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1

Prevalence of cervical spondylotic myelopathy.  

PubMed

BACKGROUND: Patients with signs and/or symptoms of cervical spondylotic myelopathy are frequently encountered in spinal practice. Exact numbers of prevalence or incidence are not known. METHODS: A literature search was performed by an experienced librarian in Pubmed, Embase, and Scopus. After selection of articles based on titles and abstracts, a full text review was performed. The prevalence of people needing surgical treatment was also estimated in a neurosurgical practice with a population adherence of 1.7 million people and a known referral pattern of the neurologists; all patients operated upon because of cervical spondylotic myelopathy between July 2009 and July 2012 were collected and prevalence calculated. RESULTS: The search of the literature did not reveal any article reporting an incidence or prevalence of cervical spondylotic myelopathy. Eighty of 5,992 patients were operated upon because of a cervical spondylotic myelopathy: 1.6 per 100,000 inhabitants. CONCLUSION: Surprisingly, an extensive search of the literature did not reveal exact data about the incidence or prevalence of cervical spondylotic myelopathy. The prevalence of surgically treated cervical spondylotic myelopathy was estimated as 1.6 per 100,000 inhabitants. Although the population adherence to the surgical practice is reasonably fixed and referral patterns are known, this estimate will still be too low for various reasons. At best, this estimate is the minimal prevalence of cervical spondylotic myelopathy that has been operated upon. To address the exact incidence or prevalence of cervical spondylotic myelopathy in general or needing surgical treatment, other investigations are warranted. PMID:23616201

Boogaarts, Hieronymus D; Bartels, Ronald H M A

2013-04-25

2

Surgical Management of Cervical Spondylotic Myelopathy  

PubMed Central

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

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

2010-01-01

3

Pathogenesis of cervical spondylotic myelopathy.  

PubMed Central

OBJECTIVE: To determine whether either of two mechanical theories predicts the topographic pattern of neuropathology in cervical spondylotic myelopathy (CSM). The compression theory states that the spinal cord is compressed between a spondylotic bar anteriorly and the ligamenta flava posteriorly. The dentate tension theory states that the spinal cord is pulled laterally by the dentate ligaments, which are tensed by an anterior spondylotic bar. METHODS: The spinal cord cross section, at the level of a spondylotic bar, is modelled as a circular disc subject to forces applied at its circumference. These forces differ for the two theories. From the pattern of forces at the circumference the distribution of shear stresses in the interior of the disc-that is, over the transverse section of the spinal cord-is calculated. With the assumption that highly stressed areas are most subject to damage, the stress pattern predicted by each theory can be compared to the topographic neuropathology of CSM. RESULTS: The predicted stress pattern of the dentate tension theory corresponds to the reported neuropathology, whereas the predicted stress pattern of the compression theory does not. CONCLUSIONS: The results strongly favour the theory that CSM is caused by tensile stresses transmitted to the spinal cord from the dura via the dentate ligaments. A spondylotic bar can increase dentate tension by displacing the spinal cord dorsally, while the dural attachments of the dentate, anchored by the dural root sleeves and dural ligaments, are displaced less. The spondylotic bar may also increase dentate tension by interfering locally with dural stretch during neck flexion, the resultant increase in dural stress being transmitted to the spinal cord via the dentate ligaments. Flexion of the neck increases dural tension and should be avoided in the conservative treatment of CSM. Both anterior and posterior extradural surgical operations can diminish dentate tension, which may explain their usefulness in CSM. The generality of these results must be tempered by the simplifying assumptions required for the mathematical model. Images

Levine, D N

1997-01-01

4

Surgical management of cervical spondylotic myelopathy.  

PubMed

Introduction: The surgical procedure by the anterior, posterior and combined antero-posterior approaches had applied for the treatment of cervical spondylotic myelopathy. Methods: During the treatment process, all patients were pre-operatively as well post-operatively graded according to Japanese Orthopaedics Association. Several surgical methods such as anterior approach, posterior approach, and combined antero-posterior approach have been addressed for CSM patients, with the choice based on the pathogenesis of the myelopathy. The main indications for surgery were evidence of myelopathy on physical examinations, a JOA score below 13 points help with spinal cord compression observed on plain X-ray, CT scan, MRI studies. Results: The pre-operative JOA scores were 7.60±1.23 in laminoplasty, 8.30±1.03 in diskectomy and corpectomy and 7.10±1.20 in combined antero-posterior approach patients. At the follow-up after three months the JOA scores were laminoplasty 13.30±1.30, diskectomy and corpectomy 13.55±1.15 and combined antero-posterior 13.50±1.08. The JOA recovery rate averaged, 61.08±11.25% in laminoplasty, 60.67±10.60% in diskectomy and corpectomy and 64.67±10.72% in combined antero-posterior approach. The high- signal intensity changed to normal in 18 out of 28 and no any kyphotic change and instability were found in cervical spine at the follow up. Conclusions: Patients with OPLL (continuous, segmental and mixed type), stenosis of cervical spinal canal, multilevel cervical spondylosis, large and high ossification of IVDP with stenosis were improved with laminoplasty. Patients with PIVD, CSM with kyphosis, post laminectomy , OPLL herniated type, unstable vertebral alignment, stenosis by osteophytes, were improved with anterior approach . Ossified or deformed OPLL, unstable vertebral with stenosis ,OPLL or OYL with cervical meandearing (swan-neck) were improved with Combined anterior and posterior approach. Keywords: Cervical spondylotic mylopathy, anterior cervical diskectomy and fusion, corpectomy. PMID:23591248

Sah, S; Wang, L; Dahal, M; Acharya, P; Dwivedi, R

5

Cervical Spondylotic Myelopathy: Pathophysiology, Clinical Presentation, and Treatment  

Microsoft Academic Search

Age-related changes in the spinal column result in a degenerative cascade known as spondylosis. Genetic, environmental, and\\u000a occupational influences may play a role. These spondylotic changes may result in direct compressive and ischemic dysfunction\\u000a of the spinal cord known as cervical spondylotic myelopathy (CSM). Both static and dynamic factors contribute to the pathogenesis.\\u000a CSM may present as subclinical stenosis or

Darren R. Lebl; Alex Hughes; Frank P. Cammisa; Patrick F. O’Leary

2011-01-01

6

Surgical outcomes of elderly patients with cervical spondylotic myelopathy  

Microsoft Academic Search

BackgroundCervical spondylotic myelopathy is a potentially serious neurologic disorder that commonly presents with gait difficulty and hand dysfunction. Because the development of CSM is in large part related to advanced spondylosis and degenerative disk disease, elderly patients appear to be at an increased risk to develop this condition. The surgical outcomes of this patient population have been understudied; the authors

Langston T. Holly; Parham Moftakhar; Larry T. Khoo; A. Nick Shamie; Jeffrey C. Wang

2008-01-01

7

Presymptomatic spondylotic cervical myelopathy: an updated predictive model  

PubMed Central

Spondylotic cervical cord compression detected by imaging methods is a prerequisite for the clinical diagnosis of spondylotic cervical myelopathy (SCM). Little is known about the spontaneous course and prognosis of clinically “silent” presymptomatic spondylotic cervical cord compression (P-SCCC). The aim of the present study was to update a previously published model predictive for the development of clinically symptomatic SCM, and to assess the early and late risks of this event in a larger cohort of P-SCCC subjects. A group of 199 patients (94 women, 105 men, median age 51 years) with magnetic resonance signs of spondylotic cervical cord compression, but without clear clinical signs of myelopathy, was followed prospectively for at least 2 years (range 2–12 years). Various demographic, clinical, imaging, and electrophysiological parameters were correlated with the time for the development of symptomatic SCM. Clinical evidence of the first signs and symptoms of SCM within the follow-up period was found in 45 patients (22.6%). The 25th percentile time to clinically manifested myelopathy was 48.4 months, and symptomatic SCM developed within 12 months in 16 patients (35.5%). The presence of symptomatic cervical radiculopathy and electrophysiological abnormalities of cervical cord dysfunction detected by somatosensory or motor-evoked potentials were associated with time-to-SCM development and early development (?12 months) of SCM, while MRI hyperintensity predicted later (>12 months) progression to symptomatic SCM. The multivariate predictive model based on these variables correctly predicted early progression into SCM in 81.4% of the cases. In conclusion, electrophysiological abnormalities of cervical cord dysfunction together with clinical signs of cervical radiculopathy and MRI hyperintensity are useful predictors of early progression into symptomatic SCM in patients with P-SCCC. Electrophysiological evaluation of cervical cord dysfunction in patients with cervical radiculopathy or back pain is valuable. Meticulous follow-up is justified in high-risk P-SCCC cases.

Kadanka, Zdenek; Dusek, Ladislav; Kerkovsky, Milos; Vohanka, Stanislav; Novotny, Oldrich; Urbanek, Igor; Kratochvilova, Dagmar

2008-01-01

8

MRI in the management of suspected cervical spondylotic myelopathy.  

PubMed Central

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

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

1991-01-01

9

Functional outcome of corpectomy in cervical spondylotic myelopathy  

PubMed Central

Background: Cervical spondylotic myelopathy (CSM) is serious consequence of cervical intervertebral disk degeneration. Morbidity ranges from chronic neck pain, radicular pain, headache, myelopathy leading to weakness, and impaired fine motor coordination to quadriparesis and/or sphincter dysfunction. Surgical treatment remains the mainstay of treatment once myelopathy develops. Compared to more conventional surgical techniques for spinal cord decompression, such as anterior cervical discectomy and fusion, laminectomy, and laminoplasty, patients treated with corpectomy have better neurological recovery, less axial neck pain, and lower incidences of postoperative loss of sagittal plane alignment. The objective of this study was to analyze the outcome of corpectomy in cervical spondylotic myelopathy, to assess their improvement of symptoms, and to highlight complications of the procedure. Materials and Methods: Twenty-four patients underwent cervical corpectomy for cervical spondylotic myelopathy during June 1999 to July 2005.The anterior approach was used. Each patient was graded according to the Nuricks Grade (1972) and the modified Japanese Orthopaedic Association (mJOA) Scale (1991), and the recovery rate was calculated. Results: Preoperative patients had a mean Nurick's grade of 3.83, which was 1.67 postoperatively. Preoperative patients had a mean mJOA score of 9.67, whereas postoperatively it was 14.50. The mean recovery rate of patients postoperatively was 62.35% at a mean follow-up of 1 year (range, 8 months to 5 years).The complications included one case (4.17%) of radiculopathy, two cases (8.33%) of graft displacement, and two cases (8.33%) of screw back out/failure. Conclusions: Cervical corpectomy is a reliable and rewarding procedure for CSM, with functional improvement in most patients.

Williams, Kanishka E; Paul, Rajesh; Dewan, Yashbir

2009-01-01

10

Cervical Spondylotic Myelopathy: Factors in Choosing the Surgical Approach  

PubMed Central

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

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

2012-01-01

11

C3-4 level cervical spondylotic myelopathy  

Microsoft Academic Search

Cervical spondylotic myelopathy (CSM) is uncommon at the C3-4 level. Fourteen patients with C3-4 CSM were treated over a period of 3 years. The radiological factors contribut- ing to CSM at the C3-4 level were studied. These factors included the assessment of static and dynamic canal diam- eters, retrolisthesis, posterior osteophytes and degenera- tive spinal segmental fusion on plain X-rays;

K. H. Vyas; Deepu Banerji; S. Behari; S. Jain; V. K. Jain; D. K. Chhabra

12

Laminoplasty versus Laminectomy and Fusion for Multilevel Cervical Spondylotic Myelopathy  

Microsoft Academic Search

Background  Cervical spondylotic myelopathy is increasingly prevalent in the elderly and is the leading cause of spinal cord dysfunction\\u000a in this population. Laminectomy with fusion and laminoplasty halt progression of myelopathy in these patients; however, both\\u000a procedures have well-documented complications and associated morbidity and it is unclear which might be most advantageous.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes  We therefore compared the pain, function and alignment of

Barrett I. Woods; Justin Hohl; Joon Lee; William Donaldson III; James Kang

2011-01-01

13

Cervical Spondylotic Myelopathy: Pathophysiology, Diagnosis, and Surgical Techniques  

PubMed Central

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

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

2011-01-01

14

(iv) Cervical spondylotic myelopathy: a brief review of its pathophysiology, presentation, assessment, natural history and management  

Microsoft Academic Search

Cervical spondylotic myelopathy (CSM) is a debilitating condition associated with spinal cord dysfunction. It frequently occurs in the elderly and accounts for the majority of non-traumatic spastic paraparesis and quadriparesis. Cervical myelopathy refers to the clinical syndrome of long-tract aberrations in both upper and lower extremities arising from cervical spinal cord compression. It is most commonly caused by degenerative spondylosis

Lushun Wang; Hwan Tak Hee; Hee Kit Wong

2011-01-01

15

Influence of intramedullary stress on cervical spondylotic myelopathy.  

PubMed

Study design:A cross-sectional analysis.Objective:To examine whether intramedullary stress is related to the appearance of symptoms in cervical spondylotic myelopathy (CSM).Setting:Japan.Methods:Thirty-three consecutive patients with CSM and 30 consecutive patients without CSM were enrolled. A total of 99 disc levels from C3 to C6 in 33 patients with CSM were divided into two groups: 33 disc levels with high signal intensity (HSI) on T2-weighted magnetic resonance image (HSI group) and 66 disc levels without HSI (Non-HSI group). Ninety disc levels from C3 to C6 in patients without CSM were set up in a control group. Intramedullary stress value at each level was analyzed using the finite element method. Stress was compared among the three groups. A cutoff value of stress to present HSI was investigated from receiver operator characteristics (ROC) curve.Results:In all the patients with CSM, the disc level with HSI presented the highest stress among the three disc levels evaluated. The stress was 3.16±0.86?kPa (mean±s.d.) in the HSI group, 1.81±0.72?kPa in the Non-HSI group and 1.01±0.37?kPa in the control group. The stress differed significantly among the three groups (P<0.0001). The qualified cutoff value derived from the ROC curve was 2.30?kPa (sensitivity 78.8%, specificity 91.9%). None of the disc levels in the control group exceeded 2.30?kPa.Conclusion:HSI was strongly associated with intramedullary stress. Threshold of intramedullary stress to present HSI that related closely to the symptoms of myelopathy was revealed. PMID:23999109

Takahashi, K; Ozawa, H; Sakamoto, N; Minegishi, Y; Sato, M; Itoi, E

2013-09-03

16

Motor evoked potentials in the post-surgical follow-up of cervical spondylotic myelopathy  

Microsoft Academic Search

Eighteen patients (6 female, 12 male; average age 51 years, range 37–79) with clinical and radiological evidence (MRI) of cervical spondylotic myelopathy (CSM) were examined. The subjects were divided into two groups depending on whether radiology indicated single level (9 patients) or multilevel (9 patients) compression of the cervical cord. All of the patients underwent surgical decompression. Seriate exam with

M. De Mattei; B. Paschero; D. Cassano; A. Campanella; L. Rizzo; E. Morgando

1995-01-01

17

Anterolisthesis and retrolisthesis of the cervical spine in cervical spondylotic myelopathy in the elderly  

Microsoft Academic Search

Background  Degenerative spondylolisthesis of the cervical spine has received insufficient attention in contrast to that of the lumbar\\u000a spine. The authors analyzed the functional significance of anterior and posterior degenerative spondylolisthesis (anterolisthesis\\u000a and retrolisthesis) of the cervical spine to elucidate its role in the development of cervical spondylotic myelopathy (CSM)\\u000a in the elderly.\\u000a \\u000a \\u000a \\u000a Methods  A total of 79 patients aged 65 or

Motohiro Kawasaki; Toshikazu Tani; Takahiro Ushida; Kenji Ishida

2007-01-01

18

A comparison of anterior cervical discectomy and corpectomy in patients with multilevel cervical spondylotic myelopathy  

Microsoft Academic Search

Background  The optimal surgical approach for multilevel cervical spondylotic myelopathy (CSM) has not been defined, and the relative\\u000a merits of multilevel anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy (2-level or skip 1-level\\u000a corpectomy) and fusion (ACCF) remain controversial. However, few comparative studies have been conducted on these two surgical\\u000a approaches.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  This study retrospectively reviewed the case histories of

Qiushui Lin; Xuhui Zhou; Xinwei Wang; Peng Cao; Nicholas Tsai; Wen Yuan

19

Imaging Modalities for Cervical Spondylotic Stenosis and Myelopathy  

PubMed Central

Cervical spondylosis is a spectrum of pathology presenting as neck pain, radiculopathy, and myelopathy or all in combination. Diagnostic imaging is essential to diagnosis and preoperative planning. We discuss the modalities of imaging in common practice. We examine the use of imaging to differentiate among central, subarticular, and lateral stenosis and in the assessment of myelopathy.

