rare and are most commonly reported at the cervicothoracic junction. Only six cases of symptomatic C5-C6 synovial cysts have been reported in the literature; the condition is usually treated with decompressive laminectomy. We present a patient with a synovial cyst arising from the C5-C6 facet joint, associated with spondylolisthesis, and causing radiculomyelopathy. The patient was treated with a posterior excision of the cyst, decompressive laminectomy, and fusion. Methods A 67-year-old man had vertebral canal stenosis at C5-C6 secondary to a synovial cyst and spondylolisthesis with symptoms and signs of radiculopathy and myelopathy. Surgical management involved C5-C6 posterior decompressive laminectomy and excision of the cyst and C4-C6 instrumented fusion with lateral mass screws and rods. A literature review of symptomatic cervical synovial cysts is presented. Results The imaging studies identified grade I spondylolisthesis and a 3.3 × 4.3-mm extradural lentiform-like mass associated with focal compression of the spinal cord and exiting the C6 nerve root. After the surgery, the patient had an immediate full recovery and was asymptomatic by the 6-month examination. No operative complications were reported. The histologic report confirmed the presence of a synovial cyst. Conclusions C5-C6 is an unusual localization for symptomatic synovial cysts. Similar cases reported in the literature achieved excellent results after cyst excision and decompressive laminectomy. Because spondylolisthesis plus laminectomy are risk factors for segmental instability in the cervical spine, we report a case of a C5-C6 facet synovial cyst successfully treated with posterior laminectomy and C4-C6 fusion. PMID:26225291

  16. Cervical Synovial Cyst Causing Cervical Radiculomyelopathy: Case Report and Review of the Literature

    PubMed Central

    Corredor, José A.; Quan, Gerald

    2014-01-01

    Study Design Case report. Objective Synovial cysts in the subaxial cervical spine are rare and are most commonly reported at the cervicothoracic junction. Only six cases of symptomatic C5–C6 synovial cysts have been reported in the literature; the condition is usually treated with decompressive laminectomy. We present a patient with a synovial cyst arising from the C5–C6 facet joint, associated with spondylolisthesis, and causing radiculomyelopathy. The patient was treated with a posterior excision of the cyst, decompressive laminectomy, and fusion. Methods A 67-year-old man had vertebral canal stenosis at C5–C6 secondary to a synovial cyst and spondylolisthesis with symptoms and signs of radiculopathy and myelopathy. Surgical management involved C5–C6 posterior decompressive laminectomy and excision of the cyst and C4–C6 instrumented fusion with lateral mass screws and rods. A literature review of symptomatic cervical synovial cysts is presented. Results The imaging studies identified grade I spondylolisthesis and a 3.3 × 4.3-mm extradural lentiform-like mass associated with focal compression of the spinal cord and exiting the C6 nerve root. After the surgery, the patient had an immediate full recovery and was asymptomatic by the 6-month examination. No operative complications were reported. The histologic report confirmed the presence of a synovial cyst. Conclusions C5–C6 is an unusual localization for symptomatic synovial cysts. Similar cases reported in the literature achieved excellent results after cyst excision and decompressive laminectomy. Because spondylolisthesis plus laminectomy are risk factors for segmental instability in the cervical spine, we report a case of a C5–C6 facet synovial cyst successfully treated with posterior laminectomy and C4–C6 fusion. PMID:26225291

  17. Cervical Cancer Stage IVB

    MedlinePlus

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

  18. Cervical Cancer Screening

    MedlinePlus

    ... Cancer found early may be easier to treat. Cervical cancer screening is usually part of a woman's health ... may do more tests, such as a biopsy. Cervical cancer screening has risks. The results can sometimes be ...

  19. Cervical exenteration.

    PubMed

    Grillo, H C; Mathisen, D J

    1990-03-01

    Cervical exenteration is a radical operation to remove the larynx, portion of the trachea, and the esophagus, and frequently requires a mediastinal tracheostomy. Highly selected patients with obstructing neoplasms of the esophagus and airway can be palliated and sometimes cured by this aggressive surgical approach. Fatal hemorrhage from pressure or exposure of the innominate artery is avoided by elective division of the artery (preoperative angiograms and intraoperative electroencephalographic control are essential), using the omentum to separate the trachea and great vessels, and removal of a bony plaque of chest wall to allow a well-vascularized bipedicled skin flap to drop into the mediastinum for the tracheocutaneous anastomosis. Eighteen exenterations were performed. Mediastinal tracheostomy was performed in 14 patients and division of the innominate artery was performed in 7. Esophageal replacement was predominantly with the left colon. Complications include esophageal leak (2 patients), stomal separation (2), transient hemiplegia (1), colonic obstruction by substernal tunnel (1), and need for prolonged mechanical ventilation (4). There was a single operative death. Postoperative survival was disease dependent. All patients achieved an excellent airway and relief from dysphagia. PMID:2178569

  20. Remarkable recovery in an infant presenting with extensive perinatal cervical cord injury

    PubMed Central

    Ul Haq, Israr; Gururaj, A K

    2012-01-01

    Cervical-cord damage is a complication of a difficult delivery, and results in spinal shock with flaccidity progressing to spastic paralysis. Conventionally, outlook for such patients is extremely poor and most will recover only slightly from quadriplegia and autonomic dysfunction. Here, we report a case in which the extent of damage considerably contrasted with the outcome and recovery. A full-term baby girl born by difficult vaginal delivery displayed bilateral flaccid paralysis of the lower limbs with absent spontaneous movements, weakness of both upper limbs, hyporeflexia in all limbs and axial hypotonia. MRI of cervicothoracic spine exhibited raised signal intensity in the dorsal aspects of C7 to T1 signifying myelopathy. MRI at 4 months revealed a near-total transection of the cervical cord. However, at 6 months, the child could move all lower limbs independently with a marked increase in power. There was no spasticity, wasting or incontinence. Reflexes had also returned. PMID:23230249

  1. Suspected cervical spinal cord vascular anomaly in an African warthog (Phacochoerus africanus).

    PubMed

    Whiteside, Douglas P; Shury, Todd K; Black, Sandra R; Raverty, Stephen

    2006-09-01

    Vascular myelopathies of the spinal cord have not been described in Suidae, and are a rare finding in companion animals. An 8.5-yr female African warthog (Phacochoerus africanus) presented with an acute onset of tetraparesis. Based on neurologic findings, a cervical spinal cord lesion between C7-T2 was suspected. Magnetic resonance imaging revealed severe intramedullary hemorrhage with suspected abnormal vessels in the spinal cord at the level of the seventh cervical vertebrae. The acute onset of clinical signs and rapid deterioration of neurological status precluded surgical managements. A vascular anomaly was suspected on gross pathology and histology. Immunohistochemistry identified the lesion as a spontaneous intramedullary hematoma. Spontaneous intramedullary hematomyelia should be considered as a differential for acute onset of paresis in suid species. PMID:17319141

  2. Cervical Cancer Stage IA

    MedlinePlus

    ... historical Searches are case-insensitive Cervical Cancer Stage IA Add to My Pictures View /Download : Small: 720x576 ... Large: 3000x2400 View Download Title: Cervical Cancer Stage IA Description: Stage IA1 and IA2 cervical cancer; drawing ...

  3. Veliparib, Topotecan Hydrochloride, and Filgrastim or Pegfilgrastim in Treating Patients With Persistent or Recurrent Cervical Cancer

    ClinicalTrials.gov

    2016-03-25

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

  4. Radiation response of the rat cervical spinal cord after irradiation at different ages: Tolerance, latency and pathology

    SciTech Connect

    Ruifrok, A.C.C.; Van Der Kogel, A.J. ); Stephens, L.C. )

    1994-04-30

    Investigation of the age dependent single-dose radiation tolerance, latency to radiation myelopathy, and the histopathological changes after irradiation of the rat cervical spinal cord is presented. Rats were irradiated with graded single doses of 4 MV photons to the cervical spinal cord. When the rats showed definite signs of paresis of the forelegs, they were killed and processed for histological examination. The radiation dose resulting in paresis due to white matter damage in 50% of the animals (ED[sub 50]) after single dose irradiation was about 21.5 Gy at all ages [ge] 2 weeks. Only the Ed[sub 50] at 1 week was significantly lower. The latency to the development of paresis clearly changed with the age at irradiation, from about 2 weeks after irradiation at 1 week to 6-8 months after irradiation at age [ge] 8 weeks. The white matter damage was similar in all symptomatic animals studied. The most prominent were areas with diffuse demyelination and swollen axons, often with focal necrosis, accompanied by glial reaction. This was observed in all symptomatic animals, irrespective of the age at irradiation. Expression of vascular damage appeared to depend on the age at irradiation. Although the latency to myelopathy is clearly age dependent, single dose tolerance is not age dependent at age [ge] 2 weeks in the rat cervical spinal cord. The white matter damage is similar in all symptomatic animals studied, but the vasculopathies appear to be influenced by the age at irradiation. It is concluded that white matter damage and vascular damage are separate phenomena contributing to the development of radiation myelopathy, expression of which may depend on the radiation dose applied and the age at irradiation. 28 refs., 5 figs., 3 tabs.

  5. Lateral and Dorsal Column Hyperintensity on Magnetic Resonance Imaging in a Patient with Myelopathy Associated with Intrathecal Chemotherapy

    PubMed Central

    Saito, Fumine; Hatano, Taku; Hori, Masaaki; Kawamura, Miwako; Sasaki, Makoto; Aoki, Shigeki; Hattori, Nobutaka

    2013-01-01

    Chemotherapy-related myelopathy mimicking subacute combined degeneration (SCD) has rarely been reported. We encountered a 35-year-old female with sensory ataxia after intrathecal chemotherapy. Spinal magnetic resonance imaging showed localized abnormal signal areas in the lateral and dorsal white matter, mimicking SCD. Diffusion imaging showed restricted water diffusion and increased microstructural complexity, and cerebrospinal fluid analysis showed increased levels of myelin basic proteins, indicating demyelinating myelopathy. Advanced diffusion imaging can provide more information on the microstructure of chemotherapy-related myelopathy. PMID:23874296

  6. Cervical cord compression in pediatrics with hereditary multiple exostoses: a report of two cases and review of the literature.

    PubMed

    Kamiya, Yasunari; Horii, Emiko; Sakai, Yoshihito; Inoue, Hidenori

    2016-05-01

    Hereditary multiple exostoses (HME) generally involves the long tube bone or flat bone. Spinal involvement is rare, particularly in young children. We report two cases of children with HME who have myelopathy because of cervical spine involvement and then review the literature to clarify the clinical characteristics of spinal cord HME involvement in young children. In our cases and previously reported cases, neurological deficits remained in cases with acute onset, but other cases with slow onset showed almost complete recovery after surgery. This suggests that the assessment of spinal lesions before trauma is very important. PMID:26313505

  7. ADXS11-001 High Dose HPV+ Cervical Cancer

    ClinicalTrials.gov

    2016-06-17

    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

  8. FDG and FMISO PET Hypoxia Evaluation in Cervical Cancer

    ClinicalTrials.gov

    2015-06-03

    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

  9. Subacute myelo‑optic neuropathy, beriberi, and HTLV‑I‑associated myelopathy: elucidation of some neurological diseases in Japan.

    PubMed

    Igata, Akihiro

    2012-01-01

    Personal experience of the discovery of the cause, pathophysiology, and treatment as well as prevention of subacute myelo‑optic neuropathy, beriberi, and HTLV‑I‑associated myelopathy were described. PMID:23222550

  10. Drugs Approved for Cervical Cancer

    MedlinePlus

    ... Professionals Questions to Ask about Your Treatment Research Drugs Approved for Cervical Cancer This page lists cancer ... in cervical cancer that are not listed here. Drugs Approved to Prevent Cervical Cancer Cervarix (Recombinant HPV ...

  11. Cervical cancer - screening and prevention

    MedlinePlus

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

  12. Heterotopic ossification in cervical disc arthroplasty: Is it clinically relevant?

    PubMed Central

    Barbagallo, Giuseppe M.; Corbino, Leonardo A.; Olindo, Giuseppe; Albanese, Vincenzo

    2010-01-01

    Study design: Retrospective cohort study. Objective: To analyze the presence and clinical relevance of heterotopic ossification (HO) at 3 years mean follow-up. Methods: Thirty patients suffering from cervical radiculopathy and/or myelopathy treated with anterior disc replacement (ADR) were studied. HO was classified using the McAfee grading system. Range of motion was measured from flexion and extension x-rays. Short-form 36 and neck disability index (NDI) assessed functional outcome. Results: Forty-five prostheses were implanted in 30 patients with cervical radiculopathy and/or myelopathy, mean age 40.9 years. Nineteen patients received 1 level and 11 patients received multilevel disc replacement. The incidence rate of HO was 42.2% (19 levels). Segmental range of motion was ≥3° in 93.8% of patients with HO. There was no significant difference in functional scores between those who did and those who did not develop HO. Males tended to develop HO more frequently than females, though this was not statistically significant. The indication for surgery (soft disc hernia or spondylosis) was not associated with the formation of HO. Conclusions: Functional improvement is maintained despite the presence of HO following cervical disc arthroplasty. Indications for arthroplasty should not be halted by the risk of HO. Methods evaluation and class of evidence (CoE) Methodological principle: Study design:  Prospective cohort  Retrospective cohort •  Case-control  Case series Methods  Patients at similar point in course of treatment •  Follow-up ≥85%  Similarity of treatment protocols for patient groups •  Patients followed for long enough for outcomes to occur •  Control for extraneous risk factors* Evidence class: III *Authors must provide a description of robust baseline characteristics, and control for those that are potential prognostic factors. The definiton of the different classes of evidence is available on page 83. PMID:23544019

  13. 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

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

    2014-01-01

    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

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

    PubMed Central

    Voronov, Leonard I; Siemionow, Krzysztof B; Havey, Robert M; Carandang, Gerard; Patwardhan, Avinash G

    2016-01-01

    Introduction Lateral mass screw (LMS) fixation with plates or rods is the current standard procedure for posterior cervical fusion. Recently, implants placed between the facet joints have become available as an alternative to LMS or transfacet screws for patients with cervical spondylotic radiculopathy. The purpose of this study was to evaluate the biomechanical stability of the DTRAX® cervical cage for single- and two-level fusion and compare this to the stability achieved with LMS fixation with rods in a two-level construct. Methods Six cadaveric cervical spine (C3–C7) specimens were tested in flexion–extension, lateral bending, and axial rotation to ±1.5 Nm moment without preload (0 N) in the following conditions: 1) intact (C3–C7), 2) LMS and rods at C4–C5 and C5–C6, 3) removal of all rods (LMS retained) and placement of bilateral posterior cages at C5–C6, 4) bilateral posterior cages at C4–C5 and C5–C6 (without LMS and rods), and 5) C4–C5 and C5–C6 bilateral posterior cages at C4–C5 and C5–C6 with rods reinserted. Results Bilateral posterior cervical cages significantly reduced range of motion in all tested directions in both single- and multilevel constructs (P<0.05). Similar stability was achieved with bilateral posterior cages and LMS in a two-level construct: 0.6°±0.3° vs 1.2°±0.4° in flexion–extension (P=0.001), (5.0°±2.6° vs 3.1°±1.3°) in lateral bending (P=0.053), (1.3°±1.0° vs 2.2°±0.9°) in axial rotation (P=0.091) for posterior cages and LMS, respectively. Posterior cages, when placed as an adjunct to LMS, further reduced range of motion in a multilevel construct (P<0.05). Conclusion Bilateral posterior cages provide similar cervical segmental stability compared with a LMS and rod construct and may be an alternative surgical option for select patients. Furthermore, supplementation of a lateral mass construct with posterior cages increases cervical spine stability in single- and multilevel conditions. PMID

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

    PubMed

    Lanska, Douglas J; Remler, Bernd

    2014-04-01

    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

  16. Ossification of ligamentum flavum, a rare cause of myelopathy: First case report of a Lebanese patient.

    PubMed

    El Helou, Antonios; Alaywan, Moussa; Tarabay, Antonio; Nachanakian, Antoine

    2016-01-01

    Ossification of ligamentum flavum (OLF) is a well-known pathology causing myelopathy, although it is a rare disease. The most commonly affected population is from the Far East and mainly Japanese. However, few reports and studies have shown the prevalence of the disease all over the world. We report the case of a 33-year-old man presenting with signs of progressive myelopathy. Magnetic resonance imaging (MRI) showed Th2-Th11 OLF with severe narrowing and intramedullary hypersignal at the level Th2-Th3. This is the first Lebanese case reported in the literature. A decompressive laminectomy with flavectomy was done. This case adds to the previous reported cases on the occurrence of the disease in different populations. PMID:27057241

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

    ClinicalTrials.gov

    2014-09-22

    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

  18. HTLV-1-associated infective dermatitis and probable HTLV-1- associated myelopathy in an adolescent female*

    PubMed Central

    Steglich, Raquel Bisacotti; Tonoli, Renata Elise; Souza, Paulo Ricardo Martins; Pinto, Giselle Martins; Riesgo, Rudimar dos Santos

    2015-01-01

    Human T cell lymphotropic virus type 1 (HTLV-1)-associated infective dermatitis (ID) is a chronic, severe and recurrent eczema occurring during childhood in patients vertically infected with HTLV-1. HTLV-1-associated myelopathy/tropical spastic paraparesia (HAM/ TSP) is slow and progressive. We report the case of an adolescent female from a non-endemic area for HTLV-1 who presents ID and, most likely, associated HAM/TSP. PMID:26312674

  19. Breed Distribution of SOD1 Alleles Previously Associated with Canine Degenerative Myelopathy

    PubMed Central

    Zeng, R; Coates, JR; Johnson, GC; Hansen, L; Awano, T; Kolicheski, A; Ivansson, E; Perloski, M; Lindblad-Toh, K; O'Brien, DP; Guo, J; Katz, ML; Johnson, GS

    2014-01-01

    Background Previous reports associated 2 mutant SOD1 alleles (SOD1:c.118A and SOD1:c.52T) with degenerative myelopathy in 6 canine breeds. The distribution of these alleles in other breeds has not been reported. Objective To describe the distribution of SOD1:c.118A and SOD1:c.52T in 222 breeds. Animals DNA from 33,747 dogs was genotyped at SOD1:c.118, SOD1:c.52, or both. Spinal cord sections from 249 of these dogs were examined. Methods Retrospective analysis of 35,359 previously determined genotypes at SOD1:c.118G>A or SOD1:c.52A>T and prospective survey to update the clinical status of a subset of dogs from which samples were obtained with a relatively low ascertainment bias. Results The SOD1:c.118A allele was found in cross-bred dogs and in 124 different canine breeds whereas the SOD1:c.52T allele was only found in Bernese Mountain Dogs. Most of the dogs with histopathologically confirmed degenerative myelopathy were SOD1:c.118A homozygotes, but 8 dogs with histopathologically confirmed degenerative myelopathy were SOD1:c.118A/G heterozygotes and had no other sequence variants in their SOD1 amino acid coding regions. The updated clinical conditions of dogs from which samples were obtained with a relatively low ascertainment bias suggest that SOD1:c.118A homozygotes are at a much higher risk of developing degenerative myelopathy than are SOD1:c.118A/G heterozygotes. Conclusions and Clinical Importance We conclude that the SOD1:c.118A allele is widespread and common among privately owned dogs whereas the SOD1:c.52T allele is rare and appears to be limited to Bernese Mountain Dogs. We also conclude that breeding to avoid the production of SOD1:c.118A homozygotes is a rational strategy. PMID:24524809

  20. Negative MRI findings in a case of degenerative myelopathy in a dog.

    PubMed

    Okada, M; Kitagawa, M; Kanayama, K; Yamamura, H; Sakai, T

    2009-12-01

    An 11-year-old male Rough collie was submitted with paraparesis, but did not respond to medical treatment. Clinical signs worsened and the dog displayed paralysis, inability to stand and loss of voluntary bladder control, whereupon magnetic resonance imaging (MRI) was performed. No significant abnormalities were identified from MRI, blood tests, cerebrospinal fluid tests or radiography. After MRI, the dog developed dyspnoea and died. Autopsy and subsequent histopathological examination led to a diagnosis of degenerative myelopathy. PMID:20458868

  1. Seropositive Neuromyelitis Optica imitating an Intramedullary Cervical Spinal Cord Tumor: Case Report and Brief Review of the Literature.

    PubMed

    Woo, Peter Yat-Ming; Chiu, Jennifer Hiu-Fung; Leung, Kar-Ming; Chan, Kwong-Yau

    2014-10-01

    A 44-year-old woman with progressive cervical myelopathy and central cord syndrome was noted to have an extensive cervical intramedullary contrast-enhancing lesion on magnetic resonance imaging (MRI). The lesion resembled a spinal astrocytoma or ependymoma that required surgical intervention. She was subsequently diagnosed to have neuromyelitis optica (NMO), a rare idiopathic inflammatory demyelinating disorder, when the clinical examination revealed left optic atrophy. This was confirmed by a test showing seropositivity for NMO-immunoglobulin (IgG). Disease control was achieved with corticosteroids and immunosuppressive therapy. We report a rare case of a patient with NMO who had MRI features that could have easily led to the condition being misdiagnosed as a spinal cord tumor. The importance of careful history taking, awareness of typical radiological findings and the usefulness of serum NMO-IgG as a diagnostic tool are emphasized. PMID:25346824

  2. Idiopathic spinal cord herniation of the cervical cord: unusual cause of proximal muscle weakness in upper limbs.

    PubMed

    Rajapakse, Dilina; Mapara, Leah; Maniharan, Sathiyaseelan

    2016-01-01

    Idiopathic spinal cord herniation (ISCH) is a recognised rare cause of progressive and potentially curable myelopathy. Around 170 cases have been described in the literature, all to be found between the T2 and T8 vertebrae. We report a case of ISCH in the cervical region. A 23-year-old man with no history of trauma presented with a 6-year history of bilateral mild resting hand tremor and left scapular pain radiating to the left arm for a duration of 8 months. Nerve conduction studies showed some denervation changes of the upper limbs and bulbar regions. MRI of the spine showed anterior midline herniation of the spinal cord at the level of C7 vertebra with an associated collection of cerebrospinal fluid in the extradural space in the cervical region. Owing to the non-progressive nature of symptoms, currently the patient is managed conservatively. PMID:27190115

  3. Spontaneous delivery through a cervical tear without cervical os dilatation.

    PubMed

    Djokovic, Dusan; Costa, Cristina; Martins, Ana; Abushad, Shadi

    2015-01-01

    Spontaneous delivery through a cervical tear, provoked by prostaglandin-induced uterine contractions, was described in a G2P0 woman with a history of cervical dilatation and uterine curettage. This rare complication with potentially serious maternal-fetal consequences can be predicted by an aberrant cervical response to prostaglandins in parturients with previous cervical interventions. PMID:25678963

  4. Cervical Discitis in Children.

    PubMed

    Scheuerman, Oded; Landau, Daniel; Schwarz, Michael; Hoffer, Vered; Marcus, Nufar; Hoffnung, Liat Ashkenazi; Levy, Itzhak

    2015-07-01

    Cervical discitis, though rare, should be included in the differential diagnosis of torticollis, neck pain and neurodevelopmental regression in motor skills in children and infants. Magnetic resonance imaging is the diagnostic method of choice. Treatment should be conservative with antibiotics only. The aim of this study was to describe the 10-year experience of a tertiary pediatric medical center with cervical discitis. PMID:25886786

  5. Outcome of posterior decompression with instrumented fusion surgery for K-line (-) cervical ossification of the longitudinal ligament.

    PubMed

    Saito, Junya; Maki, Satoshi; Kamiya, Koshiro; Furuya, Takeo; Inada, Taigo; Ota, Mitsutoshi; Iijima, Yasushi; Takahashi, Kazuhisa; Yamazaki, Masashi; Aramomi, Masaaki; Mannoji, Chikato; Koda, Masao

    2016-10-01

    We investigated the outcome of posterior decompression and instrumented fusion (PDF) surgery for patients with K-line (-) ossification of the posterior longitudinal ligament (OPLL) of the cervical spine, who may have a poor surgical prognosis. We retrospectively analyzed the outcome of a series of 27 patients who underwent PDF without correction of cervical alignment for K-line (-) OPLL and were followed-up for at least 1 year after surgery. We had performed double-door laminoplasty followed by posterior instrumented fusion without excessive correction of cervical spine alignment. The preoperative Japanese Orthopedic Association (JOA) score for cervical myelopathy was 8.0 points and postoperative JOA score was 11.9 points on average. The mean JOA score recovery rate was 43.6%. The average C2-C7 angle was 2.2° preoperatively and 3.1° postoperatively. The average maximum occupation ratio of OPLL was 56.7%. In conclusion, PDF without correcting cervical alignment for patients with K-line (-) OPLL showed moderate neurological recovery, which was acceptable considering K-line (-) predicts poor surgical outcomes. Thus, PDF is a surgical option for such patients with OPLL. PMID:27591553

  6. Effect of posterior decompression extent on biomechanical parameters of the spinal cord in cervical ossification of the posterior longitudinal ligament.

    PubMed

    Khuyagbaatar, Batbayar; Kim, Kyungsoo; Park, Won Man; Kim, Yoon Hyuk

    2016-06-01

    Ossification of the posterior longitudinal ligament is a common cause of the cervical myelopathy due to compression of the spinal cord. Patients with ossification of the posterior longitudinal ligament usually require the decompression surgery, and there is a need to better understand the optimal surgical extent with which sufficient decompression without excessive posterior shifting can be achieved. However, few quantitative studies have clarified this optimal extent for decompression of cervical ossification of the posterior longitudinal ligament. We used finite element modeling of the cervical spine and spinal cord to investigate the effect of posterior decompression extent for continuous-type cervical ossification of the posterior longitudinal ligament on changes in stress, strain, and posterior shifting that occur with three different surgical methods (laminectomy, laminoplasty, and hemilaminectomy). As posterior decompression extended, stress and strain in the spinal cord decreased and posterior shifting of the cord increased. The location of the decompression extent also influenced shifting. Laminectomy and laminoplasty were very similar in terms of decompression results, and both were superior to hemilaminectomy in all parameters tested. Decompression to the extents of C3-C6 and C3-C7 of laminectomy and laminoplasty could be considered sufficient with respect to decompression itself. Our findings provide fundamental information regarding the treatment of cervical ossification of the posterior longitudinal ligament and can be applied to patient-specific surgical planning. PMID:26951839

  7. Role of Decompression in Late Presentation of Cervical Spinal Cord Disorders

    PubMed Central

    Sakale, Harshal; Dulani, Rajesh; Singh, Pradeep K; Sanrakhia, Manoj

    2014-01-01

    Study Design Prospective study conducted at Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, India. Purpose To show the efficacy of decompression in the late presentation of cervical spinal cord disorders. Overview of Literature Studies by various authors have shown that early spinal decompression results in better neurological outcomes. Methods From January 2003 to January 2005, 11 of the 41 patients with cervical spinal cord compression, meeting the inclusion criteria, underwent anterior decompression; interbody graft placement and stabilization by anterior cervical locking plate. The neurologic and functional outcomes were recorded. Results Five patients had spinal cord injury and 6 patients had compressive cervical myelopathy. Complications included 1 death and 1 plate loosening. No patient lost their preoperative neurological status. One patient had no improvement, 2 patients showed full recovery. The mean follow-up is 28.3 month. At the of rehabilitation, 6 were able to walk without support), 2 could walk with support, and 1 needed a wheelchair. The average American Spinal Injury Association motor score on admission to the hospital, 32.8 (standard deviation [SD], 30.5); admission to rehabilitation, 38.6 (SD, 32.4); discharge from rehabilitation, 46.2 (SD, 33.7). The most recent follow-up was 64.0 (SD, 35.3). Conclusions The anterior approach for cervical decompression allows for adequate decompression. This decompression is the best chance offered in even late reported cases, including posttraumatic cases where there is no evidence of cord transactions. The use of anterior cervical plates reduces the chances of graft loosening, extruding, or collapsing. PMID:24761201

  8. Comparison of in vivo and simulator-retrieved metal-on-metal cervical disc replacements

    PubMed Central

    Kurtz, Steven M.; Ciccarelli, Lauren; Harper, Megan L.; Siskey, Ryan; Shorez, Jacob; Chan, Frank W.

    2012-01-01

    Background Cervical disc arthroplasty is regarded as a promising treatment for myelopathy and radiculopathy as an alternative to cervical spine fusion. On the basis of 2-year clinical data for the PRESTIGE® Cervical Disc (Medtronic, Memphis, Tennessee), the Food and Drug Administration recommended conditional approval in September 2006 and final approval in July 2007; however, relatively little is known about its wear and damage modes in vivo. The main objective was to analyze the tribological findings of the PRESTIGE® Cervical Disc. This study characterized the in vivo wear patterns of retrieved cervical discs and tested the hypothesis that the total disc replacements exhibited similar surface morphology and wear patterns in vitro as in vivo. Methods Ten explanted total disc replacements (PRESTIGE®, PRESTIGE® I, and PRESTIGE® II) from 10 patients retrieved after a mean of 1.8 years (range, 0.3–4.1 years) were analyzed. Wear testing included coupled lateral bending ( ±4.7°) and axial rotation ( ±3.8°) with a 49 N axial load for 5 million cycles followed by 10 million cycles of flexion-extension ( ±9.7°) with 148 N. Implant surfaces were characterized by the use of white-light interferometry, scanning electron microscopy, and energy dispersive spectroscopy. Results The explants generally exhibited a slightly discolored, elliptic wear region of varying dimension centered in the bearing center, with the long axis oriented in the medial-lateral direction. Abrasive wear was the dominant in vivo wear mechanism, with microscopic scratches generally oriented in the medial-lateral direction. Wear testing resulted in severe abrasive wear in a curvilinear fashion oriented primarily in the medial-lateral direction. All retrievals showed evidence of an abrasive wear mechanism. Conclusions This study documented important similarity between the wear mechanisms of components tested in vitro and explanted PRESTIGE® Cervical Discs; however, the severity of wear was

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

    ClinicalTrials.gov

    2016-06-24

    Cervical Adenocarcinoma; Cervical Adenosquamous Carcinoma; Cervical Squamous Cell Carcinoma; Cervical Undifferentiated Carcinoma; Recurrent Cervical Carcinoma; Stage IB2 Cervical Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage IIIA Cervical Cancer; Stage IIIB Cervical Cancer; Stage IVA Cervical Cancer

  10. [Isolated anterior cervical hypertrichosis].

    PubMed

    Monteagudo, B; Cabanillas, M; de las Heras, C; Cacharrón, J M

    2009-01-01

    Anterior cervical hypertrichosis was described by Trattner and coworkers in 1991. It consists of a of hair at the anterior cervical level just above the laryngeal prominence. To date, only 28 cases of anterior cervical hypertrichosis have been reported. Although it is normally an isolated finding, it may be associated with mental retardation, hallux valgus, retinal disorders, other hair disorders, facial dysmorphism, or sensory and motor peripheral neuropathy. We report the case of a 27-year-old woman who presented with this condition as an isolated finding. PMID:19268113

  11. Single-stage Anterior and Posterior Fusion Surgery for Correction of Cervical Kyphotic Deformity Using Intervertebral Cages and Cervical Lateral Mass Screws: Postoperative Changes in Total Spine Sagittal Alignment in Three Cases with a Minimum Follow-up of Five Years.

    PubMed

    Ogihara, Satoshi; Kunogi, Junichi

    2015-01-01

    The surgical treatment of cervical kyphotic deformity remains challenging. As a surgical method that is safer and avoids major complications, the authors present a procedure of single-stage anterior and posterior fusion to correct cervical kyphosis using anterior interbody fusion cages without plating, as illustrated by three consecutive cases. Case 1 was a 78-year-old woman who presented with a dropped head caused by degeneration of her cervical spine. Case 2 was a 54-year-old woman with athetoid cerebral palsy. She presented with cervical myelopathy and cervical kyphosis. Case 3 was a 71-year-old woman with cervical kyphotic deformity following a laminectomy. All three patients underwent anterior release and interbody fusion with cages and posterior fusion with cervical lateral mass screw (LMS) fixation. Postoperative radiographs showed that correction of kyphosis was 39° in case 1, 43° in case 2, and 39° in case 3. In all three cases, improvement of symptoms was established without major perioperative complications, solid fusion was achieved, and no loss of correction was observed at a minimum follow-up of 61 months. We also report that preoperative total spine sagittal malalignment was improved after corrective surgery for cervical kyphosis and was maintained at the latest follow-up in all three cases. The combination of anterior fusion cages and LMS is considered a safe and effective procedure in cases of severe cervical kyphotic deformity. Preoperative total spine sagittal malalignment improved, accompanied by correction of cervical kyphosis, and was maintained at last follow-up in all three cases. PMID:26119893

  12. Cervical Cancer Stage IIIB

    MedlinePlus

    ... Cancer Stage IIIB Description: Stage IIIB cervical cancer; drawing shows cancer in the cervix, the vagina, and ... that connect the kidneys to the bladder). The drawing shows the ureter on the right blocked by ...

  13. Prevent Cervical Cancer

    MedlinePlus

    ... Fighting Cervical Cancer Worldwide Stay Informed Printable Versions Standard quality PDF [PDF-877KB] High-quality PDF for professional ... uterus, vagina, and vulva. Stay Informed Printable Versions Standard quality PDF [PDF-877KB] High-quality PDF for professional ...

  14. Cervical Cancer Screening

    MedlinePlus

    ... cervical cancer in women aged 30–65 years. Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body’s immune system and causes acquired immunodeficiency syndrome (AIDS). Human Papillomavirus ( ...

  15. Immunotherapy for Cervical Cancer

    Cancer.gov

    In an early phase NCI clinical trial, two patients with metastatic cervical cancer had a complete disappearance of their tumors after receiving treatment with a form of immunotherapy called adoptive cell transfer.

  16. Radiation Therapy Plus Cisplatin and Gemcitabine in Treating Patients With Cervical Cancer

    ClinicalTrials.gov

    2014-12-23

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

  17. Extensive arachnoid ossification with associated syringomyelia presenting as thoracic myelopathy. Case report and review of the literature.

    PubMed

    Slavin, K V; Nixon, R R; Nesbit, G M; Burchiel, K J

    1999-10-01

    The authors present the case of progressive thoracic myelopathy caused by the extensive ossification of the arachnoid membrane and associated intramedullary syrinx. Based on their findings and results of the literature search, they describe a pathological basis for this rare condition, discuss its incidence and symptomatology, and suggest a simple classification for various types of the arachnoid ossification. They also discuss the magnetic resonance imaging features of arachnoid ossification and associated spinal cord changes. The particular value of plain computerized tomography, which is highly sensitive in revealing intraspinal calcifications and ossifications, in the diagnostic evaluation of patients with a clinical picture of progressive myelopathy is emphasized. PMID:10505510

  18. Demographic Trends of Patients with Compressive Myelopathy in a Developing Asian Country

    PubMed Central

    Kumar, Vishal; Kumar, Avinash; Bahadur, Raj

    2016-01-01

    Study Design Prospective case series. Purpose To analyze the demographic picture of the patients suffering from compression myelopathy due to various spinal problems. Overview of Literature: There is a lack of literature depicting demographic picture of such patients with spinal injuries as most of the articles have shown the epidemiology of spinal cord injuries either managed conservatively or operatively. None have focused on the patients with compressive myelopathy requiring surgeries. Methods Patients with spinal pathologies with a neurological deficit due to compressive myelopathy requiring surgical decompression of dorsal and thoracolumbar region were studied. The different kinds of etiologies, the demographic profiles involved, the involvement of various regions of spine in each of the etiologies, sex distribution of different etiologies, association of age and sex with the occurrence of paraplegia, and association of thoracolumbar junction (TLJ) involvement by age and sex were studied. This study addressed the dorsal and TLJ till L2 vertebrae surgically treated by anterior transthoracic transpleural approach. Results With regard to gender, 75% of the females and 67.3% of the males were paraplegic but there was no relationship between gender and the occurrence of paraplegia (p >0.05). There was also no association between TLJ involvement and the age and sex of the patients (p >0.05). Seventy percent of the patients were paraplegic with a mean age of 38.90 years and 30% were paraparetic with a mean age of 43.43 years. Male to female ratio stood at 4.43:1. Conclusions Traumatic spine in females is increasing. The occurrence of paraplegia and involvement of TLJ is not affected by the age and the sex of the patients. Deep epidemiological understanding of spinal pathologies can lead to a better appreciation of the potential impact of health care management strategies and health policies to prevent and minimize their consequences considering limited worldwide

  19. [Cervical fractures in autopsy records].

    PubMed

    Pankowski, Rafał; Wilmanowska, Anita; Gos, Tomasz; Smoczyński, Andrzej

    2003-01-01

    We reviewed the autopsy records of 1872 cases of death because of politrauma, gunshot wounds and suicidal hanging. The analysis included causes and frequency of cervical spine fractures, their most common localisation, architecture of bone destruction and their influence on cervical cord. The most common cause of cervical spine injury was motor vehicle accidents. We examined 82 specimens with traumatic fractures of cervical spine obtained from accident victims. About half of the injuries occurred in upper cervical spine. The most common fracture localisation was C2 with dens fracture as the most frequent injury. The most common spinal cord lesion was complete rupture mainly at the upper cervical spine level. PMID:14564791

  20. Delayed myelopathy secondary to stab wound with a retained blade tip within the laminae: case report

    PubMed Central

    Wang, Hui; Ma, Lei; Ding, Wen-Yuan

    2015-01-01

    Delayed neurologic deficit after a stab wound with a retained foreign body near the spinal canal is unusual, adequate radiological examination is fundamental in detecting retained foreign bodies, especially the CT scan, surgical extraction of the foreign body is the primary task and the surgical outcome is satisfactory. Here, we report a rare case of delayed myelopathy caused by spinal stenosis secondary to broken blade tip within thoracic laminae in an old man, who was injured in a knife attack 39 years ago. The incidence, clinical presentation, diagnosis and prognosis are discussed. PMID:26629221

  1. Subacute posttraumatic ascending myelopathy in a 15-year-old boy.

    PubMed

    Kovanda, Timothy J; Horn, Eric M

    2014-09-01

    Secondary injury following initial spinal cord trauma is uncommon and frequently attributed to mismanagement of an unprotected cord in the acute time period after injury. Subacute posttraumatic ascending myelopathy (SPAM) is a rare occurrence in the days to weeks following an initial spinal cord injury that is unrelated to manipulation of an unprotected cord and involves 4 or more vertebral levels above the original injury. The authors present a case of SPAM occurring in a 15-year-old boy who sustained a T3-4 fracture-dislocation resulting in a complete spinal cord injury, and they highlight the imaging findings and optimum treatment for this rare event. PMID:24905393

  2. Intraoperative monitoring of spinal cord function using motor evoked potentials via transcutaneous epidural electrode during anterior cervical spinal surgery.

    PubMed

    Gokaslan, Z L; Samudrala, S; Deletis, V; Wildrick, D M; Cooper, P R

    1997-08-01

    Because false-positive results are not infrequent when monitoring somatosensory evoked potentials during surgery, monitoring of motor evoked potentials (MEPs) has been proposed and successfully used during the removal of spinal cord tumors. However, this often requires direct visual placement of an epidural electrode after a laminectomy. We evaluated the use of MEPs, recorded via a transcutaneously placed epidural electrode, to monitor motor pathway functional integrity during surgery on the anterior cervical spine. Sixteen patients underwent anterior cervical vertebral decompression and fusion for cervical myelopathy and/or radiculopathy. Before surgery, an epidural monitoring electrode was placed transcutaneously at the midthoracic level and was used to record MEPs after transcranial cortical electrical stimulation. Electrode placement was successful in all patients but one, and satisfactory baseline spinal MEPs were obtained except for one patient who had cerebral palsy with significant motor dysfunction. Patients showed no significant changes in spinal MEPs during surgery, and all had baseline or better motor function postoperatively. None had complications from epidural electrode placement or electrical stimulation. We conclude that motor pathways can be monitored safely during anterior cervical spinal surgery using spinal MEPs recorded via a transcutaneously placed epidural electrode, that MEP preservation during surgery correlates with good postoperative motor function, and that cerebral palsy patients may possess too few functional motor fibers to allow MEP recording. PMID:9278914

  3. Nivolumab in Treating Patients With Persistent, Recurrent, or Metastatic Cervical Cancer

    ClinicalTrials.gov

    2016-09-12

    Cervical Adenocarcinoma; Cervical Adenosquamous Carcinoma; Cervical Squamous Cell Carcinoma, Not Otherwise Specified; Recurrent Cervical Carcinoma; Stage IVA Cervical Cancer; Stage IVB Cervical Cancer

  4. Operative stabilization of the remaining mobile segment in ankylosed cervical spine in systemic onset - juvenile idiopathic arthritis: A case report

    PubMed Central

    Suhodolčan, Lovro; Mihelak, Marko; Brecelj, Janez; Vengust, Rok

    2016-01-01

    We describe a case of a 19-year-old young man with oligoarthritis type of juvenile idiopathic arthritis, who presented with several month duration of lower neck pain and progressive muscular weakness of all four limbs. X-rays of the cervical spine demonstrated spontaneous apophyseal joint fusion from the occipital condyle to C6 and from C7 to Th2 with marked instability between C6 and C7. Surgical intervention began with anterolateral approach to the cervical spine performing decompression, insertion of cage and anterior vertebral plate and screws, followed by posterior approach and fixation. Care was taken to restore sagittal balance. The condition was successfully operatively managed with multisegmental, both column fixation and fusion, resulting in pain cessation and resolution of myelopathy. Postoperatively, minor swallowing difficulties were noted, which ceased after three days. Patient was able to move around in a wheelchair on the sixth postoperative day. Stiff neck collar was advised for three months postoperatively with neck pain slowly decreasing in the course of first postoperative month. On the follow-up visit six months after the surgery patient exhibited no signs of spastic tetraparesis, X-rays of the cervical spine revealed solid bony fusion at single mobile segment C6-C7. He was able to gaze horizontally while sitting in a wheelchair. Signs of myelopathy with stiff neck and single movable segment raised concerns about intubation, but were successfully managed using awake fiber-optic intubation. Avoidance of tracheostomy enabled us to perform an anterolateral approach without increasing the risk of wound infection. Regarding surgical procedure, the same principles are obeyed as in management of fracture in ankylosing spondylitis or Mb. Forestrier. PMID:27458558

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

    PubMed

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

    2013-03-01

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

  6. Operative stabilization of the remaining mobile segment in ankylosed cervical spine in systemic onset - juvenile idiopathic arthritis: A case report.

    PubMed

    Suhodolčan, Lovro; Mihelak, Marko; Brecelj, Janez; Vengust, Rok

    2016-07-18

    We describe a case of a 19-year-old young man with oligoarthritis type of juvenile idiopathic arthritis, who presented with several month duration of lower neck pain and progressive muscular weakness of all four limbs. X-rays of the cervical spine demonstrated spontaneous apophyseal joint fusion from the occipital condyle to C6 and from C7 to Th2 with marked instability between C6 and C7. Surgical intervention began with anterolateral approach to the cervical spine performing decompression, insertion of cage and anterior vertebral plate and screws, followed by posterior approach and fixation. Care was taken to restore sagittal balance. The condition was successfully operatively managed with multisegmental, both column fixation and fusion, resulting in pain cessation and resolution of myelopathy. Postoperatively, minor swallowing difficulties were noted, which ceased after three days. Patient was able to move around in a wheelchair on the sixth postoperative day. Stiff neck collar was advised for three months postoperatively with neck pain slowly decreasing in the course of first postoperative month. On the follow-up visit six months after the surgery patient exhibited no signs of spastic tetraparesis, X-rays of the cervical spine revealed solid bony fusion at single mobile segment C6-C7. He was able to gaze horizontally while sitting in a wheelchair. Signs of myelopathy with stiff neck and single movable segment raised concerns about intubation, but were successfully managed using awake fiber-optic intubation. Avoidance of tracheostomy enabled us to perform an anterolateral approach without increasing the risk of wound infection. Regarding surgical procedure, the same principles are obeyed as in management of fracture in ankylosing spondylitis or Mb. Forestrier. PMID:27458558

  7. Cervical Perineural Cyst Masquerading as a Cervical Spinal Tumor

    PubMed Central

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

    2014-01-01

    Tarlov (perineural) cysts of the nerve roots are common and usually incidental findings during magnetic resonance imaging of the lumbosacral spine. There are only a few case reports where cervical symptomatic perineural cysts have been described in the literature. We report such a case where a high cervical perineural cyst was masquerading as a cervical spinal tumor. PMID:24761204

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

    PubMed

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

    2014-04-01

    Tarlov (perineural) cysts of the nerve roots are common and usually incidental findings during magnetic resonance imaging of the lumbosacral spine. There are only a few case reports where cervical symptomatic perineural cysts have been described in the literature. We report such a case where a high cervical perineural cyst was masquerading as a cervical spinal tumor. PMID:24761204

  9. A Review of Fibrocartilaginous Embolic Myelopathy and Different Types of Peracute Non-Compressive Intervertebral Disk Extrusions in Dogs and Cats

    PubMed Central

    De Risio, Luisa

    2015-01-01

    This review discusses terminology, pathological, clinical, and magnetic resonance imaging (MRI) findings, treatment, outcome, and prognostic factors of fibrocartilaginous embolic myelopathy (FCEM), acute non-compressive nucleus pulposus extrusion (ANNPE), and intradural/intramedullary intervertebral disk extrusion (IIVDE). FCEM, ANNPE, and IIVDE have a similar clinical presentation characterized by peracute onset of neurological dysfunction that is generally non-progressive after the initial 24–48 h. Differentiating between these conditions can be challenging, however, certain clinical and imaging findings can help. FCEM can occur in both adult and immature animals, whereas ANNPE or IIVDE have been reported only in animals older than 1 year. In dogs, ANNPE and IIVDE most commonly occur in the intervertebral disk spaces between T12 and L2, whereas FCEM has not such site predilection. In cats, FCEM occurs more frequently in the cervical spinal cord than in other locations. Data on cats with ANNPE and IIVDE are limited. Optimal MRI definition and experience in neuroimaging can help identify the findings that allow differentiation between FCEM, ANNPE, and IIVDE. In animals with ANNPE and IIVDE, the affected intervertebral disk space is often narrowed and the focal area of intramedullary hyperintensity on T2-weighted images is located above the affected intervertebral disk space. In dogs with ANNPE signal changes associated with the extruded nucleus pulposus and epidural fat disruption can be identified in the epidural space dorsal to the affected intervertebral disk. Identification of a linear tract (predominantly hyperintense on T2-weighted images, iso to hypointense on T1-weighted images and hypointense on T2*-weighted gradient recall echo images) extending from the intervertebral disk into the spinal cord parenchyma is highly suggestive of IIVDE. Treatment of FCEM and ANNPE is conservative. Dogs reported with IIVDE have been managed either conservatively or

  10. Get Tested for Cervical Cancer

    MedlinePlus

    ... section Cervical Cancer 3 of 5 sections Take Action! Take Action: Get Tested Take these steps to help prevent ... section Pap Test 4 of 5 sections Take Action: Lower Your Risk Lower your risk of cervical ...

  11. Spinal surgery -- cervical - series (image)

    MedlinePlus

    The cervical spinal column is made up of vertebral bodies which protect the spinal cord. ... spinal nerves, trauma, and narrowing (stenosis) of the spinal column around the spinal cord. Symptoms of cervical spine ...

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

    PubMed Central

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

    2009-01-01

    In this retrospective cohort study, two surgical methods of conventional open-door laminoplasty and deep extensor muscle-preserving laminoplasty were allocated for the treatment of cervical myelopathy, and were specifically compared in terms of axial pain, cervical spine function, and quality of life (QOL) with a minimum follow-up period of 2 years. Eighty-four patients were divided into two groups and received either a conventional open-door laminoplasty (CL group) or laminoplasty using a deep extensor muscle-preserving approach (MP group). The latter approach was performed by preserving multifidus and semispinalis cervicis attachments followed by open-door laminoplasty and re-suture of the bisected spinous processes at each decompression level. The average follow-up period was 38 months (25–53 months). The preoperative and follow-up evaluations included the original Japanese Orthopaedic Association (JOA) score, the new tentative JOA score including cervical spine function and QOL, and the visual analogue scale (VAS) of axial pain. Radiological analyses included cervical lordosis and flexion–extension range of motion (flex–ext ROM) (C2–7), and deep extensor muscle areas on MR axial images. The JOA recovery rates were statistically equivalent between two groups. The MP group demonstrated a statistically superior cervical spine function (84% vs 63%) and QOL (61% vs 45%) when compared to the CL group at final follow-up (P < 0.05). The average VAS scores at final follow-up were 2.3 and 4.9 in MP and CL groups (P < 0.05). The cervical lordosis and flex–ext ROM were statistically equivalent. The percent deep muscle area on MRI demonstrated a significant atrophy in CL group compared to that in MP group (56% vs 88%; P < 0.01). Laminoplasty employing the deep extensor muscle-preserving approach appeared to be effective in reducing the axial pain and deep muscle atrophy as well as improving cervical spine function and QOL when compared to conventional open

  13. Effect of Pulsed Methylprednisolone on Pain, in Patients with HTLV-1-Associated Myelopathy

    PubMed Central

    Buell, Kevin G.; Puri, Aiysha; Demontis, Maria Antonietta; Short, Charlotte L.; Adonis, Adine; Haddow, Jana; Martin, Fabiola; Dhasmana, Divya

    2016-01-01

    HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is an immune mediated myelopathy caused by the human T-lymphotropic virus type 1 (HTLV-1). The efficacy of treatments used for patients with HAM/TSP is uncertain. The aim of this study is to document the efficacy of pulsed methylprednisolone in patients with HAM/TSP. Data from an open cohort of 26 patients with HAM/TSP was retrospectively analysed. 1g IV methylprednisolone was infused on three consecutive days. The outcomes were pain, gait, urinary frequency and nocturia, a range of inflammatory markers and HTLV-1 proviral load. Treatment was well tolerated in all but one patient. Significant improvements in pain were: observed immediately, unrelated to duration of disease and maintained for three months. Improvement in gait was only seen on Day 3 of treatment. Baseline cytokine concentrations did not correlate to baseline pain or gait impairment but a decrease in tumour necrosis factor-alpha (TNF-α) concentration after pulsed methylprednisolone was associated with improvements in both. Until compared with placebo, treatment with pulsed methylprednisolone should be offered to patients with HAM/TSP for the treatment of pain present despite regular analgesia. PMID:27077747

  14. Methotrexate-induced myelopathy responsive to substitution of multiple folate metabolites.

    PubMed

    Ackermann, R; Semmler, A; Maurer, G D; Hattingen, E; Fornoff, F; Steinbach, J P; Linnebank, M

    2010-05-01

    Methotrexate (MTX)-associated myelopathy is a rare but serious subacute complication of MTX-based chemotherapy. We report the case of a woman with breast cancer and meningeal carcinomatosis who developed severe progressive myelopathy after four cycles of intrathecal MTX administration. We substituted high doses of the key metabolites of the methyl-transfer pathway: S-adenosylmethionine (SAM), 200 mg three times daily i.v.; folinate, 20 mg four times daily i.v.; cyanocobalamin, 100 microg once daily i.v.; and methionine, 5 g daily p.o. The patient's paraparesis improved rapidly thereafter, and magnetic resonance (MR) imaging showed resolution of the intramedullary lesions. Genetic analyses revealed homozygosity for the A allele of methylenetetrahydrofolate reductase (MTHFR) c.1298A>C (p.E429A), whereas other genetic variants of folate/methionine metabolism associated with MTX neurotoxicity were not present. Substitution with multiple folate metabolites may be a promising strategy for the treatment of MTX-induced neurotoxicity. PMID:19821069

  15. CT myelography of the thoraco-lumbar spine in 8 dogs with degenerative myelopathy.

    PubMed

    Jones, Jeryl C; Inzana, Karen D; Rossmeisl, John H; Bergman, Robert L; Wells, Tana; Butler, Katherine

    2005-12-01

    CT myelography of the T11-L2 region was performed in 8 large-breed dogs with a clinical diagnosis of degenerative myelopathy (DM) and 3 large-breed dogs that were clinically normal. CT myelographic characteristics were recorded for each dog, at each disc level. Area measurements of the spinal cord, dural sac, vertebral canal, and vertebral body were recorded at 4 slice locations for each disc level. Mean area ratios were calculated and graphically compared, by slice location and group. In all dogs, CT myelography identified morphologic abnormalities that were not suspected from conventional myelograms. Characteristics observed with higher frequency in DM versus normal dogs were: spinal stenosis, disc protrusion, focal attenuation of the subarachnoid space, spinal cord deformity, small spinal cord, and paraspinal muscle atrophy. Mean spinal cord:dural sac, spinal cord:vertebral canal, dural sac: vertebral canal, and vertebral canal:vertebral body ratios were smaller in DM versus normal dogs at more than one disc level. Some CT myelographic characteristics in DM dogs were similar to those previously reported in humans, dogs and horses with stenotic myelopathy. PMID:16293999

  16. Evaluation of a proposed therapeutic protocol in 12 dogs with tentative degenerative myelopathy.

    PubMed

    Polizopoulou, Zoe S; Koutinas, Alexander F; Patsikas, Michael N; Soubasis, Nektarios

    2008-09-01

    The objective of this work was to evaluate the long-term efficacy of a proposed therapeutic protocol in 12 dogs with a tentative diagnosis of degenerative myelopathy, followed-up for a 6-month period. Twelve dogs fulfilling the antemortem inclusion criteria (breed, age, adequate vaccination, history of progressive posterior ataxia and/or paraparesis, no radiographic and myelographic abnormalities in the spinal cord and vertebral column) were allocated. All these dogs presented signs of thoracolumbar syndrome (T3-L3), scored as grade I (mild to moderate ataxia and paraparesis) in 10 and grade II (severe ataxia and ambulatory paraparesis) in 2 cases. Treatment included the use of epsilon-aminocaproic acid and N-acetylcysteine, supplemented with vitamins B, C and E. Prednisolone was given for the first two weeks and upon worsening of neurological signs. Daily exercise, performed as walking or swimming, was strongly recommended. Clinicopathological evaluation was normal in all 12 dogs, and survey radiographs and myelograms did not show spinal cord compression. Magnetic resonance imaging (MRI), performed only in 4 dogs, did not disclose compressive disorders or intramedullary lesions. Neurological signs were progressively worsening in all 12 animals, eventually resulting in severe paraparesis (grade III) or paraplegia (grade IV). The applied medications do not appear to be an attractive alternative to conservative management (physiotherapy) or euthanasia in canine degenerative myelopathy, irrespective of its chronicity. PMID:18828481

  17. Cervical Total Disc Arthroplasty

    PubMed Central

    Basho, Rahul; Hood, Kenneth A.

    2012-01-01

    Symptomatic adjacent segment degeneration of the cervical spine remains problematic for patients and surgeons alike. Despite advances in surgical techniques and instrumentation, the solution remains elusive. Spurred by the success of total joint arthroplasty in hips and knees, surgeons and industry have turned to motion preservation devices in the cervical spine. By preserving motion at the diseased level, the hope is that adjacent segment degeneration can be prevented. Multiple cervical disc 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. PMID:24353955

  18. The degenerative cervical spine.

    PubMed

    Llopis, E; Belloch, E; León, J P; Higueras, V; Piquer, J

    2016-04-01

    Imaging techniques provide excellent anatomical images of the cervical spine. The choice to use one technique or another will depend on the clinical scenario and on the treatment options. Plain-film X-rays continue to be fundamental, because they make it possible to evaluate the alignment and bone changes; they are also useful for follow-up after treatment. The better contrast resolution provided by magnetic resonance imaging makes it possible to evaluate the soft tissues, including the intervertebral discs, ligaments, bone marrow, and spinal cord. The role of computed tomography in the study of degenerative disease has changed in recent years owing to its great spatial resolution and its capacity to depict osseous components. In this article, we will review the anatomy and biomechanical characteristics of the cervical spine, and then we provide a more detailed discussion of the degenerative diseases that can affect the cervical spine and their clinical management. PMID:26878769

  19. Eight years of follow-up after laminectomy of calcium pyrophosphate crystal deposition in the cervical yellow ligament of patient with Coffin–Lowry syndrome

    PubMed Central

    Morino, Tadao; Ogata, Tadanori; Horiuchi, Hideki; Yamaoka, Shintaro; Fukuda, Mitsumasa; Miura, Hiromasa

    2016-01-01

    Abstract Background: We report 8 years of follow-up after decompression to treat cervical myelopathy in a patient with Coffin–Lowry syndrome (CLS). CLS is a rare X-linked semidominant syndrome associated with growth and psychomotor retardation, general hypotonia, and skeletal abnormalities. In this patient, the spinal cord was compressed by calcium pyrophosphate crystal deposition in the cervical yellow ligament (YL). To date, only 1 report has described clinical features after surgery for calcified cervical YL in CLS. Methods: A 15-year-old male with tetraplegia secondary to compression of the cervical spinal cord induced by a hypoplastic posterior arch of C1 and calcification of the YL from C2 to C7 was treated surgically with laminectomy from C1 to C7. The patient's history, clinical examination, imaging findings, and treatment are reported. The patient was incapable of speech because of mental retardation, so he could not describe his symptoms. Gait disturbance worsened over the 2 months before admission to our hospital. At admission, the patient could not move his extremities, and tendon reflexes of the upper and lower extremities were significantly increased. Computed tomography of the cervical spine showed YL calcification from C2 to C7. Magnetic resonance imaging showed consecutive compression of the cervical spinal cord. We diagnosed quadriplegia secondary to cervical cord damage and performed emergency surgery. Results: During C1–C7 laminectomy, YL calcification in C2–C7 was observed. The calcification was confirmed as calcium pyrophosphate by crystal analysis. Quadriplegia gradually resolved, and almost disappeared by 2 weeks after the operation. Cervical hyperlordosis was observed in radiographs starting from 1 month after the operation, but it has not progressed and is not associated with any symptoms. Conclusions: The efficacy of decompression continued, and no postoperative complications have occurred during at least 8 years of follow-up. PMID

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

    ClinicalTrials.gov

    2014-06-18

    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

  1. Chemoradiation Therapy and Ipilimumab in Treating Patients With Locally Advanced Cervical Cancer

    ClinicalTrials.gov

    2016-08-24

    Cervical Adenocarcinoma; Cervical Adenosquamous Carcinoma; Cervical Squamous Cell Carcinoma, Not Otherwise Specified; Stage IB Cervical Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage IIIB Cervical Cancer; Stage IVA Cervical Cancer

  2. Muscular weakness represents the main limiting factor of walk, functional independence and quality of life of myelopathy patients associated to HTLV-1.