Green, C.; Butler, J.; Eustace, S.; Poynton, A.; O'Byrne, J. M.

2012-01-01

20

Surgical and conservative treatment of cervical spondylotic radiculopathy and myelopathy  

Microsoft Academic Search

Summary One hundred and fourteen patients were admitted to our department for evaluation of their cervical spondylogenetic symptoms, including local cervical pain, radiculopathy and myelopathy. This retrospective study gives the results, expressed as improved, unchanged or worse, of anterior surgery, posterior surgery and conservative treatment. Local cervical pain improved in about half of the patients, without any difference between the

O. Arnasson; C. A. Carlsson; L. Pellettieri

1987-01-01

21

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

Microsoft Academic Search

BackgroundResults showed good clinical outcomes of anterior corpectomy and fusion (ACCF) for patients with cervical spondylotic myelopathy (CSM) during a short term follow-up; however, studies assessing long term results are relatively scarce. In this study we intended to assess the long term clinical and radiographic outcomes, find out the factors that may affect the long term clinical outcome and evaluate

Rui Gao; Lili Yang; Huajiang Chen; Yang Liu; Lei Liang; Wen Yuan

2012-01-01

22

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

Microsoft Academic Search

OBJECTIVES: To investigate clinical effects and manual operational point of Bryan cervical disc prosthesis in Chinese, to observe the stability and range of movement (ROM) post-operatively. METHODS AND MATERIALS: From 2003,12 to 2005,12, Bryan disc prosthesis replacement applied in 83 cases (102 levels) of cervical spondylotic myelopathy (CSM) after anterior decompression in our hospital. Clinical (JOA grade and Odom's scale)

Yan Wang; Xuesong Zhang; Songhua Xiao; Ning Lu; Zheng Wang; Mi Zhou

2006-01-01

23

Computed tomography in cervical spondylotic myelopathy and radiculopathy: visualisation of structures, myelographic comparison, cord measurements and clinical utility  

Microsoft Academic Search

Sixty-nine patients with cervical spondylotic myelopathy (CSM), radiculopathy (CSR), or both (CSMR) were studied with computed tomography (CT). Computer-assisted myelography (CAM) accurately determines the site and nature of spondylotic protrusions and provides good visualisation of the subarachnoid space and cord deformities even in areas with dilute metrizamide. However, excessive vertebral movement and bulging ligamenta flava with their effects on cord

Y. L. Yu; G. H. Boulay; J. M. Stevens; B. E. Kendall

1986-01-01

24

Manual therapy and therapeutic exercise in patient with symptomatic cervical spondylotic myelopathy: A case report.  

PubMed

Cervical spondylotic myelopathy (CSM) is caused by narrowing of the cervical spinal canal, although surgical decompression is an obvious indication for spinal cord stenosis, there are not enough data to determine that surgery is the most indicated intervention for milder forms. The purpose of the present case report was to describe the outcomes results of the physical therapy treatment with emphasis on manual therapy and therapeutic exercise for a patient with CSM. A 58-year-old male patient attended the physical therapy clinic due to pain and paresthesia in the upper and lower limbs. The magnetic resonance imaging was compatible with spondylotic myelopathy. Following physical therapy treatment, the patient exhibited an improvement in functional capacity (triangle step test and timed 10-m walk), pain, paresthesia, mJOA scale and Neck Disability Index. Based on the lack of rapid evolution of neurological impairment, physical therapy treatment was indicated, which achieved satisfactory results. PMID:24139010

Almeida, Gabriel Peixoto Leão; Carneiro, Kysia Karine Almeida; Marques, Amélia Pasqual

2013-04-10

25

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

Microsoft Academic Search

The objective of the study was to investigate the comorbidity of degenerative spondylolisthesis (DS), in elderly cervical\\u000a spondylotic myelopathy (CSM) patients in our hospital, and the correlation between surgical results and preoperative DS. There\\u000a are few studies on the outcome of laminoplasty for CSM with DS. A total of 49 elderly patients (>65 years old) who eventually\\u000a had surgical treatment for

Hideki Shigematsu

2010-01-01

26

Imaging of spinal stenosis: neurogenic intermittent claudication and cervical spondylotic myelopathy.  

PubMed

Spinal stenosis in either the cervical or lumbar spinal segments is one of the most common indications for spine imaging and intervention, particularly among the elderly. This article examines the pathophysiology and imaging of the corresponding clinical syndromes, cervical spondylotic myelopathy or neurogenic intermittent claudication. The specificity fault of spine imaging is readily evident in evaluation of spinal stenosis, as many patients with anatomic cervical or lumbar central canal narrowing are asymptomatic. Imaging also may be insensitive to dynamic lesions. Those imaging features that identify symptomatic patients, or predict response to interventions, are emphasized. PMID:22643390

Maus, Timothy P

2012-07-01

27

Decompressive laminoplasty in multisegmental cervical spondylotic myelopathy: bilateral cutting versus open-door technique  

Microsoft Academic Search

Purpose  The aim of the study was to evaluate patients with multisegmental cervical spondylotic myelopathy (MCM) surgically treated\\u000a via a dorsal approach. Two different laminoplasty techniques were compared by assessment of enlargement of the spinal canal\\u000a and the neurological outcome.\\u000a \\u000a \\u000a \\u000a Methods  Thirteen patients (mean age 49 years, 11 males) underwent decompressive laminoplasty over a 7-year period. The average duration\\u000a of symptoms was 21 months.

Siamak Asgari; Hischam Bassiouni; Nagi Massoud; Marc Schlamann; Dietmar Stolke; I. Erol Sandalcioglu

2009-01-01

28

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

PubMed

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

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

2013-07-17

29

Anterior corpectomy and reconstruction with titanium mesh cage and dynamic cervical plate for cervical spondylotic myelopathy in elderly osteoporosis patients  

Microsoft Academic Search

Objective  This retrospective study was to evaluate the relationship between osteoporosis and dynamic cervical plates in screw–plate\\u000a or screw–bone interface of elderly cervical spondylotic myelopathy (CSM) patients.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Retrospective study was conducted on elderly CSM patients, treated by anterior corpectomy and reconstruction with titanium\\u000a mesh cages (TMC) and dynamic cervical plate between July 2004 and June 2007. All patients underwent bone mineral

Denglu Yan; Zhaojie Wang; Shaojie Deng; Jian Li; Chenglong Soo

30

Cervical spondylotic radiculo-myelopathy in patients with athetoid-dystonic cerebral palsy: clinical evaluation and surgical treatment.  

PubMed Central

The acute onset of symptoms of severe cervical radiculo-myelopathy in four patients with athetoid-dystonic cerebral palsy is reported. Neurological and radiological examination showed that the spondylotic changes of the cervical spine were responsible for new neurological deficits leading to the patients being bedridden. Dystonic-athetoid neck movements may cause excessive axial neck rotation as well as flexion and extension movements of the spine. These repetitive exaggerated movements may result in early degenerative changes of the vertebrae which may enhance the radiculo-myelopathy. The four patients were treated with an anterior discectomy with interbody fusion. They were bedridden pre-operatively but all have since been able to walk with or without a cane. It is concluded that early anterior decompression with interbody fusion is a treatment of choice for cervical spondylotic radiculo-myelopathy in association with athetoid cerebral palsy. Images

Hirose, G; Kadoya, S

1984-01-01

31

Cervical spondylotic radiculo-myelopathy in patients with athetoid-dystonic cerebral palsy: clinical evaluation and surgical treatment.  

PubMed

The acute onset of symptoms of severe cervical radiculo-myelopathy in four patients with athetoid-dystonic cerebral palsy is reported. Neurological and radiological examination showed that the spondylotic changes of the cervical spine were responsible for new neurological deficits leading to the patients being bedridden. Dystonic-athetoid neck movements may cause excessive axial neck rotation as well as flexion and extension movements of the spine. These repetitive exaggerated movements may result in early degenerative changes of the vertebrae which may enhance the radiculo-myelopathy. The four patients were treated with an anterior discectomy with interbody fusion. They were bedridden pre-operatively but all have since been able to walk with or without a cane. It is concluded that early anterior decompression with interbody fusion is a treatment of choice for cervical spondylotic radiculo-myelopathy in association with athetoid cerebral palsy. PMID:6470718

Hirose, G; Kadoya, S

1984-08-01

32

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

PubMed Central

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

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

2012-01-01

33

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

PubMed Central

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

2010-01-01

34

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

PubMed Central

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

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

2013-01-01

35

Surgical approach to cervical spondylotic myelopathy on the basis of radiological patterns of compression: prospective analysis of 129 cases  

Microsoft Academic Search

This is a prospective analysis of 129 patients operated for cervical spondylotic myelopathy (CSM). Paucity of prospective\\u000a data on surgical management of CSM, especially multilevel CSM (MCM), makes surgical decision making difficult. The objectives\\u000a of the study were (1) to identify radiological patterns of cord compression (POC), and (2) to propose a surgical protocol\\u000a based on POC and determine its

Mihir R. Bapat; Kshitij Chaudhary; Amit Sharma; Vinod Laheri

2008-01-01

36

Cervical spondylotic myelopathy with vitamin B12 deficiency: Two case reports  

PubMed Central

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

XU, YAO; CHEN, WENJUN; JIANG, JIANYUAN

2013-01-01

37

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

PubMed Central

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

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

2012-01-01

38

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

PubMed Central

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

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

2012-01-01

39

Decompression for cervical myelopathy  

Microsoft Academic Search

Background contextCervical spondylotic myelopathy is a degenerative condition of the cervical spine. Surgical decompression is considered the gold standard of treatment, yet multiple published studies failed to yield consistent clinical results. Properly designed clinical outcomes studies using physiological, functional, and self-reported measures have the ability to define the best intervention for this disease entity. Many validated outcomes measures for cervical

Brian T. Jankowitz; Peter C. Gerszten

2006-01-01

40

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

PubMed Central

Objectives To investigate clinical effects and manual operational point of Bryan cervical disc prosthesis in Chinese, to observe the stability and range of movement (ROM) post-operatively. Methods and materials From 2003,12 to 2005,12, Bryan disc prosthesis replacement applied in 83 cases (102 levels) of cervical spondylotic myelopathy (CSM) after anterior decompression in our hospital. Clinical (JOA grade and Odom's scale) and radiological (X-ray of flexion, extension; left and right bending position) follow-up was performed. Systemic radiographic study about stability and ROM of replaced level post operationally were measured. CT or MRI scans were applied in all cases to evaluate the signs of the prosthesis deflexion and hetero-ossification in the replaced levels. Results At least 12 months follow-up were done in 65/83 of these paients. All of 83 patients were improved according to Odsm's scale. JOA score increased from average 8.7 to 15.5. There was no prosthesis subsidence. Replaced segment achieved stability and restored partial of normal ROM 4.73°(3.7°–5.9°) early postoperation and 8.12°(5.8°–13.6°) more than 12 months postoperation in flex and extension position. No obvious loss of lordosis was found. CT or MRI follow-up shows position deflexion of the prosthesis metal endplates (<1.5 mm) in 14/77 levels and (1.5~3 mm) in 4/77. heter-ossification was found in the replaced levels only in 2 cases. Conclusion Byran cervical disc prosthesis restored motion to the level of the intact segment in flexion-extension and lateral bending in post-operative images. At the same time, it can achieve good anterior decompression treatment effect and immediate stability in replaced 1 or 2 levels, and which is a new choice for the treatment of CSM.

Wang, Yan; Zhang, Xuesong; Xiao, Songhua; Lu, Ning; Wang, Zheng; Zhou, Mi

2006-01-01

41

Cervical spondylotic myelopathy with occult foramen magnum meningioma--a case for MRI?  

Microsoft Academic Search

A fatal case of occult foramen magnum meningioma is described which presented with features of cervical myelopathy confirmed by cervical myelogram. Surgical decompression led to initial improvement followed by progressive deterioration and death. Postmortem examination revealed a 4 cm diameter foramen magnum meningioma. The dangers of using only standard radiographic investigations of the cervical cord are discussed.

K. Chakravarty; D. G. Scott; D. Dick; J. Visick

1993-01-01

42

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

PubMed Central

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

Swanson, Brian T

2012-01-01

43

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

PubMed

Tandem spinal stenosis is a clinical phenomenon which may cause a functional loss related to neurologic compression in numerous areas of the spinal cord. In this phenomenon, the second area of symptomatic neurologic insult is not revealed until the primary symptomatic area has been treated. This case describes a 71-year-old male referred to physical therapy 4 weeks following a combined anterior/posterior C3/4 decompression and fusion for treatment of cervical spondylotic myelopathy. Approximately 8 weeks post-operatively (4 weeks after initiation of physical therapy), the patient began to complain of bilateral lower extremity weakness, primarily with climbing stairs. At 12 weeks post-operatively, the patient developed bowel incontinence and saddle paresthesia. Magnetic resonance imaging revealed multiple levels of critical stenosis of the lower thoracic and upper lumbar spine, which resulted in referral for surgical intervention. Following surgical decompression there was complete recovery of lower extremity strength, saddle area sensation and bowel function. This case highlights the need for the clinician to remain vigilant for concomitant pathology despite successful surgical intervention. A thorough knowledge of the presentation of various spinal disorders, as well as a thorough neurologic examination, is required to accurately recognize both candid and subtle red flags requiring immediate referral for surgical intervention. PMID:23372394

Swanson, Brian T

2012-02-01

44

Cervical spondylotic amyotrophy  

Microsoft Academic Search

Cervical spondylotic amyotrophy is characterized with weakness and wasting of upper limb muscles without sensory or lower\\u000a limb involvement. Two different mechanisms have been proposed in the pathophysiology of cervical spondylotic amyotrophy. One\\u000a is selective damage to the ventral root or the anterior horn, and the other is vascular insufficiency to the anterior horn\\u000a cell. Cervical spondylotic amyotrophy is classified

Sheng-Dan Jiang; Lei-Sheng Jiang; Li-Yang Dai

2011-01-01

45

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

PubMed Central

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

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

2013-01-01

46

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

PubMed

The present study aimed to evaluate the value of pre-operative magnetic resonance imaging (MRI) combined with electromyography (EMG) for predicting clinical outcome following surgical management of cervical spondylotic myelopathy (CSM). A total of 94 patients with cervical compressive myelopathy were prospectively enrolled and treated with anterior, posterior and posterior-anterior united decompression between October 2007 and February 2009. Prior to surgery 1.5-T MRI and EMG were performed in all patients. The patients were classified into four types based on the presence (+) or absence (-) of an increased signal intensity (ISI) on the T2-weighted magnetic resonance (MR) images and also based on the positive (+)/negative (-) results of the EMG. The four types were as follows: Type I, MRI/EMG (-/-); Type II, MRI/EMG (+/-); Type III, MRI/EMG (-/+); and Type IV, MRI/EMG (+/+). The clinical outcome was also graded according to a modified Japanese Orthopedic Association (JOA) scoring system. Furthermore, pre- and post-operative clinical data were statistically analyzed to explore the correlation between the factors. There were 36 cases (38%) of Type I, 16 (17%) of Type II, 13 (14%) of Type III and 29 (31%) of Type IV. According to the analysis of the clinical data between the four types, there were significant differences in the disability classifications, pre-operative JOA scores and disease duration (P<0.05), but there were no significant differences in gender, age or cord compression ratios (P>0.05). Until the final follow-up, there was a significant difference in the recovery ratio between the four study groups (Hc=27.46, P<0.05). Further comparison showed that the surgical outcome was best in Type I patients and worst in Type IV patients. In conclusion, there was a distinct correlation between classification and the rate of clinical improvement. Patients who had a negative EMG and those without an ISI on T2-weight images tended to suffer only mild symptoms, a short disease duration and, most significantly, experience a good surgical outcome. PMID:23596492

Liu, Fa-Jing; Sun, Ya-Peng; Shen, Yong; Ding, Wen-Yuan; Wang, Lin-Feng

2013-01-30

47

Predictors of outcome in patients with degenerative cervical spondylotic myelopathy undergoing surgical treatment: results of a systematic review.  

PubMed

PURPOSE: To conduct a systematic review of the literature to determine important clinical predictors of surgical outcome in patients with cervical spondylotic myelopathy (CSM). METHODS: A literature search was performed using MEDLINE, MEDLINE in Process, EMBASE and Cochrane Database of Systematic Reviews. Selected articles were evaluated using a 14-point modified SIGN scale and classified as either poor (<7), good (7-9) or excellent (10-14) quality of evidence. For each study, the association between various clinical factors and surgical outcome, evaluated by the (modified) Japanese Orthopaedic Association scale (mJOA/JOA), Nurick score or other measures, was defined. The results from the EXCELLENT studies were compared to the combined results from the EXCELLENT and GOOD studies which were compared to the results from all the studies. RESULTS: The initial search yielded 1,677 citations. Ninety-one of these articles, including three translated from Japanese, met the inclusion and exclusion criteria and were graded. Of these, 16 were excellent, 38 were good and 37 were poor quality. Based on the excellent studies alone, a longer duration of symptoms was associated with a poorer outcome evaluated on both the mJOA/JOA scale and Nurick score. A more severe baseline score was related with a worse outcome only on the mJOA/JOA scale. Based on the GOOD and EXCELLENT studies, duration of symptoms and baseline severity score were consistent predictors of mJOA/JOA, but not Nurick. Age was an insignificant predictor of outcome on any of the functional outcomes considered. CONCLUSION: The most important predictors of outcome were preoperative severity and duration of symptoms. This review also identified many other valuable predictors including signs, symptoms, comorbidities and smoking status. PMID:23386279

Tetreault, Lindsay A; Karpova, Alina; Fehlings, Michael G

2013-02-01

48

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

PubMed Central

Surgical treatment of cervical spondylotic myelopathy (CSM) aims to prevent or delay the progression of the disease. Many patients are diagnosed in advanced stages of the disease, presenting severe functional disability and extensive radiologic changes, which suggests clinical irreversibility. There are doubts about the real benefit of surgery in patients who are seriously ill, bedridden or in a wheelchair. The objective of the study is to evaluate the effects of surgical treatment in the clinical outcomes of patients severely affected by CSM. We analyzed patients with CSM who received an operation at a single institution between 1996 and 2008. Cases with a preoperative Nurick score equal to 5 were studied. We describe postoperative clinical improvement and compare the demographics and clinical data between the patients who improved and those who had no improvement. Radiological findings were also analyzed. We evaluated 55 patients operated on. Nine presented with preoperative Nurick score of 5 (16.3%). The mean age was 69.77 ± 6.6 years (95% CI 64.65–79.90). The mean follow-up was 53.44 ± 35.09 months (CI 26.46–80.42). Six patients (66.6%) achieved functional improvement when assessed by the Nurick scale, regaining the ability to walk. All patients improved on the JOAm scale, except one. The mean preoperative Nurick score was 5, while the mean postoperative Nurick score was 4.11 ± 0.92 (95% CI 3.39–4.82) (Wilcoxon p = 0.027). The mean preoperative JOAm score was 6.4, and postoperative was 9.88 ± 2.31 (CI 95% 8.10–11.66) (Wilcoxon p = 0.011). All spinal cords presented high-intensity signal on T2-weighted images. There was no correlation between the number of spinal cord high-intensity signal levels and clinical improvement. Three out of seven patients (whose image was adequate for analysis) had evident spinal cord atrophy, and two of them did not improve clinically. In the whole sample of patients, the mean length of disease for those who improved was 9.25 ± 7.31 months (95% CI 1.56–16.93), and for those who did not improve was 38.00 ± 19.28 months (95% CI 9.91–85.91) (Mann–Whitney p = 0.02). In conclusion, two-thirds of patients with CSM Nurick scores of 5 who were either bedridden or in wheelchairs at the time of diagnosis improved at least one degree on the Nurick scale after surgical treatment, thus returning to walking. The JOAm scale was more sensitive to clinical changes than the Nurick scale. Patients with longer lengths of disease had worse outcomes.

Rocha, Leonardo Poubel; Barcelos, Alecio Cristino Evangelista Santos; Rotta, Jose Marcus; Botelho, Ricardo Vieira

2010-01-01

49

The genetic association of Vitamin D receptor polymorphisms and cervical spondylotic myelopathy in Chinese subjects  

Microsoft Academic Search

BackgroundThe association of vitamin D receptor (VDR) gene polymorphisms to the lumbar degenerative disc disease has been previously studied; however, the role of VDR gene polymorphisms in cervical spondylosis remains unknown.

Zhan Chao Wang; Xiong Sheng Chen; Da Wei Wang; Jian Gang Shi; Lian Shun Jia; Guang Hui Xu; Jian Hou Huang; Lei Fan

2010-01-01

50

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

NASA Astrophysics Data System (ADS)

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

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

2009-10-01

51

Operative Treatment of Cervical Myelopathy: Cervical Laminoplasty  

PubMed Central

Cervical spondylotic myelopathy (CSM) is a degenerative process which may result in clinical signs and symptoms which require surgical intervention. Many treatment options have been proposed with various degrees of technical difficulty and technique sensitive benefits. We review laminoplasty as a motion-sparing posterior decompressive method. Current literature supports the use of laminoplasty for indicated decompression. We also decribe our surgical technique for an open-door, or “hinged”, laminoplasty.

Braly, Brett A.; Lunardini, David; Cornett, Chris; Donaldson, William F.

2012-01-01

52

Comparison of ventral corpectomy and plate-screw-instrumented fusion with dorsal laminectomy and rod-screw-instrumented fusion for treatment of at least two vertebral-level spondylotic cervical myelopathy  

Microsoft Academic Search

The objective of the article is to verify the hypothesis that the dorsal multilevel laminectomy and rod-screw-instrumented\\u000a fusion (DLF) for multilevel spondylotic cervical myelopathy (MSCM) is less strenuous for patients, and less prone to perioperative\\u000a complications, than ventral multilevel corpectomy and plate-screw-instrumented fusion (VCF), while clinical outcome is comparable.\\u000a One hundred and three successive patients were treated for at least

Rudolf Andreas Kristof; Thomas Kiefer; Marcus Thudium; Florian Ringel; Michael Stoffel; Attlila Kovacs; Christian-Andreas Mueller

2009-01-01

53

Clinical study Posterior cervical decompression and fusion for circumferential spondylotic cervical stenosis: Review of 50 consecutive cases  

Microsoft Academic Search

Purpose of Study: This study presents a clinical and radiological evaluation of 50 consecutive patients with symptomatic spondylotic cervical myelopathy and circumferential spinal cord compression who were managed with a single stage wide posterior laminectomy and lateral mass instrumented fusion. Methods Used: 50 consecutive patients (33 male, 17 female) over a 4 year period presenting with symptomatic cervical myelopathy due

Lali H. S. Sekhon

54

Radiculopathy and Myelopathy in Patients with Primary Cervical Dystonia  

Microsoft Academic Search

In a prospective series of 34 incident patients with primary cervical dystonia (CD), 6 showed clinical or radiological signs of cervical radiculopathy (RP) or myelopathy (MP) during the course of their movement disorder. Age at onset in these patients was in the range reported for pure spondylotic cervical RP without an accompanying movement disorder. Radiologically, spondylosis was mild in 1

Johann M. Hagenah; Alexandra Vieregge; Peter Vieregge

2001-01-01

55

Operative Outcomes for Cervical Myelopathy and Radiculopathy  

PubMed Central

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.

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

2012-01-01

56

Symptomatic progression of cervical myelopathy and the role of nonsurgical management: a consensus statement.  

PubMed

This section of the cervical spondylotic myelopathy Spine focus issue collates the existing evidence related to natural history and nonoperative management. In the case of patients with symptomatic cervical spondylotic myelopathy treated nonoperatively, while 20% to 62% will deteriorate at 3 to 6 years of follow-up, no specific patient or disease characteristics have been shown to predict this change reliably. For patients without myelopathy with spondylotic cord compression, the rate of myelopathy development is approximately 8% at 1 year and approximately 23% at 4 years of follow-up. Clinical and/or electrophysiological evidence of cervical radiculopathy has been shown to predict such progression and should prompt strong consideration of surgical decompression. With respect to nonoperative care, in the case of mild myelopathy, there is low evidence that such treatment may have a role; for moderate and severe myelopathy, this treatment results in outcomes inferior to those of surgery and is not recommended. Given the unpredictably progressive nature of cervical myelopathy, the indications for nonoperative management are ostensibly limited. Finally, the preclinical rationale and clinical translation of a putative neuroprotective drug, which may one day serve to augment the effects of surgery in the treatment of cervical spondylotic myelopathy, is presented and discussed. PMID:23963011

Fehlings, Michael G; Wilson, Jefferson R; Yoon, S Tim; Rhee, John M; Shamji, Mohammed F; Lawrence, Brandon D

2013-10-15

57

Cervical spondylotic radiculomyelopathy in patients with athetoid-dystonic cerebral palsy: clinical evaluation and surgical treatment  

Microsoft Academic Search

The acute onset of symptoms of severe cervical radiculo-myelopathy in four patients with athetoid-dystonic cerebral palsy is reported. Neurological and radiological examination showed that the spondylotic changes of the cervical spine were responsible for new neurological deficits leading to the patients being bedridden. Dystonic-athetoid neck movements may cause excessive axial neck rotation as well as flexion and extension movements of

G Hirose; S Kadoya

1984-01-01

58

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

PubMed Central

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

Kotil, Kadir; Ozyuvaci, Emine

2011-01-01

59

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

PubMed

BACKGROUND: Cervical spondylotic myelopathy is frequently encountered in neurosurgical practice. The posterior surgical approach includes laminectomy and laminoplasty. OBJECTIVE: To perform a systematic review evaluating the effectiveness of posterior laminectomy compared with posterior laminoplasty for patients with cervical spondylotic myelopathy. METHODS: An extensive search of the literature in Pubmed, Embase, and Cochrane library was performed by an experienced librarian. Risk of bias was assessed by two authors independently. The quality of the studies was graded, and the following outcome measures were retrieved: pre- and postoperative (m)JOA, pre- and postoperative ROM, postoperative VAS neck pain, and Ishira cervical curvature index. If possible data were pooled, otherwise a weighted mean was calculated for each study and a range mentioned. RESULTS: All studies were of very low quality. Due to inadequate description of the data in most articles, pooling of the data was not possible. Qualitative interpretation of the data learned that there were no clinically important differences, except for the higher rate of procedure-related complications with laminoplasty. CONCLUSION: Based on these results, a claim of superiority for laminoplasty or laminectomy was not justified. The higher number of procedure-related complications should be considered when laminoplasty is offered to a patient as a treatment option. A study of robust methodological design is warranted to provide objective data on the clinical effectiveness of both procedures. PMID:23575659

Bartels, Ronald H M A; van Tulder, Maurits W; Moojen, Wouter A; Arts, Mark P; Peul, Wilco C

2013-04-11

60

A Prospective, Randomized Trial Comparing Expansile Cervical Laminoplasty versus Cervical Laminectomy and Fusion for Multi-level Cervical Myelopathy.  

PubMed

BACKGROUND:: Controversy exists as to the best posterior operative procedure to treat multi-level compressive cervical spondylotic myelopathy. OBJECTIVE:: To determine clinical, radiological and patient satisfaction outcomes between these two surgical procedures. METHODS:: We performed a prospective, randomized study of Expansile Cervical Laminoplasty (ECL) vs. Cervical Laminectomy and Fusion (CLF) in patients suffering from cervical spondylotic myelopathy. End-points included the SF-36, the NDI, VAS, modified JOA score, Nurick score and radiographic measures. RESULTS:: A survey of academic North American spine surgeons (n=30) demonstrated that CLF is the most commonly used (70%) posterior procedure to treat multi-level spondylotic cervical myelopathy. A total of 16 patients were randomized: CLF (n=7) / ECL (n=9). Both groups showed improvements in their Nurick grade and JOA score postoperatively, but only the improvement in the Nurick grade for the ECL group was statistically significant (p<0.05). The cervical ROM between C2 and C7 was reduced by 75% in the CLF group and by only 20% in the ECL group when comparing pre- and post-op range of motion. The overall increase in canal area was significantly (p<0.001) greater in the CLF, but there was a suggestion that the adjacent level was more narrowed in the CLF group in as little as 1 year post-operative. CONCLUSION:: ECL compares favorably in many respects to CLF. While patient numbers are small, there were significant improvements in pain measures in the ECL group while still maintaining range of motion. Restoration of spinal canal area was superior in the CLF group. PMID:21817931

Manzano, Glen R; Casella, Gizelda; Wang, Michael Y; D O D C, Steven Vanni; Levi, Allan D

2011-08-02

61

Conservative treatment with hyperbaric oxygen therapy for cervical spondylotic amyotrophy  

Microsoft Academic Search

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

K Tofuku; H Koga; K Yone; S Komiya

2011-01-01

62

Surgical management of degenerative cervical myelopathy: a consensus statement.  

PubMed

Degenerative cervical myelopathy (DCM), including cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament, presents a heterogenous set of variables reflecting its complex nature. Multiple studies in the past have attempted to elucidate an ideal surgical algorithm that surgeons may use when treating these patients, unfortunately all studies to date, including the rigorous systematic review used in this focus issue, have fallen short in identifying a superior approach when addressing DCM. Likely because of a superior approach being nonexistent because there are multiple pathoanatomical considerations. In addition to the multitude of variables that spine surgeons face when deciding the treatment options for patients with DCM, the previous studies that have been published, unfortunately, lack in consistent outcome and complication reporting. Therefore, synthesizing a treatment algorithm remains difficult, however, the articles in this focus issue use the GRADE system to assess the overall quality (strength) of available evidence and, where appropriate, formulate evidence-based recommendations. Factors that should be included in surgical decision making are the sagittal alignment, anatomical location of the compressive pathology, number of levels of compression, presence of absence or instability or subluxation, the type compressive pathology (e.g., spondylosis vs. ossification of the posterior longitudinal ligament), neck anatomy, bone quality, and surgeon experience or preference. Fortunately, as reviewed in the accompanying articles, a number of excellent surgical options exist that can be selected on the basis of the aforementioned pathoanatomical considerations. PMID:23963012

Lawrence, Brandon D; Shamji, Mohammed F; Traynelis, Vincent C; Yoon, S Tim; Rhee, John M; Chapman, Jens R; Brodke, Darrel S; Fehlings, Michael G

2013-10-15

63

Pathophysiology and treatment for cervical flexion myelopathy  

Microsoft Academic Search

Previous studies have suggested that spinal cord compression by the vertebral bodies and intervertebral discs during neck flexion cause cervical flexion myelopathy (CFM). However, the exact pathophysiology of CFM is still unknown, and surgical treatment for CFM remains controversial. We examined retrospectively patients with CFM based on studies of the clinical features, neuroradiological findings, and neurophysiological assessments. The objectives of

Yoshinori Fujimoto; Shinichi Oka; Nobuhiro Tanaka; Kohichiro Nishikawa; Hiroyuki Kawagoe; Itsushi Baba

2002-01-01

64

Cervical myelopathy due to degenerative spondylolisthesis  

PubMed Central

Objective To investigate clinical-radiological features of cervical myelopathy due to degenerative spondylolisthesis (DSL). Methods A total of 448 patients were operated for cervical myelopathy at Nishitaga National Hospital between 2000 and 2003. Of these patients, DSL at the symptomatic disc level was observed in 22 (4.9%) patients. Clinical features were investigated by medical records, and radiological features were investigated by radiographs. Results Disc levels of DSL were C3/4 in 6 cases and C4/5 in 16 cases. Distance of anterior slippage was 2 to 5 mm (average 2.9 mm) in flexion position. Space available for the spinal cord (SAC) was 11 to 15 mm (average 12.8 mm) in flexion position and 11 to 18 mm (average14.6 mm) in extension position; 11 cases were reducible and 11 cases were irreducible in extension position. Myelograms demonstrated compression of spinal cord by the ligamentum flavum in extension position. Compression of spinal cord was not demonstrated in flexion position. C5-7 lordosis angle was lower than control. C5-7 range of motion (ROM) was reduced compared to controls. These alterations were statistically significant. Conclusions DSL occurs in the mid-cervical spine. Lower cervical spine demonstrated restricted ROM and lower lordosis angle. Pathogenesis of cervical myelopathy due to DSL is compression of spinal cord by the ligamentum flavum in extension position and not by reduced SAC in flexion position.