    PubMed

    Caiafa, Renata Costa; Orsini, Marco; Felicio, Lilian R; Puccioni-Sohler, Marzia

    2016-04-01

    HTLV-1-associated myelopathy is a progressive disabling disease associated with gait abnormalities. Objective To identify and quantify the main muscles affected by weakness and spasticity, their impact on gait, functional capacity and on quality of life of HTLV-1-associated myelopathy patients. Method We evaluated lower limbs muscular strength according to the Medical Research Council scale, spasticity according to the modified Ashworth scale, daily activities according to the Barthel Index and quality of life according to the Short-Form Health Survey-36 of 26 HTLV-1-associated myelopathy patients. Results The muscles most affected by weakness included the dorsal flexors and knee flexors. Spasticity predominated in the hip adductor muscles and in plantar flexors. Assistance for locomotion, minimal dependence in daily activities, limitations in functional capacity and physical aspects were the most common findings. Conclusion The impairment of gait, functional dependence and quality of life were predominantly a consequence of intense muscle weakness in HTLV-1-associated myelopathy patients. PMID:27096999

  3. Cervical Neoplasia Probe Control

    Energy Science and Technology Software Center (ESTSC)

    1997-01-24

    This software, which consists of a main executive and several subroutines, performs control of the optics, image acquisition, and Digital Signal Processing (DSP) of this image, of an optical based medical instrument that performs fluoresence detection of precancerous lesions (neoplasia) of the human cervix. The hardware portion of this medical instrument is known by the same name Cervical Neoplasia Probe (CNP)

  4. Cervical silicone lymphadenopathy.

    PubMed

    Gilbert, Latoni Kaysha; Thiruchelvam, Janavikulam

    2016-07-01

    A patient presented to the department of oral and maxillofacial surgery with a rare case of cervical silicone lymphadenopathy. She had a painless ovoid mass in the left side of her neck and had had cosmetic breast augmentation 10 years before. Radiological imaging and core biopsy examination were consistent with silicone lymphadenopathy. PMID:26830068

  5. Congenital Midline Cervical Cleft

    PubMed Central

    Villanueva-Meyer, Javier; Glastonbury, Christine; Marcovici, Peter

    2015-01-01

    Congenital midline cervical cleft is a rare anomaly that typically presents in the neonatal period as a thin suprasternal vertical band of erythematous skin with a nipple-like projection superiorly, which may exude fluid. We present the clinical and pathophysiologic features and the imaging findings of this uncommon, and rarely described entity in a newborn girl. PMID:25926928

  6. Cervical ectopic pregnancy.

    PubMed

    Samal, Sunil Kumar; Rathod, Setu

    2015-01-01

    Cervical pregnancy is a rare type of ectopic pregnancy and it represents <1% of all ectopic pregnancies. Early diagnosis and medical management with systemic or local administration of methotrexate is the treatment of choice. If the pregnancy is disturbed, it may lead to massive hemorrhage, which may require hysterectomy to save the patient. We report three cases of cervical pregnancy managed successfully with different approaches of management. Our first case, 28 years old G3P2L2 with previous two lower segment cesarean sections, presented with bleeding per vaginum following 6 weeks of amenorrhea. Clinical examination followed by transvaginal ultrasound confirmed the diagnosis of cervical pregnancy. Total abdominal hysterectomy was done in view of intractable bleeding to save the patient. The second case, a 26-year-old second gravida with previous normal vaginal delivery presented with pain abdomen and single episode of spotting per vaginum following 7 weeks of amenorrhea. Transvaginal ultrasound revealed empty endometrial cavity, closed internal os with gestational sac containing live fetus of 7 weeks gestational age in cervical canal and she was treated with intra-amniotic potassium chloride followed by systemic methotrexate. Follow up with serum beta human chorionic gonadotropin level revealed successful outcome. Our third case, a 27-year-old primigravida with history of infertility treatment admitted with complaints of bleeding per vaginum for 1 day following 8 weeks amenorrhea. She was diagnosed as cervical pregnancy by clinical examination, confirmed by transvaginal ultrasonography and subsequently managed by dilation and curettage with intracervical Foleys' ballon tamponade. PMID:25810679

  7. Early clinical and radiographical results of keel-less and shallow keel cervical disc replacement

    PubMed Central

    Ling, Ji Min; Tiruchelvarayan, Rajendra

    2015-01-01

    Background: Cervical disc replacements has been shown to be as effective as fusions in the treatment of radiculopathy or myelopathy due to disc prolapse. Newer implants were designed to reduce the difficulty of end-plate preparation. Since 2010, the authors have started using Discocerv (Alphatec Spine, Carlsbad, USA) a keel-less implant and Activ-C (B. Braun, Sheffield, UK), a shallow keel implant. Aim: The aim of this study was to compare the duration of surgery between cervical disc replacement and anterior cervical discectomy and fusion, and also to evaluate the functional outcome, complications, and radiographic outcome of cervical disc replacement. Results: Fifty patients were included (20 disc replacement and 30 fusion). This was a single surgeon retrospective study, with all surgery performed by the senior author (RT). The mean operation duration for single-level disc replacement was 2.6 h, and for single-level fusion was 2.4 h (P = 0.4684). For 2-levels surgery, the result was 3.5 h for 2-level hybrid surgery (one level disc replacement and one level fusion) and 3.4 h for fusion (P = 0.4489). Disc replacement resulted in preservation of an average of 67% of the angle of motion at the sagittal plane (FFflexion-extension). The average range of motion after disc replacement was 6.1°. The median clinical follow-up duration was 2 years (average 1.8 years). There was no incidence of major complications or significant neurovascular injury in this series of patients. A significant improvement in short form-36 scores was seen as early as 3 months postoperative (from 58 preoperative to 92 at 3 months). The improvement was sustained up to the fourth year of follow-up. Conclusion: Cervical arthroplasty with keel-less and shallow keel implants are safe and relatively easy to perform. The surgical time for disc replacement is not significantly longer than standard fusion surgery. There is reasonably good preservation of motion. The short-term functional improvement is

  8. Intracranial Dural Arteriovenous Fistula Draining into Spinal Perimedullary Veins: A Rare Cause of Myelopathy

    PubMed Central

    Atamaz, Funda; Oran, Ismail; Durmaz, Berrin

    2006-01-01

    We report a rare case of progressive myelopathy caused by intracranial dural arteriovenous fistula with venous drainage into the spinal perimedullary veins. A 45-yr-old man developed urinary and fecal incontinence and muscle weakness in the lower limbs. Magnetic resonance imaging revealed brainstem edema and dilated veins of the brainstem and spinal cord. Cerebral angiography showed a dural arteriovenous fistula fed by the neuromeningeal branch of the left ascending pharyngeal artery. Occlusion of the fistula could be achieved by embolization after a diagnostic and subsequent therapeutic delay. There was no improvement in clinical condition. For the neurologic outcome of these patients it is important that fistula must be treated before ischemic and gliotic changes become irreversible. PMID:17043439

  9. Solitary spinal epidural cavernous haemangiomas as a rare cause of myelopathy.

    PubMed

    Meng, Ying; Shamji, Mohammed F

    2015-01-01

    Cavernous haemangiomas rarely occur in the spinal epidural space. We report the case of a 27-year-old man who presented with myelopathy secondary to spinal cord compression from a purely epidural lesion. The imaging characteristics of cavernous haemangiomas are unique, reflecting a highly vascular lesion. Key differentiating features from intracranial or intramedullary lesions include the lack of a surrounding hemosiderin ring and popcorn appearance. An urgent referral to a neurosurgeon is recommended given the possibility of acute neurological deterioration from intralesional haemorrhage, and good recovery from early surgical resection. Preoperative planning with thorough patient counselling and availability of matched blood is important, and an en bloc resection approach should be taken to minimise blood loss. In this case, the patient experienced complete recovery after surgical resection. No recurrence after complete resection has been reported in the literature. This suggests a good long-term outcome for the patient and that no early adjuvant therapy is necessary. PMID:26409007

  10. A Peruvian family with a high burden of HTLV-1-associated myelopathy/tropical spastic paraparesis.

    PubMed

    Alvarez, Carolina; Verdonck, Kristien; Tipismana, Martín; Gotuzzo, Eduardo

    2015-01-01

    Human T-lymphotropic virus 1 (HTLV-1) is frequent in Peru; an estimated 1-2% of the Peruvian population carry this retrovirus. HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a chronic disabling disease that affects about 1% of the carriers of HTLV-1. It is not yet known why some HTLV-1-infected people develop HAM/TSP while others do not. In this case report, we present a family with an unusually high burden of HAM/TSP: 5 (the 2 parents and 3 of their children) of 7 HTLV-1 carriers developed the same disease. We describe the clinical presentation and discuss the clustering of disease against the current knowledge of the pathogenesis of HAM/TSP. Families such as this may hold the key to discovering which factors trigger the development of HAM/TSP. PMID:26392440

  11. Immunohistochemical observation of canine degenerative myelopathy in two Pembroke Welsh Corgi dogs.

    PubMed

    Ogawa, Mizue; Uchida, Kazuyuki; Park, Eun-Sil; Kamishina, Hiroaki; Sasaki, Jun; Chang, Hye-Sook; Yamato, Osamu; Nakayama, Hiroyuki

    2011-10-01

    Immunohistochemistry was performed to assess whether oxidative stress and/or denatured proteins play roles in the pathogenesis of canine degenerative myelopathy (DM). Two Pembroke Welsh Corgi (PWC) dogs with a homozygous mutation (c.118G>A) in the canine superoxide dismutase 1 (SOD1) gene were examined. The pathological features of the dogs were consistent with those of previous cases of DM in PWC. In the spinal lesions, diffuse SOD1 expression was observed in the neurons while no inclusion-like aggregates had formed, which disagreed with the findings of a previous study. A unique inducible nitric oxide synthase (iNOS) staining pattern in reactive astrocytes and a significant increase in ubiquitin immunoreactivity in the spinal lesions were also observed. These findings indicate the involvement of oxidative stress and the accumulation of ubiquitinated proteins in the pathogenesis of canine DM, whereas the role of SOD1 remains unclear. PMID:21628865

  12. Cisplatin and Radiation Therapy Followed by Paclitaxel and Carboplatin in Treating Patients With Stage IB-IVA Cervical Cancer

    ClinicalTrials.gov

    2016-03-16

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

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

    ClinicalTrials.gov

    2014-12-29

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

  14. Adenocarcinoma of the cervical stump

    SciTech Connect

    Goodman, H.M.; Niloff, J.M.; Buttlar, C.A.; Welch, W.R.; Marck, A.; Feuer, E.J.; Lahman, E.A.; Jenison, E.; Knapp, R.C. )

    1989-11-01

    Sixteen women with adenocarcinoma of the cervical stump were treated over a 15-year period. The median survivals of 40 months for stage IB and 17 months for stages II and III were significantly worse compared with those for patients treated for cervical adenocarcinoma of the intact uterus or squamous carcinoma of the cervical stump. The poor results were due to both local and distant failure. Implications regarding tumor radiosensitivity and adjuvant therapy in these high-risk patients are discussed.

  15. The cervical spine: radiologist's perspective.

    PubMed

    Mink, Jerrold H; Gordon, Rachael E; Deutsch, Andrew L

    2003-08-01

    This article provides an essential curriculum in cervical spine radiology. It discusses the uses of plain radiographs, MR imaging, computed tomography (CT), and CT myelography, in addition to the methodologies of discography, epidural injections under visualization, and facet and nerve root injections. It explains how radiographic images of the cervical spine can differentiate tumors, inflammation, recent or prior trauma, and the range of discal, arthritic, neural, and vascular cervical pathologies and, just as importantly, when they cannot. PMID:12948340

  16. Syphilitic myelopathy

    MedlinePlus

    ... not reverse existing nerve damage. For neurosyphilis, aqueous penicillin G (by injection) is the drug of choice. Some patients (for example, pregnant women) with penicillin allergies may have to be desensitized to penicillin ...

  17. Degenerative myelopathy.

    PubMed

    Clemmons, R M

    1992-07-01

    DM in the German Shepherd is an immune-related disorder whose clinical signs are explained by a widespread degeneration of the white matter pathways in the thoracolumbar spinal cord. Therapy includes exercise, vitamin supplementation, and EACA medication. Avoiding unnecessary surgical procedures is also important to preclude permanent deterioration that can result following surgery in DM patients. In dogs other than German Shepherds, other identifiable causes should be treated. Additional confirmation of the diagnosis of DM may be assisted by performing cell-mediated immune studies or other serodiagnostic tests as they become available. PMID:1641928

  18. [Primary cervical cancer screening].

    PubMed

    Vargas-Hernández, Víctor Manuel; Vargas-Aguilar, Víctor Manuel; Tovar-Rodríguez, José María

    2015-01-01

    Cervico-uterine cancer screening with cytology decrease incidence by more than 50%. The cause of this cancer is the human papilloma virus high risk, and requires a sensitive test to provide sufficient sensitivity and specificity for early detection and greater interval period when the results are negative. The test of the human papilloma virus high risk, is effective and safe because of its excellent sensitivity, negative predictive value and optimal reproducibility, especially when combined with liquid-based cytology or biomarkers with viral load, with higher sensitivity and specificity, by reducing false positives for the detection of cervical intraepithelial neoplasia grade 2 or greater injury, with excellent clinical benefits to cervical cancer screening and related infection of human papilloma virus diseases, is currently the best test for early detection infection of human papillomavirus and the risk of carcinogenesis. PMID:26162490

  19. Preinduction cervical ripening.

    PubMed

    Thiery, M

    1983-01-01

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

  20. Congenital midline cervical cleft.

    PubMed

    Agag, Richard; Sacks, Justin; Silver, Lester

    2007-01-01

    Congenital midline cervical cleft (CMCC) is a rare disorder of the ventral neck that is clinically evident at birth and must be differentiated from the more common thyroglossal duct cyst. The case of CMCC presented here was associated with chromosomes 13/14 de novo Robertsonian translocations as well as midline deformities including a sacral tuft and a minor tongue-tie. The case is presented as well as discussion of histopathology, embryology, and surgical treatment. PMID:17214531

  1. INTERFERON BETA-1A TREATMENT IN HTLV-1-ASSOCIATED MYELOPATHY/TROPICAL SPASTIC PARAPARESIS: A CASE REPORT

    PubMed Central

    Viana, Graça Maria de Castro; da Silva, Marcos Antonio Custódio Neto; Souza, Victor Lima; Lopes, Natália Barbosa da Silva; da Silva, Diego Luz Felipe; Nascimento, Maria do Desterro Soares Brandão

    2014-01-01

    Here a young patient (< 21 years of age) with a history of infective dermatitis is described. The patient was diagnosed with myelopathy associated with HTLV-1/tropical spastic paraparesis and treated with interferon beta-1a. The disease was clinically established as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), and laboratory tests confirmed the presence of antibodies to HTLV-1 in the cerebrospinal fluid (CSF). Mumps, cytomegalovirus, Epstein-Barr virus, schistosomiasis, herpes virus 1 and 2, rubella, measles, varicella-zoster toxoplasmosis, hepatitis, HIV, and syphilis were excluded by serology. The patient was diagnosed with neurogenic bladder and presented with nocturia, urinary urgency, paresthesia of the lower left limb, a marked reduction of muscle strength in the lower limbs, and a slight reduction in upper limb strength. During the fourth week of treatment with interferon beta-1a, urinary urgency and paresthesia disappeared and clinical motor skills improved. PMID:25229227

  2. Interferon beta-1a treatment in HTLV-1-associated myelopathy/tropical spastic paraparesis: a case report.

    PubMed

    Viana, Graça Maria de Castro; Silva, Marcos Antonio Custódio Neto da; Souza, Victor Lima; Lopes, Natália Barbosa da Silva; Silva, Diego Luz Felipe da; Nascimento, Maria do Desterro Soares Brandão

    2014-01-01

    Here a young patient (< 21 years of age) with a history of infective dermatitis is described. The patient was diagnosed with myelopathy associated with HTLV-1/tropical spastic paraparesis and treated with interferon beta-1a. The disease was clinically established as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), and laboratory tests confirmed the presence of antibodies to HTLV-1 in the cerebrospinal fluid (CSF). Mumps, cytomegalovirus, Epstein-Barr virus, schistosomiasis, herpes virus 1 and 2, rubella, measles, varicella-zoster toxoplasmosis, hepatitis, HIV, and syphilis were excluded by serology. The patient was diagnosed with neurogenic bladder and presented with nocturia, urinary urgency, paresthesia of the lower left limb, a marked reduction of muscle strength in the lower limbs, and a slight reduction in upper limb strength. During the fourth week of treatment with interferon beta-1a, urinary urgency and paresthesia disappeared and clinical motor skills improved. PMID:25229227

  3. A Caucasian Australian presenting with human T-lymphotropic virus type I associated myelopathy: a case report

    PubMed Central

    2014-01-01

    Introduction We report the first known case of human T-lymphotropic virus type I associated myelopathy/tropical spastic paraparesis in an Australian Caucasian, a disease reported in Aboriginal and immigrant populations where the virus is often endemic. Case presentation A 41-year-old Caucasian Australian man had a 3-year background of progressive functional decline from a myelopathy with spastic paraparesis and sphincteric dysfunction. Conclusions Although studies have shown a very low prevalence of human T-lymphotropic virus type I in the greater Australian population, increased focus on Aboriginal health, and the expanding diversity and integration of the Australian population means that presentation of human T-lymphotropic virus type I-associated disease is likely to increase. PMID:25416840

  4. [Pediatric orthopedic cervical spine problems].

    PubMed

    Helenius, Ilkka

    2016-01-01

    Treatment-requiring diseases of the cervical spine in children are rare. The most common cases requiring medical assessment and treatment are acute torticollis and various accidents. A torticollis having lasted for more than a week should be recognized, because it can be treated by skull traction. Cervical spine fractures in children under school age are very rare, the most common being a fracture of the base of the dens of the second cervical vertebra. Cervical spine instability is almost always associated with an underlying disease. PMID:27400588

  5. Osteotomies in the Cervical Spine

    PubMed Central

    Nemani, Venu M.; Derman, Peter B.

    2016-01-01

    Rigid cervical deformities are difficult problems to treat. The goals of surgical treatment include deformity correction, achieving a rigid fusion, and performing a thorough neural decompression. In stiff and ankylosed cervical spines, osteotomies are required to restore sagittal and coronal balance. In this chapter, we describe the clinical and radiographic workup for patients with cervical deformities, and delineate the various factors that must be considered when planning surgical treatment. We also describe in detail the various types of cervical osteotomies, along with their surgical technique, advantages, and potential complications. PMID:26949476

  6. Fitting the cervical cap.

    PubMed

    Brokaw, A K; Baker, N N; Haney, S L

    1988-07-01

    The cervical cap is now available for general use by American women. Several steps are necessary to select women who are good candidates for cap usage and to successfully fit the cap. Many women are not good candidates for the cap. The cap is generally not suitable for women who have recently become sexually active or who are first-time contraceptors. Many users are women who cannot use more widely available contraceptives. Successful cap use requires a highly motivated, persistent woman who will correctly insert and remove her cap. The size, shape, length, position and location of the cervix must be assessed by the clinician prior to fitting the cap. The cervix should be visually inspected for lesions or cervicitis and a Pap smear should be taken. After an initial cap is selected, the stability of the cap, gaps between the cap and cervix, areas of uncovered cervix and the adequacy of the suction seal should be assessed. The woman should be taught how to insert and remove the cap. Additionally, she should be instructed to use a backup method of contraception until she is sure that the cap will remain in place during sexual intercourse. Successful cap fitting requires a careful, methodical approach by the clinician and a carefully selected, highly motivated client. This article presents the steps of cervical cap fitting. PMID:3405494

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

    ClinicalTrials.gov

    2014-12-29

    Anemia; Cervical Adenocarcinoma; Cervical Adenosquamous Carcinoma; Cervical Squamous Cell Carcinoma; Drug Toxicity; Radiation Toxicity; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage IVA Cervical Cancer

  8. [Anterior cervical hypertrichosis: case report].

    PubMed

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

    2016-10-01

    The non-syndromic anterior cervical hypertrichosis (OMIM N° 600457) is a genetic disorder characterized by a patch of hair at the level of the laryngeal prominence. We present a 12-year-old boy with anterior cervical hypertrichosis and mild generalized hypertrichosis. He has no neurological, ophthalmological or skeletal anomalies. The clinical follow up is 10 years. PMID:27606653

  9. Compressive myelopathy associated with ectasia of the vertebral and spinal arteries in a dog.

    PubMed

    Bozynski, C C; Vasquez, L; O'Brien, D P; Johnson, G C

    2012-09-01

    A 4-year-old dog was presented for acute, progressive tetraparesis and cervical hyperesthesia. Symmetrical tubular structures coursing along the lateroventral aspects of the spinal cord at the fourth and fifth cervical vertebrae were identified in magnetic resonance images. At necropsy, vertebral arteries and their spinal branches were severely ectatic bilaterally, and the cervical spinal cord was compressed. Histologically, the ectatic branches of the vertebral and ventral spinal arteries were surrounded by fibrosis with scant mononuclear cell infiltrates and hemorrhage. Spinal branches of the vertebral arteries had focally severe reduction in the tunica media. A thrombus was in an arterial branch. Smaller vessels in adjacent tissue had fibrinoid degeneration. Axonal degeneration was detected in the affected spinal cord and nerve roots. The segmental degenerative radiculomyelopathy in this dog was attributed to anomalous ectasia of the vertebral and ventral spinal arteries. PMID:21856870

  10. Obtuse-angled Laminotomy as a Modification of Multilevel Laminectomy for Spinal Cord Decompression.

    PubMed

    Jhas, Sumit; Pirouzmand, Farhad

    2016-03-01

    The purpose of this note is to describe an obtuse-angled laminotomy of C7 during cervical decompression that aims to preserve cervicothoracic junction stability and potentially reduce pain. Cervical spondylotic myelopathy can result from degenerative cervical spinal disease including, herniated disk material, osteophytes, redundant ligamentum flavum, or ossification of the posterior longitudinal ligament. Surgical intervention for multilevel myelopathy aims to decompress the spinal cord and maintain stability of the cervical spine. Multilevel laminectomy is traditionally used when degenerative changes affect 3 or more levels and when there is primarily dorsal compressive disease. Traditional laminectomy can result in instability and kyphosis. The C7 lamina can be particularly vulnerable given the location at cervicothoracic junction. We describe an obtuse-angled laminotomy for the most caudal lamina in a planned decompression. This lamina is left attached to ligamentum nuchea, adjacent fascia, and paravertebral muscles. Only the base of spinous process and ventral portion of lamina's cortical and cancellous bone are removed in an obtuse angle through the opening. This variation is aimed to preserve as much of the cervical stability while still achieving the goal of decompression. PMID:26889986

  11. Fractures of the cervical spine

    PubMed Central

    Marcon, Raphael Martus; Cristante, Alexandre Fogaça; Teixeira, William Jacobsen; Narasaki, Douglas Kenji; Oliveira, Reginaldo Perilo; de Barros Filho, Tarcísio Eloy Pessoa

    2013-01-01

    OBJECTIVES: The aim of this study was to review the literature on cervical spine fractures. METHODS: The literature on the diagnosis, classification, and treatment of lower and upper cervical fractures and dislocations was reviewed. RESULTS: Fractures of the cervical spine may be present in polytraumatized patients and should be suspected in patients complaining of neck pain. These fractures are more common in men approximately 30 years of age and are most often caused by automobile accidents. The cervical spine is divided into the upper cervical spine (occiput-C2) and the lower cervical spine (C3-C7), according to anatomical differences. Fractures in the upper cervical spine include fractures of the occipital condyle and the atlas, atlanto-axial dislocations, fractures of the odontoid process, and hangman's fractures in the C2 segment. These fractures are characterized based on specific classifications. In the lower cervical spine, fractures follow the same pattern as in other segments of the spine; currently, the most widely used classification is the SLIC (Subaxial Injury Classification), which predicts the prognosis of an injury based on morphology, the integrity of the disc-ligamentous complex, and the patient's neurological status. It is important to correctly classify the fracture to ensure appropriate treatment. Nerve or spinal cord injuries, pseudarthrosis or malunion, and postoperative infection are the main complications of cervical spine fractures. CONCLUSIONS: Fractures of the cervical spine are potentially serious and devastating if not properly treated. Achieving the correct diagnosis and classification of a lesion is the first step toward identifying the most appropriate treatment, which can be either surgical or conservative. PMID:24270959

  12. Radiotherapy of Cervical Cancer.

    PubMed

    Vordermark, Dirk

    2016-01-01

    Curative-intent radical radiotherapy of cervical cancer consists of external-beam radiotherapy, brachytherapy, and concomitant chemotherapy with cisplatin. For each element, new developments aim to improve tumor control rates or treatment tolerance. Intensity-modulated radiotherapy (IMRT) has been shown to reduce gastrointestinal toxicity and can be used to selectively increase the radiotherapy dose. Individualized, image-guided brachytherapy enables better adaptation of high-dose volumes to the tumor extension. Intensification of concomitant or sequential systemic therapy is under evaluation. PMID:27614991

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

    PubMed Central

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

    2014-01-01

    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 χ2 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. PMID:24741136

  14. Posterior Cervical Foraminotomy: Indications, Technique, and Outcomes.

    PubMed

    Dodwad, Shah-Jahan M; Dodwad, Shah-Nawaz M; Prasarn, Mark L; Savage, Jason W; Patel, Alpesh A; Hsu, Wellington K

    2016-06-01

    Cervical radiculopathy presents with upper extremity pain, decreased sensation, and decreased strength caused by irritation of specific nerve root(s). After failure of conservative management, surgical options include anterior cervical decompression and fusion, disk arthroplasty, and posterior cervical foraminotomy. In this review, we discuss indications, techniques, and outcomes of posterior cervical laminoforaminotomy. PMID:27187617

  15. Cervical extravasation of bevacizumab.

    PubMed

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

    2013-04-01

    Monoclonal antibodies such as bevacizumab are widely used in medical oncology, either alone or in combination with chemotherapy. No specific recommendations on the management of monoclonal antibodies extravasation exist. Incidence rates vary considerably. Estimates of 0.5-6% have been reported in the literature. Also, patient-associated and procedure-associated risk factors of extravasation are multiple, such as bolus injections or poorly implanted central venous access. We report on an 86-year-old woman with colon cancer with liver metastasis who was treated with 5-fluorouracil, folinic acid, and bevacizumab. Extravasation occurred during chemotherapy infusion because of a catheter migration of the port outside of the superior vena cava, causing cervical pain without skin modifications. Diagnosis was confirmed with the appearance of clinical right cervical tumefaction and cervicothoracic computed tomography scan indicated a perijugular hypodense collection, corresponding to the extravasation. Conservative management was proposed. The patient recovered within 3 weeks from all symptoms. Physicians should be aware that in cases of bevacizumab extravasation, a nonsurgical approach might be effective. PMID:23262983

  16. A case report of HTLV-I associated myelopathy presenting with cerebellar ataxia and nystagmus.

    PubMed

    Taki, Masakatsu; Nin, Fumiaki; Hasegawa, Tatsuhisa; Sakaguchi, Hirofumi; Suzuki, Toshihiro; Hisa, Yasuo; Azuma, Yumiko; Nakagawa, Masanori

    2011-06-01

    HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP) is characterized by spastic paraparesis in the lower extremities, and urinary disturbance. HAM/TSP has also been less frequently associated with cerebellar syndromes and nystagmus. We report a case of HAM/TSP presenting with cerebellar ataxia and nystagmus. The patient was a 73-year-old woman who was born in southern Japan. At age 41, she developed pain and spasticity in the bilateral lower limbs and gradually progressive gait disturbance. At age 57, she was diagnosed with HAM/TSP based on spastic paraparesis in the lower limbs, urinary disturbance and positive anti HTLV-I antibody in serum and cerebrospinal fluid. In June 2008, she was referred to our university and hospitalized for rehabilitation. Twenty days later, she experienced rotatory vertigo sensation. Magnetic resonance imaging revealed pontocerebellar atrophy. The patient presented with cerebellar signs in the upper limbs, gaze-evoked nystagmus in the sitting position and right-beating horizontal nystagmus in the supine and head-hanging positions. Electronystagmography (ENG) showed horizontal saccadic overshoot dysmetria and horizontal saccadic pursuit. Nystagmus is rare among the literature on HAM/TSP. ENG is helpful to evaluate and confirm the cerebellar syndromes of HAM/TSP. PMID:21035292

  17. Characterization of Intercostal Muscle Pathology in Canine Degenerative Myelopathy: A Disease Model for Amyotrophic Lateral Sclerosis

    PubMed Central

    Morgan, Brandie R.; Coates, Joan R.; Johnson, Gayle C.; Bujnak, Alyssa C.; Katz, Martin L.

    2014-01-01

    Dogs homozygous for missense mutations in the SOD1 gene develop a late-onset neuromuscular disorder called degenerative myelopathy (DM) that has many similarities to amyotrophic lateral sclerosis (ALS). Both disorders are characterized by widespread progressive declines in motor functions accompanied by atrophic changes in the descending spinal cord tracts , and some forms of ALS are also associated with SOD1 mutations. In end-stage ALS, death usually occurs as a result of respiratory failure due to severe functional impairment of respiratory muscles. The mechanisms that lead to this loss of function are not known. Dogs with DM are euthanized at all stages of disease progression providing an opportunity to characterize the onset and progression of any pathological changes in the respiratory muscles that may precede respiratory failure. To characterize such potential disease-related pathology we evaluated intercostal muscles from Boxer and Pembroke Welsh Corgi dogs that were euthanized at various stages of DM disease progression. DM was found to result in intercostal muscle atrophy, fibrosis, increased variability in muscle fiber size and shape, and an alteration in muscle fiber type composition. This pathology was not accompanied by retraction of the motor neuron terminals from the muscle acetylcholine receptor complexes, suggesting that the muscle atrophy did not result from physical denervation. These findings provide a better understanding of the mechanisms that likely lead to respiratory failure in at least some forms of ALS and will be useful in the development and evaluation of potential therapeutic interventions using the DM model. PMID:24043596

  18. Variants within the SP110 nuclear body protein modify risk of canine degenerative myelopathy

    PubMed Central

    Ivansson, Emma L.; Kozyrev, Sergey V.; Murén, Eva; Körberg, Izabella Baranowska; Swofford, Ross; Koltookian, Michele; Tonomura, Noriko; Zeng, Rong; Kolicheski, Ana L.; Hansen, Liz; Katz, Martin L.; Johnson, Gayle C.; Johnson, Gary S.; Coates, Joan R.; Lindblad-Toh, Kerstin

    2016-01-01

    Canine degenerative myelopathy (DM) is a naturally occurring neurodegenerative disease with similarities to some forms of amyotrophic lateral sclerosis (ALS). Most dogs that develop DM are homozygous for a common superoxide dismutase 1 gene (SOD1) mutation. However, not all dogs homozygous for this mutation develop disease. We performed a genome-wide association analysis in the Pembroke Welsh Corgi (PWC) breed comparing DM-affected and -unaffected dogs homozygous for the SOD1 mutation. The analysis revealed a modifier locus on canine chromosome 25. A haplotype within the SP110 nuclear body protein (SP110) was present in 40% of affected compared with 4% of unaffected dogs (P = 1.5 × 10−5), and was associated with increased probability of developing DM (P = 4.8 × 10−6) and earlier onset of disease (P = 1.7 × 10−5). SP110 is a nuclear body protein involved in the regulation of gene transcription. Our findings suggest that variations in SP110-mediated gene transcription may underlie, at least in part, the variability in risk for developing DM among PWCs that are homozygous for the disease-related SOD1 mutation. Further studies are warranted to clarify the effect of this modifier across dog breeds. PMID:27185954

  19. Posterior decompression with instrumented fusion for thoracic myelopathy caused by ossification of the posterior longitudinal ligament.