2011-01-01

65

Cervical spondylotic amyotrophy presenting as dropped head syndrome.  

PubMed

We report a case of acute-onset dropped head syndrome in a 65-year-old patient in whom the diagnosis of amyotrophic lateral sclerosis (ALS) was initially proposed based on electromyographic signs of neck and shoulder muscle denervation. There were no signs of pyramidal involvement and the clinical and electromyographic signs of motor denervation never evolved beyond the neck and shoulder girdle muscles after a 6-year follow-up period, which argued against ALS. Other causes of dropped head syndrome were carefully ruled out based on clinical findings, electrodiagnostic studies and blood investigations. The restriction of muscle denervation to a few cervical myotomes, the presence of C3-C4 spondylotic changes without associated root or spinal cord compression, and the absence of an alternative explanation to the patient's symptoms strongly supported the diagnosis of cervical spondylotic amyotrophy (CSA). CSA is thought to result from spinal cord microcirculatory disturbances and secondary anterior horn cell degeneration due to ischemia. Our case enlarges the clinical spectrum of focal cervical anterior horn disease, which classically results in more distal monomelic atrophy affecting one or both upper limbs. PMID:19647927

Ahdab, Rechdi; Créange, Alain; Benaderette, Sandrine; Lefaucheur, Jean-Pascal

2009-08-03

66

[Langerhans cell histiocytosis causing cervical myelopathy].  

PubMed

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

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

2012-05-01

67

Posterior Cervical Inclinatory Foraminotomy for Spondylotic Radiculopathy Preliminary  

PubMed Central

Posterior cervical foraminotomy is an attractive therapeutic option in selected cases of cervical radiculopathy that maintains cervical range of motion and minimize adjacent-segment degeneration. The focus of this procedure is to preserve as much of the facet as possible with decompression. Posterior cervical inclinatory foraminotomy (PCIF) is a new technique developed to offer excellent results by inclinatory decompression with minimal facet resection. The highlight of our PCIF technique is the use of inclinatory drilling out for preserving more of facet joint. The operative indications are radiculopathy from cervical foraminal stenosis (single or multilevel) with persistent or recurrent root symptoms. The PCIFs were performed between April 2007 and December 2009 on 26 male and 8 female patients with a total of 55 spinal levels. Complete and partial improvement in radiculopathic pain were seen in 26 patients (76%), and 8 patients (24%), respectively, with preserving more of facet joint. We believe that PCIF allows for preserving more of the facet joint and capsule when decompressing cervical foraminal stenosis due to spondylosis. We suggest that our PCIF technique can be an effective alternative surgical approach in the management of cervical spondylotic radiculopathy.

Chang, Jae-Chil; Choi, Soon-Kwan

2011-01-01

68

Amyotrophic cervical myelopathy in adolescence.  

PubMed Central

The clinical and radiological features in seven patients who had asymmetric muscular atrophy of the hand and forearm when young are reported and a new hypothesis for its aetiology is proposed. Investigation of body growth curves (a surrogate for velocity of arm growth) showed close relation between (a) the age when the body height increased most rapidly and the onset age of this disorder, and (b) the age when the rapid body growth period ended and the age when symptom progression ceased. Cervical radiological evidence is provided showing asymmetric anterior cord atrophy, disappearance of slackness of dorsal roots in neck extension, and anterior and lateral displacement of the lower cervical cord against the posterior aspects of the vertebral bodies during neck flexion. These results suggest that disproportionate shortening of the dorsal roots is further accentuated during the juvenile growth spurt, which determines the onset and self limited course of the condition, and that repeated neck flexion causes micro-trauma and relative ischaemia of anterior horn cells, which finally results in atrophy of the muscles innervated by motoneurons with long axons. Predisposing anatomical factors are a straight neck due to lack of physiological cervical lordosis and the presence of foreshortened dorsal roots. Images

Toma, S; Shiozawa, Z

1995-01-01

69

Cervical arthroplasty for myelopathy adjacent to previous multisegmental fusion  

Microsoft Academic Search

In recent years, there has been increasing interest in the use of cervical arthroplasty for the treatment of degenerative cervical pathology. In its relative infancy, the applications for this technique are still being explored. In this report, we present the use of cervical arthroplasty in the treatment of progressive cervical myelopathy due to adjacent segment disease related to previous multisegmental

Ralph J. Mobbs; Nicholas Mehan; Peter Khong

2009-01-01

70

Clinical outcomes of microendoscopic decompression surgery for cervical myelopathy  

Microsoft Academic Search

Retrospective study on the results of microendoscopic decompression surgery for the treatment of cervical myelopathy. The\\u000a purpose of this study was to describe the microendoscopic laminoplasty (MEL) technique as the surgical method in the treatment\\u000a of cervical myelopathy, and to document the clinical outcomes for MEL surgery. Endoscopic surgery poses several challenges\\u000a for the aspiring endoscopic surgeons, the most critical

Akihito Minamide; Munehito Yoshida; Hiroshi Yamada; Yukihiro Nakagawa; Kazuhiro Maio; Masaki Kawai; Hiroshi Iwasaki

2010-01-01

71

An outcome measure for patients with cervical myelopathy: Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ): Part 1  

Microsoft Academic Search

Background  An outcome measure to evaluate the neurological function of cervical myelopathy was proposed by the Japanese Orthopaedic Association\\u000a in 1975 (JOA score), and has been widely used in Japan. However, the JOA score does not include patients’ satisfaction, disability,\\u000a handicaps, or general health, which can be affected by cervical myelopathy. The purpose of this study was to develop a new

Mitsuru Fukui; Kazuhiro Chiba; Mamoru Kawakami; Shin-ichi Kikuchi; Shin-ichi Konno; Masabumi Miyamoto; Atsushi Seichi; Tadashi Shimamura; Osamu Shirado; Toshihiko Taguchi; Kazuhisa Takahashi; Katsushi Takeshita; Toshikazu Tani; Yoshiaki Toyama; Eiji Wada; Kazuo Yonenobu; Takashi Tanaka; Yoshio Hirota

2007-01-01

72

Neurogenic bladder in patients with cervical compressive myelopathy.  

PubMed

We examined the urinary disturbances in 56 consecutive patients with cervical compressive myelopathy using the latest International Continence Society classification. Of the 56 patients with cervical compressive myelopathy, 29 (52%) had some urinary subjective complaints, whereas the remaining 27 (48%) had none. Urologic examination indicated that 8 of these 29 (28%) patients with urinary complaints had urologic disorders other than neurogenic bladder. Of the remaining 21 patients, only 6 (25%) were judged to have neurogenic bladder on urodynamic study. Urodynamic study may be of limited value in diagnosing urinary disturbance in cervical myelopathy. Further, four cases (83%) showed underactive bladder activity in voiding phase, and only one case (17%) showed overactive bladder activity in filling phase. These results were contrary to those of previous studies indicating that cervical compressive myelopathy is associated with overactive bladder activity in filling phase. There were no significant differences in motor or sensory Japanese Orthopedic Association scores between the patients with and without urinary complaints. However, the patients with urinary complaints had significantly longer durations of myelopathy and delayed motor evoked potential latencies than those without urinary complaints. After surgery, 19 of the 21 (90%) patients with urinary complaints showed recovery from urinary disturbance. Operations in patients with cervical myelopathy were also effective against urinary disturbance. Urinary complaints may be an indication for surgical treatment despite the results of urodynamic study. PMID:16021011

Misawa, Tomoko; Kamimura, Mikio; Kinoshita, Tetsuya; Itoh, Hidehiro; Yuzawa, Yohei; Kitahara, Jun

2005-08-01

73

Correlation between pyramidal signs and the severity of cervical myelopathy  

PubMed Central

A retrospective study was performed to determine the sensitivities of the pyramidal signs in patients with cervical myelopathy, focusing on those with increased signal intensity (ISI) in T2-weighted magnetic resonance imaging (MRI). The relationship between prevalence of the pyramidal signs and the severity of myelopathy was investigated. We reviewed the records of 275 patients with cervical myelopathy who underwent surgery. Of these, 143 patients were excluded from this study due to comorbidities that might complicate neurological findings. The MR images of the remaining 132 patients were evaluated in a blinded fashion. The neurological findings of 120 patients with ISI (90 men and 30 women; mean age 61 years) were reviewed for hyperreflexia (patellar tendon reflex), ankle clonus, Hoffmann reflex, and Babinski sign. To assess the severity of myelopathy, the motor function scores of the upper and lower extremities for cervical myelopathy set by the Japanese Orthopaedic Association (m-JOA score) were used. The most prevalent signs were hyperreflexia (94%), Hoffmann reflex (81%), Babinski sign (53%), and ankle clonus (35%). Babinski sign (P < 0.001), ankle clonus, and Hoffmann reflex showed significant association with the lower m-JOA score. Conversely, no association was found with the upper m-JOA score. In patients with cervical myelopathy, hyperreflexia showed the highest sensitivity followed by Hoffmann reflex, Babinski sign, and ankle clonus. The prevalence of the pyramidal signs correlated with increasing severity of myelopathy. Considering their low sensitivity in patients with mild disability, the pyramidal signs may have limited utility in early diagnosis of cervical myelopathy.

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

2010-01-01

74

Patient perceived outcome after central corpectomy for cervical spondylotic myelopathy  

Microsoft Academic Search

BackgroundPatient perception of outcome after decompressive surgery for CSM is infrequently reported. We evaluated a simple, quantitative patient-reported assessment of outcome after CC for CSM by comparing it with the NGRR.

Vedantam Rajshekhar; Jayaprakash Muliyil

2007-01-01

75

Ubiquitin expression in degenerating axons of equine cervical compressive myelopathy.  

PubMed

Neuropathologic examination revealed axonal swelling and breakdown leading to Wallerian degeneration of affected myelinated nerve fibers in the spinal cord white matter of four young horses with equine cervical compressive myelopathy. Immunohistochemical reactions for the cell stress protein ubiquitin revealed an enhanced presence in the swollen axons, which may reflect a role for ubiquitin in the neuronal catabolic process of axonal compression and degeneration in this myelopathy. PMID:8740714

Jortner, B S; Scarratt, W K; Modransky, P D; Walton, A; Perkins, S K

1996-05-01

76

Pallidal deep brain stimulation in patients with cervical dystonia and severe cervical dyskinesias with cervical myelopathy  

PubMed Central

Objectives: Surgical treatment of complex cervical dystonia and of cervical dyskinesias associated with cervical myelopathy is challenging. In this prospective study, the long term effect of chronic pallidal stimulation in cervical dystonia and on combining the technique with spinal surgery in patients with severe cervical dyskinesias and secondary cervical myelopathy is described. Methods: Eight patients with a history of chronic dystonia who did not achieve adequate benefit from medical treatment or botulinum toxin injection participated in the study. Five patients had complex cervical dystonia with tonic postures and phasic movements. Three patients had rapidly progressive cervical myelopathy secondary to severe cervical dyskinesias and dystonia in the context of a generalised movement disorder. Quadripolar electrodes were implanted in the posteroventral lateral globus pallidus internus with stereotactic CT and microelectrode guidance. In the three patients with secondary cervical myelopathy, spinal surgery was performed within a few weeks and included multilevel laminectomies and a four level cervical corporectomy with spinal stabilisation. Results: Improvement of the movement disorder was noted early after pallidal surgery, but the full benefit could be appreciated only with a delay of several months during chronic stimulation. Three months after surgery, patients with cervical dystonia had improved by 38% in the severity score, by 54% in the disability score, and by 38% in the pain score of a modified version of the Toronto western spasmodic torticollis rating scale. At a mean follow up of 20 months, the severity score had improved by 63%, the disability score by 69%, and the pain score by 50% compared with preoperatively. There was also sustained amelioration of cervical dyskinesias in the three patients who underwent spinal surgery. Lead fractures occurred in two patients. The mean amplitude needed for chronic deep brain stimulation was 3.8 V at a mean pulse width of 210 µs, which is higher than that used for pallidal stimulation in Parkinson's disease. Conclusions: Chronic pallidal stimualtion is effective for complex cervical dystonia and it is a useful adjunct in patients with cervical dyskinesias and secondary cervical myelopathy who undergo spinal surgery.

Krauss, J; Loher, T; Pohle, T; Weber, S; Taub, E; Barlocher, C; Burgunder, J

2002-01-01

77

Cervical myelopathy due to nuclear herniations in young adults: clinical and radiological profile, results of microdiscectomy without interbody fusion.  

PubMed Central

A study was made of the clinical and radiological characteristics and the results of microsurgical discectomy without interbody fusion, of 26 young adults, who presented with cervical myelopathy due to nuclear herniations. Neck trauma was not a significant aetiological factor. The disease produced moderate to very severe functional disability in most patients (73%), in a relatively short period (mean symptom duration 6.3 months). Radiological assessment revealed the presence of canal stenosis, significant disc protrusions with paucity of spondylotic changes in most patients. At operation, soft disc lesions were found in 85% and sequestrated discs in 31%. Microsurgical discectomy without fusion produced gratifying recovery of functional disability without significant deleterious effects on the cervical spine. Images

Selladurai, B M

1992-01-01

78

A rodent model of chronic compressive cervical myelopathy  

Microsoft Academic Search

Degenerative chronic spinal cord compression induced cervical myelopathy is a common cause of spinal cord dysfunction. The disease generally leads to impairment of the sensory and motor function of the cord progressively and insidiously. However, the underlying pathophysiology and the precise mechanism of the disease are still uncertain and remain to be investigated. The establishment of an animal model which

Darrell T. H. Li; Y. Hu; Ed X. Wu; K. D. K. Luk

2009-01-01

79

Cervical myelopathy in an adolescent with hallervorden-spatz disease  

Microsoft Academic Search

Hallervorden-Spatz disease is a rare neurodegenerative disorder characterized by progressive dystonia, rigidity, and dementia. In these patients, chronic repeated dystonic movements, especially of the head and neck, can lead to excessive stress on the cervical spine, resulting in early degenerative changes and myelopathy. This report focuses on a young patient with Hallervorden-Spatz disease who presented with C4 to C5 cervical

Genevieve Po Gee Fung; Kwok Yin Chan

2003-01-01

80

Myelopathy and spinal deformity: relevance of spinal alignment in planning surgical intervention for degenerative cervical myelopathy.  

PubMed

Surgical management of degenerative cervical myelopathy requires careful pathoanatomic consideration to select between various surgical options from both anterior and posterior approach. Hitherto, unexplored is the relevance of cervical deformity to the pathophysiology of such neurological disability, and whether correction of that deformity should be a surgical objective when planning for reconstruction after spinal cord decompression. Such correction could address both the static cord compression and the dynamic repetitive cord injury, while also restoring more normal biomechanics to the cervical spine. The articles in this focus issue's section on cervical spinal deformity reveal that cervical sagittal alignment is geometrically related to thoracolumbar spinal pelvic alignment and to T1 slope, and that it is further clinically correlated to regional disability and general health scores and to myelopathy severity. These conclusions are based on narrative reviews and a selection of primary research data, reflecting the nascency of this field. They further recommend for preoperative assessment of spinal alignment when significant deformity is suspected, and that correction of cervical kyphosis should be an objective when surgery is planned. PMID:23963013

Shamji, Mohammed F; Ames, Christopher P; Smith, Justin S; Rhee, John M; Chapman, Jens R; Fehlings, Michael G

2013-10-15

81

Treatment of cervical myelopathy in patients with the fibromyalgia syndrome: outcomes and implications  

Microsoft Academic Search

Some patients with fibromyalgia also exhibit the neurological signs of cervical myelopathy. We sought to determine if treatment\\u000a of cervical myelopathy in patients with fibromyalgia improves the symptoms of fibromyalgia and the patients’ quality of life.\\u000a A non-randomized, prospective, case control study comparing the outcome of surgical (n = 40) versus non-surgical (n = 31) treatment of cervical myelopathy in patients with fibromyalgia was

Dan S. Heffez; Ruth E. Ross; Yvonne Shade-Zeldow; Konstantinos Kostas; Mary Morrissey; Dean A. Elias; Alan Shepard

2007-01-01

82

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

PubMed Central

Background In primary care, it is often difficult to diagnose cervical myelopathy. However, a delay in treatment could cause irreversible aftereffects. With a brief and effective self-administered questionnaire for cervical myelopathy, cervical myelopathy may be screened more easily and oversight may be avoided. As there is presently no screening tool for cervical myelopathy, the aim of this study was to develop a self-administered questionnaire for the screening of cervical myelopathy. Methods A case-control study was performed with the following two groups at our university hospital from February 2006 to September 2008. Sixty-two patients (48 men, 14 women) with cervical myelopathy who underwent operative treatment were included in the myelopathy group. In the control group, 49 patients (20 men, 29 women) with symptoms that could be distinguished from those of cervical myelopathy, such as numbness, pain in the upper extremities, and manual clumsiness, were included. The underlying conditions were diagnosed as carpal tunnel syndrome, cubital tunnel syndrome, thoracic outlet syndrome, tarsal tunnel syndrome, diabetes mellitus neuropathy, cervical radiculopathy, and neuralgic amyotrophy. Twenty items for a questionnaire in this study were chosen from the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire, which is a new self-administered questionnaire, as an outcome measure for patients with cervical myelopathy. Data were analyzed by univariate analysis using the chi-square test and by multiple logistic regression analysis. According to the resulting odds ratio, ?-coefficients, and p value, items were chosen and assigned a score. Results Eight items were chosen by univariate and multiple logistic regression analyses and assigned a score. The Hosmer-Lemeshow statistic showed p = 0.805. The area under the receiver operation characteristic curve was 0.86. The developed questionnaire had a sensitivity of 93.5% and a specificity of 67.3%. Conclusions We successfully developed a simple self-administered questionnaire to screen for cervical myelopathy.

2010-01-01

83

Cervical radiculopathy and myelopathy: when and what can surgery contribute to treatment?  

Microsoft Academic Search

Indications and timing ¶of surgical treatment for cervical radiculopathy and myelopathy, and the long-term results for the\\u000a conditions, were reviewed. Advances in spinal imaging and accumulation of clinical experience have provided some clues as\\u000a to indications and timing of surgery for cervical myelopathy. Duration of myelopathy prior to surgery and the transverse area\\u000a of the spinal cord at the maximum

Kazuo Yonenobu

2000-01-01

84

Surgical results and complications in a series of 71 consecutive cervical spondylotic corpectomies  

Microsoft Academic Search

Background  Cervical corpectomy is a common procedure in spondylosis. It is normally a well-tolerated surgery and clinical improvement\\u000a is widely described. However, it is associated with potential risky complications (subsidence, clinical deterioration, vertebral\\u000a artery injury...); thus, a judicious surgical indication and a good technique are required.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We revised retrospectively the clinical evolution and complications of 71 spondylotic corpectomies in a series

Gaizka Bilbao; Melchor Duart; Juan Jose Aurrecoechea; Iñigo Pomposo; Alfonso Igartua; Gregorio Catalán; Maria Luisa Jauregui; Jesus Garibi

2010-01-01

85

Anterior decompressive microsurgery and osteosynthesis for the treatment of multi-segmental cervical spondylosis  

Microsoft Academic Search

Summary Surgical treatment of cervical myelopathy due to multi-segmental cervical spondylosis (MSCS) is currently performed by either anterior or posterior approaches. Considering the complex nature of the underlying disease involving more than one cervical segment, as well as the patho-biomechanical features of the spondylotic cervical spine, adequate decompression of the spinal cord and correction of hypermobility should be achieved by

V. Seifert

1995-01-01

86

Clustered clinical findings for diagnosis of cervical spine myelopathy  

PubMed Central

Cervical spine myelopathy (CSM) is a clinical diagnosis made with imaging confirmation. At present, most clinical tests used to identify CSM are specific and no clusters of tests have proven more beneficial than stand alone tests in guiding treatment decision making. This study endeavored to produce a cluster of predictive clinical findings for a sample of patients using a clinical diagnosis/imaging confirmation as the reference standard for cervical spine myelopathy. Data from 249 patients with various conditions associated with cervical spine dysfunction were analyzed to determine which clinical tests and measures, when clustered together, were most diagnostic for CSM. Using multivariate regression analyses and calculations for sensitivity, specificity, and positive and negative likelihood ratios, a definitive cluster was identified. Thirteen clinical findings were investigated for capacity to diagnosis CSM. Five clinical: (1) gait deviation; (2) +Hoffmann’s test; (3) inverted supinator sign; (4) +Babinski test; and (5) age >45 years, were demonstrated the capacity when clustered into one of five positive tests to rule out CSM (negative likelihood ratio?=?0.18; 95% CI?=?0.12–0.42), and when clustered into three of five positive findings to rule in CSM (positive likelihood ratio?=?30.9; 95% CI?=?5.5–181.8). This study found clustered combinations of clinical findings that could rule in and rule out CSM. These clusters may be useful in identifying patients with this complex diagnosis in similar patient populations.

Cook, Chad; Brown, Christopher; Isaacs, Robert; Roman, Matthew; Davis, Samuel; Richardson, William

2010-01-01

87

A comparative study of surgical approaches for cervical compressive myelopathy.  

PubMed

Since 1986, the authors have used anterior decompression and fusion to treat patients with one- or two-level lesions without spinal canal stenosis (Group A) and laminoplasty for patients with more than three-level lesions or spinal canal stenosis (Group P). The aim of this study was to compare surgical outcomes of anterior and posterior approaches for patients with cervical myelopathy because of spondylosis and disc herniation and to determine the cause of poor neurologic recovery after surgery. One hundred thirty-six patients were followed up for an average of 5.6 years. There were no significant differences in gender, preoperative neurologic deficits, axial symptoms, or duration of symptoms before surgery between the two groups. Mean recovery rates for disc herniations were 71.1% and 71.9% in Groups A and P, respectively. For spondylosis, mean recovery rates were 49.0% and 58.6% in Groups A and P, respectively. There were no differences in recovery rate for patients with either spinal disorder between Groups A and P. The neurologic recovery of patients with kyphotic spinal cord was inferior to that of patients with lordotic or straight spinal cord. It is possible that acquisition and maintenance of lordosis result in improvement of clinical outcomes after surgery for patients with myelopathy. PMID:11127649

Kawakami, M; Tamaki, T; Iwasaki, H; Yoshida, M; Ando, M; Yamada, H

2000-12-01

88

Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ): Part 2. Endorsement of the alternative item  

Microsoft Academic Search

Background  A new self-administered questionnaire as an outcome measure for patients with cervical myelopathy was drawn up in Part 1 (Japanese\\u000a Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire, JOACMEQ). Because a question with regard to driving\\u000a a car (C-41) was not suitable for this patient group, the authors composed an alternative question related to neck motion\\u000a (C-41-2). The purposes of the present

Mitsuru Fukui; Kazuhiro Chiba; Mamoru Kawakami; Shin-ichi Kikuchi; Shin-ichi Konno; Masabumi Miyamoto; Atsushi Seichi; Tadashi Shimamura; Osamu Shirado; Toshihiko Taguchi; Kazuhisa Takahashi; Katsushi Takeshita; Toshikazu Tani; Yoshiaki Toyama; Eiji Wada; Kazuo Yonenobu; Takashi Tanaka; Yoshio Hirota

2007-01-01

89

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

Microsoft Academic Search

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

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

2010-01-01

90

Surgical results of anterior corpectomy in the aged patients with cervical myelopathy  

Microsoft Academic Search

Retrospective study on the results of anterior corpectomy for the treatment of cervical myelopathy in patients over 70 years\\u000a old. To evaluate the surgical results of anterior corpectomy in aged patients with multilevel cervical myelopathy and to investigate\\u000a the probable pathomechanism by radiographic study. There are few data focused on the surgical results and post-operative complications\\u000a of anterior corpectomy in aged

Jun Lu; Xiaotao Wu; Yonggang Li; Xiangfei Kong

2008-01-01

91

Regional impairment of 18 F-FDG uptake in the cervical spinal cord in patients with monosegmental chronic cervical myelopathy  

Microsoft Academic Search

Objective  The aim of this preliminary report was to assess glucose metabolism in the cervical spine of patients with chronic compressive\\u000a myelopathy by using FDG PET.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Ten patients with monosegmental chronic degenerative stenosis and local cord compression of the upper\\/middle cervical spine\\u000a with signs of myelopathy on MRI and 10 control patients without known cervical abnormalities were investigated by FDG PET.

Frank Willi Floeth; Gabriele Stoffels; Jörg Herdmann; Paul Jansen; Wolfgang Meyer; Hans-Jakob Steiger; Karl-Josef Langen

2010-01-01

92

Synovial cyst in the cervical region causing severe myelopathy.  

PubMed

The authors describe a case of an 80-year-old man with a gradual weakness of the lower extremities not linked to any known traumatic episode over the 2 weeks before admission. CT scan and MRI of the spine revealed a cystic formation, measuring about 1 cm in diameter, at C7-T1 at the left posterolateral site at the level of the articular facet. During surgery, the mass appeared to be in the ligamentum flavum at the level of the articular facet and was in contact with the dura mater. After the removal of the mass, there was an immediate and significant improvement of the patient's symptoms. Histopathologic examination showed the cyst to be composed of nonspecific degenerative fibrous tissue with mild inflammatory change and confirmed the cyst as a synovial cyst. Synovial cyst in the cervical region is a very rare lesion causing myelopathy. Surgical removal of the cyst and decompression of the spinal cord results in good neurological recovery. PMID:15227744

Cho, Bo Young; Zhang, Ho Yeol; Kim, Han Sung

2004-06-30

93

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

Microsoft Academic Search

PurposeIntervertebral cervical disc herniation (CDH) is a relatively common disorder that can coexist with degenerative changes to worsen cervicogenic myelopathy. Despite the frequent disc abnormalities found in asymptomatic populations, magnetic resonance imaging (MRI) is considered excellent at detecting cervical spine myelopathy (CSM) associated with disc abnormality. The objective of this study was to investigate the intra- and inter-observer reliability of

Andresa Braga-Baiak; Anand Shah; Ricardo Pietrobon; Larissa Braga; Arnolfo Carvalho Neto; Chad Cook

2008-01-01

94

Successful treatment of cervical myelopathy with minimal morbidity by circumferential decompression and fusion  

Microsoft Academic Search

Circumferential cervical decompression and fusion (CCDF) is an important technique for treating patients with severe cervical\\u000a myelopathy. While circumferential cervical decompression and fusion may provide improved spinal cord decompression and stability\\u000a compared to unilateral techniques, it is commonly associated with increased morbidity and mortality. We performed a retrospective\\u000a analysis of patients undergoing CCDF at the University of California, San Francisco

Henry E. Aryan; Rene O. Sanchez-Mejia; Sharona Ben-Haim; Christopher P. Ames

2007-01-01

95

Metrizamide CT myelography in cervical myelopathy and radiculopathy: correlation with conventional myelography and surgical findings  

SciTech Connect

Conventional myelography, metrizamide computed tomographic (CT) myelography, and surgical findings were correlated in 30 patients with cervical radiculopathy and/or myelopathy. In 60% of patients, metrizamide CT myelography provided significant additional information including better characterization of the abnormality, lateralization if the conventional myelogram was indeterminate, more definitive demonstration of cord atrophy, foraminal narrowing not appreciated on myelography, and demonstration of abnormalities distal to a myelographic block. In no case was a myelographic abnormality not detected on metrizamide CT meyelography. In patients with cervical myelopathy, a cross-sectional diameter of the cord equaling less than 50% of the subarachnoid space is predictive of poor patient response to surgical intervention.

Badami, J.P.; Norman, D.; Barbaro, N.M.; Cann, C.E.; Weinstein, P.R.; Sobel, D.F.

1985-04-01

96

The natural history of asymptomatic lumbar canal stenosis in patients undergoing surgery for cervical myelopathy.  

PubMed

We retrospectively examined the prevalence and natural history of asymptomatic lumbar canal stenosis in patients treated surgically for cervical compressive myelopathy in order to assess the influence of latent lumbar canal stenosis on the recovery after surgery. Of 214 patients who had undergone cervical laminoplasty for cervical myelopathy, we identified 69 (32%) with myelographically documented lumbar canal stenosis. Of these, 28 (13%) patients with symptomatic lumbar canal stenosis underwent simultaneous cervical and lumbar decompression. Of the remaining 41 (19%) patients with asymptomatic lumbar canal stenosis who underwent only cervical surgery, 39 were followed up for ? 1 year (mean 4.9 years (1 to 12)) and were included in the analysis (study group). Patients without myelographic evidence of lumbar canal stenosis, who had been followed up for ? 1 year after the cervical surgery, served as controls (135 patients; mean follow-up period 6.5 years (1 to 17)). Among the 39 patients with asymptomatic lumbar canal stenosis, seven had lumbar-related leg symptoms after the cervical surgery. Kaplan-Meier analysis showed that 89.6% (95% confidence interval (CI) 75.3 to 96.0) and 76.7% (95% CI 53.7 to 90.3) of the patients with asymptomatic lumbar canal stenosis were free from leg symptoms for three and five years, respectively. There were no significant differences between the study and control groups in the recovery rate measured by the Japanese Orthopaedic Association score or improvement in the Nurick score at one year after surgery or at the final follow-up. These results suggest that latent lumbar canal stenosis does not influence recovery following surgery for cervical myelopathy; moreover, prophylactic lumbar decompression does not appear to be warranted as a routine procedure for coexistent asymptomatic lumbar canal stenosis in patients with cervical myelopathy, when planning cervical surgery. PMID:22371547

Tsutsumimoto, T; Shimogata, M; Yui, M; Ohta, H; Misawa, H

2012-03-01

97

Cervical Cord Compressive Myelopathy in a Man With a Primary Complaint of Knee Pain  

PubMed Central

Background: Diagnosing patients with cervical cord compressive myelopathy in a timely manner can be challenging due to varying clinical presentations, the absence of pathognomonic findings, and symptoms that are usually insidious in nature. Objective: To describe the clinical course of a patient with primary complaint of left medial knee pain that was nonresponsive to surgical and conservative measures; the patient was subsequently diagnosed with cervical cord compressive myelopathy. Design: Case report. Subject: A 63-year-old man with a primary complaint of left medial knee pain. Findings: Physical examination of the left knee was normal except for slight palpable tenderness over the medial joint line. During treatment, he noted loss of balance during activities of daily living. Reassessment revealed bilateral upper extremity hyperreflexia, bilateral Babinski reflex, and positive bilateral Hoffman reflex. Magnetic resonance imaging of the cervical spine demonstrated moderately severe spinal stenosis at the C3-C4, C5-C6, and C6-C7 levels. After C3-C7 laminoplasty for cervical cord compressive myelopathy, he reported substantial improvement of his left medial knee. Three years later, he had no complaint of knee pain. Conclusion: Appropriate diagnosis and treatment of cervical cord compressive myelopathy may avoid unnecessary diagnostic imaging, medical evaluations, invasive procedures, and potential neurologic complications.

Ross, Michael D; Elliott, Ryan

2010-01-01

98

Anterior cervical interbody fusion with plate fixation for chronic spondylotic radiculopathy: a 2- to 8-year follow-up.  

PubMed

In retrospectively analyzing 35 consecutive patients with chronic spondylotic radiculopathy treated by nerve root decompression, interbody fusion (Robinson technique), and plating, we studied the perioperative complication rate as well as the long-term clinical and radiologic outcomes of an additional plate fixation in degenerative cervical disorders. After an average of 54 months (range 24-102 months), all cases were reviewed for the purpose of this study. There were no perioperative or postoperative complications related to the plate fixation. In particular, there was no infection, graft extrusion, or neurologic deterioration. A solid fusion was obtained in all cases with a single-level fusion and in 87% of the cases with a multilevel fusion. The overall fusion rate was 94%. The clinical outcome of the patients with chronic radiculopathy was comparable with that in the literature, with only three patients (8.6%) having a poor result. This study demonstrated that plate fixation can be a useful adjunct in patients undergoing interbody fusion for cervical spondylotic radiculopathy. Plate fixation seems to reduce the rate of nonunion without additional hazards for the patient. This report should form the basis for a prospective randomized trial to answer the question more conclusively of whether an additional plate fixation is superior to uninstrumented cervical fusion in degenerative disorders. PMID:10382774

Schneeberger, A G; Boos, N; Schwarzenbach, O; Aebi, M

1999-06-01

99

Predictors of outcome of surgery for cervical compressive myelopathy: retrospective analysis and prospective study.  