    PubMed

    Yamazaki, Masashi; Okawa, Akihiko; Fujiyoshi, Takayuki; Furuya, Takeo; Koda, Masao

    2010-05-01

    We evaluated the clinical results of posterior decompression with instrumented fusion (PDF) for thoracic myelopathy due to ossification of the posterior longitudinal ligament (OPLL). A total of 24 patients underwent PDF, and their surgical outcomes were evaluated by the Japanese Orthopaedic Association (JOA) scores (0-11 points) and by recovery rates calculated at 3, 6, 9 and 12 months after surgery and at a mean final follow-up of 4 years and 5 months. The mean JOA score before surgery was 3.7 points. Although transient paralysis occurred immediately after surgery in one patient (3.8%), all patients showed neurological recovery at the final follow-up with a mean JOA score of 8.0 points and a mean recovery rate of 58.1%. The mean recovery rate at 3, 6, 9 and 12 months after surgery was 36.7, 48.8, 54.0 and 56.8%, respectively. The median time point that the JOA score reached its peak value was 9 months after surgery. No patient chose additional anterior decompression surgery via thoracotomy. The present findings demonstrate that despite persistent anterior impingement of the spinal cord by residual OPLL, PDF can result in considerable neurological recovery with a low risk of postoperative paralysis. Since neurological recovery progresses slowly after PDF, we suggest that additional anterior decompression surgery is not desirable during the early stage of recovery. PMID:20049486

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

    PubMed Central

    Caracseghi, Fabiola; Izquierdo-Blasco, Jaume; Sanchez-Montanez, Angel; Melendo-Perez, Susana; Roig-Quilis, Manuel; Modesto, Consuelo

    2011-01-01

    Blau syndrome is a rare autoinflammatory disorder within the group of pediatric granulomatous diseases. Mutations in nucleotide-binding oligomerization domain 2 (NOD2/CARD15) are responsible for this condition, which has an autosomal dominant pattern of inheritance and variable expressivity. The clinical picture includes arthritis, uveitis, skin rash, and granulomatous inflammation. Central nervous system involvement is seldom reported, although some isolated cases of seizures, neurosensorial hearing loss, and transient cranial nerve palsy have been described. Treatment consists of nonsteroidal anti-inflammatory drugs, corticosteroids, and immunosuppressive agents, among which anti-tumor-necrosis-factor-alpha (TNF-α) biologic agents, such as etanercept, play an important role. Among the major adverse effects of TNF-α inhibitors, demyelinating disease, multiple sclerosis, and acute transverse myelitis have been reported in adults. We describe a case of pediatric Blau syndrome affected by etanercept-induced myelopathy, manifesting as a clinical syndrome of transverse myelitis. The patient experienced rapid recovery after etanercept was discontinued. To our knowledge, this is the first such case reported in the literature and, possibly, the one with the latest onset, following 8 years of treatment. We discuss the etiopathogenic mechanisms of this reaction and possible explanations for the imaging findings. PMID:22937436

  1. Variants within the SP110 nuclear body protein modify risk of canine degenerative myelopathy.

    PubMed

    Ivansson, Emma L; Megquier, Kate; Kozyrev, Sergey V; Murén, Eva; Körberg, Izabella Baranowska; Swofford, Ross; Koltookian, Michele; Tonomura, Noriko; Zeng, Rong; Kolicheski, Ana L; Hansen, Liz; Katz, Martin L; Johnson, Gayle C; Johnson, Gary S; Coates, Joan R; Lindblad-Toh, Kerstin

    2016-05-31

    Canine degenerative myelopathy (DM) is a naturally occurring neurodegenerative disease with similarities to some forms of amyotrophic lateral sclerosis (ALS). Most dogs that develop DM are homozygous for a common superoxide dismutase 1 gene (SOD1) mutation. However, not all dogs homozygous for this mutation develop disease. We performed a genome-wide association analysis in the Pembroke Welsh Corgi (PWC) breed comparing DM-affected and -unaffected dogs homozygous for the SOD1 mutation. The analysis revealed a modifier locus on canine chromosome 25. A haplotype within the SP110 nuclear body protein (SP110) was present in 40% of affected compared with 4% of unaffected dogs (P = 1.5 × 10(-5)), and was associated with increased probability of developing DM (P = 4.8 × 10(-6)) and earlier onset of disease (P = 1.7 × 10(-5)). SP110 is a nuclear body protein involved in the regulation of gene transcription. Our findings suggest that variations in SP110-mediated gene transcription may underlie, at least in part, the variability in risk for developing DM among PWCs that are homozygous for the disease-related SOD1 mutation. Further studies are warranted to clarify the effect of this modifier across dog breeds. PMID:27185954

  2. Accumulation and aggregate formation of mutant superoxide dismutase 1 in canine degenerative myelopathy.

    PubMed

    Nakamae, S; Kobatake, Y; Suzuki, R; Tsukui, T; Kato, S; Yamato, O; Sakai, H; Urushitani, M; Maeda, S; Kamishina, H

    2015-09-10

    Canine degenerative myelopathy (DM) is an adult-onset progressive neurodegenerative disorder that has recently been linked to mutations in the superoxide dismutase 1 (SOD1) gene. We generated a polyclonal antibody against canine SOD1 to further characterize the mutant SOD1 protein and its involvement in DM pathogenesis. This antibody (SYN3554) was highly specific to canine SOD1 and had the ability to reveal distinct cytoplasmic aggregates in cultured cells expressing canine mutant SOD1 and also in the spinal neurons of symptomatic homozygotes. A similar staining pattern was observed in asymptomatic homozygotes. SOD1 aggregates were not detected in the spinal neurons of heterozygotes; the accumulation of SOD1 was also detected in the reactive astrocytes of homozygotes and heterozygotes to a similar extent. Our results support the hypothesis that the cytoplasmic accumulation and aggregate formation of the mutant SOD1 protein, especially in astrocytes, are closely associated with the pathogenesis of DM. Therefore, this disease is regarded as a spontaneous large-animal model of SOD1-mediated amyotrophic lateral sclerosis in humans. PMID:26162235

  3. Daily controlled physiotherapy increases survival time in dogs with suspected degenerative myelopathy.

    PubMed

    Kathmann, I; Cizinauskas, S; Doherr, M G; Steffen, F; Jaggy, A

    2006-01-01

    The purposes of the study reported here were to evaluate the signalment and clinical presentation in 50 dogs with degenerative myelopathy, to evaluate whether mean survival time was significantly affected by various means of physiotherapy performed in 22 dogs, and to determine whether neurologic status, anatomic localization, or age at onset had an influence on survival time in dogs that received physiotherapy. We found a significant (P < .05) breed predisposition for the German Shepherd Dog, Kuvasz, Hovawart, and Bernese Mountain Dog. Mean age at diagnosis was 9.1 years, and both sexes were affected equally. The anatomic localization of the lesion was spinal cord segment T3-L3 in 56% (n = 28) and L3-S3 in 44% (n = 22) of the dogs. Animals that received intensive (n = 9) physiotherapy had longer (P < .05) survival time (mean 255 days), compared with that for animals with moderate (n = 6; mean 130 days) or no (n = 7; mean 55 days) physiotherapy. In addition, our results indicate that affected dogs which received physiotherapy remained ambulatory longer than did animals that did not receive physical treatment. PMID:16955818

  4. Characterization of intercostal muscle pathology in canine degenerative myelopathy: a disease model for amyotrophic lateral sclerosis.

    PubMed

    Morgan, Brandie R; Coates, Joan R; Johnson, Gayle C; Bujnak, Alyssa C; Katz, Martin L

    2013-12-01

    Dogs homozygous for missense mutations in the SOD1 gene develop a late-onset neuromuscular disorder called degenerative myelopathy (DM) that has many similarities to amyotrophic lateral sclerosis (ALS). Both disorders are characterized by widespread progressive declines in motor functions, accompanied by atrophic changes in the descending spinal cord tracts. Some forms of ALS are also associated with SOD1 mutations. In end-stage ALS, death usually occurs as a result of respiratory failure from severe functional impairment of respiratory muscles. The mechanisms that lead to this loss of function are not known. Dogs with DM are euthanized at all stages of disease progression, providing an opportunity to characterize the onset and progression of any pathological changes in the respiratory muscles that may precede respiratory failure. To characterize such potential disease-related pathology, we evaluated intercostal muscles from Boxer and Pembroke Welsh Corgi dogs that were euthanized at various stages of DM disease progression. DM was found to result in intercostal muscle atrophy, fibrosis, increased variability in muscle fiber size and shape, and alteration in muscle fiber type composition. This pathology was not accompanied by retraction of the motor neuron terminals from the muscle acetylcholine receptor complexes, suggesting that the muscle atrophy did not result from physical denervation. These findings provide a better understanding of the mechanisms that likely lead to respiratory failure in at least some forms of ALS and will be useful in the development and evaluation of potential therapeutic interventions using the DM model. PMID:24043596

  5. Cervical Tissue Engineering Using Silk Scaffolds and Human Cervical Cells

    PubMed Central

    Sanchez, Cristina C.; Rice, William L.; Socrate, Simona; Kaplan, David L.

    2010-01-01

    Spontaneous preterm birth is a frequent complication of pregnancy and a common cause of morbidity in childhood. Obstetricians suspect abnormalities of the cervix are implicated in a significant number of preterm births. The cervix is composed of fibrous connective tissue and undergoes significant remodeling in preparation for birth. We hypothesized that a tissue engineering strategy could be used to develop three-dimensional cervical-like tissue constructs that would be suitable for investigating cervical remodeling. Cervical cells were isolated from two premenopausal women undergoing hysterectomy for a benign gynecological condition, and the cells were seeded on porous silk scaffolds in the presence or absence of dynamic culture and with 10% or 20% serum. Morphological, biochemical, and mechanical properties were measured during the 8-week culture period. Cervical cells proliferated in three-dimensions and synthesized an extracellular matrix with biochemical constituents and morphology similar to native tissue. Compared to static culture, dynamic culture was associated with significantly increased collagen deposition (p < 0.05), sulfated glycosaminoglycan synthesis (p < 0.05), and mechanical stiffness (p < 0.05). Serum concentration did not affect measured variables. Relevant human tissue-engineered cervical-like constructs constitute a novel model system for a range of fundamental and applied studies related to cervical remodeling. PMID:20121593

  6. Cervical tissue engineering using silk scaffolds and human cervical cells.

    PubMed

    House, Michael; Sanchez, Cristina C; Rice, William L; Socrate, Simona; Kaplan, David L

    2010-06-01

    Spontaneous preterm birth is a frequent complication of pregnancy and a common cause of morbidity in childhood. Obstetricians suspect abnormalities of the cervix are implicated in a significant number of preterm births. The cervix is composed of fibrous connective tissue and undergoes significant remodeling in preparation for birth. We hypothesized that a tissue engineering strategy could be used to develop three-dimensional cervical-like tissue constructs that would be suitable for investigating cervical remodeling. Cervical cells were isolated from two premenopausal women undergoing hysterectomy for a benign gynecological condition, and the cells were seeded on porous silk scaffolds in the presence or absence of dynamic culture and with 10% or 20% serum. Morphological, biochemical, and mechanical properties were measured during the 8-week culture period. Cervical cells proliferated in three-dimensions and synthesized an extracellular matrix with biochemical constituents and morphology similar to native tissue. Compared to static culture, dynamic culture was associated with significantly increased collagen deposition (p < 0.05), sulfated glycosaminoglycan synthesis (p < 0.05), and mechanical stiffness (p < 0.05). Serum concentration did not affect measured variables. Relevant human tissue-engineered cervical-like constructs constitute a novel model system for a range of fundamental and applied studies related to cervical remodeling. PMID:20121593

  7. Resection of cervical ependymoma.

    PubMed

    Lanzino, Giuseppe; Morales-Valero, Saul F; Krauss, William E; Campero, Mario; Marsh, W Richard

    2014-09-01

    Intramedullary ependymomas are surgically curable tumors. However, their surgical resection poses several challenges. In this intraoperative video we illustrate the main steps for the surgical resection of a cervical intramedullary ependymoma. These critical steps include: adequate exposure of the entire length of the tumor; use of the intraoperative ultrasound; identification of the posterior median sulcus and separation of the posterior columns; Identification of the plane between the spinal cord and the tumor; mobilization and debulking of the tumor and disconnection of the vascular supply (usually from small anterior spinal artery branches). Following these basic steps a complete resection can be safely achieved in many cases. The video can be found here: http://youtu.be/QMYXC_F4O4U. PMID:25175575

  8. Get Tested for Cervical Cancer

    MedlinePlus

    ... help understanding your Pap test result . What about cost? Testing for cervical cancer is covered under the ... may be able to get tested at no cost to you. If you have private insurance, check ...

  9. Spinal surgery -- cervical - series (image)

    MedlinePlus

    ... on the vertebral bodies (osteophytes), which compress spinal nerves, trauma, and narrowing (stenosis) of the spinal column around the spinal cord. Symptoms of cervical spine problems include: pain that interferes with daily ...

  10. 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? ...

  11. How Are Cervical Cancers and Pre-Cancers Diagnosed?

    MedlinePlus

    ... How is cervical cancer staged? How is cervical cancer diagnosed? The first step in finding cervical cancer ... systems. Tests for women with symptoms of cervical cancer or abnormal Pap results Medical history and physical ...

  12. Glycoprotein and Glycan in Tissue and Blood Samples of Patients With Stage IB-IVA Cervical Cancer Undergoing Surgery to Remove Pelvic and Abdominal Lymph Nodes

    ClinicalTrials.gov

    2016-02-19

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

  13. Ipilimumab-induced necrotic myelopathy in a patient with metastatic melanoma: A case report and review of literature.

    PubMed

    Abdallah, Al-Ola; Herlopian, Aline; Ravilla, Rahul; Bansal, Meghana; Chandra-Reddy, Sowmya; Mahmoud, Fade; Ong, Shirley; Gokden, Murat; Hutchins, Laura

    2016-06-01

    Ipilimumab is a novel humanized monoclonal antibody directed against cytotoxic T lymphocyte antigen 4, a T-cell surface molecule involved in down-regulation and suppression of the T cell response to stimuli. Patients treated with ipilimumab are at risk for immune-related adverse events involving the skin, digestive tract, liver and endocrine organs. Few case reports of immune-related adverse effects involving central or peripheral nervous system due to ipilimumab are published. These include inflammatory myopathy, aseptic meningitis, severe meningo-radiculo-neuritis, temporal arteritis, Guillain-Barre syndrome, and posterior reversible encephalopathy syndrome. We report the first case of ipilimumab-induced progressive necrotic myelopathy. PMID:25712627

  14. Subacute post-traumatic ascending myelopathy (SPAM): two cases of SPAM following surgical treatment of thoracolumbar fractures.

    PubMed

    Farooque, Kamran; Kandwal, Pankaj; Gupta, Ankit

    2014-01-01

    To report two cases of traumatic paraplegia who developed Sub-acute Post-Traumatic Ascending Myelopathy (SPAM) following surgical decompression.We hereby report two cases (both 35yr old male) with traumatic paraplegia that developed ascending weakness at 3rd and 5th Post-Op day respectively following surgical decompression. Both the patients experienced remarkable improvement in Neurology after treatment with steroids. The authors conclude by emphasizing on minimum cord handling during surgical decompression of the spinal cord to avoid this potentially life threatening complication. PMID:24823733

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

    PubMed

    Gessain, A; Mahieux, R

    2012-03-01

    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

  16. Corpectomy with Adjacent-Level Kyphoplasty to Treat Metastatic Lung Cancer in Three Contiguous Cervical Vertebrae Causing Focal Neurologic Compromise

    PubMed Central

    Bateman, Antony H.; Way, Adam C.

    2014-01-01

    Study Design Case report. Objectives Decompression of metastatic spinal cord compression has been shown to improve quality of life and prolong ambulation in patients undergoing palliative treatment. We report a case of metastatic cervical myelopathy treated with a combined approach using corpectomy and stabilization together with balloon kyphoplasty to allow adequate decompression and immediate stability in a patient with significant destruction of adjacent vertebral bodies. Methods The cervical spine was approached anteriorly and decompressed with a C7 corpectomy. Subsequent stability was achieved with insertion of a trabecular metal cage. Balloon kyphoplasty was used to treat lytic lesions within the posterior body of the adjacent vertebrae for pain relief and increased stability. Additional stability was achieved through the application of an anterior plate. Results Full limited decompression and stabilization were successfully achieved. The patient had no further neurologic deterioration and made modest improvements that allowed a return to independent ambulation. Conclusion This limited approach may be an option for patients with metastatic spinal cord compression, lytic destruction of adjacent vertebral bodies, and limited life expectancy. PMID:25844288

  17. Cervical Disc Arthroplasty with Prestige LP Disc Versus Anterior Cervical Discectomy and Fusion: Seven-Year Outcomes

    PubMed Central

    Burkus, J. Kenneth; Shaffrey, Mark E.; Nian, Hui; Harrell, Frank E.

    2016-01-01

    Background Cervical disc arthroplasty (CDA) has emerged as an alternative to anterior cervical discectomy and fusion (ACDF) for the treatment of cervical pathologies. Studies are on-going to assess the long term outcomes of CDA. This study assessed the safety and efficacy of the Prestige® LP Disc at 84-months follow up. Methods Prospective data from 280 CDA patients with single-level cervical disc disease with radiculopathy or myelopathy were compared with 265 historical control ACDF patients. Clinical and radiographic follow up was completed pre-operatively, intraoperatively, and at intervals up to 84 months. Results Follow-up rate was 75.9% for CDA and 70.0% for ACDF patients. Statistical improvements (p < 0.001) in Neck Disability Index (NDI), neck/arm pain, and SF-36 were achieved by 1.5 months in both groups and maintained through 84 months. At 84 months, 86.1% of CDA versus 80.1% of ACDF patients achieved NDI success, (≥15-point improvement over baseline). Mean NDI score improvements exceeded 30 points in both groups. SF-36 PCS/MCS mean improvements were 13.1±11.9/8.2±12.3 points for CDA and 10.7±11.8/8.3±13.6 points for ACDF. Neurological success was 92.8% for CDA and 79.7% for ACDF patients. The rate of Overall Success was 74.9% for CDA and 63.2% for ACDF. At 84 months, 17.5% of CDA and 16.6% of ACDF patients had a possibly implant- or implant-surgical procedure-related adverse event. Eighteen (6.4%) CDA and 29 (10.9%) ACDF patients had a second surgery at the index level. In CDA patients, mean angular motion at the target level was maintained at 24 (7.5°) and 84 (6.9°) months. Bridging bone was reported in 5.9%/9.5%/10.2%/13.0% of CDA patients at 24/36/60/84 months. Change in mean preoperative angulation of the adjacent segment above/below the index level was1.06±4.39/1.25±4.06 for CDA and (-0.23)±5.37/1.25±5.07 for ACDF patients. At 84 months, 90.9% of CDA and 85.6% of ACDF patients were satisfied with the results of their treatment

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

    SciTech Connect

    Sahgal, Arjun; Weinberg, Vivian; Ma, Lijun; Chang, Eric; Chao, Sam; Muacevic, Alexander; Gorgulho, Alessandra; Soltys, Scott; Gerszten, Peter C.; Ryu, Sam; Angelov, Lilyana; Gibbs, Iris; Wong, C. Shun; Larson, David A.

    2013-02-01

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

  19. Neurogenic Bladder and Urodynamic Outcomes in Patients with Spinal Cord Myelopathy

    PubMed Central

    Dillon, Louise

    2015-01-01

    Background: Urodynamics (UDs) are routine in traumatic spinal cord injury (SCI), but there are few reports regarding nontraumatic spinal cord myelopathy (SCM) patients. Purpose: To describe the neurogenic bladder and UD outcomes in SCM patients and determine whether the UD recommendations result in clinically important changes to bladder management. Methods: This retrospective case study examined a series of SCM patients admitted to a spinal rehabilitation service who underwent UDs between January 1, 2000 and June 30, 2010. Results: Sixty-five UD tests were performed a median of 7 months post SCM. Most (n = 34; 57%) patients were male, and the median age was 60 years. Most patients (n = 46; 77%) were paraplegic and were continent of urine (n = 38; 58%). Thirty-five (46%) patients voided on sensation, 26 (40%) performed intermittent self-catheterization, and 9 (14%) had an indwelling catheter. The most common UD finding was overactive detrusor with no dysynergia (n = 31; 48%), followed by overactive detrusor with sphincter dysynergia (n = 16; 25%) and detrusor areflexia/underactive (n = 12; 18%). Key UD findings were median cystometric capacity 414 mL (interquartile range [IQR], 300–590), median maximum detrusor contraction 49.5 cmH2O (IQR, 25–85), and median residual volume post voiding 100 mL (IQR, 5–200). The recommendations for changes to bladder management following UDs resulted in clinically important changes to existing strategies in 57 studies (88%). Conclusions: Future studies should ascertain whether our screening protocol is appropriate, and a longer-term follow-up should examine the relationship between UD recommendations and prevention of complications. PMID:26363592

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

    PubMed

    Zeiler, Gareth E; Van der Zwan, Henriette; Oosthuizen, Marinda C

    2013-01-01

    Canine degenerative myelopathy (DM) is a progressive disease process that is diagnosed late in life and mainly affects the pelvic limbs. Factors that make an ante-mortem definitive diagnosis of DM include: an insidious onset and clinical manifestation that mimics other disease processes of the pelvic limbs (hip dysplasia, cranial cruciate ligament rupture, etc.) or there may even be concurrent disease processes, old-age onset and lack of reliable diagnostic methods. Until recently, South African dog owners had to submit samples to laboratories overseas for genetic testing in order to confirm an affected dog (homozygous A/A) and to aid in the ante-mortem diagnosis of DM. Only affected dogs have been confirmed to manifest the clinical signs of DM. This study aimed to verify whether genetic testing by a local genetic laboratory was possible in order to detect a missense mutation of the superoxide dismutase gene (SOD1) that is implicated in causing the clinical signs of DM. The study also aimed to detect and map the inheritance of this disease process in a local Boxer dog population where the pedigree of the sampled population was known. Venous blood collected from Boxer dogs using a simple random sampling technique. The samples were genotyped for the SOD1:c.118G>A polymorphism. Carrier and affected Boxer dogs were detected. A pedigree that demonstrated the significance of inheriting a carrier or affected state in the population was mapped. The present study concludes that genotyping of the missense mutation in Boxer dogs is possible in South Africa. There are carrier and affected Boxer dogs in the local population, making DM a plausible diagnosis in aged dogs presenting with pelvic limb pathology. PMID:27476391

  1. Embolization followed by surgery for treatment of perimedullary arteriovenous fistula causing acute myelopathy

    PubMed Central

    Hsiao, I-Han; Lee, Han-Chung; Yen, Pao-Sheng; Cho, Der-Yang

    2015-01-01

    Background: Perimedullary arteriovenous fistula (AVF) is rare. There are three subtypes, and the treatment strategies for each are different. Subtype B (multiple fistulas) can be treated by either embolization or surgery. On the basis of a case from our treatment experience, we propose a method for achieving optimal outcome while minimizing nerve injury. Case Description: A 51-year-old female was admitted to our hospital with acute myelopathy caused by a perimedullary AVF. Initially, we treated her by embolization using the chemical agent Onyx. Her symptoms improved immediately but gradually returned beginning 1 week later. Two months later, the symptoms had returned to pretreatment status, so we removed the fistulas surgically. Severe adhesions between nerve and occult venous varices were noted during the operation. Afterward, the patient's symptoms improved significantly. Histopathological sections showed an inflammatory reaction around the varices. Conclusions: We initially considered several possible reasons for the return of symptoms: (a) Hypoperfusion of the spinal cord; (b) mass effect of the occult vein varices; (c) residual AVF or vascular remodeling resulting in recurrent cord hypertension; (d) Onyx-induced perivascular inflammation resulting in nerves adhering to each other and to occult venous varices. Clinical, surgical, and pathological findings ruled out the first three, leaving Onyx-induced perivascular inflammation as the probable reason. Given our treatment experience and the pros and cons of the two methods, we propose that initial embolization followed by surgery after 5 days to remove occult venous varices is the ideal strategy for treating perimedullary AVF of subtype B. PMID:26069849

  2. Cervical Cord Decompression Using Extended Anterior Cervical Foraminotomy Technique

    PubMed Central

    Kim, Sung-Duk; Lee, Cheol-Young; Kim, Hyun-Woo; Jung, Chul-Ku; Kim, Jong Hyun

    2014-01-01

    Objective At present, gold-standard technique of cervical cord decompression is surgical decompression and fusion. But, many complications related cervical fusion have been reported. We adopted an extended anterior cervical foraminotomy (EACF) technique to decompress the anterolateral portion of cervical cord and report clinical results and effectiveness of this procedure. Methods Fifty-three patients were operated consecutively using EACF from 2008 to 2013. All of them were operated by a single surgeon via the unilateral approach. Twenty-two patients who exhibited radicular and/or myelopathic symptoms were enrolled in this study. All of them showed cervical cord compression in their preoperative magnetic resonance scan images. Results In surgical outcomes, 14 patients (64%) were classified as excellent and six (27%), as good. The mean difference of cervical cord anterior-posterior diameter after surgery was 0.92 mm (p<0.01) and transverse area was 9.77 mm2 (p<0.01). The dynamic radiological study showed that the average post-operative translation (retrolisthesis) was 0.36 mm and the disc height loss at the operated level was 0.81 mm. The change in the Cobb angle decreased to 3.46, and showed slight kyphosis. The average vertebral body resection rate was 11.47%. No procedure-related complications occurred. Only one patient who had two-level decompression needed anterior fusion at one level as a secondary surgery due to postoperative instability. Conclusions Cervical cord decompression was successfully performed using EACF technique. This procedure will be an alternative surgical option for treating cord compressing lesions. Long-term follow-up and a further study in larger series will be needed. PMID:25328648

  3. Analysis of digitized cervical images to detect cervical neoplasia

    NASA Astrophysics Data System (ADS)

    Ferris, Daron G.

    2004-05-01

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

  4. Immunohistochemical evidence for immunoglobulin and complement deposition in spinal cord lesions in degenerative myelopathy in German shepherd dogs.

    PubMed

    Barclay, K B; Haines, D M

    1994-01-01

    The purpose of this study was to examine the distribution of immunoglobulin and complement component C3 in spinal cord tissues of dogs with degenerative myelopathy. Sections of formalin-fixed paraffin-embedded spinal cord from five German Shepherd dogs with clinical and histological features consistent with degenerative myelopathy (DM) and one normal dog were tested immunohistochemically for deposition of immunoglobulin G (IgG) and the third component of complement (C3). In all dogs there was staining associated with large and small blood vessels. In addition, in the dogs with DM there was focal staining for IgG and C3 in spinal nerve tracts characteristically affected in DM. Deposition of IgG and C3 was found in histological lesions, and in addition, in other areas independent of visible lesions, suggesting that IgG and C3 deposition may precede histological evidence of spinal cord damage. These findings suggest a role for immune-mediated destruction of the spinal cord which may contribute to the pathogenesis of DM in German Shepherd dogs. PMID:8143248

  5. Preventing Cervical Cancer with HPV Vaccines

    Cancer.gov

    Cervical cancer can be prevented with HPV vaccines. NCI-supported researchers helped establish HPV as a cause of cervical cancer. They also helped create the first HPV vaccines, were involved in the vaccine trials, and contribute to ongoing studies.

  6. NIH Research Leads to Cervical Cancer Vaccine

    MedlinePlus

    ... Issues Sexually Transmitted Diseases NIH Research Leads to Cervical Cancer Vaccine Past Issues / Fall 2008 Table of Contents ... in women, the cause of the majority of cervical cancers. Photo courtesy of Judy Folkenberg, NLM Writer By ...

  7. Cervical cancer screening.

    PubMed Central

    Katz, A.

    1998-01-01

    OBJECTIVE: To review the role of family physicians in screening for cancer of the cervix, to review the evidence for screening, in particular, frequency and technique for screening, and to review the reasons cervical cancer has not been prevented and the role of family physicians in addressing these failures. QUALITY OF EVIDENCE: The value of screening has been established with level II evidence. Many of the unresolved issues are not supported either way by good evidence; level II and III evidence predominates. MAIN FINDINGS: In Canada, 1350 women were predicted to be diagnosed with cancer of the cervix in 1996. Most of these women had not been screened. Minority, rural, low-income, and older women face important barriers to screening. Family physicians have a role in reaching out to these women to provide effective health care, including cancer screening. When cancer screening is performed, it should conform to recommended techniques with appropriate follow up of abnormal test results. CONCLUSIONS: Family physicians have an important role in preventing cancer of the cervix. Efforts should be concentrated on encouraging a greater proportion of eligible women to be screened. Criteria are suggested for effective screening. PMID:9721422

  8. Cervical interfacet spacers and maintenance of cervical lordosis.

    PubMed

    Tan, Lee A; Straus, David C; Traynelis, Vincent C

    2015-05-01

    OBJECT The cervical interfacet spacer (CIS) is a relatively new technology that can increase foraminal height and area by facet distraction. These offer the potential to provide indirect neuroforaminal decompression while simultaneously enhancing fusion potential due to the relatively large osteoconductive surface area and compressive forces exerted on the grafts. These potential benefits, along with the relative ease of implantation during posterior cervical fusion procedures, make the CIS an attractive adjuvant in the management of cervical pathology. One concern with the use of interfacet spacers is the theoretical risk of inducing iatrogenic kyphosis. This work tests the hypothesis that interfacet spacers are associated with loss of cervical lordosis. METHODS Records from patients undergoing posterior cervical fusion at Rush University Medical Center between March 2011 and December 2012 were reviewed. The FacetLift CISs were used in all patients. Preoperative and postoperative radiographic data were reviewed and the Ishihara indices and cervical lordotic angles were measured and recorded. Statistical analyses were performed using STATA software. RESULTS A total of 64 patients were identified in whom 154 cervical levels were implanted with machined allograft interfacet spacers. Of these, 15 patients underwent anterior-posterior fusions, 4 underwent anterior-posterior-anterior fusions, and the remaining 45 patients underwent posterior-only fusions. In the 45 patients with posterior-only fusions, a total of 110 levels were treated with spacers. There were 14 patients (31%) with a single level treated, 16 patients (36%) with two levels treated, 5 patients (11%) with three levels treated, 5 patients (11%) with four levels treated, 1 patient (2%) with five levels treated, and 4 patients (9%) with six levels treated. Complete radiographic data were available in 38 of 45 patients (84%). On average, radiographic follow-up was obtained at 256.9 days (range 48-524 days

  9. Human Papillomavirus and Cervical Cancer

    PubMed Central

    Burd, Eileen M.

    2003-01-01

    Of the many types of human papillomavirus (HPV), more than 30 infect the genital tract. The association between certain oncogenic (high-risk) strains of HPV and cervical cancer is well established. Although HPV is essential to the transformation of cervical epithelial cells, it is not sufficient, and a variety of cofactors and molecular events influence whether cervical cancer will develop. Early detection and treatment of precancerous lesions can prevent progression to cervical cancer. Identification of precancerous lesions has been primarily by cytologic screening of cervical cells. Cellular abnormalities, however, may be missed or may not be sufficiently distinct, and a portion of patients with borderline or mildly dyskaryotic cytomorphology will have higher-grade disease identified by subsequent colposcopy and biopsy. Sensitive and specific molecular techniques that detect HPV DNA and distinguish high-risk HPV types from low-risk HPV types have been introduced as an adjunct to cytology. Earlier detection of high-risk HPV types may improve triage, treatment, and follow-up in infected patients. Currently, the clearest role for HPV DNA testing is to improve diagnostic accuracy and limit unnecessary colposcopy in patients with borderline or mildly abnormal cytologic test results. PMID:12525422

  10. Surgical conditions of the cervical spine.

    PubMed

    Tomlinson, J

    1996-11-01

    This article reviews the four most common surgical conditions of the cervical spinal cord other than vertebral fractures including atlantoaxial instability, cervical disc disease, caudal cervical spondylomyelopathy, and spinal cord tumors. Each disease is reviewed by signalment, history, neurological examination, differential diagnosis, pertinent diagnostic testing, treatment, postoperative care, and prognosis. PMID:9020576

  11. 21 CFR 884.3200 - Cervical drain.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Cervical drain. 884.3200 Section 884.3200 Food and... OBSTETRICAL AND GYNECOLOGICAL DEVICES Obstetrical and Gynecological Prosthetic Devices § 884.3200 Cervical drain. (a) Identification. A cervical drain is a device designed to provide an exit channel for...