PubMed

The outcomes of surgical treatment in 80 patients with cervical compressive myelopathy were retrospectively reviewed to examined the correlations between surgical outcomes and the following seven predictive factors: age at surgery, duration of symptoms, severity of myelopathy, number of compressed segments, intramedullary high intensity segments on T(2)-weighted magnetic resonance (MR) imaging, surgical method, and the type of disease. The recovery rates were evaluated at 3 months after the surgery. Significant correlations were observed between recovery rate and duration of symptoms, severity of myelopathy, and high intensity segments on T(2)-weighted MR imaging. No statistical correlation was observed with the other factors. Multivariate analysis revealed significant correlations between recovery rate and duration of symptoms and number of high intensity segments on T(2)-weighted MR imaging. The multiple regression equation was expressed as follows: recovery rate = 82.981 + 0.101 x (age) - 0.675 x (duration) - 1.452 x (number of compressed segments) - 1.451 x (preoperative Neurosurgical Cervical Spine Scale) - 13.826 x (number of high intensity segments). Based on this predicted formula, we compared the predicted and actual recovery rates for 17 patients treated recently. The two values were similar except in two patients with long duration of symptoms. We conclude that the surgical outcome can be predicted to a certain extent and this information could be provided to patients considering surgery for cervical compressive myelopathy. PMID:16723815

Park, Young-Su; Nakase, Hiroyuki; Kawaguchi, Shoichiro; Sakaki, Toshisuke; Nikaido, Yuji; Morimoto, Tetsuya

2006-05-01

100

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

PubMed

To assess neurological status and to evaluate the effect of surgical decompression in patients with cervical myelopathy, we performed computerized gait analysis in 24 patients with cervical compressive myelopathy who showed spastic walking. Gait analysis was repeated during neurological follow-up that averaged 32.4 months. The gait pattern in patients with severe myelopathy was characterized by hyperextension of the knee in the stance phase without plantar flexion of the ankle in the swing phase, significantly reduced walking speed and step length, prolonged stance phase duration and decreased single-stance phase duration, and increased step width. The angle of flexion of the knee joint in the stance phase was significantly correlated with the Japanese Orthopaedic Association (JOA) score. Postoperative neurological improvement was associated with increased walking speed and decreased extension angle of the knee joint (single-stance phase and swing phase). Postoperatively, 12 patients had normalized extension of the knee in stance phase and their walking speed, cadence, stance phase duration, and single-stance phase duration, as well as step length and width, showed nonsignificant differences from these parameters in healthy controls. Our results show that kinesiological gait analysis is clinically useful for the functional assessment of the severity of spastic walking in cervical myelopathy. PMID:11845345

Maezawa, Y; Uchida, K; Baba, H

2001-01-01

101

Cervical myelopathy in athetoid and dystonic cerebral palsy: retrospective study and literature review  

PubMed Central

The early onset of degenerative cervical lesions has been well described in patients suffering from athetoid or dystonic cerebral palsy. Myelopathy can occur and aggravate of their unstable neurological status. Diagnosis and treatment are delayed and disrupted by the abnormal movements. This retrospective study was implemented to evaluate the symptoms, the anatomical findings, and the surgical management of seven patients from 20 to 56 years old suffering from cervical myelopathy and athetoid or dystonic cerebral palsy. The mean delay in diagnosis was 15 months and the mean follow-up was 33 months. The initial symptoms were spasticity, limbs weakness, paresthesias and vesico-sphinteric dysfunction. In addition to abnormal movements, imaging demonstrated disc herniation, spinal stenosis and instability. All patients were managed surgically by performing simultaneous spinal cord decompression and fusion. Two patients benefited from preoperative botulinum toxin injections, which facilitated postoperative care and immobilization. Strict postoperative immobilization was achieved for 3 months by a Philadelphia collar or a cervico-thoracic orthosis. All patients improved functionally with a mean Japanese Orthopaedic Association score gain of 1.5 points, in spite of the permanent disabilities of the myelopathy. Complications occurred with wound infection, metal failure and relapse of cervical myelopathy at an adjacent level in one case each. All the previous authors advised against isolated laminectomy but no consensus emerged from the literature analysis. Spinal fusion is usually recommended but can be complicated by degenerative adjacent deterioration. Surgical management provides good outcomes but requires a long-term follow-up.

Rech, Celia; Garreau de Loubresse, Christian

2010-01-01

102

Successful treatment of cervical myelopathy with minimal morbidity by circumferential decompression and fusion  

PubMed Central

Circumferential cervical decompression and fusion (CCDF) is an important technique for treating patients with severe cervical myelopathy. While circumferential cervical decompression and fusion may provide improved spinal cord decompression and stability compared to unilateral techniques, it is commonly associated with increased morbidity and mortality. We performed a retrospective analysis of patients undergoing CCDF at the University of California, San Francisco (UCSF) between January 2003 and December 2004. We identified 53 patients and reviewed their medical records to determine the effectiveness of CCDF for improving myelopathy, pain, and neurological function. Degree of fusion, functional anatomic alignment, and stability were also assessed. Operative morbidity and mortality were measured. The most common causes of cervical myelopathy, instability, or deformity were degenerative disease (57%) and traumatic injury (34%). Approximately one-fifth of patients had a prior fusion performed elsewhere and presented with fusion failure or adjacent-level degeneration. Postoperatively, all patients had stable (22.6%) or improved (77.4%) Nurick grades. The average preoperative and postoperative Nurick grades were 2.1 ± 1.9 and 0.4 ± 0.9, respectively. Pain improved in 85% of patients. All patients had radiographic evidence of fusion at last follow-up. The most common complication was transient dysphagia. Our average clinical follow-up was 27.5 ± 9.5 months. We present an extensive series of patients and demonstrate that cervical myelopathy can successfully be treated with CCDF with minimal operative morbidity. CCDF may provide more extensive decompression of the spinal cord and may be more structurally stable. Concerns regarding operation-associated morbidity should not strongly influence whether CCDF is performed.

Sanchez-Mejia, Rene O.; Ben-Haim, Sharona; Ames, Christopher P.

2007-01-01

103

Anterior versus posterior surgery for multilevel cervical myelopathy, which one is better? A systematic review  

Microsoft Academic Search

The objective of the study is to perform a systematic review to compare the clinical outcomes and complications of anterior\\u000a surgery with posterior surgery for multilevel cervical myelopathy (MCM). MEDLINE, EMBASE databases and other databases were\\u000a searched for all the relevant original articles published from January 1991 to November 2009 comparing anterior with posterior\\u000a surgery for MCM. Subgroup analysis was

Tao Liu; Wen Xu; Tao Cheng; Hui-Lin Yang

2011-01-01

104

Cervical myelopathy in athetoid and dystonic cerebral palsy: retrospective study and literature review  

Microsoft Academic Search

The early onset of degenerative cervical lesions has been well described in patients suffering from athetoid or dystonic cerebral\\u000a palsy. Myelopathy can occur and aggravate of their unstable neurological status. Diagnosis and treatment are delayed and disrupted\\u000a by the abnormal movements. This retrospective study was implemented to evaluate the symptoms, the anatomical findings, and\\u000a the surgical management of seven patients

Raphael Jameson; Celia Rech; Christian Garreau de Loubresse

2010-01-01

105

Laminoplasty Techniques for the Treatment of Multilevel Cervical Stenosis  

PubMed Central

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

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

2012-01-01

106

Static versus dynamic factors for the development of myelopathy in patients with cervical ossification of the posterior longitudinal ligament  

Microsoft Academic Search

We studied 27 patients with cervical ossification of the posterior longitudinal ligament (OPLL) but no clinical symptoms of myelopathy. We investigated the occupation ratio of the spinal canal by OPLL with cervical radiographs, assessed the morphological types of OPLL, and measured the segmental range of motion (ROM) at the level of maximum cord compression on flexion and extension radiographs. Patients

Takayuki Fujiyoshi; Masashi Yamazaki; Akihiko Okawa; Junko Kawabe; Koichi Hayashi; Tomonori Endo; Takeo Furuya; Masao Koda; Kazuhisa Takahashi

2010-01-01

107

Clinical long-term results of anterior discectomy without fusion for treatment of cervical radiculopathy and myelopathy  

Microsoft Academic Search

Summary Between 1976 and 1983, 251 patients underwent surgery for the treatment of cervical degenerative disc disease. Anterior microsurgical discectomy at one or more cervical segments without interbody fusion was performed in each case. 109 patients with radiculopathy and 55 patients with myelopathy were followed up clinically 1 to 8 years postoperatively. A soft disc lesion was found in 72,

H. Bertalanffy; H.-R. Eggert

1988-01-01

108

Cervical myelopathy caused by dropped head syndrome. Case report and review of the literature.  

PubMed

The authors present a rare case of cervical myelopathy caused by dropped head syndrome. This 68-year-old woman presented with her head hanging forward. After 1 month, she was admitted to the medical service because of head drop progression. Examination of biopsy specimens from her cervical paraspinal muscles showed nonspecific myopathic features without inflammation, and isolated neck extensor myopathy was diagnosed. The patient's condition did not respond to the administration of corticosteroids. During follow up as an outpatient, the patient's head drop continued to gradually progress. At 1 year after onset, she developed bilateral weakness of the upper and lower extremities, clumsiness of the hands, and gait disturbance. A radiograph of the cervical spine obtained in a standing position showed a pronounced kyphotic deformity and instability at the level of C4-5. Magnetic resonance imaging demonstrated spinal cord compression at C-3 and C-4. The patient underwent a C3-4 laminectomy and occipitocervicothoracic fixation. Gait and hand coordination gradually improved, and she was able to walk with no support 1 month postoperatively. Surgical fixation was beneficial in this patient with dropped head syndrome, myelopathy, and cervical instability. PMID:17330586

Nakanishi, Kinya; Taneda, Mamoru; Sumii, Toshihisa; Yabuuchi, Tomonari; Iwakura, Norihiro

2007-02-01

109

Bioresorbable anterior cervical plate device for multi-level degenerative disc disease: Case report with 8-year follow-up  

Microsoft Academic Search

Anterior cervical decompression and fusion is most successful when bone graft is combined with stabilizing instrumentation. The use of bioresorbable anterior cervical plates has been reported recently instead of the traditional titanium plate. We report a novel application of a bioresorbable plate in the management of a 69-year-old Caucasian female with multi-level, long-standing cervical spondylotic myelopathy. The patient previously had

Robert G. Whitmore; Elana S. Tykocinski; Matthew R. Sanborn; William C. Welch

110

Fluorotic cervical compressive myelopathy, 20 years after laminectomy: A rare event  

PubMed Central

Background: Spinal cord compression in flourosis is a common complication. These complications are mainly due to compression of the spinal cord by thickening and ossification of posterior longitudinal ligament and ligamentum flavum. Surgical decompression is the treatment of choice for fluorotic spinal cord compression. The recurrence of spinal cord compression after surgical decompression in flourosis is a rare event. Case Description: We are presenting a case of a 63-year-old man who belonged to Kanpur, an endemic fluorosis region in India, with symptoms of cervical cord compression cranial to the operative site, 20 years after laminectomy for cervical fluorotic myelopathy. Urinary and serum fluoride levels were elevated. The patient underwent a skeletal survey: computed tomography and magnetic resonance imaging of the cervical spine showed a postoperative defect of laminectomy, osteosclerosis, osteophyte formation, calcification of the intraosseus membrane in the forearm, thickening and ossification of the posterior longitudinal ligament at C1, thickening and ossification of the residual ligamentum flavum at C1/C2, and dural calcification at the C2 vertebral level and compressive myelopathy. The patient refused surgical decompression and was managed with tizanidine HCl (an antispasticity medicine), a sublingual single night dose, 8 mg for symptomatic relief. Conclusion: The recurrence of spinal cord compression in the fluorotic spine 20 years after laminectomy is a very unusual event and hence the patient should be kept under observation for a long duration. This case report contributes to the literature associated with the management of fluorotic spine.

Kumar, Praveen; Gupta, AK; Sood, Shashank; Verma, Ashok Kumar

2011-01-01

111

Chronic cervical compressive myelopathy in horses: patterns of astrocytosis in the spinal cord.  

PubMed

The distribution and morphology of fibrous astrocytes in the cervical spinal cord of normal horses and horses with chronic compressive myelopathy were demonstrated using immunohistochemical staining for glial fibrillary acidic protein. In the spinal cord from normal horses, astrocytes with stellate cell bodies and short processes were irregularly distributed in grey matter. In the white matter, their cell bodies were small and angular in areas adjacent to grey matter and larger and more stellate-shaped in the subpial area. Astrocyte processes were fine, and evenly distributed in a predominantly radial pattern in transverse sections of cord. Gliosis was marked in the spinal cords of horses with cervical compressive myelopathy. In the grey matter at the level of compression astrocytes were often enlarged and rounded, with short, blunt processes, but the gliosis was generally mild. In the white matter, gliosis was obvious in areas of nerve fibre swelling and degeneration at the level of compression and in areas of ascending and descending Wallerian degeneration. The fine radial pattern of astrocyte fibres was replaced by a dense, irregular arrangement. Gliosis persisted in the cords of chronically affected horses after active nerve fibre degeneration had subsided. The areas of gliosis coincided with the areas of Marchi staining for degenerating myelin and with areas of myelin loss in osmium tetroxide post-fixed tissue. Histological observations were consistent with astrocytes replacing areas of extracellular space that remained after nerve fibre degeneration. it is concluded that astrocytic gliosis is a prominent and persistent alteration of the spinal cord of horses with chronic cervical compressive myelopathy. PMID:1755785

Yovich, J V; Gould, D H; LeCouteur, R A

1991-10-01

112

Comparative study of anterior versus posterior decompression in elderly patients of cervical myelopathy with co-morbid conditions  

Microsoft Academic Search

Study design  Prospective.\\u000a \\u000a \\u000a \\u000a Objective  To assess the results of laminectomy in patients suffering from multilevel multidirectional compressive cervical myelopathy\\u000a with co-morbid conditions and to compare results of anterior and laminectomy clinically, radiologically and functionally.\\u000a \\u000a \\u000a \\u000a Summary of background data  Cervical myelopathy or myeloradiculopathy is a progressive degenerative disorder that usually starts in the middle age. It\\u000a leads to circumferential cord compression leading to a

Sudeep Jain; Saurabh Singh; Anil Kumar Joshi; Chirayu Pamecha; Bharat Dave; Pankaj Patel

2009-01-01

113

[Clinical studies on the significance of en bloc laminoplasty for cervical compressive myelopathy].  

PubMed

The aim of this study was clinical evaluation of en bloc laminoplasty for compressive myelopathy. Subjects were 55 patients with severe myelopathy due to ossification of posterior longitudinal ligament or spinal canal stenosis in the cervical spine. The average age at surgery was 58 years old and average follow-up period 25 months. Stable expansion of the spinal canal was shown and the average extent of the canal enlargement in sagittal diameter was 4.8 +/- 1.8 mm roentgenologically. Symmetrical expansion of the canal, good bony fusion and remodelling of the posterior elements of the spine were observed in CT. No marked malalignment or instability of the cervical spine were found, but limitation of flexion-extension movement was noticed. Neurological recovery was remarkable; 44 patients were rated as excellent or good by Robinson's criteria. The average recovery rate was 76.4 +/- 20.1% according to the evaluation system of Japanese Orthopaedic Association (JOA). En-bloc laminoplasty can accomplish a stable expansion of the canal with adequate decompression of the spinal cord. PMID:3819538

Itoh, T

1986-11-01

114

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

Microsoft Academic Search

Hirayama’s disease is a benign juvenile form of focal amyotrophy affecting the upper limbs. Previous studies have suggested\\u000a that the disorder is a neck flexion induced cervical myelopathy. We report clinical and magnetic resonance imaging findings\\u000a in nine patients with Hirayama’s disease. Cervical imaging of seven patients revealed spinal cord changes consisting of focal\\u000a atrophy and foci of signal alterations.

Rolf Schröder; Ewald Keller; Sebastian Flacke; Stephan Schmidt; Christoph Pohl; Thomas Klockgether; Uwe Schlegel

1999-01-01

115

Radiolucent cage for cervical vertebral reconstruction: A prospective study of 17 cases with 2-year minimum follow-up  

Microsoft Academic Search

In cervical spondylotic myelopathy, extended anterior spinal cord decompression necessitates subsequent stable vertebral reconstruction.\\u000a Reconstruction with an iliac crest graft and screw-plate fixation gives satisfactory clinical and radiological results, but\\u000a they are often compromised by morbidity involving the bone harvest. The purpose of this study was to evaluate the contribution\\u000a to cervical reconstruction of a biocompatible, radiolucent cage combined with

C. H. Söderlund; V. Pointillart; M. Pedram; G. Andrault; J. M. Vital

2004-01-01

116

Tetraparesis following dental extraction: case report and discussion of preventive measures for cervical spinal hyperextension injury.  

PubMed

This concerns a patient with compression myelopathy following passive hyperextension of the cervical spine during a dental procedure. Although he had been asymptomatic prior to the procedure, subsequent cervical spinal imaging revealed advanced spondylosis and spinal stenosis. Spinal stenosis is often asymptomatic for a long time. However, when radiculomyelopathy occurs after minor trauma to the head or neck, the patient is often found to have spinal stenosis. Specifically, hyperextension of a cervical spine with spondylotic changes can lead to compression myelopathy. Acquired spinal stenosis correlates positively with aging. As the size of the elderly population continues to increase the prevalence of cervical spondylotic radiculo-myelopathy will likely increase as well. Since appropriate precautions against potential neurologic damage can be undertaken, we suggest radiographic screening for pre-existing spinal stenosis prior to a procedure requiring hyperextension of the neck. Preventive measures for individuals with asymptomatic spondylotic changes and education of all health-care professionals to avoid abrupt or prolonged hyperextension of the cervical spine is emphasized. PMID:9360224

Whiteson, J H; Panaro, N; Ahn, J H; Firooznia, H

1997-10-01

117

Social and economic outcome after posterior microforaminotomy for cervical spondylotic radiculopathy.  

PubMed

Between 1993 and 1998, the surgical technique of posterior cervical foraminotomy as described by Frykholm, with individual cervical nerve root decompression had been applied at the Neurosurgical Department of the University of Vienna. We conducted a retrospective study to assess the functional and socio-economic outcome. Thirty-two patients were included in this study, 21 men and 11 women with a median age of 48 years (range 30 to 70 years). Prior to surgical management, median duration of symptoms had been 7 weeks (range 1-50 weeks), with cervicobrachialgia in 28 of the patients, 27 of the patients had sustained radicular sensory loss, and in 25 of the patients radicular paresis occurred. Measured by the Prolo Functional Economic Outcome Rating Scale, 64% of the patients were classified with a good outcome (scale 8-10), 18% of the patients were classified with a moderate outcome (scale 5-7), and 18% of the patients were classified with a poor outcome (scale < 5). Two of the patients required additional anterior cervical discectomy and one patient suffered a superficial wound infection which needed surgical drainage. This study confirms that posterior microforaminotomy is a useful technique for degenerative disease causing cervical radiculopathy with the advantage of avoiding fusion and immobilisation. Criteria for evaluating the results of treating cervical spinal disorders vary widely. Comparative analyses of outcome among different therapy protocols are compromised by the diversity among the groups studied, as well as by the varying methods of measuring success. We propose a scale based on the socio-economic and functional status of the patient before and after treatment This scale is easily applicable and can delineate pre- and postoperative conditions of patients. A more universal acceptance of common criteria for judging the outcome of spinal operations should facilitate comparisons among various methods of treatment. PMID:12238309

Schöggl, Andreas; Reddy, Marion; Saringer, Walter; Ungersböck, Karl

2002-03-28

118

Clinical features of the localized girdle sensation of mid-trunk (false localizing sign) appeared in cervical compressive myelopathy patients.  

PubMed

Cervical compressive myelopathy patients sometimes show localized girdle sensation in the mid trunk (so-called false localizing sign). This symptom often confuses physicians, but the clinical features and mechanism of this symptom are still unclear. We investigated the clinical features and possible mechanism. In each of five cases of cervical compressive myelopathy disease with and without mid-truncal girdle sensation, the clinical features, degree and shape of cord compression were analysed. The girdle sensation was expressed as a vague or burning sensation, and was localized with a width of 3 or 4 dermatomes from the T3 to T11 level. There was no correlation between the appearance of the girdle sensation and etiology and level of cervical cord compression. Pyramidal tract signs and disturbance of superficial sensation were observed in all cases. Furthermore, on axial MRI, the midline ventral surface of the cervical cord was remarkably compressed in cases with girdle sensation, as if the compressive lesion entered the anterior medial fissure of the cervical cord. From these findings, this false localizing sign may be caused by severe compression of midline ventral structure of the cervical cord. Ischemia of the thoracic watershed zone of the anterior spinal artery from the compression of the anterior spinal artery at the cervical level might also be considered to be a possible cause. PMID:12021944

Ochiai, Hidenobu; Yamakawa, Yuzo; Minato, Seiichiro; Nakahara, Keiichi; Nakano, Shinichi; Wakisaka, Shinichiro

2002-05-01

119

Tumor necrosis factor-?, interleukin-1?, and interleukin-6 in the cerebrospinal fluid of patients with cervical myelopathy and lumbar radiculopathy  

Microsoft Academic Search

There have been few reports describing cytokines in the cerebrospinal fluid (CSF) of patients with spinal degenerative disorders.\\u000a This study investigated whether interleukin-1? (IL-1?), interleukin-6 (IL-6), and tumor necrosis factor-? (TNF-?) could be\\u000a detected in CSF of patients with cervical myelopathy or lumbar radiculopathy and whether the concentrations of those cytokines\\u000a correlated with the severity of disease conditions. CSF samples

Hideki Nagashima; Yasuo Morio; Koji Yamane; Yoshiro Nanjo; Ryota Teshima

2009-01-01

120

Effectiveness of multiple-level decompression in laminoplasty and simultaneous C1 laminectomy for patients with cervical myelopathy  

Microsoft Academic Search

A retrospective study to investigate the relationship between the surgical levels and decompression effects was performed in patients with cervical myelopathy who had undergone Tension-band laminoplasty (TBL) with\\/without simultaneous C1 laminectomy. One hundred and sixty-eight patients (115 males, 53 females; age: 31–80 years, average 58.9 years; follow-up period: 12–120 months, average 20 months) were divided into three groups according to the range of the

Junwei Zhang; Shigeru Hirabayashi; Kunio Saiki; Hiroya Sakai

2006-01-01

121

Chronic cervical compressive myelopathy in horses: clinical correlations with spinal cord alterations.  

PubMed

Histological examination was performed on the cervical spinal cord from 13 horses with chronic cervical compressive myelopathy of 4 to 29 months duration. Structural alterations were correlated with clinical features. At the level of compression, the spinal cord was grossly deformed. Histological alterations included nerve fibre swelling and degeneration, occasional spheroids, astrocytic gliosis, increased macrophage activity and increased perivascular collagen. Myelin degeneration or loss at the level of the compressive lesion was greatest in the ventral and lateral funiculi and less consistently present in the dorsal funiculi. Asymmetry of lesions in the dorsal funiculi was associated with asymmetry of clinical signs in 5 horses. Histological alterations in areas of Wallerian degeneration were similar to that at the level of spinal cord compression, except that perivascular collagen was not increased. Wallerian degeneration was present cranial to the compressed site in the superficial portions of the lateral funiculi and in the middle of the dorsal funiculi. Caudal to the compressed site it was present in the ventral funiculi adjacent to the ventral median fissure and in the middle of the lateral funiculi. Deformation of the spinal cord did not correlate with the severity or duration of clinical signs but was positively correlated with the amount of perivascular collagen increase. The amount of nerve fibre swelling was not correlated with the severity of clinical signs but was negatively correlated with their duration. A rapid loss of nerve fibres apparently occurred early in the course of compression, since there was a marked decrease in the amount of nerve fibre swelling and Marchi stained degenerating myelin with increasing clinical duration.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1755784

Yovich, J V; leCouteur, R A; Gould, D H

1991-10-01

122

Is there any relationship between proinflammatory mediator levels in disc material and myelopathy with cervical disc herniation and spondylosis? A non-randomized, prospective clinical study  

Microsoft Academic Search

The proinflammatory mediator (PIM) levels were assessed in surgically removed samples of herniated cervical intervertebral\\u000a discs. The objective of this study was to investigate if there is a correlation between the levels of PIMs in disc material\\u000a and myelopathy associated with cervical intervertebral disc herniation and spondylosis. The role of proinflammatory mediators\\u000a in the degeneration of intervertebral disc and the

Mehmet Nusret Demircan; Alparslan Asir; Ahmet Cetinkal; Nursal Gedik; Ahmet Murat Kutlay; Ahmet Çolak; Sedat Kurtar; Hakan Simsek

2007-01-01

123

Lordotic alignment and posterior migration of the spinal cord following en bloc open-door laminoplasty for cervical myelopathy: A magnetic resonance imaging study  

Microsoft Academic Search

We investigated lordotic alignment and posterior migration of the spinal cord following en bloc open-door laminoplasty for cervical myelopathy. Fifty-five patients (32 men and 23 women) were studied, with an average follow-up of 2.4 years. Radiological examination included evaluation of lordosis of the cervical spine and spinal cord, degree of enlargement of bony spinal canal, and the magnitude of posterior

Hisatoshi Baba; Kenzo Uchida; Yasuhisa Maezawa; Nobuaki Furusawa; Miki Azuchi; Shinichi Imura

1996-01-01

124

The results of surgical treatment of spondylotic radiculomyelopathy with complete cervical laminectomy and posterior foramen magnum decompression  

Microsoft Academic Search

Summary Twenty-six patients with cervical spondylosis and radiculomyelopathy were treated surgically. Eight patients had cervical laminectomy C1-C7, and 16 patients had complete cervical laminectomy C1-C7 with excision of the posterior rim of the foramen magnum. Follow-up of patients was from two months to eight years.

H. Alsharif; Sh. Ezzat; A. Hay; N. A. Motty; S. A. Malek

1979-01-01

125

A new rabbit model for the study on cervical compressive myelopathy.  

PubMed

Development process and pathology of myelopathy due to chronic spinal cord compression have not been fully elucidated. This study was conducted in order to establish an experimental model which can efficiently produce myelopathy and be useful in the studies on myelopathy due to chronic spinal cord compression. Under electrophysiological monitoring of the spinal cord, anterior compression was produced on C5 using a plastic screw. Two weeks later, a plastic plate was inserted under the C5 arch. For the subsequent 10 months on average, walking pattern and MR images were periodically monitored. Before the sacrifice, electrophysiological test was performed and then histopathological examination was done. Palsy appeared at 5 months on average after the addition of posterior compression. Mean compression ratio of the spinal cord calculated on MR images was 34%. All animals with compression showed a high intramedullary signal intensity, and the mean contrast-to-noise ratio (CNR) in the compressed area was 49%. Electrophysiological test showed a significant decrease in the amplitude of spinal cord evoked potentials (SCEPs) at the given compression level. Histology showed flattening of the anterior horn, disappearance and necrosis of anterior horn cells in the gray matter; and demyelination and axonal degeneration in the white matter. The antero-posterior compression produces the condition of spinal canal stenosis. Repeated antero-posterior compression to the spinal cord is important in establishing myelopathy. The present animal model was evaluated to be useful in the studies on myelopathy. PMID:11518269

Kanchiku, T; Taguchi, T; Kaneko, K; Yonemura, H; Kawai, S; Gondo, T

2001-07-01

126

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

PubMed

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

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

2009-11-04

127

Anterior cervical discectomy and fusion for the management of axial neck pain in the absence of radiculopathy or myelopathy  

PubMed Central

Study design:?Systematic review Study rationale:?Anterior cervical discectomy and fusion (ACDF) is a proven, effective treatment for relieving neck pain due to degenerative conditions of the cervical spine. Since most patients also present with radiculopathy or myelopathy, little is known as to the effectiveness of ACDF to relieve pain and improve function in patients without radicular or myelopathic symptoms. Objective:?To examine the clinical outcome in patients undergoing (ACDF) for axial neck pain without radicular or myelopathic symptoms. Methods:?A systematic review was undertaken for articles published up to March 2010. Electronic databases and reference lists of key articles were searched to identify studies evaluating ACDF for the treatment of axial neck pain only. Radiculopathy and myelopathy, patients who suffered severe trauma, or with tumor/metastatic disease or infection were excluded. Two independent reviewers assessed the strength of evidence using the grading of recommendations assessment, development and evaluation (GRADE) system, and disagreements were resolved by consensus. Results:?No comparative studies were identified. Three case series met our inclusion criteria and were evaluated. All studies showed a mean improvement of pain of at least 50% approximately 4-years following surgery. Functional outcomes improved between 32% and 52% from baseline. Most patients reported satisfaction with surgery, 56% in one study and 79% in another. Complications varied among studies ranging from 1% to 10% and included pseudoarthrosis (9%), nonunion and revision (3%) and screw removal (1%). Conclusion:?There is low evidence suggesting that patients with axial neck pain without radicular or myelopathic symptoms may receive some improvement in pain and function following ACDF. However, whether this benefit is greater than nontreatment or other treatments cannot be determined with the present literature.

Riew, K Daniel; Ecker, Erika; Dettori, Joseph R.

2010-01-01

128

Laminoplasty and pedicle screw fixation for cervical myelopathy associated with athetoid cerebral palsy: minimum 5-year follow-up.  

PubMed

Study design. Retrospective case series.Objective. To evaluate the outcomes following laminoplasty and posterior spinal fusion utilizing pedicle screws for cervical myelopathy associated with athetoid cerebral palsy.Summary of Background data. A variety of surgical procedures have been reported including decompression without fusion, spinal fusion by anterior, posterior or circumferential approach in this population. However, involuntary neck movements bring risk of postoperative neurological deterioration due to progression of kyphosis, pseudoarthrosis or adjacent segmental degeneration.Methods. A consecutive series of 17 patients who underwent midline T-saw laminoplasty and posterior spinal fusion using pedicle screws were retrospectively reviewed. There were 8 female and 9 male with a mean age at the time of surgery of 52 years. The mean follow-up was 71 months. Radiographic measures were made in change of Cobb angle of sagittal plane from C2 to C7 and accuracy of pedicle screws. Barthel index (BI) which shows independence in activities of daily life and the Japanese Orthopaedic Association (JOA) score were also evaluated.Results. Preoperative Cobb angle of sagittal plane from C2 to C7 measured 11.0 ± 14.5 degrees of kyphosis which improved to 1.5 ± 12.7 degrees postoperatively (p<0.05). Solid posterior bony fusion was achieved in all cases without rigid orthosis such as Halo vest. There were two cases of adjacent segmental instability, which required additional surgery. Nineteen (13%) out of the 138 screws showed deviation from the pedicle with postoperative computed tomography. However, there were no neurovascular complications during or after the surgery in any cases. Postoperative JOA score and BI significantly improved in 32 ± 16%, and 48 ± 26% respectively.Conclusions. laminoplasty and pedicle screw fixation provided strong internal fixation and improved neurological function and activities of daily living for cervical myelopathy associated with athetoid cerebral palsy. PMID:24042720

Demura, Satoru; Murakami, Hideki; Kawahara, Norio; Kato, Satoshi; Yoshioka, Katsuhito; Tsuchiya, Hiroyuki

2013-09-15

129

Anterior versus posterior surgery for multilevel cervical myelopathy, which one is better? A systematic review  

PubMed Central

The objective of the study is to perform a systematic review to compare the clinical outcomes and complications of anterior surgery with posterior surgery for multilevel cervical myelopathy (MCM). MEDLINE, EMBASE databases and other databases were searched for all the relevant original articles published from January 1991 to November 2009 comparing anterior with posterior surgery for MCM. Subgroup analysis was performed according to the follow-up years. The following end points were mainly evaluated: final follow-up JOA (Japanese Orthopaedic Association) scale, recovery rate and complication outcomes. Ten articles fulfilled all inclusion criteria. For multilevel CSM patients, the final follow-up JOA score for the anterior group was significantly higher than the posterior group (p < 0.05, WMD 0.83 [0.24, 1.43]) in the ‘follow-up time ?5 years’ subgroup, but had no significant differences in the ‘follow-up time >5 years’ subgroup (p > 0.05). The recovery rate for the anterior group was significantly higher than the posterior group (p < 0.05, WMD 10.08 [1.39, 18.78]) in the ‘follow-up time ?5 years’ subgroup. No study reported the recovery rate for the follow-up time >5 years. For multilevel OPLL patients, the final follow-up JOA score and recovery rate for the anterior group were both significantly higher than the posterior group in the ‘follow-up time ?5 years’ subgroup (p < 0.05, WMD 2.50 [0.16, 4.85]; p < 0.05, WMD 29.48 [29.09, 29.87], respectively). One study [31] which mean follow-up time was 6 years was enrolled in the ‘follow-up time >5 years’ subgroup. The results showed there was no significant difference in final follow-up JOA score and recovery rate between anterior and posterior group for patients with occupying ratio of OPLL <60% (p > 0.05), while in patients with occupying ratio ?60%, the final follow-up JOA score and recovery rate of anterior surgery were both superior to that of posterior surgery (p < 0.05). For both multilevel CSM and OPLL patients, the complications for the anterior group were significantly more than the posterior group in the ‘follow-up time ?5 years’ subgroup (p < 0.05, OR 7.33 [2.96, 18.20] for CSM patients; p < 0.05, OR 4.44 [1.80, 10.98] for OPLL patients), but were similar to the posterior group in the ‘follow-up time >5 years’ subgroup (p > 0.05). In conclusion, anterior surgery had better clinical outcomes and more complications at the early stage after operation for both multilevel CSM and OPLL patients. At the late stage, posterior surgery had similar clinical outcomes and complications to anterior surgery for CSM patients, and OPLL patients with occupying ratio of OPLL <60%. While for OPLL patients with occupying ratio ?60%, anterior surgery had superior clinical outcome to posterior surgery.