  12. Stress-induced cervical lesions.

    PubMed

    Braem, M; Lambrechts, P; Vanherle, G

    1992-05-01

    The increasing occurrence of dental lesions at the cervical surfaces requires more knowledge of the causes of the process. Acidic and abrasive mechanisms have clearly been documented as causes but the stress theory by Lee and Eakle is still controversial. This report describes several incidences of possible stress-induced lesions according to the characteristics described by Lee and Eakle. The occurrences of subgingival lesions lend credence to the stress-induction theory by exclusion of other superimposing etiologic factors. With the current concepts, a perceptive approach to the treatment of cervical lesions can be executed. PMID:1527763

  13. No Carious Cervical Lesions: Abfraction

    PubMed Central

    Shetty, Sumanth M; Shetty, Rashmi G; Mattigatti, Sudha; Managoli, Noopur A; Rairam, Surabhi G; Patil, Ashwini M

    2013-01-01

    Abfraction or Theory of Abfraction is a theory explaining the non-carious cervical lesions (NCCL). It suggests that they are caused by flexural forces, usually from cyclic loading; the enamel, especially at the cementoenamel junction (CEJ), undergoes this pattern of destruction by separating the enamel rods. Clinical aspect importance of these ineart lesions are at most important to be detected for early intervention and treatment modalities as options during the progression of the disease. How to cite this article: Shetty SM, Shetty RG, Mattigatti S, Managoli NA, Rairam SG, Patil AM. No Carious Cervical Lesions: Abfraction. J Int Oral Health 2013; 5(5):142-5. PMID:24324319

  14. A review of prognostic factors for surgical outcome of ossification of the posterior longitudinal ligament of cervical spine

    PubMed Central

    Li, Hai; Jiang, Lei-Sheng

    2008-01-01

    For patients with ossification of the posterior longitudinal ligament (OPLL) who have neurological-symptoms, surgery is necessary but not always effective. Various clinical factors influence the surgical outcome. The studies identifying these factors have been inconclusive and conflicting. It is essential for surgeons to understand the significance of the factors and choose the optimal therapeutic strategy for OPLL. The objective of this review is to determine the clinical factors predictive of the surgical outcome of cervical OPLL. The authors conducted a review of literature published in the English language. They examined studies in which the correlation between clinical factors and outcome were statistically evaluated. The results showed that the traverse area of the spinal cord, the spinal cord-evoked potentials (SCEPs), the increase of the range of motion in the cervical spine (ROM), diabetes, history of trauma, the onset of ossification of the ligament flavum (OLF) in the thoracic spine, snake-eye appearance (SEA) and incomplete decompression may be predictive factors. Age at surgery seems to be closely related to the outcome of posterior surgical procedure. Whether the neurological score, OPLL type, pre-operative duration of symptoms, focal intra-medullar high signal intensity in T2-weighted (IMHSI) and progression of OPLL or kyphosis and expansion of the spinal canal predict the surgical outcome remains unclear. The use of uniform neurological score and proper statistic analysis should facilitate comparison of data from different studies. It is important to analyze the effect of each factor on groups with different surgical procedures as well as patients with different compressive pathology. Research on the etiology and pathology of cervical myelopathy due to OPLL should be helpful in precisely understanding these clinical factors and predicting surgical outcome. PMID:18704517

  15. Human papillomavirus testing in cervical cancer screening.

    PubMed

    Castle, Philip E; Cremer, Miriam

    2013-06-01

    Human papillomavirus (HPV) testing is more reliable and sensitive but less specific than Papanicolaou (Pap) testing/cervical cytology for the detection of cervical precancer and cancer. HPV-negative women are at lower risk of cervical cancer than Pap-negative women. In high-resource settings, HPV testing can be used to make cervical cancer prevention programs more efficient by focusing clinical attention on women who have HPV. In lower-resource settings, where Pap testing has not been sustained or widespread, new, lower-cost HPV tests may make cervical cancer screening feasible. PMID:23732037

  16. Cervical Whiplash: Considerations in the Rehabilitation of Cervical Myofascial Injury

    PubMed Central

    Ameis, Arthur

    1986-01-01

    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. PMID:21267293

  17. Percutaneous cervical nucleoplasty in the treatment of cervical disc herniation

    PubMed Central

    Li, Jian; Zhang, Zai-Heng

    2008-01-01

    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

  18. Drugs Approved for Cervical Cancer

    Cancer.gov

    This page lists cancer drugs approved by the Food and Drug Administration (FDA) for cervical cancer. The list includes generic names, brand names, and common drug combinations, which are shown in capital letters. The drug names link to NCI's Cancer Drug Information summaries.

  19. CNP. Cervical Neoplasia Probe Control

    SciTech Connect

    Vargo, T.

    1995-05-17

    This software, which consists of a main executive and several subroutines, performs control of the optics, image acquisition, and Digital Signal Processing (DSP) of this image, of an optical based medical instrument that performs fluoresence detection of precancerous lesions (neoplasia) of the human cervix. The hardware portion of this medical instrument is known by the same name Cervical Neoplasia Probe (CNP)

  20. Primary adenocarcinoma of cervical esophagus.

    PubMed

    Alrawi, S J; Winston, J; Tan, D; Gibbs, J; Loree, T R; Hicks, W; Rigual, N; Lorè, J M

    2005-06-01

    Most upper esophageal malignancies are squamous cell carcinomas, rarely adenocarcinomas arising from Barrett's esophagus and very rarely adenocarcinomas from heterotopic gastric mucosa without evidence of Barrett's especially in the cervical part of the esophagus. We report a case of adenocarcinoma of the polypoid type in the upper esophagus (cervical esophagus) arising from ectopic gastric mucosa, in a 60 year-old man who presented with progressive dysphagia. Accurate diagnosis by esophagogram revealed a large mass in the cervical esophagus; CAT scan showed intraluminal mass at the level of thoracic inlet, esophagogastroscopy showed a fleshy polyp (3.2cm x 3.0cm) at 20 cm from the incisors with a biopsy confirming moderately differentiated adenocarcinoma with no evidence of Barrett's esophagus. Through a left cervical approach and resection of medial third of clavicle, the tumor was removed by partial esophagectomy followed by lymph node dissection, and proved to be T1NOMO, stage I (AJCC staging 6th ed.). Post operatively, the patient received chemoradiation with no evidence of recurrence or metastasis in six years of follow up. It seems this tumor has a much better prognosis than adenocarcinomas arising from Barrett's. To our knowledge only 19 cases have been reported in literature so far. PMID:16110768

  1. Cervical Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing cervical cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  2. Cost-utility analysis modeling at 2-year follow-up for cervical disc arthroplasty versus anterior cervical discectomy and fusion: A single-center contribution to the randomized controlled trial

    PubMed Central

    Warren, Daniel; Andres, Tate; Hoelscher, Christian; Ricart-Hoffiz, Pedro; Bendo, John; Goldstein, Jeffrey

    2013-01-01

    Background Patients with cervical disc herniations resulting in radiculopathy or myelopathy from single level disease have traditionally been treated with Anterior Cervical Discectomy and Fusion (ACDF), yet Cervical Disc Arthroplasty (CDA) is a new alternative. Expert suggestion of reduced adjacent segment degeneration is a promising future result of CDA. A cost-utility analysis of these procedures with long-term follow-up has not been previously reported. Methods We reviewed single institution prospective data from a randomized trial comparing single-level ACDF and CDA in cervical disc disease. Both Medicare reimbursement schedules and actual hospital cost data for peri-operative care were separately reviewed and analyzed to estimate the cost of treatment of each patient. QALYs were calculated at 1 and 2 years based on NDI and SF-36 outcome scores, and incremental cost effectiveness ratio (ICER) analysis was performed to determine relative cost-effectiveness. Results Patients of both groups showed improvement in NDI and SF-36 outcome scores. Medicare reimbursement rates to the hospital were $11,747 and $10,015 for ACDF and CDA, respectively; these figures rose to $16,162 and $13,171 when including physician and anesthesiologist reimbursement. The estimated actual cost to the hospital of ACDF averaged $16,108, while CDA averaged $16,004 (p = 0.97); when including estimated physicians fees, total hospital costs came to $19,811 and $18,440, respectively. The cost/QALY analyses therefore varied widely with these discrepancies in cost values. The ICERs of ACDF vs CDA with Medicare reimbursements were $18,593 (NDI) and $19,940 (SF-36), while ICERs based on actual total hospital cost were $13,710 (NDI) and $9,140 (SF-36). Conclusions We confirm the efficacy of ACDF and CDA in the treatment of cervical disc disease, as our results suggest similar clinical outcomes at one and two year follow-up. The ICER suggests that the non-significant added benefit via ACDF comes at a

  3. Nanomechanical clues from morphologically normal cervical squamous cells could improve cervical cancer screening

    NASA Astrophysics Data System (ADS)

    Geng, Li; Feng, Jiantao; Sun, Quanmei; Liu, Jing; Hua, Wenda; Li, Jing; Ao, Zhuo; You, Ke; Guo, Yanli; Liao, Fulong; Zhang, Youyi; Guo, Hongyan; Han, Jinsong; Xiong, Guangwu; Zhang, Lufang; Han, Dong

    2015-09-01

    Applying an atomic force microscope, we performed a nanomechanical analysis of morphologically normal cervical squamous cells (MNSCs) which are commonly used in cervical screening. Results showed that nanomechanical parameters of MNSCs correlate well with cervical malignancy, and may have potential in cancer screening to provide early diagnosis.Applying an atomic force microscope, we performed a nanomechanical analysis of morphologically normal cervical squamous cells (MNSCs) which are commonly used in cervical screening. Results showed that nanomechanical parameters of MNSCs correlate well with cervical malignancy, and may have potential in cancer screening to provide early diagnosis. Electronic supplementary information (ESI) available. See DOI: 10.1039/c5nr03662c

  4. Postoperative paralysis following posterior decompression with instrumented fusion for thoracic myelopathy caused by ossification of the posterior longitudinal ligament.

    PubMed

    Yamazaki, Masashi; Okawa, Akihiko; Mannoji, Chikato; Fujiyoshi, Takayuki; Furuya, Takeo; Koda, Masao

    2011-02-01

    A 60-year-old man presented with thoracic myelopathy due to ossification of the posterior longitudinal ligament (OPLL). His spinal cord was severely impinged anteriorly by a beak-type OPLL and posteriorly by ossification of the ligamentum flavum at T4/5. He underwent surgical posterior decompression with instrumented fusion (PDF). Immediately after surgery, he developed a Brown-Séquard-type paralysis, which spontaneously resolved without requiring the addition of OPLL extirpation. This example highlights that the risk of postoperative neurological deterioration cannot be eliminated even when PDF is selected as the surgical procedure for thoracic OPLL, especially in instances in which the spinal cord is severely compressed. PMID:21030260

  5. Aberrant methylation during cervical carcinogenesis.

    PubMed

    Virmani, A K; Muller, C; Rathi, A; Zoechbauer-Mueller, S; Mathis, M; Gazdar, A F

    2001-03-01

    We studied the pattern of aberrant methylation during the multistage pathogenesis of cervical cancers. We analyzed a total of 73 patient samples and 10 cervical cancer cell lines. In addition, tissue samples [peripheral blood lymphocytes (n = 10) and buccal epithelial cells (n = 12)] were obtained from 22 healthy volunteers. On the basis of the results of preliminary analysis, the cervical samples were grouped into three categories: (a) nondysplasia/low-grade cervical intraepithelial neoplasia (CIN; n = 37); (b) high-grade CIN (n = 17); and (c) invasive cancer (n = 19). The methylation status of six genes was determined (p16, RARbeta, FHIT, GSTP1, MGMT, and hMLH1). Our main findings are as follows: (a) methylation was completely absent in control tissues; (b) the frequencies of methylation for all of the genes except hMLH1 were >20% in cervical cancers; (c) aberrant methylation commenced early during multistage pathogenesis and methylation of at least one gene was noted in 30% of the nondysplasia/low-grade CIN group; (d) an increasing trend for methylation was seen with increasing pathological change; (e) methylation of RARbeta and GSTP1 were early events, p16 and MGMT methylation were intermediate events, and FHIT methylation was a late, tumor-associated event; and (f) methylation occurred independently of other risk factors including papillomavirus infection, smoking history, or hormone use. Although our findings need to be extended to a larger series, they suggest that the pattern of aberrant methylation in women with or without dysplasia may help identify subgroups at increased risk for histological progression or cancer development. PMID:11297252

  6. A new model of radiation-induced myelopathy: A comparison of the response of mature and immature pigs

    SciTech Connect

    Aardweg, G.J.M.J. van den; Hopewell, J.W.; Whitehouse, E.M.; Calvo, W.

    1994-07-01

    The purpose was development of an experimental model of radiation-induced myelopathy in the pig which would facilitate the study of the effects of clinically relevant treatment volumes. The effects of local spinal cord irradiation, to a standard 10 X 5 cm field, have been evaluated in mature (37-42.5 weeks) and immature (15.5-23 weeks) pigs. Irradiation was with single doses of {sup 60}Co {gamma}rays at a dose-rate of 0.21-0.65 Gy/min. The incidence of paralysis was used as an endpoint. Irradiation of mature animals resulted in the development of frank paralysis with animals showing combined parenchymal and vascular pathologic changes in their white matter. These lesions, in common with those seen in patients, had a clear evidence of an inflammatory component. The latency for paralysis was short, 7.5-16.5 weeks, but within the wide range reported for patients. However, it was shorter than that reported in other large animal models. The ED{sub 50} value ({+-}SE) for paralysis was 27.02{+-}0.36 Gy, similar to that in rats taking into account dose-rate factors. The irradiation of immature pigs only resulted in transient neurological changes after doses comparable to those used in the mature animals, ED{sub 50} value ({+-}SE) 26.09{+-}0.37 Gy. The reasons for these transient neurological symptoms are uncertain. A reliable experimental model of radiation-induced myelopathy has been developed for mature pigs. This model is suitable for the study of clinically relevant volume effects. 39 refs., 4 figs., 1 tab.

  7. Cervical cancer: screening, diagnosis and staging.

    PubMed

    Tsikouras, Panagiotis; Zervoudis, Stefanos; Manav, Bachar; Tomara, Eirini; Iatrakis, George; Romanidis, Constantinos; Bothou, Anastasia; Galazios, George

    2016-01-01

    Purpose: Despite the widespread screening programs, cervical cancer remains the third most common cancer in developing countries. Based on the implementation of cervical screening programs with the referred adoption of improved screening methods in cervical cytology with the knowledge of the important role of the human papilloma virus (HPV) it's incidence is decreased in the developed world. Even if cervical HPV infection is incredibly common, cervical cancer is relatively rare. Depending on the rarity of invasive disease and the improvement of detection of pre-cancerous lesions due to the participation in screening programs, the goal of screening is to detect the cervical lesions early in order to be treated before cancer is developed. In populations with many preventive screening programs, a decrease in cervical cancer mortality of 50-75% is mentioned over the past 50 years. The preventive examination of vagina and cervix smear, Pap test, and the HPV DNA test are remarkable diagnostic tools according to the American Cancer Association guidelines, in the investigation of asymptomatic women and in the follow up of women after the treatment of pre-invasive cervical cancer. The treatment of cervical cancer is based on the FIGO 2009 cervical cancer staging. PMID:27273940

  8. Modified Open-door Laminoplasty Using Hydroxyapatite Spacers and Miniplates

    PubMed Central

    Jin, Sung-Won; Kim, Bum-Joon; Choi, Jong-Il; Ha, Sung-Kon; Kim, Sang-Dae; Lim, Dong-Jun

    2014-01-01

    Objective Cervical laminoplasty has been widely accepted as one of the major treatments for cervical myelopathy and various modifications and supplementary procedures have been devised to achieve both proper decompression and stability of the cervical spine. We present the retrospectively analyzed results of a modified unilateral open-door laminoplasty using hydroxyapatite (HA) spacers and malleable titanium miniplates. Methods From June 2008 to May 2012, among patients diagnosed with cervical spondylotic myelopathy and ossification of posterior longitudinal ligament, the patients who received laminoplasty were reviewed. Clinical outcome was assessed using Frankel grade and Japanese Orthopaedic Association score. The radiologic parameters were obtained from plain films, 3-dimensional computed tomography and magnetic resonance images. Results A total of 125 cervical laminae were operated in 38 patients. 11 patients received 4-level laminoplasty and 27 patients received 3-level laminoplasty. Postoperatively, the mean Frankel grade and JOA score were significantly improved from 3.97 to 4.55 and from 12.76 to 14.63, respectively (p<0.001). Radiologically, cervical curvature was worsened from 19.09 to 15.60 (p=0.025). The percentage of range of motion preservation was 73.32±22.39%. The axial dimension of the operated spinal canal was increased from 1.75 to 2.70 cm2 (p<0.001). Conclusion In the presenting study, unilateral open-door laminoplasty using HA spacers and miniplates appears to be a safe, rapid and easy procedure to obtain an immediate and rigid stabilization of the posterior elements of the cervical spine. This modified laminoplasty method showed effective expansion of the spinal canal and favorable clinical outcomes. PMID:25346767

  9. Spinal stenosis.

    PubMed

    Melancia, João Levy; Francisco, António Fernandes; Antunes, João Lobo

    2014-01-01

    Narrowing of the spinal canal or foramina is a common finding in spine imaging of the elderly. Only when symptoms of neurogenic claudication and/or cervical myelopathy are present is a spinal stenosis diagnosis made, either of the lumbar spine, cervical spine or both (only very rarely is the thoracic spine involved). Epidemiological data suggest an incidence of 1 case per 100 000 for cervical spine stenosis and 5 cases per 100 000 for lumbar spine stenosis. Cervical myelopathy in patients over 50 years of age is most commonly due to cervical spine stenosis. Symptomatic spinal narrowing can be congenital, or, more frequently, acquired. The latter may be the result of systemic illneses, namely endocrinopathies (such as Cushing disease or acromegaly), calcium metabolism disorders (including hyporarthyroidism and Paget disease), inflammatory diseases (such as rheumathoid arthritis) and infectious diseases. Physical examination is more often abnormal in cervical spondylotic myeloptahy whereas in lumbar spinal stenosis it is typically normal. Therefore spinal stenosis diagnosis relies on the clinical picture corresponding to conspicuous causative changes identified by imaging techniques, most importantly CT and MRI. Other ancillary diagnostic tests are more likely to be yielding for establishing a differential diagnosis, namely vascular claudication. Most patients have a progressive presentation and are offered non operative management as first treatment strategy. Surgery is indicated for progressive intolerable symptoms or, more rarely, for the neurologically catastrophic initial presentations. Surgical strategy consists mainly of decompression (depending on the anatomical level and type of narrowing: laminectomy, foraminotomy, discectomy, corporectomy) with additional instrumentation should spinal stability and sagittal balance be at risk. For cervical spine stenosis the main objective of surgery is to halt disease progression. There is class 1b evidence that surgery

  10. [Injury of upper cervical spine].

    PubMed

    Ryba, Luděk; Cienciala, Jan; Chaloupka, Richard; Repko, Martin; Vyskočil, Robert

    2016-01-01

    Injuries of the upper cervical spine represent 1/3 of all cervical spine injuries and approximately 40 % result by the death. Every level of the cervical spine can be injured - fractures of condyles of the occipital bone (CO), atlantooccipital dislocation (AOD), fractures of the Atlas (C1), atlantoaxial dislocation (AAD) and fractures of the axis (C2). Most of cases in younger patients are caused by high-energy trauma, while by elderly people, because of the osteoporosis, is needed much less energy and even simple falls can cause the injury of the cervical spine. That´s why the etiology of injuries can be different. In younger patients are caused mainly by car accidents, motorcycle and bicycle accidents and pedestrian crashes by car and in elderly populations are the main reason falls. The mechanism of the injury is axial force, hyperflexion, hyperextension, latero-flexion, rotation and combination of all. The basic diagnostic examination is X ray in AP, lateral and transoral projection. But in the most of cases is CT examination necessary and in the suspicion of the ligamentous injury and neurological deterioration must be MRI examination added. Every injury of the upper cervical spine has its own classification. Clinical symptoms can vary from the neck pain, restricted range of motion, antalgic position of the head, injury of the cranial nerves and different neurologic symptoms from the irritation of nerves to quadriplegia. A large percentage of deaths is at the time of the injury. Therapy is divided to conservative treatment, which is indicated in bone injuries with minimal dislocation. In more severe cases, with the dislocation and ligamentous injury, when is high chance of the instability, is indicated the surgical treatment. We can use anterior or posterior approach, make the osteosynthesis, stabilisation and fusion of the spine. Complex fractures and combination of different types of injuries are often present in this part of the spine. Correct and early

  11. What's New in Cervical Cancer Research and Treatment?

    MedlinePlus

    ... resources for cervical cancer What`s new in cervical cancer research and treatment? New ways to prevent and treat ... Your Doctor After Treatment What`s New in Cervical Cancer Research? Other Resources and References Cancer Information Cancer Basics ...

  12. Cervical spondylosis and hypertension: a clinical study of 2 cases.

    PubMed

    Peng, Baogan; Pang, Xiaodong; Li, Duanming; Yang, Hong

    2015-03-01

    Cervical spondylosis and hypertension are all common diseases, but the relationship between them has never been studied. Patients with cervical spondylosis are often accompanied with vertigo. Anterior cervical discectomy and fusion is an effective method of treatment for cervical spondylosis with cervical vertigo that is unresponsive to conservative therapy. We report 2 patients of cervical spondylosis with concomitant cervical vertigo and hypertension who were treated successfully with anterior cervical discectomy and fusion. Stimulation of sympathetic nerve fibers in pathologically degenerative disc could produce sympathetic excitation, and induce a sympathetic reflex to cause cervical vertigo and hypertension. In addition, chronic neck pain could contribute to hypertension development through sympathetic arousal and failure of normal homeostatic pain regulatory mechanisms. Cervical spondylosis may be one of the causes of secondary hypertension. Early treatment for resolution of symptoms of cervical spondylosis may have a beneficial impact on cardiovascular disease risk in patients with cervical spondylosis. PMID:25761188

  13. Cervical disc arthroplasty: Pros and cons

    PubMed Central

    Moatz, Bradley; Tortolani, P. Justin

    2012-01-01

    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. PMID:22905327

  14. Cervical Cancer, Version 2.2015.

    PubMed

    Koh, Wui-Jin; Greer, Benjamin E; Abu-Rustum, Nadeem R; Apte, Sachin M; Campos, Susana M; Cho, Kathleen R; Chu, Christina; Cohn, David; Crispens, Marta Ann; Dorigo, Oliver; Eifel, Patricia J; Fisher, Christine M; Frederick, Peter; Gaffney, David K; Han, Ernest; Huh, Warner K; Lurain, John R; Mutch, David; Fader, Amanda Nickles; Remmenga, Steven W; Reynolds, R Kevin; Teng, Nelson; Tillmanns, Todd; Valea, Fidel A; Yashar, Catheryn M; McMillian, Nicole R; Scavone, Jillian L

    2015-04-01

    The NCCN Guidelines for Cervical Cancer provide interdisciplinary recommendations for treating cervical cancer. These NCCN Guidelines Insights summarize the NCCN Cervical Cancer Panel's discussion and major guideline updates from 2014 and 2015. The recommended systemic therapy options for recurrent and metastatic cervical cancer were amended upon panel review of new survival data and the FDA's approval of bevacizumab for treating late-stage cervical cancer. This article outlines relevant data and provides insight into panel decisions regarding various combination regimens. Additionally, a new section was added to provide additional guidance on key principles of evaluation and surgical staging in cervical cancer. This article highlights 2 areas of active investigation and debate from this new section: sentinel lymph node mapping and fertility-sparing treatment approaches. PMID:25870376

  15. Postoperative cerebrospinal-fluid fistula associated with erosion of the dura. Findings after anterior resection of ossification of the posterior longitudinal ligament in the cervical spine.

    PubMed

    Smith, M D; Bolesta, M J; Leventhal, M; Bohlman, H H

    1992-02-01

    Of twenty-two patients who had had anterior decompression of the spinal canal for ossification of the posterior longitudinal ligament and cervical myelopathy, seven had absence of the dura adjacent to the ossified part of the ligament. The spinal cord and nerve-roots were visible through this defect. Although the arachnoid membrane appeared to be intact and watertight in most patients, a cerebrospinal-fluid fistula developed postoperatively in five, and three had a second operation to repair the defect in the dura. On the basis of this experience, we recommend use of autogenous muscle or fascial dural patches, immediate lumbar subarachnoid shunting, and modification of the usual postoperative regimen, such as limitation of mechanical pulmonary ventilation to the shortest time that is safely possible and use of anti-emetic and antitussive medications to protect the remaining coverings of the spinal cord when the dura is found to be absent adjacent to an ossified portion of the posterior longitudinal ligament in the cervical spine. PMID:1541620

  16. OXYTOCIN-INDUCED CERVICAL DILATION AND CERVICAL MANIPULATION IN SHEEP: EFFECTS ON LAPAROSCOPIC ARTIFICIAL INSEMINATION

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Difficulty of cervical penetration during transcervical artificial insemination (TAI), limits its use in sheep. Trauma of cervical manipulation (CM) may explain low fertility after TAI. We investigated effects of cervical dilation using exogenous oxytocin (OT) to facilitate TAI and its effect on rep...

  17. Cervical vertebral fusion with anterior meningocele

    PubMed Central

    Chavredakis, Emmanuel; Carter, David; Bhojak, Manesh; Jenkinson, Michael D; Clark, Simon R

    2015-01-01

    We present the first described case of cervical vertebral fusion associated with anterior meningocele and syringomyelia. A 45-year-old woman presented with minor trauma, and plain cervical spine radiographs highlighted a congenital deformity of the cervical vertebral bodies. She had a normal neurological examination; however, further imaging revealed a meningocele and syringomyelia. This case highlights the importance of thorough imaging investigation when presented with a congenital deformity in order to detect and prevent development of degenerative spinal cord pathologies. PMID:25923673

  18. Cervical Spine Instrumentation in Children.

    PubMed

    Hedequist, Daniel J; Emans, John B

    2016-06-01

    Instrumentation of the cervical spine enhances stability and improves arthrodesis rates in children undergoing surgery for deformity or instability. Various morphologic and clinical studies have been conducted in children, confirming the feasibility of anterior or posterior instrumentation of the cervical spine with modern implants. Knowledge of the relevant spine anatomy and preoperative imaging studies can aid the clinician in understanding the pitfalls of instrumentation for each patient. Preoperative planning, intraoperative positioning, and adherence to strict surgical techniques are required given the small size of children. Instrumentation options include anterior plating, occipital plating, and a variety of posterior screw techniques. Complications related to screw malposition include injury to the vertebral artery, neurologic injury, and instrumentation failure. PMID:27097300

  19. Molecular imaging in cervical cancer.

    PubMed

    Khan, Sairah R; Rockall, Andrea G; Barwick, Tara D

    2016-06-01

    Despite the development of screening and of a vaccine, cervix cancer is a major cause of cancer death in young women worldwide. A third of women treated for the disease will recur, almost inevitably leading to death. Functional imaging has the potential to stratify patients at higher risk of poor response or relapse by improved delineation of disease extent and tumor characteristics. A number of molecular imaging biomarkers have been shown to predict outcome at baseline and/or early during therapy in cervical cancer. In future this could help tailor the treatment plan which could include selection of patients for close follow up, adjuvant therapy or trial entry for novel agents or adaptive clinical trials. The use of molecular imaging techniques, FDG PET/CT and functional MRI, in staging and response assessment of cervical cancer is reviewed. PMID:26859085

  20. Human cervical mucus: research update.

    PubMed

    Katz, D F

    1991-12-01

    Evaluation of cervical mucus is a standard for determining the fertile period in natural family planning. Cervical mucus accepts, filters, prepares, and releases sperm for successful transport to the egg and fertilization. Recent scientific advances provide answers to how the mucus regulates fertility as its physical properties change during the menstrual cycle. Transmission electron microscopy reveals small interstices between mucus macromolecules relative to a sperm head. Thus advancing sperm must push aside or cut through the microstructure. The interstices are largest in the periovulatory phase of the cycle. Small magnetic spheres, comparable with the size of a sperm head, are now being used to study the physical properties of the mucus on the scale of individual sperm. PMID:1755453

  1. Surgery for cervical intraepithelial neoplasia

    PubMed Central

    Martin-Hirsch, Pierre PL; Paraskevaidis, Evangelos; Bryant, Andrew; Dickinson, Heather O; Keep, Sarah L

    2014-01-01

    Background Cervical intraepithelial neoplasia (CIN) is the most common pre-malignant lesion. Atypical squamous changes occur in the transformation zone of the cervix with mild, moderate or severe changes described by their depth (CIN 1, 2 or 3). Cervical intraepithelial neoplasia is treated by local ablation or lower morbidity excision techniques. Choice of treatment depends on the grade and extent of the disease. Objectives To assess the effectiveness and safety of alternative surgical treatments for CIN. Search methods We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE and EMBASE (up to April 2009). We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of included studies. Selection criteria Randomised controlled trials (RCTs) of alternative surgical treatments in women with cervical intraepithelial neoplasia. Data collection and analysis Two review authors independently abstracted data and assessed risks of bias. Risk ratios that compared residual disease after the follow-up examination and adverse events in women who received one of either laser ablation, laser conisation, large loop excision of the transformation zone (LLETZ), knife conisation or cryotherapy were pooled in random-effects model meta-analyses. Main results Twenty-nine trials were included. Seven surgical techniques were tested in various comparisons. No significant differences in treatment failures were demonstrated in terms of persistent disease after treatment. Large loop excision of the transformation zone appeared to provide the most reliable specimens for histology with the least morbidity. Morbidity was lower than with laser conisation, although the trials did not provide data for every outcome measure. There were not enough data to assess the effect on morbidity when compared with laser ablation. Authors’ conclusions The evidence

  2. Cervical arterial dissection: current concepts .

    PubMed

    Menon, Ranjith K; Norris, John W

    2008-10-01

    The increasing use and safety of noninvasive imaging in recent years has revealed the surprising frequency of dissection of the carotid and vertebral arteries (cervical arterial dissection [CAD]) as a cause of ischemic and hemorrhagic stroke. This review is an overview of current concepts and practice of patients with CAD, but our ideas are constantly evolving with new discoveries from neurovascular imaging and medical and surgical management in this area. PMID:18990128

  3. Lynch syndrome and cervical cancer.

    PubMed

    Antill, Yoland C; Dowty, James G; Win, Aung Ko; Thompson, Tina; Walsh, Michael D; Cummings, Margaret C; Gallinger, Steven; Lindor, Noralane M; Le Marchand, Loïc; Hopper, John L; Newcomb, Polly A; Haile, Robert W; Church, James; Tucker, Katherine M; Buchanan, Daniel D; Young, Joanne P; Winship, Ingrid M; Jenkins, Mark A

    2015-12-01

    Carriers of germline mutations in DNA mismatch repair (MMR) genes are at increased risk of several cancers including colorectal and gynecologic cancers (Lynch syndrome). There is no substantial evidence that these mutations are associated with an increased risk of cervical cancer. A total of 369 families with at least one carrier of a mutation in a MMR gene (133 MLH1, 174 MSH2, 35 MSH6 and 27 PMS2) were ascertained via population cancer registries or via family cancer clinics in Australia, New Zealand, Canada, and USA. Personal and family histories of cancer were obtained from participant interviews. Modified segregation analysis was used to estimate the hazard ratio (incidence rates for carriers relative to those for the general population), and age-specific cumulative risks of cervical cancer for carriers. A total of 65 cases of cervical cancer were reported (including 10 verified by pathology reports). The estimated incidence was 5.6 fold (95% CI: 2.3-13.8; p = 0.001) higher for carriers than for the general population with a corresponding cumulative risk to 80 years of 4.5% (95% CI: 1.9-10.7%) compared with 0.8% for the general population. The mean age at diagnosis was 43.1 years (95% CI: 40.0-46.2), 3.9 years younger than the reported USA population mean of 47.0 years (p = 0.02). Women with MMR gene mutations were found to have an increased risk of cervical cancer. Due to limited pathology verification we cannot be certain that a proportion of these cases were not lower uterine segment endometrial cancers involving the endocervix, a recognized cancer of Lynch syndrome. PMID:26077226

  4. Clinical technique for invasive cervical root resorption

    PubMed Central

    Silveira, Luiz Fernando Machado; Silveira, Carina Folgearini; Martos, Josué; Piovesan, Edno Moacir; César Neto, João Batista

    2011-01-01

    This clinical case report describes the diagnosis and treatment of an external invasive cervical resorption. A 17-year-old female patient had a confirmed diagnosis of invasive cervical resorption class 4 by cone beam computerized tomography. Although, there was no communication with the root canal, the invasive resorption process was extending into the cervical and middle third of the root. The treatment of the cervical resorption of the lateral incisor interrupted the resorptive process and restored the damaged root surface and the dental functions without any esthetic sequelae. Both the radiographic examination and computed tomography are imperative to reveal the extent of the defect in the differential diagnosis. PMID:22144822

  5. Laparoscopic fertility sparing management of cervical cancer.

    PubMed

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

    2014-04-01

    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

  6. Nanotechnology in the management of cervical cancer.

    PubMed

    Chen, Jiezhong; Gu, Wenyi; Yang, Lei; Chen, Chen; Shao, Renfu; Xu, Kewei; Xu, Zhi Ping

    2015-03-01

    Cervical cancer is a major disease with high mortality. All cervical cancers are caused by infection with human papillomaviruses (HPV). Although preventive vaccines for cervical cancer are successful, treatment of cervical cancer is far less satisfactory because of multidrug resistance and side effects. In this review, we summarize the recent application of nanotechnology to the diagnosis and treatment of cervical cancer as well as the development of HPV vaccines. Early detection of cervical cancer enables tumours to be efficiently removed by surgical procedures, leading to increased survival rate. The current method of detecting cervical cancer by Pap smear can only achieve 50% sensitivity, whereas nanotechnology has been used to detect HPVs with greatly improved sensitivity. In cervical cancer treatment, nanotechnology has been used for the delivery of anticancer drugs to increase treatment efficacy and decrease side effects. Nanodelivery of HPV preventive and therapeutic vaccines has also been investigated to increase vaccine efficacy. Overall, these developments suggest that nanoparticle-based vaccine may become the most effective way to prevent and treat cervical cancer, assisted or combined with some other nanotechnology-based therapy. PMID:25752817

  7. Laparoscopic Fertility Sparing Management of Cervical Cancer

    PubMed Central

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

    2014-01-01

    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

  8. Neuroendocrine differentiation in cervical carcinoma.

    PubMed Central

    Savargaonkar, P R; Hale, R J; Mutton, A; Manning, V; Buckley, C H

    1996-01-01

    AIMS: To examine neuroendocrine differentiation, as shown by chromogranin A (CGA) expression, in cervical carcinomas. METHODS: Sixty seven cervical carcinomas were studied and were classified as adenocarcinomas, adenosquamous carcinomas or squamous cell carcinomas based on the assessment of haematoxylin and eosin staining and stains for mucin. Where features of glandular differentiation were identified, sections were also stained for evidence of intestinal type mucin. CGA immunostaining was done and the results were graded on a three point scale: 0, + (1-5% of cells positive) and ++ (> 5% of cells positive). These findings were then analysed with respect to lymph node status, tumour differentiation and clinical outcome. RESULTS: There were 32 adenocarcinomas, 18 adenosquamous carcinomas and 17 squamous cell carcinomas. Positive staining was seen in 14 (20.9%) cases, of which four were strongly positive. All but one case were either adenocarcinomas or adenosquamous carcinomas. There was a trend for CGA positivity to be related to intestinal differentiation but this failed to reach statistical significance. No correlation could be demonstrated between CGA staining and lymph node status, tumour differentiation and clinical outcome. CONCLUSIONS: Neuroendocrine differentiation is common in cervical carcinomas where there is evidence of glandular differentiation. Whilst the numbers in this study are relatively small, the presence of neuroendocrine cells in otherwise typical carcinomas does not seem to have any association with clinical behaviour. Images PMID:8655680

  9. Studying the Physical Function and Quality of Life Before and After Surgery in Patients With Stage I Cervical Cancer

    ClinicalTrials.gov

    2016-02-09

    Cervical Adenocarcinoma; Cervical Adenosquamous Carcinoma; Cervical Squamous Cell Carcinoma; Lymphedema; Sexual Dysfunction and Infertility; Stage IA1 Cervical Cancer; Stage IA2 Cervical Cancer; Stage IB1 Cervical Cancer

  10. Accumulation of p62 in degenerated spinal cord under chronic mechanical compression

    PubMed Central

    Tanabe, Fumito; Yone, Kazunori; Kawabata, Naoya; Sakakima, Harutoshi; Matsuda, Fumiyo; Ishidou, Yasuhiro; Maeda, Shingo; Abematsu, Masahiko; Komiya, Setsuro

    2011-01-01

    Intracellular accumulation of altered proteins, including p62 and ubiquitinated proteins, is the basis of most neurodegenerative disorders. The relationship among the accumulation of altered proteins, autophagy, and spinal cord dysfunction by cervical spondylotic myelopathy has not been clarified. We examined the expression of p62 and autophagy markers in the chronically compressed spinal cord of tiptoe-walking Yoshimura mice. In addition, we examined the expression and roles of p62 and autophagy in hypoxic neuronal cells. Western blot analysis showed the accumulation of p62, ubiquitinated proteins, and microtubule-associated protein 1 light chain 3 (LC3), an autophagic marker, in the compressed spinal cord. Immunohistochemical examinations showed that p62 accumulated in neurons, axons, astrocytes, and oligodendrocytes. Electron microscopy showed the expression of autophagy markers, including autolysosomes and autophagic vesicles, in the compressed spinal cord. These findings suggest the presence of p62 and autophagy in the degenerated compressed spinal cord. Hypoxic stress increased the expression of p62, ubiquitinated proteins, and LC3-II in neuronal cells. In addition, LC3 turnover assay and GFP-LC3 cleavage assay showed that hypoxic stress increased autophagy flux in neuronal cells. These findings suggest that hypoxic stress induces accumulation of p62 and autophagy in neuronal cells. The forced expression of p62 decreased the number of neuronal cells under hypoxic stress. These findings suggest that p62 accumulation under hypoxic stress promotes neuronal cell death. Treatment with 3-methyladenine, an autophagy inhibitor decreased the number of neuronal cells, whereas lithium chloride, an autophagy inducer increased the number of cells under hypoxic stress. These findings suggest that autophagy promotes neuronal cell survival under hypoxic stress. Our findings suggest that pharmacological inducers of autophagy may be useful for treating cervical spondylotic

  11. Preoperative opioid strength may not affect outcomes of anterior cervical procedures: a post hoc analysis of 2 prospective, randomized trials

    PubMed Central

    Kelly, Michael P.; Anderson, Paul A.; Sasso, Rick C.; Riew, K. Daniel

    2015-01-01

    Object The aim of this study is to evaluate the relationship between preoperative opioid strength and outcomes of anterior cervical decompressive surgery. Methods A retrospective cohort of 1004 patients enrolled in 1 of 2 investigational device exemption studies comparing cervical total disc arthroplasty (TDA) and anterior cervical discectomy and fusion (ACDF) for single-level cervical disease causing radiculopathy or myelopathy was selected. At a preoperative visit, opioid use data, Neck Disability Index (NDI) scores, 36-ltem Short-Form Health Survey (SF-36) scores, and numeric rating scale scores for neck and arm pain were collected. Patients were divided into strong (oxycodone/morphine/meperidine), weak (codeine/propoxyphene/ hydrocodone), and opioid-naïve groups. Preoperative and postoperative (24 months) outcomes scores were compared within and between groups using the paired t-test and ANCOVA, respectively. Results Patients were categorized as follows: 226 strong, 762 weak, and 16 opioid naïve. The strong and weak groups were similar with respect to age, sex, race, marital status, education level, Worker's Compensation status, litigation status, and alcohol use. At 24-month follow-up, no differences in change in arm or neck pain scores (arm: strong –52.3, weak –50.6, naïve –54.0, p = 0.244; neck: strong –52.7, weak –50.8, naïve –44.6, p = 0.355); NDI scores (strong –36.0, weak –33.3, naïve –32.3, p = 0.181); or SF-36 Physical Component Summary scores (strong: 14.1, weak 13.3, naïve 21.7, p = 0.317) were present. Using a 15-point improvement in NDI to determine success, the authors found no between-groups difference in success rates (strong 80.6%, weak 82.7%, naïve 73.3%, p = 0.134). No difference existed between treatment arms (TDA vs ACDF) for any outcome at any time point. Conclusions Preoperative opioid strength did not adversely affect outcomes in this analysis. Careful patient selection can yield good results in this patient

  12. Bilateral cervical ribs in a Dobermann Pinscher.

    PubMed

    Ricciardi, M; De Simone, A; Gernone, F; Giannuzzi, P

    2015-01-01

    An 11-year-old intact female Doberman Pinscher was presented with the complaint of non-ambulatory tetraparesis. Clinical and neurological examination revealed a caudal cervical spinal cord disfunction (C6-T2 spinal cord segments). Magnetic resonance imaging and computed tomographic (CT) findings of the cervical spine were consistent with caudal cervical spondylomyelopathy (CSM). During the diagnostic work-up for the cervical spine, bilateral bone anomalies involving the seventh cervical vertebra and the first ribs were found on radiographs and CT examination. The rib anomalies found in this dog appear similar to cervical ribs widely described in human medicine. In people, cervical ribs are associated with a high rate of stillbirth, early childhood cancer, and can cause the thoracic outlet syndrome, characterized by neurovascular compression at level of superior aperture of the chest. In dogs, only some sporadic anatomopathological descriptions of cervical ribs exist. In this report the radiographic and CT findings of these particular vertebral and rib anomalies along with their relationships with adjacent vasculature and musculature are shown intravitam in a dog. Specific radiographic and CT findings described in this report may help in reaching a presumptive diagnosis of this anomaly. Finally, their clinical and evolutionary significance are discussed. PMID:25650786

  13. Cervical Spine Injuries in the Athlete.

    PubMed

    Schroeder, Gregory D; Vaccaro, Alexander R

    2016-09-01

    Cervical spine injuries are extremely common and range from relatively minor injuries, such as cervical muscle strains, to severe, life-threatening cervical fractures with spinal cord injuries. Although cervical spine injuries are most common in athletes who participate in contact and collision sports, such as American football and rugby, they also have been reported in athletes who participate in noncontact sports, such as baseball, gymnastics, and diving. Cervical spine injuries in athletes are not necessarily the result of substantial spine trauma; some athletes have chronic conditions, such as congenital stenosis, that increase their risk for a serious cervical spine injury after even minor trauma. Therefore, physicians who cover athletic events must have a thorough knowledge of cervical spine injures and the most appropriate ways in which they should be managed. Although cervical spine injuries can be career-ending injuries, athletes often are able to return to play after appropriate treatment if the potential for substantial re-injury is minimized. PMID:27479833

  14. Cervical spondylomyelopathy (wobbler syndrome) in dogs.

    PubMed

    da Costa, Ronaldo C

    2010-09-01

    Cervical spondylomyelopathy (CSM) is a common and controversial disease of the cervical spine of large and giant breed dogs. Not many diseases in veterinary medicine have been referred to by 14 different names and have had 21 surgical techniques proposed to treat it. This article reviews the current knowledge of CSM with regard to its etiology, pathophysiology, diagnosis, treatment, and outcome. PMID:20732597

  15. 21 CFR 884.3200 - Cervical drain.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cervical drain. 884.3200 Section 884.3200 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES... drain. (a) Identification. A cervical drain is a device designed to provide an exit channel for...

  16. Cervical screening in Luxembourg: 1990-1999.

    PubMed

    Scheiden, R; Wagener, C; Knolle, U; Wehenkel, A; Dippel, W; Capesius, C

    2003-10-01

    For quality assurance purposes, the results of the 1990's obtained by the National Cervical Cancer Screening Programme (NCCSP) launched in 1962 were reviewed. The positive cytodiagnosis, the histologically verified in situ and invasive cervical cancers and the mortality rates were reported. PMID:14510886

  17. Radiation myelopathy in the rat: an interpretation of dose effect relationships

    SciTech Connect

    Leith, J.T.; DeWyngaert, J.K.; Glicksman, A.S.

    1981-12-01

    Data were collected on the production of overt paralysis in the rat after low linear energy transfer (LET) ionizing radiation exposure of different regions of the spinal cord. Data from both single and multiple radiation exposure schedules were interpreted using the ED/sub 50/ value (estimated dose needed to produce 50% paralysis in a group of irradiated animals) as the isoeffect comparison dose. Plots were made of the reciprocal of the ED/sub 50/ total dose versus the size of the dose per fraction used. The use of multifractionation data in such a way allows implications to be made about the nature of the in vivo response curve. These reciprocal dose plots indicate that the spinal cord normal tissue system shows two responses that may be specifically characterized by the ratio of the intercept (..cap alpha..) of the linear regression fit of the reciprocal total dose versus dose per fraction curve to the slope (..beta..) of the curve (..cap alpha../..beta..). For rat spinal cord, this value is about 3.8 +/- 0.4 (standard error) for the thoraco-lumbar region and about 2.0 +/- 0.3 (standard error) for the cervical region. While absolute dose response data vary somewhat among investigators, all of the data on production of paralysis in rats show similar trends with respect to the (..cap alpha../..beta..) ratio. We feel this ratio may uniquely characterize this (and other) normal tissue systems. Knowledge of this parameter and how it varies after different treatments (e.g., high LET radiation exposure) may be important.

  18. Radiation myelopathy in the rat: an interpretation of dose effect relationships

    SciTech Connect

    Leith, J.T.; DeWyngaert, J.K.; Glicksman, A.S.

    1981-12-01

    Data were collected on the production of overt paralysis in the rat after low linear energy transfer (LET) ionizing radiation exposure of different regions of the spinal cord. Data from both single and multiple radiation exposure schedules were interpreted using the ED/sub 50/ value (estimated dose needed to produce 50% paralysis in a group of irradiated animals) as the isoeffect comparison dose. Plots were made of the reciprocal of the ED/sub 50/ total dose versus the size of the dose per fraction used. The use of multifractionation data in such a way allows implications to be made about the nature of the in vivo response curve. These reciprocal dose plots indicate that the spinal cord normal tissue system shows two responses that may be specifically characterized by the ration of the intercept (..cap alpha..) of the linear regression fit of the reciprocal total dose versus dose per fraction curve to the slope (..beta..) of the curve (..cap alpha../..beta..). For rat spinal cord, this value is about 3.8 +/- 0.4 (standard error) for the thoraco-lumbar region and about 2.0 +/- 0.3 (standard error) for the cervical region. While absolute dose response data vary somewhat among investigators, all of the data on production of paralysis in rats show similar trends with respect the the (..cap alpha../..beta..) ratio. We feel that this ratio may uniquely characterize this (and other) normal tissue systems. Knowledge of this parameter and how it varies after different treatments (e.g., high LET radiation exposure) may be important.

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

    ClinicalTrials.gov

    2014-04-21

    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

  20. Reoperations Following Cervical Disc Replacement

    PubMed Central

    Skovrlj, Branko; Lee, Dong-Ho; Caridi, John Michael

    2015-01-01

    Cervical disc replacement (CDR) has emerged as an alternative surgical option to cervical arthrodesis. With increasing numbers of patients and longer follow-ups, complications related to the device and/or aging spine are growing, leaving us with a new challenge in the management and surgical revision of CDR. The purpose of this study is to review the current literature regarding reoperations following CDR and to discuss about the approaches and solutions for the current and future potential complications associated with CDR. The published rates of reoperation (mean, 1.0%; range, 0%-3.1%), revision (mean, 0.2%; range, 0%-0.5%), and removal (mean, 1.2%; range, 0%-1.9%) following CDR are low and comparable to the published rates of reoperation (mean, 1.7%; range; 0%-3.4%), revision (mean, 1.5%; range, 0%-4.7%), and removal (mean, 2.0%; range, 0%-3.4%) following cervical arthrodesis. The surgical interventions following CDR range from the repositioning to explantation followed by fusion or the reimplantation to posterior foraminotomy or fusion. Strict patient selection, careful preoperative radiographic review and surgical planning, as well as surgical technique may reduce adverse events and the need for future intervention. Minimal literature and no guidelines exist for the approaches and techniques in revision and for the removal of implants following CDR. Adherence to strict indications and precise surgical technique may reduce the number of reoperations, revisions, and removals following CDR. Long-term follow-up studies are needed, assessing the implant survivorship and its effect on the revision and removal rates. PMID:26097667

  1. Cervical cancer screening in Luxembourg.

    PubMed

    Scheiden, R; Knolle, U; Wagener, C; Wehenkel, A M; Capesius, C

    2000-11-01

    In 1962, a programme for early detection of cervical cancer was established at the national level. The programme is based on the collaboration of different groups of doctors and not on a system of sending out invitations to every woman. This programme was re-adapted twice according to the needs for assuring quality in a system of mainly liberal medicine. At present the programme is 'institutionalised' and is carried out according to the criteria defined in 1990. This includes a centralisation of the smear readings and handing out the material needed to take the smears. The contribution of the doctors is regulated by a system of bonuses given by the government and a reimbursement by the Health Fund. The annual cervical smear is free of charge for every woman. The participation of the women targeted by the programme (>15 years old) has increased by approximately 50% every decade from the early 1970s increasing from 10950 in 1972 to 70441 in 1999. Between 1980 and 1999, the number of women at risk taking part in the programme increased from 10.80 to 38.92%. The number of all the doctors taking smear samples increased from 68 to 105 and the number of gynaecologists increased from 19 (ratio Gyn/GP (gynaecologists/General Practitioners) of 28%) to 52 (ratio Gyn/GP of 50%). The mortality rate has decreased continuously from 6. 1/100000 in 1990 to 0.9/100000 in 1997. In conclusion, to be successful, a cervical cancer screening programme should be flexible enough to allow short-term adaptations to unexpected local situations and needs a highly motivated team of the different participants involved in the regional and national health policy. PMID:11072212

  2. Cervical disc hernia operations through posterior laminoforaminotomy

    PubMed Central

    Yolas, Coskun; Ozdemir, Nuriye Guzin; Okay, Hilmi Onder; Kanat, Ayhan; Senol, Mehmet; Atci, Ibrahim Burak; Yilmaz, Hakan; Coban, Mustafa Kemal; Yuksel, Mehmet Onur; Kahraman, Umit

    2016-01-01

    Objective: The most common used technique for posterolateral cervical disc herniations is anterior approach. However, posterior cervical laminotoforaminomy can provide excellent results in appropriately selected patients with foraminal stenosis in either soft disc prolapse or cervical spondylosis. The purpose of this study was to present the clinical outcomes following posterior laminoforaminotomy in patients with radiculopathy. Materials and Methods: We retrospectively evaluated 35 patients diagnosed with posterolateral cervical disc herniation and cervical spondylosis with foraminal stenosis causing radiculopathy operated by the posterior cervical keyhole laminoforaminotomy between the years 2010 and 2015. Results: The file records and the radiographic images of the 35 patients were assessed retrospectively. The mean age was 46.4 years (range: 34-66 years). Of the patients, 19 were males and 16 were females. In all of the patients, the neurologic deficit observed was radiculopathy. The posterolaterally localized disc herniations and the osteophytic structures were on the left side in 18 cases and on the right in 17 cases. In 10 of the patients, the disc level was at C5-6, in 18 at C6-7, in 2 at C3-4, in 2 at C4-5, in 1 at C7-T1, in 1 patient at both C5-6 and C6-7, and in 1 at both C4-5 and C5-6. In 14 of these 35 patients, both osteophytic structures and protruded disc herniation were present. Intervertebral foramen stenosis was present in all of the patients with osteophytes. Postoperatively, in 31 patients the complaints were relieved completely and four patients had complaints of neck pain and paresthesia radiating to the arm (the success of operation was 88.5%). On control examinations, there was no finding of instability or cervical kyphosis. Conclusion: Posterior cervical laminoforaminotomy is an alternative appropriate choice in both cervical soft disc herniations and cervical stenosis. PMID:27217655

  3. Histological aspects of cervical ripening.

    PubMed

    Ichijo, M; Shimizu, T; Sasai, Y

    1976-02-01

    There is a close relationship between the rate of the uterine cervix opening during parturition and the presence or absence of a completely ripened cervix. In order to learn the basic pattern of the ripening of cervix, histological and histochemical studies were performed on the human uterine cervix during pregnancy. It was noted that the collagen bundles disintegrated into fine fibers and also underwent quantitative changes during the ripening process of the cervix. During pregnancy, the number of connective tissue cells was increased, but that of mast cells was decreased. Acid mucopolysaccharides in the cervical ground substance were found to increase in late pregnancy. PMID:136067

  4. Overview of Cervical Insufficiency: Diagnosis, Etiologies, and Risk Factors.

    PubMed

    Roman, Amanda; Suhag, Anju; Berghella, Vincenzo

    2016-06-01

    The diagnosis of cervical insufficiency can be made in women with or without prior pregnancy losses. Cervical insufficiency has been defined by transvaginal ultrasound cervical length <25 mm before 24 weeks in women with prior pregnancy losses or preterm births at 14 to 36 weeks, or by cervical changes detected on physical examination before 24 weeks of gestation. PMID:27015229

  5. The Effect of the PEEK Cage on the Cervical Lordosis in Patients Undergoing Anterior Cervical Discectomy

    PubMed Central

    Gulsen, Salih

    2015-01-01

    BACKGROUND: Loss of cervical lordosis is a significant factor in the development of degeneration of the spine with aging. This degenerative changings of the cervical spine would cause pressure effect on the cervical root and/or medulla spinalis. AIM: Our goal is to understand the effect of the PEEK cage on cervical lordosis in the early postoperative period. Also, to interpret the effects of one- level, two- level, three-level and four- level disc pathologies on cervical lordosis. MATERIAL AND METHODS: We retrospectively investigated our archive, and we selected thirty-four patients undergoing anterior cervical discectomy and fusion with PEEK cage filled with demineralized bone matrix (ACDFP). RESULTS: We determined that ACDFP provides improvement in the cervical lordosis angle in both groups. Also, we found statistically significant difference between group 1 and 2 regarding causes of radiculomyelopathy statistically. CONCLUSION: We achieved better cervical lordotic angles at the postoperative period by implanting one-level, two-level, three-level or four-level PEEK cage filled with demineralized bone matrix. Also, the causes of cervical root and or medulla spinalis impingement were different in group1 and 2. While extruded cervical disc impingement was the first pathology in group 1, osteophyte formation was the first pathology in group 2.

  6. Human T-lymphotropic virus type I-associated myelopathy and tax gene expression in CD4+ T lymphocytes.

    PubMed

    Moritoyo, T; Reinhart, T A; Moritoyo, H; Sato, E; Izumo, S; Osame, M; Haase, A T

    1996-07-01

    Infection by human T-lymphotropic virus type I (HTLV-I) is associated with adult T-cell leukemia and a slowly progressive disease of the central nervous system (CNS), HTLV-I-associated myelopathy/tropical spastic paraparesis, characterized pathologically by inflammation and white matter degeneration in the spinal cord. One of the explanations for the tissue destruction is that HTLV-I infects cells in the CNS, or HTLV-I-infected CD4+ T lymphocytes enter the CNS, and this drives local expansion of virus-specific CD8+ cytotoxic T lymphocytes, which along with cytokines cause the pathological changes. Because both in the circulation and in the cerebrospinal fluid, CD8+ cytotoxic T lymphocytes are primarily reactive to the product of the HTLV-I tax gene, we sought evidence of expression of this gene within cells in the inflammatory lesions. After using double-label in situ hybridization techniques, we now report definitive localization of HTLV-I tax gene expression in CD4+ T lymphocytes in areas of inflammation and white matter destruction. These findings lend support to a hypothetical scheme of neuropathogenesis in which HTLV-I tax gene expression provokes and sustains an immunopathological process that progressively destroys myelin and axons in the spinal cord. PMID:8687197

  7. Genome-wide association analysis reveals a SOD1 mutation in canine degenerative myelopathy that resembles amyotrophic lateral sclerosis.

    PubMed

    Awano, Tomoyuki; Johnson, Gary S; Wade, Claire M; Katz, Martin L; Johnson, Gayle C; Taylor, Jeremy F; Perloski, Michele; Biagi, Tara; Baranowska, Izabella; Long, Sam; March, Philip A; Olby, Natasha J; Shelton, G Diane; Khan, Shahnawaz; O'Brien, Dennis P; Lindblad-Toh, Kerstin; Coates, Joan R

    2009-02-24

    Canine degenerative myelopathy (DM) is a fatal neurodegenerative disease prevalent in several dog breeds. Typically, the initial progressive upper motor neuron spastic and general proprioceptive ataxia in the pelvic limbs occurs at 8 years of age or older. If euthanasia is delayed, the clinical signs will ascend, causing flaccid tetraparesis and other lower motor neuron signs. DNA samples from 38 DM-affected Pembroke Welsh corgi cases and 17 related clinically normal controls were used for genome-wide association mapping, which produced the strongest associations with markers on CFA31 in a region containing the canine SOD1 gene. SOD1 was considered a regional candidate gene because mutations in human SOD1 can cause amyotrophic lateral sclerosis (ALS), an adult-onset fatal paralytic neurodegenerative disease with both upper and lower motor neuron involvement. The resequencing of SOD1 in normal and affected dogs revealed a G to A transition, resulting in an E40K missense mutation. Homozygosity for the A allele was associated with DM in 5 dog breeds: Pembroke Welsh corgi, Boxer, Rhodesian ridgeback, German Shepherd dog, and Chesapeake Bay retriever. Microscopic examination of spinal cords from affected dogs revealed myelin and axon loss affecting the lateral white matter and neuronal cytoplasmic inclusions that bind anti-superoxide dismutase 1 antibodies. These inclusions are similar to those seen in spinal cord sections from ALS patients with SOD1 mutations. Our findings identify canine DM to be the first recognized spontaneously occurring animal model for ALS. PMID:19188595

  8. Physiotherapy for human T-lymphotropic virus 1-associated myelopathy: review of the literature and future perspectives

    PubMed Central

    Sá, Katia N; Macêdo, Maíra C; Andrade, Rosana P; Mendes, Selena D; Martins, José V; Baptista, Abrahão F

    2015-01-01

    Human T-lymphotropic virus 1 (HTLV-1) infection may be associated with damage to the spinal cord – HTLV-associated myelopathy/tropical spastic paraparesis – and other neurological symptoms that compromise everyday life activities. There is no cure for this disease, but recent evidence suggests that physiotherapy may help individuals with the infection, although, as far as we are aware, no systematic review has approached this topic. Therefore, the objective of this review is to address the core problems associated with HTLV-1 infection that can be detected and treated by physiotherapy, present the results of clinical trials, and discuss perspectives on the development of knowledge in this area. Major problems for individuals with HTLV-1 are pain, sensory-motor dysfunction, and urinary symptoms. All of these have high impact on quality of life, and recent clinical trials involving exercises, electrotherapeutic modalities, and massage have shown promising effects. Although not influencing the basic pathologic disturbances, a physiotherapeutic approach seems to be useful to detect specific problems related to body structures, activity, and participation related to movement in HTLV-1 infection, as well as to treat these conditions. PMID:25759588

  9. Anterior Cervical Spine Surgery for Degenerative Disease: A Review

    PubMed Central

    SUGAWARA, Taku

    Anterior cervical spine surgery is an established surgical intervention for cervical degenerative disease and high success rate with excellent long-term outcomes have been reported. However, indications of surgical procedures for certain conditions are still controversial and severe complications to cause neurological dysfunction or deaths may occur. This review is focused mainly on five widely performed procedures by anterior approach for cervical degenerative disease; anterior cervical discectomy, anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, anterior cervical foraminotomy, and arthroplasty. Indications, procedures, outcomes, and complications of these surgeries are discussed. PMID:26119899

  10. Cervical cytology biobanking in Europe.

    PubMed

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

    2010-01-01

    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

  11. Invasive Cervical Resorption: A Review

    PubMed Central

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

    2013-01-01

    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

  12. Network Topologies Decoding Cervical Cancer

    PubMed Central

    Jalan, Sarika; Kanhaiya, Krishna; Rai, Aparna; Bandapalli, Obul Reddy; Yadav, Alok

    2015-01-01

    According to the GLOBOCAN statistics, cervical cancer is one of the leading causes of death among women worldwide. It is found to be gradually increasing in the younger population, specifically in the developing countries. We analyzed the protein-protein interaction networks of the uterine cervix cells for the normal and disease states. It was found that the disease network was less random than the normal one, providing an insight into the change in complexity of the underlying network in disease state. The study also portrayed that, the disease state has faster signal processing as the diameter of the underlying network was very close to its corresponding random control. This may be a reason for the normal cells to change into malignant state. Further, the analysis revealed VEGFA and IL-6 proteins as the distinctly high degree nodes in the disease network, which are known to manifest a major contribution in promoting cervical cancer. Our analysis, being time proficient and cost effective, provides a direction for developing novel drugs, therapeutic targets and biomarkers by identifying specific interaction patterns, that have structural importance. PMID:26308848

  13. Network Topologies Decoding Cervical Cancer.

    PubMed

    Jalan, Sarika; Kanhaiya, Krishna; Rai, Aparna; Bandapalli, Obul Reddy; Yadav, Alok

    2015-01-01

    According to the GLOBOCAN statistics, cervical cancer is one of the leading causes of death among women worldwide. It is found to be gradually increasing in the younger population, specifically in the developing countries. We analyzed the protein-protein interaction networks of the uterine cervix cells for the normal and disease states. It was found that the disease network was less random than the normal one, providing an insight into the change in complexity of the underlying network in disease state. The study also portrayed that, the disease state has faster signal processing as the diameter of the underlying network was very close to its corresponding random control. This may be a reason for the normal cells to change into malignant state. Further, the analysis revealed VEGFA and IL-6 proteins as the distinctly high degree nodes in the disease network, which are known to manifest a major contribution in promoting cervical cancer. Our analysis, being time proficient and cost effective, provides a direction for developing novel drugs, therapeutic targets and biomarkers by identifying specific interaction patterns, that have structural importance. PMID:26308848

  14. Epidemiology and Early Detection of Cervical Cancer.

    PubMed

    Hillemanns, Peter; Soergel, Phillip; Hertel, Hermann; Jentschke, Matthias

    2016-01-01

    The new German S3 guideline 'Prevention of Cervical Cancer' published in 2016 is based on the latest available evidence about cervical cancer screening and treatment of cervical precancer. Large randomized controlled trials indicate that human papillomavirus (HPV)-based screening may provide better protection against cervical cancer than cytology alone through improved detection of premalignant disease in the first screening round prior to progression. Therefore, women aged 30 years and older should preferably be screened with HPV testing every 3-5 years (cytology alone every 2 years is an acceptable alternative). Co-testing is not recommended. Screening should start at 25 years using cytology alone every 2 years. The preferred triage test after a positive HPV screening test is cytology. Women positive for HPV 16 and HPV 18 should receive immediate colposcopy. Another alternative triage method is p16/Ki-67 dual stain cytology. The mean yearly participation rate in Germany is between 45 and 50%. Offering devices for HPV self-sampling has the potential to increase participation rates in those women who are at higher risk of developing cervical cancer. Regarding primary prevention, the 9-valent vaccine may provide protection against up to 85% of cervical intraepithelial neoplasia (CIN) 3 and 90% of cervical cancer, and is available in Europe as a 2-dose schedule from May 2016. PMID:27614953

  15. HOXB homeobox gene expression in cervical carcinoma.

    PubMed

    López, R; Garrido, E; Piña, P; Hidalgo, A; Lazos, M; Ochoa, R; Salcedo, M

    2006-01-01

    The homeobox (HOX) genes are a family of transcription factors that bind to specific DNA sequences in target genes regulating gene expression. Thirty-nine HOX genes have been mapped in four conserved clusters: A, B, C, and D; they act as master genes regulating the identity of body segments along the anteroposterior axis of the embryo. The role played by HOX genes in adult cell differentiation is unclear to date, but growing evidence suggests that they may play an important role in the development of cancer. To study the role played by HOX genes in cervical cancer, in the present work, we analyzed the expression of HOXB genes and the localization of their transcripts in human cervical tissues. Reverse transcription-polymerase chain reaction analysis and nonradioactive RNA in situ hybridization were used to detect HOXB expression in 11 normal cervical tissues and 17 cervical carcinomas. It was determined that HOXB1, B3, B5, B6, B7, B8, and B9 genes are expressed in normal adult cervical epithelium and squamous cervical carcinomas. Interestingly, HOXB2, HOXB4, and HOXB13 gene expression was found only in tumor tissues. Our findings suggest that the new expression of HOXB2, HOXB4, and B13 genes is involved in cervical cancer. PMID:16445654

  16. The Korean guideline for cervical cancer screening.

    PubMed

    Min, Kyung Jin; Lee, Yoon Jae; Suh, Mina; Yoo, Chong Woo; Lim, Myong Cheol; Choi, Jaekyung; Ki, Moran; Kim, Yong Man; Kim, Jae Weon; Kim, Jea Hoon; Park, Eal Whan; Lee, Hoo Yeon; Lim, Sung Chul; Cho, Chi Heum; Hong, Sung Ran; Dang, Ji Yeon; Kim, Soo Young; Kim, Yeol; Lee, Won Chul; Lee, Jae Kwan

    2015-07-01

    The incidence rate of cervical cancer in Korea is still higher than in other developed countries, notwithstanding the national mass-screening program. Furthermore, a new method has been introduced in cervical cancer screening. Therefore, the committee for cervical cancer screening in Korea updated the recommendation statement established in 2002. The new version of the guideline was developed by the committee using evidence-based methods. The committee reviewed the evidence for the benefits and harms of the Papanicolaou test, liquid-based cytology, and human papillomavirus (HPV) testing, and reached conclusions after deliberation. The committee recommends screening for cervical cancer with cytology (Papanicolaou test or liquid-based cytology) every three years in women older than 20 years of age (recommendation A). The cervical cytology combined with HPV test is optionally recommended after taking into consideration individual risk or preference (recommendation C). The current evidence for primary HPV screening is insufficient to assess the benefits and harms of cervical cancer screening (recommendation I). Cervical cancer screening can be terminated at the age of 74 years if more than three consecutive negative cytology reports have been confirmed within 10 years (recommendation D). PMID:26197860

  17. [Cervical actinomycosis due to Actinomyces naeslundii].

    PubMed

    Kimura, Hiroshi

    2011-07-01

    Actinomyces naeslundii, an oral biofilm bacterium of, can be cured using intravenous piperacillin, clindamycin, and surgery. We report a case of cervical actinomycosis due to Actinomyces naeslundii. A 56-year-old man seen for right cervical swelling had undergone dental work. Computed tomography indicated an abscess, from which we aspirated pus using a needle. Although no sulfur granules were found, pus yielded Actinomyces naeslundii. This case is, to our knowledge, the first reported in Japan of cervical actinomycosis due to A. naeslundii. PMID:21838058

  18. [Induction chemotherapy for locally advanced cervical cancer].

    PubMed

    Morkhov, K Yu; Nechushkina, V M; Kuznetsov, V V

    2015-01-01

    The main methods of treatment for cervical cancer are surgery, radiotherapy or their combination. During past two decades chemotherapy are increasingly being used not only in patients with disseminated forms of this disease but also in patients undergoing chemoradiotherapy or as induction therapy. Possibilities of adjuvant chemotherapy for cervical cancer are being studied. According to A.D.Kaprin and V.V. Starinskiy in 2013 in Russia, 32% of patients with newly diagnosed cervical cancer underwent only radiation therapy, 32%--combined or complex treatment, 27.3%--only surgery, and just 8.7%--chemoradiotherapy. PMID:26087600

  19. Cervical squamous cell carcinoma metastatic to placenta.

    PubMed

    Can, Nhu Thuy T; Robertson, Patricia; Zaloudek, Charles J; Gill, Ryan M

    2013-09-01

    A pregnant 29-year-old gravida 4, para 3 woman with Stage IIB cervical cancer was admitted at 33 weeks and 4 days of gestation and delivered a healthy neonate. Her placenta was small but otherwise grossly unremarkable. Microscopic examination revealed metastatic squamous cell carcinoma. An immunohistochemical stain for p16 was positive in the carcinoma cells, supporting metastasis from the cervical tumor. Cervical squamous cell carcinoma metastatic to placenta is very rare. We report a case and discuss metastatic cancer during pregnancy with recommendations for infant follow-up. PMID:23896714

  20. How will HPV vaccines affect cervical cancer?

    PubMed Central

    Roden, Richard; Wu, T.-C.

    2011-01-01

    Cancer of the uterine cervix is the second largest cause of cancer deaths in women, and its toll is greatest in populations that lack screening programmes to detect precursor lesions. Persistent infection with ‘high risk’ genotypes of human papillomavirus (HPV) is necessary, although not sufficient, to cause cervical carcinoma. Therefore, HPV vaccination provides an opportunity to profoundly affect cervical cancer incidence worldwide. A recently licensed HPV subunit vaccine protects women from a high proportion of precursor lesions of cervical carcinoma and most genital warts. Here we examine the ramifications and remaining questions that surround preventive HPV vaccines. PMID:16990853

  1. Canine degenerative myelopathy: biochemical characterization of superoxide dismutase 1 in the first naturally occurring non-human amyotrophic lateral sclerosis model.

    PubMed

    Crisp, Matthew J; Beckett, Jeffrey; Coates, Joan R; Miller, Timothy M

    2013-10-01

    Mutations in canine superoxide dismutase 1 (SOD1) have recently been shown to cause canine degenerative myelopathy, a disabling neurodegenerative disorder affecting specific breeds of dogs characterized by progressive motor neuron loss and paralysis until death, or more common, euthanasia. This discovery makes canine degenerative myelopathy the first and only naturally occurring non-human model of amyotrophic lateral sclerosis (ALS), closely paralleling the clinical, pathological, and genetic presentation of its human counterpart, SOD1-mediated familial ALS. To further understand the biochemical role that canine SOD1 plays in this disease and how it may be similar to human SOD1, we characterized the only two SOD1 mutations described in affected dogs to date, E40K and T18S. We show that a detergent-insoluble species of mutant SOD1 is present in spinal cords of affected dogs that increases with disease progression. Our in vitro results indicate that both canine SOD1 mutants form enzymatically active dimers, arguing against a loss of function in affected homozygous animals. Further studies show that these mutants, like most human SOD1 mutants, have an increased propensity to form aggregates in cell culture, with 10-20% of cells possessing visible aggregates. Creation of the E40K mutation in human SOD1 recapitulates the normal enzymatic activity but not the aggregation propensity seen with the canine mutant. Our findings lend strong biochemical support to the toxic role of SOD1 in canine degenerative myelopathy and establish close parallels for the role mutant SOD1 plays in both canine and human disorders. PMID:23707216

  2. Distracted cervical spinal fusion for management of caudal cervical spondylomyelopathy in large-breed dogs.

    PubMed

    Ellison, G W; Seim, H B; Clemmons, R M

    1988-08-15

    Using an autogenous bone graft (obtained from the iliac crest), 4-mm cancellous bone screws, and polymethylmethacrylate, a distracted cervical spinal fusion technique was performed on 10 dogs with myelographic evidence of caudal cervical spondylomyelopathy. All dogs had evidence of dynamic soft tissue spinal cord compression, as indicated by flexion, extension, and traction myelographic views. Of the 10 dogs, 4 previously had undergone surgery by use of ventral slot or cervical disk fenestration techniques, and their neurologic status had deteriorated after the original surgery. Preoperative neurologic status of the 10 dogs included nonambulatory tetraparesis (n = 5), severe ataxia with conscious proprioceptive deficits (n = 2), and mild ambulatory ataxia with conscious proprioceptive deficits (n = 3). Five dogs had signs of various degrees of cervical pain. Clinical improvement was observed in 8 of 10 dogs--either improved neurologic status or elimination of cervical pain. Implant loosening developed in 3 dogs; 2 of them were euthanatized because of lack of neurologic improvement. Radiographic evidence of bony cervical fusion was observed during a 9- to 24-week period in 6 of the 8 surviving dogs. The distracted cervical fusion technique appears to be a valid surgical procedure to manage cervical spondylomyelopathy in those dogs in which the lesions are limited to one cervical intervertebral disk space. PMID:3049487

  3. The Langerhans' cell histiocytosis (eosinophilic granuloma) of the cervical spine: a rare diagnosis of cervical pain.

    PubMed

    Simanski, C; Bouillon, B; Brockmann, M; Tiling, T

    2004-05-01

    We present the case of a 44-year-old man who complained of cervical pain. He was treated with physiotherapy and analgetics. Because of persistent pain, computed tomography (CT) scan and MRI were performed. They revealed an osteolytic destruction of the fourth cervical vertebra. The patient was treated surgically for removal of the tumor and stabilization of his cervical spine. Histology of the osteolytic material led to the diagnosis of an eosinophilic granuloma of the cervical spine. This case report describes the incidence, clinical significance, background and therapy of an eosinophilic granuloma of the spine. PMID:15120180

  4. 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

    2016-03-25

    Cervical Adenocarcinoma; Cervical Adenosquamous Carcinoma; Cervical Squamous Cell Carcinoma; Stage IB2 Cervical Cancer; Stage II Vaginal Cancer; Stage IIA1 Cervical Cancer; Stage IIA2 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 Adenosquamous Carcinoma; Vaginal Squamous Cell Carcinoma

  5. [Updates of ossification of posterior longitudinal ligament. Clinical results and complication of surgery for thoracic myelopathy due to ossification of posterior longitudinal ligament].

    PubMed

    Yamazaki, Masashi

    2009-10-01

    We performed 3 types of surgical procedures for thoracic myelopathy due to OPLL : posterior decompression, OPLL-extirpation, and posterior decompression with instrumented fusion (PDF) . A considerable degree of neurological recovery was obtained in all patients who underwent PDF, despite the anterior impingement of the spinal cord by OPLL remaining. In addition, the rate of post-operative complications was extremely low with PDF, when compared with posterior decompression and OPLL-extirpation groups. We recommend that one stage posterior decompression with instrumented fusion be selected for cases in whom the spinal cord is severely damaged pre-operatively. PMID:19794260

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

    ClinicalTrials.gov

    2016-03-17

    Cervical Adenocarcinoma; Cervical Adenosquamous Carcinoma; Cervical Squamous Cell Carcinoma; Chemotherapeutic Agent Toxicity; Cognitive Side Effects of Cancer Therapy; Psychological Impact of Cancer; Radiation Toxicity; Sexual Dysfunction and Infertility; Stage IB Cervical Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage IVA Cervical Cancer

  7. Cervicitis

    MedlinePlus

    ... during their adult life. Risks include: High-risk sexual behavior History of STIs Many sexual partners Sex (intercourse) ... Sexual partners who have engaged in high-risk sexual behavior or have had an STI Bacteria (such as ...

  8. Differential cytology of cervical neoplasias

    NASA Astrophysics Data System (ADS)

    Koenig, Rainer; Bergander, S.

    1990-11-01

    In the context of the early recognition of cervical cancer the cytology has to detect tumor positive cases among a bulk of un suspicious specimens. Unfortunately there is a group of cases with a vague diaxosis, the so called PAP-ill-group. There are many reasons for the recent impossibility of a safe conclusion from the PAP-Ill-smears to their histological diagnoses (Pig. 1). Today for an exact statement a cone biopsy and a microscopical investigation of its histological sections for such caseS are necessary. That results in a high medical and economical expense and, last not least, that means a higher risk of complications and of future family planning problems for the women affected.

  9. 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 ... gov . What's New Community-wide treatment of ... of Allergy and Infectious Diseases (NIAID). The study was conducted in a rural ...

  10. Airway management in cervical spine injury

    PubMed Central

    Austin, Naola; Krishnamoorthy, Vijay; Dagal, Arman

    2014-01-01

    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. PMID:24741498

  11. Congenital narrowing of the cervical spinal canal.

    PubMed Central

    Kessler, J T

    1975-01-01

    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. PMID:1219087

  12. Cervical Cancer - Multiple Languages: MedlinePlus

    MedlinePlus

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Cervical Cancer URL of this page: https://medlineplus.gov/languages/cervicalcancer.html Other topics A-Z A B ...

  13. Anterior Cervical Discectomy and Fusion with Plating

    MedlinePlus Videos and Cool Tools

    Anterior Cervical Discectomy and Fusion with Plating Broward Health Medical Center Fort Lauderdale, FL November 17, 2011 I'm Dr. Matthew Moore, head of the Spine Care Center here at North Broward Medical Center. And ...

  14. The pathogenesis of tropical spastic paraparesis/human T-cell leukemia type I-associated myelopathy.

    PubMed

    Casseb, J; Penalva-de-Oliveira, A C

    2000-12-01

    Tropical spastic paraparesis/human T-cell leukemia type I-associated myelopathy (TSP/HAM) is caused by a human T-cell leukemia virus type I (HTLV-I) after a long incubation period. TSP/HAM is characterized by a chronic progressive paraparesis with sphincter disturbances, no/mild sensory loss, the absence of spinal cord compression and seropositivity for HTLV-I antibodies. The pathogenesis of this entity is not completely known and involves a multivariable phenomenon of immune system activation against the presence of HTLV-I antigens, leading to an inflammatory process and demyelination, mainly in the thoracic spinal cord. The current hypothesis about the pathogenesis of TSP/HAM is: 1) presence of HTLV-I antigens in the lumbar spinal cord, noted by an increased DNA HTLV-I load; 2) CTL either with their lytic functions or release/production of soluble factors, such as CC-chemokines, cytokines, and adhesion molecules; 3) the presence of Tax gene expression that activates T-cell proliferation or induces an inflammatory process in the spinal cord; 4) the presence of B cells with neutralizing antibody production, or complement activation by an immune complex phenomenon, and 5) lower IL-2 and IFN-gamma production and increased IL-10, indicating drive to a cytokine type 2 pattern in the TSP/HAM subjects and the existence of a genetic background such as some HLA haplotypes. All of these factors should be implicated in TSP/HAM and further studies are necessary to investigate their role in the development of TSP/HAM. PMID:11105090

  15. Expression of Autophagy-Related Proteins in the Spinal Cord of Pembroke Welsh Corgi Dogs With Canine Degenerative Myelopathy.

    PubMed

    Ogawa, M; Uchida, K; Yamato, O; Mizukami, K; Chambers, J K; Nakayama, H

    2015-11-01

    Canine degenerative myelopathy (DM) is a progressive neurodegenerative disease frequently found in Pembroke Welsh Corgi (PWC) dogs, and it has clinical and pathologic similarities to human amyotrophic lateral sclerosis. Autophagy is a major intracellular protein degradation system. Abnormalities of autophagy--resulting in cell death through mechanisms called type II programmed cell death--have recently been reported to occur in various neurodegenerative diseases, including amyotrophic lateral sclerosis. Thus, the distribution and expression levels of proteins involved in autophagy were examined in the spinal cords of 8 PWC dogs suffering from DM with superoxide dismutase mutation, 5 non-DM PWC dogs, and 6 Beagle dogs without neurologic signs. There was no significant difference in the ratio of neurons with microtubule-associated protein light chain 3 (LC3)-positive somata relative to those that were LC3 negative among the 3 groups, whereas the number of LC3-positive neurites was significantly increased in DM dogs. Punctate LC3 immunoreactivity did not colocalize with a lysosome marker, LAMP2 (lysosome-associated membrane protein 2). NBR1 (neighbor of BRCA gene 1) was localized mostly in reactive astrocytes, whereas there were p62 (p62/A170/SQSTM1)-positive foci in the neuropil of the spinal cord of DM dogs. Western blotting revealed in DM dogs the decreased expression of Beclin1 and Atg16 L, which are molecules involved in formation of the isolation membrane. These findings suggest that altered autophagosome degradation may result in LC3 and p62 accumulation in the DM spinal cord, whereas the early stage of membrane formation is likely to be downregulated. PMID:25732177

  16. Grading of cervical dysplasias by frozen section.

    PubMed

    Fletcher, S; Smart, G E; Livingstone, J R

    1985-09-14

    Grading of cervical dysplasias at colposcopy by means of rapid frozen section avoids the delay inevitable with paraffin sections. The immediacy of the diagnosis benefits the patient, who can be treated at her first visit. A comparison of grading by frozen sections with paraffin sections has confirmed the safety of the frozen method. Additional advantages are opportunities for optimum orientation and "rescue" of specimens, improved colposcopic training, and the facilitation of special investigations on fresh cervical tissue. PMID:2863606

  17. Tophaceous gout in the cervical spine.

    PubMed

    Cabot, Jonathan; Mosel, Leigh; Kong, Andrew; Hayward, Mike

    2005-12-01

    Gout is a common metabolic disorder typically affecting the distal joints of the appendicular skeleton. Involvement of the axial skeleton, particularly the facet joints and posterior column of the cervical spine, is rare. This case report highlights such a presentation in a 76-year old female who presented with cervical spine pain following a fall. Her radiological findings were suggestive of a destructive metastatic process. Histological diagnosis confirmed tophaceous gout. PMID:16028084

  18. Anterior cervical hypertrichosis: a sporadic case

    PubMed Central

    Bostan, Sezen; Yaşar, Şirin; Serdar, Zehra Aşiran; Gizlenti, Sevda

    2016-01-01

    Anterior cervical hypertrichosis is a very rare form of primary localized hypertrichosis. It consists of a tuft of terminal hair on the anterior neck just above the laryngeal prominence. The etiology is still unknown. In this article, we reported a 15-year-old female patient who presented to our clinic with a complaint of hypertrichosis on the anterior aspect of the neck for the last five years. Her past medical history revealed no pathology except for vesicoureteral reflux. On the basis of clinical presentation, our patient was diagnosed with anterior cervical hypertrichosis and she was considered to be a sporadic case due to lack of other similar cases in familial history. To date, 33 patients with anterior cervical hypertrichosis have been reported. Anterior cervical hypertrichosis can be associated with other abnormalities, but it frequently presents as an isolated defect (70%). The association of vesicoureteral reflux and anterior cervical hypertrichosis which was observed in our patient might be coincidental. So far, no case of anterior cervical hypertrichosis associated with vesicoureteral reflux has been reported in the literature. PMID:27103865

  19. Automated image analysis of uterine cervical images

    NASA Astrophysics Data System (ADS)

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

    2007-03-01

    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.

  20. Targeted treatments for cervical cancer: a review

    PubMed Central

    Peralta-Zaragoza, Oscar; Bermúdez-Morales, Víctor Hugo; Pérez-Plasencia, Carlos; Salazar-León, Jonathan; Gómez-Cerón, Claudia; Madrid-Marina, Vicente

    2012-01-01

    Cervical cancer is the second most common cause of cancer death in women worldwide and the development of new diagnosis, prognostic, and treatment strategies merits special attention. Although surgery and chemoradiotherapy can cure 80%–95% of women with early stage cancer, the recurrent and metastatic disease remains a major cause of cancer death. Many efforts have been made to design new drugs and develop gene therapies to treat cervical cancer. In recent decades, research on treatment strategies has proposed several options, including the role of HPV E6 and E7 oncogenes, which are retained and expressed in most cervical cancers and whose respective oncoproteins are critical to the induction and maintenance of the malignant phenotype. Other efforts have been focused on antitumor immunotherapy strategies. It is known that during the development of cervical cancer, a cascade of abnormal events is induced, including disruption of cellular cycle control, perturbation of antitumor immune response, alteration of gene expression, and deregulation of microRNA expression. Thus, in this review article we discuss potential targets for the treatment of cervical cancer associated with HPV infection, with special attention to immunotherapy approaches, clinical trials, siRNA molecules, and their implications as gene therapy strategies against cervical cancer development. PMID:23144564

  1. Cervical cerclage: a review of the evidence.

    PubMed

    Fox, Nathan S; Chervenak, Frank A

    2008-01-01

    Cervical insufficiency is a difficult and confusing diagnosis. Its diagnostic criteria, etiology, and treatment are all debated. Cervical cerclage has been a common practice in obstetrics since it was first described by Shirodker and then McDonald in the 1950s. Cerclages have been placed because of a patient's obstetrical history, physical examination, ultrasound, or a combination of the above. However, the data supporting cerclage placement is limited. There has never been a prospective, randomized, controlled trial of cerclage versus no cerclage in patients with a classic history of cervical insufficiency (multiple painless second trimester losses occurring at progressively earlier gestational ages). This article attempts to review the relevant studies regarding cerclage placement for the treatment of cervical insufficiency. Based on the current literature, there is evidence supporting cervical cerclage in the following limited circumstances: a history of 3 or more spontaneous preterm births or second trimester losses; a high-risk patient with a singleton pregnancy who has a short cervix in the second trimester. Because the majority of patients with risk factors for preterm birth and second trimester loss (poor obstetric history, short cervix) will still deliver at term or near-term, studies on the effectiveness of cervical cerclage would need many patients to be powered appropriately. PMID:18081941

  2. Simple trachelectomy during pregnancy for cervical cancer

    PubMed Central

    Moreno-Luna, Estefania; Alonso, Patricia; Santiago, Javier De; Zapardiel, Ignacio

    2016-01-01

    Invasive cervical cancer is rare during a pregnancy, even though it is one of the most frequently diagnosed neoplasias during that time. It is noted that around 30% of women diagnosed with cervical cancer are of reproductive age. This means that up to 3% of cases of cervical cancer are found in pregnant women or those who are in the post-birth period. A cervicovaginal Pap smear is performed as part of the regular checkup for a pregnant woman during the first visit so that cervical cancer can easily be diagnosed early in these women, detecting it early in up to 70–80% of cases. We present here the case of a patient with initial diagnosis of cervical cancer made around 20th week of pregnancy. It was then treated by a simple trachelectomy and cerclage during week 24. The pregnant woman gave birth to a healthy baby at the end of her pregnancy. Definitive treatment was completed three months after giving birth with a total hysterectomy and laparoscopic bilateral salpingectomy while preserving both ovaries. After 17 months of monitoring the patient showed no signs of reoccurrence. In conclusion, during the early stage of cervical cancer conservative management may be a reasonable option to preserve the current pregnancy. PMID:27610199

  3. [Uterine cervical carcinoma and human papillomaviruses].

    PubMed

    Sugase, M

    1992-06-01

    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

  4. Targeted treatments for cervical cancer: a review.

    PubMed

    Peralta-Zaragoza, Oscar; Bermúdez-Morales, Víctor Hugo; Pérez-Plasencia, Carlos; Salazar-León, Jonathan; Gómez-Cerón, Claudia; Madrid-Marina, Vicente

    2012-01-01

    Cervical cancer is the second most common cause of cancer death in women worldwide and the development of new diagnosis, prognostic, and treatment strategies merits special attention. Although surgery and chemoradiotherapy can cure 80%-95% of women with early stage cancer, the recurrent and metastatic disease remains a major cause of cancer death. Many efforts have been made to design new drugs and develop gene therapies to treat cervical cancer. In recent decades, research on treatment strategies has proposed several options, including the role of HPV E6 and E7 oncogenes, which are retained and expressed in most cervical cancers and whose respective oncoproteins are critical to the induction and maintenance of the malignant phenotype. Other efforts have been focused on antitumor immunotherapy strategies. It is known that during the development of cervical cancer, a cascade of abnormal events is induced, including disruption of cellular cycle control, perturbation of antitumor immune response, alteration of gene expression, and deregulation of microRNA expression. Thus, in this review article we discuss potential targets for the treatment of cervical cancer associated with HPV infection, with special attention to immunotherapy approaches, clinical trials, siRNA molecules, and their implications as gene therapy strategies against cervical cancer development. PMID:23144564

  5. Simple trachelectomy during pregnancy for cervical cancer.

    PubMed

    Moreno-Luna, Estefania; Alonso, Patricia; Santiago, Javier De; Zapardiel, Ignacio

    2016-01-01

    Invasive cervical cancer is rare during a pregnancy, even though it is one of the most frequently diagnosed neoplasias during that time. It is noted that around 30% of women diagnosed with cervical cancer are of reproductive age. This means that up to 3% of cases of cervical cancer are found in pregnant women or those who are in the post-birth period. A cervicovaginal Pap smear is performed as part of the regular checkup for a pregnant woman during the first visit so that cervical cancer can easily be diagnosed early in these women, detecting it early in up to 70-80% of cases. We present here the case of a patient with initial diagnosis of cervical cancer made around 20th week of pregnancy. It was then treated by a simple trachelectomy and cerclage during week 24. The pregnant woman gave birth to a healthy baby at the end of her pregnancy. Definitive treatment was completed three months after giving birth with a total hysterectomy and laparoscopic bilateral salpingectomy while preserving both ovaries. After 17 months of monitoring the patient showed no signs of reoccurrence. In conclusion, during the early stage of cervical cancer conservative management may be a reasonable option to preserve the current pregnancy. PMID:27610199

  6. Anterior cervical hypertrichosis: a sporadic case.

    PubMed

    Bostan, Sezen; Yaşar, Şirin; Serdar, Zehra Aşiran; Gizlenti, Sevda

    2016-03-01

    Anterior cervical hypertrichosis is a very rare form of primary localized hypertrichosis. It consists of a tuft of terminal hair on the anterior neck just above the laryngeal prominence. The etiology is still unknown. In this article, we reported a 15-year-old female patient who presented to our clinic with a complaint of hypertrichosis on the anterior aspect of the neck for the last five years. Her past medical history revealed no pathology except for vesicoureteral reflux. On the basis of clinical presentation, our patient was diagnosed with anterior cervical hypertrichosis and she was considered to be a sporadic case due to lack of other similar cases in familial history. To date, 33 patients with anterior cervical hypertrichosis have been reported. Anterior cervical hypertrichosis can be associated with other abnormalities, but it frequently presents as an isolated defect (70%). The association of vesicoureteral reflux and anterior cervical hypertrichosis which was observed in our patient might be coincidental. So far, no case of anterior cervical hypertrichosis associated with vesicoureteral reflux has been reported in the literature. PMID:27103865

  7. Intrapartum Cervical Laceration and Subsequent Pregnancy Outcomes

    PubMed Central

    Wong, Luchin F.; Wilkes, Jacob; Korgenski, Kent; Varner, Michael W.; Manuck, Tracy A.

    2016-01-01

    Objective  The objective of this study was to describe pregnancy outcomes, including cervical insufficiency and preterm birth, in the subsequent pregnancy following an intrapartum cervical laceration. Study Design  Retrospective cohort of women with their first two consecutive singleton pregnancies carried to ≥ 200/7 weeks' gestation within a tertiary health care system from 2002 to 2012. Cervical laceration cases were identified by ICD9 codes and included if suture repair was required. Results  In this study, 55 women were confirmed to have a cervical laceration in the first delivery; 43 lacerations after vaginal delivery (VD) and 12 after cesarean delivery (CD). The median gestational age of the first delivery was 400/7 weeks and the median birth weight 3,545 g; these did not differ between VD and CD. In the second pregnancy, 2 of 55 women (4.6%) had a prophylactic cerclage placed; 1 carried to term and the other delivered at 356/7 weeks. In total, four women (9.3%) delivered the second pregnancy < 37 weeks: three had a prior term VD and one had a prior 34 weeks VD. There was only one case of recurrent cervical laceration, occurring in the setting of vaginal deliveries. Conclusion  Obstetric cervical lacerations are uncommon. Complications in the following pregnancy were low, despite lack of additional prophylactic cerclage use. PMID:27621953

  8. Correlation of diffusion tensor imaging parameters with neural status in Pott’s spine

    PubMed Central

    Jain, Nikhil; Saini, Namita Singh; Kumar, Sudhir; Rajagopalan, Mukunth; Chakraborti, Kanti Lal; Jain, Anil Kumar

    2016-01-01

    Introduction: Diffusion tensor imaging (DTI) has been used in cervical trauma and spondylotic myelopathy, and it has been found to correlate with neural deficit and prognosticate neural recovery. Such a correlation has not been studied in Pott’s spine with paraplegia. Hence, this prospective study has been used to find correlation of DTI parameters with neural deficit in these patients. Methods: Thirty-four patients of spinal TB were enrolled and DTI was performed before the start of treatment and after six months. Fractional anisotropy (FA), Mean diffusivity (MD), and Tractography were studied. Neurological deficit was graded by the Jain and Sinha scoring. Changes in FA and MD at and below the site of lesion (SOL) were compared to above the SOL (control) using the unpaired t-test. Pre-treatment and post-treatment values were also compared using the paired t-test. Correlation of DTI parameters with neurological score was done by Pearson’s correlation. Subjective assessment of Tractography images was done. Results: Mean average FA was not significantly decreased at the SOL in patients with paraplegia as compared to control. After six months of treatment, a significant decrease (p = 0.02) in mean average FA at the SOL compared to pre-treatment was seen. Moderate positive correlation (r = 0.49) between mean average FA and neural score after six months of treatment was found. Tractography images were not consistent with severity of paraplegia. Conclusion: Unlike spondylotic myelopathy and trauma, epidural collection and its organized inflammatory tissue in Pott’s spine precludes accurate assessment of diffusion characteristics of the compressed cord. PMID:27163110

  9. Triapine With Chemotherapy and Radiation Therapy in Treating Patients With IB2-IVA Cervical or Vulvar Cancer

    ClinicalTrials.gov

    2016-07-19

    Cervical Adenocarcinoma; Cervical Adenosquamous Carcinoma; Cervical Squamous Cell Carcinoma, Not Otherwise Specified; Stage IB Vulvar Cancer; Stage IB2 Cervical Cancer; Stage II Vulvar Cancer; Stage IIA1 Cervical Cancer; Stage IIA2 Cervical Cancer; Stage IIB Cervical Cancer; Stage IIIA Cervical Cancer; Stage IIIA Vulvar Cancer; Stage IIIB Cervical Cancer; Stage IIIB Vulvar Cancer; Stage IIIC Vulvar Cancer; Stage IVA Cervical Cancer; Stage IVA Vulvar Cancer; Vulvar Adenocarcinoma; Vulvar Squamous Cell Carcinoma

  10. Congestive Myelopathy due to Intradural Spinal AVM Supplied by Artery of Adamkiewicz: Case Report with Brief Literature Review and Analysis of the Foix-Alajouanine Syndrome Definition

    PubMed Central

    Sood, Dinesh; Mistry, Kewal A.; Khatri, Garvit D.; Chadha, Veenal; Garg, Swati; Suthar, Pokhraj P.; Patel, Dhruv G.; Patel, Ankitkumar

    2015-01-01

    Summary Background Spinal arteriovenous malformations (AVMs) can lead to development of congestive myelopathy (Foix-Alajouanine syndrome). Spinal AVMs are rare and so is this syndrome. Diagnosis is often missed due to its rarity and confusing definitions of the Foix-Alajouanine syndrome. Case Report We report a case of a 47-year-old male patient suffering from this rare syndrome with an AVM arising from the artery of Adamkiewicz, which is another rarity. Our patient was treated by embolization of the lesion with 20% glue, after which he showed mild improvement of symptoms. We also present a brief review of literature on spinal AVMs and elucidate the evolution of the term Foix-Alajouanine syndrome. Conclusions Use of the term “Foix-Alajouanine syndrome” should be restricted to patients with progressive subacute to chronic neurological symptoms due to congestive myelopathy caused by intradural spinal AVMs. CT angiography should supplement DSA as preliminary Imaging modality. Patients may be treated with surgery or endovascular procedures. PMID:26171088

  11. Quantitative ultrasound assessment of cervical microstructure.

    PubMed

    Feltovich, Helen; Nam, Kibo; Hall, Timothy J

    2010-07-01

    The objective of this preliminary study was to determine whether quantitative ultrasound (QUS) can provide insight into, and characterization of, uterine cervical microstructure. Throughout pregnancy, cervical collagen reorganizes (from aligned and anisotropic to disorganized and isotropic) as the cervix changes in preparation for delivery. Premature changes in collagen are associated with premature birth in mammals. Because QUS is able to detect structural anisotropy/isotropy, we hypothesized that it may provide a means of noninvasively assessing cervical microstructure. Thorough study of cervical microstructure has been limited by lack of technology to detect small changes in collagen organization, which has in turn limited our ability to detect abnormal and/or premature changes in collagen that may lead to preterm birth. In order to determine whether QUS may be useful for detection of cervical microstructure, radiofrequency (rf) echo data were acquired from the cervices of human hysterectomy specimens (n = 10). The angle between the acoustic beam and tissue was used to assess anisotropic acoustic propagation by control of transmit/receive angles from -20 degrees to +20 degrees. The power spectrum of the echo signals from within a region of interest was computed in order to investigate the microstructure of the tissue. An identical analysis was performed on a homogeneous phantom with spherical scatterers for system calibration. Power spectra of backscattered rf from the cervix were 6 dB higher for normal (0 degree) than steered (+/- 20 degrees) beams. The spectral power for steered beams decreased monotonically (0.4 dB at +5 degrees to 3.6 dB at +20 degrees). The excess difference (compared to similar analysis for the phantom) in normally-incident (0 degree) versus steered beams is consistent with scattering from an aligned component of the cervical microstructure. Therefore, QUS appears to reliably identify an aligned component of cervical microstructure

  12. How protective is cervical cancer screening against cervical cancer mortality in developing countries? The Colombian case

    PubMed Central

    2010-01-01

    Background Cervical cancer is one of the top causes of cancer morbidity and mortality in Colombia despite the existence of a national preventive program. Screening coverage with cervical cytology does not explain the lack of success of the program in reducing incidence and mortality rates by cervical cancer. To address this problem an ecological analysis, at department level, was carried out in Colombia to assess the relationship between cervical screening characteristics and cervical cancer mortality rates. Methods Mortality rates by cervical cancer were estimated at the department level for the period 2000-2005. Levels of mortality rates were compared to cervical screening coverage and other characteristics of the program. A Poisson regression was used to estimate the effect of different dimensions of program performance on mortality by cervical cancer. Results Screening coverage ranged from 28.7% to 65.6% by department but increases on this variable were not related to decreases in mortality rates. A significant reduction in mortality was found in departments where a higher proportion of women looked for medical advice when abnormal findings were reported in Pap smears. Geographic areas where a higher proportion of women lack health insurance had higher rates of mortality by cervical cancer. Conclusions These results suggest that coverage is not adequate to prevent mortality due to cervical cancer if women with abnormal results are not provided with adequate follow up and treatment. The role of different dimensions of health care such as insurance coverage, quality of care, and barriers for accessing health care needs to be evaluated and addressed in future studies. PMID:20846446

  13. The Effect of the Cervical Orthosis on Swallowing Physiology and Cervical Spine Motion During Swallowing.

    PubMed

    Mekata, Kojiro; Takigawa, Tomoyuki; Matsubayashi, Jun; Toda, Kazukiyo; Hasegawa, Yasuhiro; Ito, Yasuo

    2016-02-01

    Cervical orthosis is used to immobilize the neck in various disorders such as trauma and post-operation. However, it is still uncertain how cervical orthosis restricts the degree of movement of the cervical spine during swallowing and how they affect swallowing physiology. The purpose of this study was to evaluate these issues using the Philadelphia(®) Collar. We conducted videofluorography of swallowing in 39 healthy subjects (23 men, 16 women; mean age of 34.3 years) with and without cervical orthosis. To compare the two conditions regarding the cervical spine motion, we determined the angular and positional changes of the occipital bone (C0) and each cervical vertebra (C1-C7) from the oral phase to the pharyngeal phase. Similarly, to compare swallowing physiology, we assessed the start and end times and the durations of soft palate elevation, rapid hyoid anterosuperior movement, epiglottis inversion, closure of the laryngeal vestibule, and pharyngoesophageal segment (PES) opening. Finally, we compared the transit times of contrast agent in the two conditions. The respective extensions of C1, C2, and C3 were 0.31°, 0.07°, and 0.05° (mean) with cervical orthosis, and the respective flexions of C1, C2, and C3 were 0.98°, 1.42°, and 0.85° (mean) without. These results suggested that cervical orthosis restricted the flexion of C1-C3. Analysis of swallowing physiology revealed that the average durations of hyoid anterosuperior elevation, epiglottic inversion, and PES opening were prolonged by 0.09, 0.19, and 0.05 s, respectively. In conclusion, the cervical orthosis restricted the movement of the cervical spine during swallowing and changed swallowing physiology. PMID:26607160

  14. Letter: Contraceptive choice and cervical cytology.

    PubMed

    Leppaluoto, P

    1974-02-15

    In the evaluation of biological potentials of contraceptives in the genesis of cervical cancer, cytology seems to have been given due attention while information on the clinical condition and specific treatment of the target organ, the cervix, is repeatedly neglected. "Cancer does not develop in a healthy cervix" is an old dogma derived from impressions gained by clinical examination of the organ. This concept is supported by epidemiologic studies indicating that cancer is extremely rare in cervices restored to a normal condition by cauterization. It may be postulated that this type of treatment destroys the permissive target cells of the cervix, thus indirectly rendering possible coitus-associated and contraceptive-associated(?) mutagen(s) invalid. Also, in comparative studies, an evaluation should be made of the significance of a higher incidence of cervical ectopy reported in women receiving oral hormonal contraceptives. The importance of ectopy in the genesis of cervical malignancy has been derived from the presumption that permissive cervical cells are thus created and exposed to vaginal contents which may harbor the mutagens(s). Therefore, it would seem not only desirable but imperative to include the neglected parameters of clinical condition and of specific treatment (both past and present) of the uterine cervix in the structure of studies like the recent one in this Journal on "Contraceptive choice and cervical cytology", by Drs. Shulman and Merritt. Still another parameter which might prove to be of significance is the predominant type of vaginal flora, which can be assessed readily in the routine examination of Papanicolaou smears. It may be that vaginal contents, which would seem to be somewhat different in wearers of the intrauterine contraceptive device as compared to "pill" users, might play a part in the advent of cervical malignancy as a medium of or for coitus-associated mutagens(s). PMID:4855868

  15. 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 ... this country. Visit the American Cancer Society’s Cancer Statistics Center for more key statistics. Last Medical Review: ...

  16. 6 Common Cancers - Gynecologic Cancers Cervical, Endometrial, and Ovarian

    MedlinePlus

    ... Bar Home Current Issue Past Issues 6 Common Cancers - Gynecologic Cancers Cervical, Endometrial, and Ovarian Past Issues / Spring 2007 ... of this page please turn Javascript on. Gynecologic Cancers Cervical, Endometrial, and Ovarian NCI estimates that endometrial, ...

  17. Inactive Women May Face Higher Risk for Cervical Cancer

    MedlinePlus

    ... html Inactive Women May Face Higher Risk for Cervical Cancer But study found just 30 minutes of exercise ... who are sedentary appear more likely to develop cervical cancer, but just 30 minutes of exercise each week ...

  18. 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

  19. 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.

  20. Hybrid Surgery Versus Anterior Cervical Discectomy and Fusion in Multilevel Cervical Disc Diseases

    PubMed Central

    Zhang, Jianfeng; Meng, Fanxin; Ding, Yan; Li, Jie; Han, Jian; Zhang, Xintao; Dong, Wei

    2016-01-01

    Abstract To investigate the outcomes and reliability of hybrid surgery (HS) versus anterior cervical discectomy and fusion (ACDF) for the treatment of multilevel cervical spondylosis and disc diseases. Hybrid surgery, combining cervical disc arthroplasty (CDA) with fusion, is a novel treatment to multilevel cervical degenerated disc disease in recent years. However, the effect and reliability of HS are still unclear compared with ACDF. To investigate the studies of HS versus ACDF in patients with multilevel cervical disease, electronic databases (Medline, Embase, Pubmed, Cochrane library, and Cochrane Central Register of Controlled Trials) were searched. Studies were included when they compared HS with ACDF and reported at least one of the following outcomes: functionality, neck pain, arm pain, cervical range of motion (ROM), quality of life, and incidence of complications. No language restrictions were used. Two authors independently assessed the methodological quality of included studies and extracted the relevant data. Seven clinical controlled trials were included in this study. Two trials were prospective and the other 5 were retrospective. The results of the meta-analysis indicated that HS achieved better recovery of NDI score (P = 0.038) and similar recovery of VAS score (P = 0.058) compared with ACDF at 2 years follow-up. Moreover, the total cervical ROM (C2–C7) after HS was preserved significantly more than the cervical ROM after ACDF (P = 0.000) at 2 years follow-up. Notably, the compensatory increase of the ROM of superior and inferior adjacent segments was significant in ACDF groups at 2-year follow-up (P < 0.01), compared with HS. The results demonstrate that HS provides equivalent outcomes and functional recovery for cervical disc diseases, and significantly better preservation of cervical ROM compared with ACDF in 2-year follow-up. This suggests the HS is an effective alternative invention for the treatment of multilevel cervical

  1. [Cervical neuroblastoma in an infant].

    PubMed

    Arvai, Krisztina; Tóth, Judit; Németh, Tamás; Kiss, Csongor; Molnár, Péter; Oláh, Eva

    2004-01-01

    The case of a one-month-old patient admitted to the Department of Pediatrics (Medical and Health Science Center, Debrecen University) because of respiratory distress caused by a cervical mass compressing the upper respiratory pathways is presented. The mass could only be partially removed, the histological diagnosis proved to be neuroblastoma (SBCT: "small blue cell tumor"). Despite the fact that the DNA index of tumor cells (ploidy measurements) and the age of the patient suggested a favourable prognosis, the tumor continued to grow and metastases appeared. Because of symptoms of compression exerted on the respiratory system by the tumor, chemotherapy had to be applied. Since a standard OPEC/OJEC chemotherapeutic protocol proved to be not entirely effective and a residual tumor was still present, retinoic acid and interferon treatment was introduced. Presently, 4 years after the diagnosis, the patient is in complete remission and can be considered to be cured. The case presented here demonstrates that despite the favorable prognosis of the majority of infant neuroblastomas, in some cases the anatomic location of the tumor, leading to disturbance of vital functions, may serve as indication of chemotherapy. Our experience also proved the efficacy of retinoic acid and interferon treatment in relapsed neuroblastoma. PMID:15105902

  2. [Monitoring cervical dilatation by impedance].

    PubMed

    Salvat, J; Lassen, M; Sauze, C; Baud, S; Salvat, F

    1992-01-01

    Several different physics procedures have been tried to mechanize the recording of partograms. Can a measure of impedance of tissue Z using potential difference V, according to Ohm's law V = Z1, and 1 is a constant, be correlated with a measure of cervical dilatation using vaginal examination? This was our hypothesis. The tissue impedance meter was made to our design and applied according to a bipolar procedure. Our work was carried out on 28 patients. 10 patients were registered before labour started in order to test the apparatus and to record the impedance variations without labour taking place, and 18 patients were registered in labour to see whether there was any correlation. The level of impedance in the cervix without labour was 302.7 Ohms with a deviation of 8.2. Using student's t tests it was found that there was a significant correlation (p less than 0.001) in four measurements between the impedance measure and measures obtained by extrapolating the degrees of dilatation calculated from vaginal examination. This is a preliminary study in which we have defined the conditions that are necessary to confirm these first results and to further develop the method. PMID:1401774

  3. Raman spectroscopic characterization on cervical neoplasm in biopsy direction

    NASA Astrophysics Data System (ADS)

    Shin, Hsiao Hsin; Tsai, Yan Sheng; Wang, Tao Yuan; Chu, Shou Chia; Chiang, Huihua Kenny

    2007-02-01

    Raman spectroscopy was applied to distinguish the spectroscopic information between normal cervical tissues (14) and cervical neoplasia (17), including low grade squamous intraepithelial lesions (6) and high grade squamous intraepithelial lesions (11). Standard pathological sections of these cervical tissues were measured from superficial to stroma layers. We have normalized significant Raman peaks, 1250 and 1579-1656 cm -1 by taking a ratio over a stationary Raman at 1004 cm -1, and successfully discriminated between normal and neoplasm cervical tissues.

  4. Cervical cytology service in Nigeria: providers' perspective.

    PubMed

    Adesina, O A; Babarinsa, I A; Fawole, O A; Oladokun, A; Adeniji, A R; Adewole, I F

    2003-07-01

    It has been noted that efforts to organise an effective screening programme in developing countries will have to find adequate financial resources, develop the infrastructure, train the necessary manpower and elaborate surveillance mechanisms. In our study, we set out to determine (a) just how frequent is cervical cancer, to warrant the investment of funds in screening programmes; (b) what proportion of surveyed health facilities offer a cervical cytology screening programme; and (c) what basic facilities are currently available where such programmes exist? A pretested, self-completed questionnaire was sent to heads of department of obstetrics and gynaecology in public tertiary and secondary care hospitals in Nigeria as well as major mission hospitals. The response rate was 63%, monthly consultations included a mean of 114 (+/-11.7) new gynaecological patients and an average of 5 (4.7+/-0.8) cervical cancer cases. One-half of the institutions had a hospital-based cervical screening programme with an average of 27 patients being screened monthly. Finance was the main difficulty encountered in maintaining a screening service. Only four had a certified gynaecological oncologist. In conclusion, there is dismal utilisation of available services and a dearth of trained specialists should any cervical cancer screening programme be considered. PMID:12881085

  5. Curcumin Nanoformulation for Cervical Cancer Treatment

    PubMed Central

    Zaman, Mohd S.; Chauhan, Neeraj; Yallapu, Murali M.; Gara, Rishi K.; Maher, Diane M.; Kumari, Sonam; Sikander, Mohammed; Khan, Sheema; Zafar, Nadeem; Jaggi, Meena; Chauhan, Subhash C.

    2016-01-01

    Cervical cancer is one of the most common cancers among women worldwide. Current standards of care for cervical cancer includes surgery, radiation, and chemotherapy. Conventional chemotherapy fails to elicit therapeutic responses and causes severe systemic toxicity. Thus, developing a natural product based, safe treatment modality would be a highly viable option. Curcumin (CUR) is a well-known natural compound, which exhibits excellent anti-cancer potential by regulating many proliferative, oncogenic, and chemo-resistance associated genes/proteins. However, due to rapid degradation and poor bioavailability, its translational and clinical use has been limited. To improve these clinically relevant parameters, we report a poly(lactic-co-glycolic acid) based curcumin nanoparticle formulation (Nano-CUR). This study demonstrates that in comparison to free CUR, Nano-CUR effectively inhibits cell growth, induces apoptosis, and arrests the cell cycle in cervical cancer cell lines. Nano-CUR treatment modulated entities such as miRNAs, transcription factors, and proteins associated with carcinogenesis. Moreover, Nano-CUR effectively reduced the tumor burden in a pre-clinical orthotopic mouse model of cervical cancer by decreasing oncogenic miRNA-21, suppressing nuclear β-catenin, and abrogating expression of E6/E7 HPV oncoproteins including smoking compound benzo[a]pyrene (BaP) induced E6/E7 and IL-6 expression. These superior pre-clinical data suggest that Nano-CUR may be an effective therapeutic modality for cervical cancer. PMID:26837852

  6. Importance of cervical length in dysmenorrhoea aetiology.

    PubMed

    Zebitay, Ali G; Verit, Fatma F; Sakar, M Nafi; Keskin, Seda; Cetin, Orkun; Ulusoy, A Ibrahim

    2016-05-01

    The objective of this prospective case-control study was to determine whether uterine corpus and cervical length measurements have a role in dysmenorrhoea aetiology in virgins. Patients with severe primary dysmenorrhoea with visual analog scale scores of ≥7 composed the dysmenorrhoea group (n = 51), while the control group (n = 51) was of women with painless menstrual cycles or with mild pain. Longitudinal and transverse axes of the uterine cervix and uterine corpus were measured. Correlation between severity of dysmenorrhoea and uterine cervix and corpus axes was calculated. Longitudinal and transverse axes of uterine cervix as well as uterine cervix volume were significantly higher in the dysmenorrhoea group compared to the controls. There was a significant positive correlation between severity of dysmenorrhoea and the length of cervical longitudinal and transverse axes and uterine cervical volume. Our findings reveal longer cervical length and greater cervical volume in young virgin patients with dysmenorrhoea and severe pain compared to those with no or less pain. PMID:27012227

  7. Genital Cancers in Women: Cervical Cancer.

    PubMed

    Morris, Elise; Roett, Michelle A

    2015-11-01

    In 2015 in the United States, it is estimated there will be approximately 12,900 new patients with cervical cancer and 4,100 will die of the disease. If diagnosed at a localized stage, the 5-year survival rate exceeds 90%. Human papillomavirus (HPV) infection is the main risk factor for cervical cancer. Current recommendations for cervical cancer screening include Papanicolaou (Pap) testing every 3 years for women ages 21 to 29 years. For women ages 30 to 65 years, an alternative is screening with Pap and HPV testing every 5 years. If screening results are abnormal, further evaluation can be guided by an algorithm. For a diagnosis of carcinoma in situ or grade 3 cervical intraepithelial neoplasia (CIN), treatment typically involves ablation or excision. Women with CIN 1 or CIN 2 that persists typically are treated with the same methods. For women diagnosed with early-stage invasive cancer, standard treatment is radical hysterectomy. More advanced cancers also are treated with surgery, but chemotherapy and/or radiation also may be used depending on cancer stage. Because most cervical cancer is caused by HPV, it is potentially preventable with HPV vaccination, which is recommended for females and males, ideally beginning at age 11 or 12 years. PMID:26569047

  8. Landscape of genomic alterations in cervical carcinomas.

    PubMed

    Ojesina, Akinyemi I; Lichtenstein, Lee; Freeman, Samuel S; Pedamallu, Chandra Sekhar; Imaz-Rosshandler, Ivan; Pugh, Trevor J; Cherniack, Andrew D; Ambrogio, Lauren; Cibulskis, Kristian; Bertelsen, Bjørn; Romero-Cordoba, Sandra; Treviño, Victor; Vazquez-Santillan, Karla; Guadarrama, Alberto Salido; Wright, Alexi A; Rosenberg, Mara W; Duke, Fujiko; Kaplan, Bethany; Wang, Rui; Nickerson, Elizabeth; Walline, Heather M; Lawrence, Michael S; Stewart, Chip; Carter, Scott L; McKenna, Aaron; Rodriguez-Sanchez, Iram P; Espinosa-Castilla, Magali; Woie, Kathrine; Bjorge, Line; Wik, Elisabeth; Halle, Mari K; Hoivik, Erling A; Krakstad, Camilla; Gabiño, Nayeli Belem; Gómez-Macías, Gabriela Sofia; Valdez-Chapa, Lezmes D; Garza-Rodríguez, María Lourdes; Maytorena, German; Vazquez, Jorge; Rodea, Carlos; Cravioto, Adrian; Cortes, Maria L; Greulich, Heidi; Crum, Christopher P; Neuberg, Donna S; Hidalgo-Miranda, Alfredo; Escareno, Claudia Rangel; Akslen, Lars A; Carey, Thomas E; Vintermyr, Olav K; Gabriel, Stacey B; Barrera-Saldaña, Hugo A; Melendez-Zajgla, Jorge; Getz, Gad; Salvesen, Helga B; Meyerson, Matthew

    2014-02-20

    Cervical cancer is responsible for 10-15% of cancer-related deaths in women worldwide. The aetiological role of infection with high-risk human papilloma viruses (HPVs) in cervical carcinomas is well established. Previous studies have also implicated somatic mutations in PIK3CA, PTEN, TP53, STK11 and KRAS as well as several copy-number alterations in the pathogenesis of cervical carcinomas. Here we report whole-exome sequencing analysis of 115 cervical carcinoma-normal paired samples, transcriptome sequencing of 79 cases and whole-genome sequencing of 14 tumour-normal pairs. Previously unknown somatic mutations in 79 primary squamous cell carcinomas include recurrent E322K substitutions in the MAPK1 gene (8%), inactivating mutations in the HLA-B gene (9%), and mutations in EP300 (16%), FBXW7 (15%), NFE2L2 (4%), TP53 (5%) and ERBB2 (6%). We also observe somatic ELF3 (13%) and CBFB (8%) mutations in 24 adenocarcinomas. Squamous cell carcinomas have higher frequencies of somatic nucleotide substitutions occurring at cytosines preceded by thymines (Tp*C sites) than adenocarcinomas. Gene expression levels at HPV integration sites were statistically significantly higher in tumours with HPV integration compared with expression of the same genes in tumours without viral integration at the same site. These data demonstrate several recurrent genomic alterations in cervical carcinomas that suggest new strategies to combat this disease. PMID:24390348

  9. Comparison of Upper Cervical Flexion and Cervical Flexion Angle of Computer Workers with Upper Trapezius and Levator Scapular Pain

    PubMed Central

    Yoo, Won-gyu

    2014-01-01

    [Purpose] In this study, we compared upper cervical flexion and cervical flexion angle of computer workers with upper trapezius and levator scapular pain. [Subject] Eight male computer workers with upper trapezius muscle pain and eight others with levator scapular muscle pain participated. [Methods] Each subject was assessed in terms of upper cervical flexion angle and total cervical flexion angles using a cervical range of motion instrument after one hour of computer work. [Results] The upper cervical flexion angle of the group with levator scapular pain was significantly lower than that of the group with upper trapezius pain after computer work. The total cervical flexion angle of the group with upper trapezius pain was significantly lower than that of the group with levator scapular pain after computer work. [Conclusion] For selective and effective intervention for neck pain, therapists should evaluate upper and lower cervical motion individually. PMID:24648646

  10. Fusion versus Bryan Cervical Disc in two-level cervical disc disease: a prospective, randomised study

    PubMed Central

    Nie, Lin; Zhang, Li; Hou, Yong

    2008-01-01

    In this prospective study, our aim was to compare the functional results and radiographic outcomes of fusion and Bryan Cervical Disc replacement in the treatment of two-level cervical disc disease. A total of 65 patients with two-level cervical disc disease were randomly assigned to two groups, those operated on with Bryan Cervical Disc replacement (31) and those operated on with anterior cervical fusion with an iliac crest autograft and plate (34). Clinical evaluation was carried out using the visual analogue scale (VAS), the Short Form 36 (SF-36) and the neck disability index (NDI) during a two year follow-up. Radiological evaluation sought evidence of range of motion, stability and subsidence of the prosthesis. Substantial reduction in NDI scores occurred in both groups, with greater percent improvement in the Bryan group (P = 0.023). The arm pain VAS score improvement was substantial in both groups. Bryan artificial cervical disc replacement seems reliable and safe in the treatment of patients with two-level cervical disc disease. PMID:18956190

  11. A cervical ectopic masquerading as a molar pregnancy.

    PubMed

    Masir, N; Tamby, M R; Jamil, M A

    2000-03-01

    We report a case of cervical pregnancy complicated by life threatening hemorrhage. An initial diagnosis of molar pregnancy was made preoperatively. During uterine evacuation she developed profuse hemorrhage which required an emergency hysterectomy for uncontrolled bleeding. Histopathological examination confirmed a cervical pregnancy. The clinical and pathological criteria for the diagnosis and the etiology of cervical pregnancy are discussed. PMID:11072500

  12. Cervical adenocarcinoma identification by testing for chromosomal abnormalities.

    PubMed

    Dittus, Janet L; Dudley, Bunyan S; Upender, Madhvi; Endress, Gregory A

    2013-12-01

    We report on a case of cervical adenocarcinoma in situ in a 42-year-old woman with a history of human papillomavirus infection. Repeat cytology, human papillomavirus testing, and colposcopy failed to identify the lesion. Testing of the cervical cell DNA identified chromosomal abnormalities, prompting a cervical cone biopsy, which identified adenocarcinoma in situ. PMID:24283864

  13. Laparoscopic uterine artery occlusion before cervical curettage in cervical ectopic pregnancy: Safe and effective for preventing massive bleeding

    PubMed Central

    Choi, Hong-Seok; Kim, Na-Young

    2015-01-01

    Cervical ectopic pregnancy is associated with high risk for massive bleeding conditions. Cervical ectopic pregnancy can usually be treated by methotrexate injection or surgery. We present 4 cases of cervical ectopic pregnancy that were treated successfully with different uterine-conserving methods. By comparing our experience of 4 cases managed in different ways, we found that laparoscopic uterine artery occlusion before cervical curettage is more effective method for preventing massive bleeding. PMID:26430673

  14. The next steps in cervical screening.

    PubMed

    Sankaranarayanan, Rengaswamy; Qiao, You-lin; Keita, Namory

    2015-03-01

    Cervical cancer is fourth most common cancer among women with four-fifths of the global burden in low- and middle-income countries (LMICs). Persistent infection with one of the high-risk types of human papillomaviruses (HPV), particularly HPV 16/18, is the central cause of cervical neoplasia. Progress in developing feasible, alternative screening methods in LMICs and HPV vaccines have further improved cervical cancer prevention prospects. While existing screening programs in high-income countries should be re-organized, in view of the downstream effects of national HPV vaccination programs, LMICs should introduce national programs to vaccinate single year cohorts of girls aged 9-13 years with two or three doses and screen 30-35-year-old women with HPV testing to pragmatically decrease their high disease burden. PMID:25776294

  15. Structural brain abnormalities in cervical dystonia

    PubMed Central

    2013-01-01

    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. PMID:24131497

  16. Cervical Meningomyelitis After Lumbar Epidural Steroid Injection.

    PubMed

    Lee, Yujin; Kim, Joon-Sung; Kim, Ji Yeon

    2015-06-01

    Epidural steroid injections (ESI) are a common treatment for back pain management. ESI-related complications have increased with the growing number of procedures. We report a case of cervical meningomyelitis followed by multiple lumbar ESI. A 60-year-old male with diabetes mellitus presented to our hospital with severe neck pain. He had a history of multiple lumbar injections from a local pain clinic. After admission, high fever and elevated inflammatory values were detected. L-spine magnetic resonance imaging (MRI) revealed hematoma in the S1 epidural space. Antibiotic treatment began under the diagnosis of a lumbar epidural abscess. Despite the treatment, he started to complain of weakness in both lower extremities. Three days later, the weakness progressed to both upper extremities. C-spine MRI revealed cervical leptomeningeal enhancement in the medulla oblongata and cervical spinal cord. Removal of the epidural abscess was performed, but there was no neurological improvement. PMID:26161360

  17. [Screening for cervical and breast cancer].

    PubMed

    Wilm, J; Schüler-Toprak, S; Ortmann, O

    2016-09-01

    Screening programs for cervical cancer and breast cancer lead to a clear reduction of mortality. Starting in 2018 screening for cervical cancer will be structured as an organized program as already exists for breast cancer. In future screening for cervical cancer will be primarily performed by human papillomavirus (HPV) testing at intervals of 5 years while cytological examination (Pap smear) will also be available as an additional or alternative procedure. For breast cancer screening in Germany an annual clinical examination with palpation and mammography screening at 2‑year intervals is provided for women aged between 50 and 69 years. In Germany only approximately 50 % of invited women have used the opportunity to participate in screening in recent years. Weighing the benefits against the harms of cancer screening programs is always important in the process of evaluation of different strategies. PMID:27577734

  18. Cigarette smoking and invasive cervical cancer

    SciTech Connect

    Brinton, L.A.; Schairer, C.; Haenszel, W.; Stolley, P.; Lehman, H.F.; Levine, R.; Savitz, D.A.

    1986-06-20

    A case-control study of 480 patients with invasive cervical cancer and 797 population controls, conducted in five geographic areas in the United States, included an evaluation of the relationship of several cigarette smoking variables to cervical cancer risk. Although smoking was correlated with both age at first intercourse and number of sexual partners, a significant smoking-related risk persisted for squamous cell carcinoma after adjustment for these factors (relative risk, 1.5). Twofold excess risks were seen for those smoking 40 or more cigarettes per day and those smoking for 40 or more years. Increased risks, however, were observed only among recent and continuous smokers. In contrast to squamous cell cancer, no relationship was observed between smoking and risk of adenocarcinoma or adenosquamous carcinoma. These results suggest a causal relationship between cigarette smoking and invasive squamous cell cervical cancer, perhaps through a late-stage or promotional event, although the mechanisms of action require further elucidation.

  19. Surgical Strategies for Cervical Spinal Neurinomas

    PubMed Central

    ITO, Kiyoshi; AOYAMA, Tatsuro; MIYAOKA, Yoshinari; HORIUCHI, Tetsuyoshi; HONGO, Kazuhiro

    Cervical spinal neurinomas are benign tumors that arise from nerve roots. Based on their location, these tumors can also take the form of a dumbbell-shaped mass. Treatment strategies for these tumors have raised several controversial issues such as appropriate surgical indications and selection of surgical approaches for cervical dumbbell-shaped spinal neurinomas. In this report, we review previous literature and retrospectively analyze cervical spinal neurinoma cases that have been treated at our hospital. Surgical indications and approaches based on tumor location and severity are discussed in detail. Thus, with advances in neuroimaging and neurophysiological monitoring, we conclude that appropriate surgical approaches and intraoperative surgical manipulations should be chosen on a case-by-case basis. PMID:26119900

  20. Cervical epidural abscess caused by brucellosis.

    PubMed

    Lampropoulos, Christos; Kamposos, Panagiotis; Papaioannou, Ioanna; Niarou, Vasiliki

    2012-01-01

    A 70-year-old Greek lady presented with fever, arthralgias of knees, cervical and lumbar pain during the last month. On clinical examination the patient was found to have tenderness of the cervical and the lumbar spine with great motion restriction. The blood tests revealed high erythrocyte sedimentation rate and C-reactive protein, abnormal liver function tests and a positive rheumatoid factor. Serological test for Brucella was positive while cervical MRI revealed epidural abscess and spondylodiscitis. Conservative treatment with streptomycin (it was substituted by rifampicin after the third week) and doxycyclin for 4 months significantly improved her symptoms. The frequency as well as the diagnosis and management of this manifestation are discussed. PMID:23188848