Liu, Tao; Xu, Wen; Cheng, Tao

2010-01-01

130

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?  

Microsoft Academic Search

Some controversy still exists over the optimal treatment time and the surgical approach for cervical myelopathy due to ossification\\u000a of the posterior longitudinal ligament (OPLL). The aim of the current study was first to analyze the effect of intramedullary\\u000a spinal cord changes in signal intensity (hyperintensity on T2-weighted imaging and hypointensity on T1-weighted imaging) on\\u000a magnetic resonance imaging (MRI) on

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

131

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

PubMed Central

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

Bokhari, Rakan

2012-01-01

132

Cervical Myelopathy Secondary to Atlas Hypoplasia - Reports of 3 Adult Cases -  

PubMed Central

There have been paucity of reports on atlas hypoplasia, and as a result this condition is not clearly defined, nor well understood. The authors reported three cases of atlas hypoplasia that were found in adults who presented with myelopathic symptoms. On radiographic examination, it was found that the anterior-posterior diameter of the atlas was remarkably narrower in all three cases in comparison with normal persons. The MRI in all three cases also revealed intramedullary high signal lesions at the levels where severe spinal cord compression was present. This led to our diagnosis of atlas hypoplasia causing myelopathy.

Cho, Woo-Jin; Park, Jong-Beom; Moon, Myung-Sang; Chae, Jong-Woo; Ryu, Jong-Seon; Kang, Hyun-Suk

2007-01-01

133

The relevance of intramedullary high signal intensity and gadolinium (Gd-DTPA) enhancement to the clinical outcome in cervical compressive myelopathy  

Microsoft Academic Search

Purpose  We prospectively investigated whether high intramedullary SI and contrast [gadolinium-diethylene-triamine-pentaacetic acid\\u000a (Gd-DTPA)] enhancement in magnetic resonance imaging (MRI) are associated with postoperative prognosis in cervical compressive\\u000a myelopathy (CCM) patients.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Seventy-four patients with ventral cord compression at one or two levels underwent anterior cervical discectomy and fusion\\u000a (ACDF) for CCM between March 2006 and June 2009. The mean follow-up period was

Yong Eun Cho; Jun Jae Shin; Keun Su Kim; Dong Kyu Chin; Sung Uk Kuh; Ji Hae Lee; Woo Ho Cho

134

A role for motor and somatosensory evoked potentials during anterior cervical discectomy and fusion for patients without myelopathy: Analysis of 57 consecutive cases  

PubMed Central

Background: Although the usage of combined motor and sensory intraoperative monitoring has been shown to improve the surgical outcome of patients with cervical myelopathy, the role of transcranial electric motor evoked potentials (tceMEP) used in conjunction with somatosensory evoked potentials (SSEP) in patients presenting with radiculopathy but without myelopathy has been less clear. Methods: We retrospectively reviewed all patients (n = 57) with radiculopathy but without myelopathy, undergoing anterior cervical decompression and fusion at a single institution over the past 3 years, who had intraoperative monitoring with both tceMEPs and SSEPs. Results: Fifty-seven (100%) patients presented with radiculopathy, 53 (93.0%) with mechanical neck pain, 35 (61.4%) with motor dysfunction, and 29 (50.9%) with sensory deficits. Intraoperatively, 3 (5.3%) patients experienced decreases in SSEP signal amplitudes and 4 (6.9%) had tceMEP signal changes. There were three instances where a change in neuromonitoring signal required intraoperative alteration of the surgical procedure: these were deemed clinically significant events/true positives. SSEP monitoring showed two false positives and two false negatives, whereas tceMEP monitoring only had one false positive and no false negatives. Thus, tceMEP monitoring exhibited higher sensitivity (33.3% vs. 100%), specificity (95.6% vs. 98.1%), positive predictive value (33.3% vs. 75.0%), negative predictive value (97.7% vs. 100%), and efficiency (91.7% vs. 98.2%) compared to SSEP monitoring alone. Conclusions: Here, we present a retrospective series of 57 patients where tceMEP/SSEP monitoring likely prevented irreversible neurologic damage. Though further prospective studies are needed, there may be a role for combined tceMEP/SSEP monitoring for patients undergoing anterior cervical decompression without myelopathy.

Xu, Risheng; Ritzl, Eva K.; Sait, Mohammed; Sciubba, Daniel M.; Wolinsky, Jean-Paul; Witham, Timothy F.; Gokaslan, Ziya L.; Bydon, Ali

2011-01-01

135

Anterior cervical discectomy without fusion: a comparison with Cloward's procedure.  

PubMed

The antero-medial microsurgical disc or osteophyte removal without formal interbody fusion is a surgical alternative in the treatment of cervical discs causing radicular compression or cervical myelopathy. In the past 20 years 379 patients underwent anterior surgery, including 240 microdiscectomies without graft and 139 Cloward's dowel procedures. The long-term results of both procedures are compared in patients suffering from radicular compression, dominant myelopathy and radiculo-myelopathy. We found no statistically significant differences between the two methods treating three different conditions. The improvement rate in patients with soft and sequestrated discs is generally better compared to those with hard discs and spondylotic changes. Functional stability of the cervical spine is present in 92% of cases treated without interbody fusion immediately after surgery. A complete osseous fusion after a period of 6-12 months was found in 90% of Cloward procedures and in 81% of discectomy without graft. No definite correlation was found between the clinical improvement and the radiological results. According to our experience the Cloward's fusion procedure has no long-term advantages over discectomy without graft except in cases of severe myelopathy caused by multilevel ventral compression due to osteophytes. No permanent postoperative complication was encountered. Most of the treated patients returned to their previous activities. PMID:18638979

Husag, L; Costabile, G; Vanloffeld, W; Keller, R J; Landolt, H

1997-07-01

136

Cervical myelopathy due to single level prolapsed disc and spondylosis: a comparative study on outcome between two groups  

Microsoft Academic Search

This article describes a retrospective study on myelopathy, induced by monosegmental prolapsed disc and spondylosis. To assess\\u000a pre- and postoperative clinical and radiological findings related to myelopathy, and factors influencing the outcome, 20 disc\\u000a herniation (group A) and 11 spondylosis patients (group B) were studied. Average duration of myelopathy in groups A and B\\u000a were 3 and 8.7 months, respectively. Anterior

Jong-Seon Ryu; Jong-Woo Chae; Woo-Jin Cho; Han Chang; Myung-Sang Moon; Sung-Soo Kim

2010-01-01

137

Reversal of lifelong mutism after anterior cervical discectomy and fusion for myelopathy.  

PubMed

A 34-year-old man with a history of spina bifida occulta, fetal alcohol syndrome and mutism presented with an acute on chronic decline of unsteady gait and right arm and leg weakness over the period of a few months. The patient was non-verbal and communicated using hand gestures. MRI of the cervical spine showed severe stenosis at C4-5 with T2 signal abnormalities. Brain MRI demonstrated mild ventriculomegaly. The patient underwent an anterior cervical discectomy and fusion for severe cervical spine stenosis. Postoperatively the patient's myelopathic symptoms improved. He also became verbal and engaged in conversation. Ten months after surgery, the patient who had previously been non-verbal had developed a vocabulary of more than 50 words. PMID:22674701

Babu, Ranjith; Grunch, Betsy H; Bagley, Carlos A; Gottfried, Oren N

2011-11-21

138

Multiple intracranial hemorrhages after cervical spinal surgery.  

PubMed

A 69-year-old woman presented with a rare case of multiple supra- and infratentorial intracranial hemorrhages after cervical laminoplasty for cervical spondylotic myelopathy without intraoperative liquorrhea. A wound drainage tube under negative pressure was placed with subsequent 380 ml of drainage in the first 12 hours. She had no complaint of headache and nausea at that time. Computed tomography of the brain obtained at 15 hours after surgery demonstrated cerebellar hemorrhage, acute subdural hemorrhage, subarachnoid hemorrhage, supratentorial intraparenchymal hemorrhage, and pneumocephalus. She was treated medically without consequent neurological deficits other than right hemianopsia. Overdrainage of cerebrospinal fluid through an occult dural tear might cause severely low intracranial pressure with subsequent multiple intracranial hemorrhages. Wound drainage should be controlled thoroughly even in patients without intraoperative liquorrhea. PMID:23006877

Takahashi, Yuichi; Nishida, Kenki; Ogawa, Koichi; Yasuhara, Takao; Kumamoto, Shinji; Niimura, Tatsuomi; Tanoue, Takashi

2012-01-01

139

Adjacent level spondylodiscitis after anterior cervical decompression and fusion  

PubMed Central

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

Basu, Saumyajit; Sreeramalingam, Rathinavelu

2012-01-01

140

Cervical myelopathy due to single level prolapsed disc and spondylosis: a comparative study on outcome between two groups  

PubMed Central

This article describes a retrospective study on myelopathy, induced by monosegmental prolapsed disc and spondylosis. To assess pre- and postoperative clinical and radiological findings related to myelopathy, and factors influencing the outcome, 20 disc herniation (group A) and 11 spondylosis patients (group B) were studied. Average duration of myelopathy in groups A and B were 3 and 8.7 months, respectively. Anterior decompression and fusion were performed. Pre- and postoperative clinical and radiological findings and outcomes were assessed. Average preoperative disc heights were 85.9% of normal in group A and 72.7% in group B. Average anteroposterior canal diameter and Pavlov ratio at diseased level were 13.9 mm and 0.81 in group A, respectively, and 12.1 mm and 0.78 in group B. Five group A (25.0%) and four group B cases (36.4%) had radiculopathy. Cord compressions among 20 group A patients were median in seven and paramedian in 13. In the 11 group B patients, nine were median and two were paramedian. High signal intensity was observed in 19 group A and ten group B patients. Postoperative regression of T2-weighted high signal intensity in 14 group A (73.7%) and two group B patients (20.0%) was observed. Preoperative JOA scores in groups A and B were 10.3 and 12.8, respectively, which became 66.2 and 22.5 postoperatively. Neurological recovery was poorer in group B than in group A. Outcome was influenced by chronicity of myelopathy.

Ryu, Jong-Seon; Chae, Jong-Woo; Cho, Woo-Jin; Chang, Han; Kim, Sung-Soo

2010-01-01

141

Dynamic somatosensory evoked potentials to determine electrophysiological effects on the spinal cord during cervical spine extension.  

PubMed

Object The goal of this prospective study was to investigate somatosensory evoked potentials (SSEPs) during dynamic motion of the cervical spine and to evaluate the efficacy of analyzing dynamic SSEPs for predicting dynamic effects on the spinal cord in patients with cervical spondylotic myelopathy (CSM). Methods In total, 40 human subjects (20 CSM patients and 20 healthy volunteers as a control group) were examined prospectively using dynamic SSEPs with median nerve stimulation. The CSM patients showed cervical myelopathy due to cervical cord compression at the C4-5 segment. The SSEPs were examined with the cervical spine in a neutral position and at a 20° extension for 10 and 20 minutes. Changes in the N20 latency and amplitude were determined and analyzed. The authors defined the changes in the N20 latency and N20 amplitude between the neutral and extension positions of the cervical spine as percent latency and amplitude, respectively. Results In the CSM patients, SSEPs tended to deteriorate after cervical spine extension, and a statistically significant deterioration of the N20 amplitude after the extension was observed. Moreover, the percent latency and amplitude progressively increased during cervical spine extension in these patients. In the healthy controls, SSEPs tended to deteriorate with cervical spine extension, but these changes did not result in statistically significant differences. Moreover, in this group the percent latency and amplitude were almost identical during the extension. When the CSM patients and the healthy controls were compared, a significant difference in the percent amplitude was observed between the 2 groups during the cervical spine extension. Conclusions This study suggests the potential of dynamic SSEPs as a useful neurophysiological technique to detect the effect of dynamic factors on the pathogenesis of CSM. PMID:23848352

Morishita, Yuichiro; Maeda, Takeshi; Ueta, Takayoshi; Naito, Masatoshi; Shiba, Keiichiro

2013-07-12

142

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

PubMed Central

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

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

2010-01-01

143

A new minimally invasive posterior approach for the treatment of cervical radiculopathy and myelopathy: surgical technique and preliminary results  

Microsoft Academic Search

Degenerative cervical disorders predominantly lead to anterior spinal cord compression (by bony spurs at the posterior margin of the vertebral body or by degenerated disc), which may be central and\\/or foraminal. In a smaller percentage of cases, there is encroachment of the canal mainly from posterior by bulging yellow ligaments or bony appositions, resulting in compression syndromes of roots or

H. Boehm; R. Greiner-Perth; H. El-Saghir; Y. Allam

2003-01-01

144

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

PubMed Central

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

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

2012-01-01

145

The relationship between the cervical spinal canal diameter and the pathological changes in the cervical spine  

PubMed Central

A congenitally narrow cervical spinal canal has been established as an important risk factor for the development of cervical spondylotic myelopathy. However, few reports have described the mechanism underlying this risk. In this study, we investigate the relationship between cervical spinal canal narrowing and pathological changes in the cervical spine using positional magnetic resonance imaging (MRI). Two hundred and ninety-five symptomatic patients underwent cervical MRI in the weight-bearing position with dynamic motion (flexion, neutral, and extension) of the cervical spine. The sagittal cervical spinal canal diameter and cervical segmental angular motion were measured and calculated. Each segment was assessed for the extent of intervertebral disc degeneration and cervical cord compression. Based on the sagittal canal diameter, the subjects were classified into three groups: A, subjects with a congenitally narrow canal, diameter of less than 13 mm; B, subjects with a normal canal, diameter of 13–15 mm; C, subjects with a wide canal, diameter of more than 15 mm. When compared with Groups A and B, the disc degeneration grades at the C3-4, C5-6, and C6-7 segments and the cervical cord compression scores at the C3-4 and C5-6 segments showed significant differences. Additionally, when compare with Groups A and C, the disc degeneration grades at all segments, except C2-3, and the cervical cord compression scores at all segments, except C2-3, showed significant differences. With respect to the cervical kinematics, few differences in the kinematics were observed between Groups B and C, however, the kinematics in Group A was different with other two groups. In Group A, the segmental mobility at the C4-5 and C6-7 segments were significantly higher than those observed in Group B, and the segmental mobility at the C3-4 segment was significantly lower than that observed in Groups B or C. We demonstrated the unique pathological and kinematic traits of cervical spine that exist in a congenitally narrow canal. We hypothesize that kinematic trait associated with a congenitally narrow canal may greatly contribute to pathological changes in the cervical spine. Our results suggest that cervical spinal canal diameter of less than 13 mm may be associated with an increased risk for development of pathological changes in cervical intervertebral discs. Subsequently, the presence of a congenitally narrow canal can expose individuals to a greater risk of developing cervical spinal stenosis.

Morishita, Yuichiro; Naito, Masatoshi; Hymanson, Henry; Miyazaki, Masashi; Wu, Guizhong

2009-01-01

146

Acute myelopathy with normal imaging.  

PubMed

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

Holland, Neil R

2012-06-29

147

Factors related to the development of myelopathy in patients with cervical ossification of the posterior longitudinal ligament.  

PubMed

This study evaluates factors related to myelopathic symptoms in patients with ossification of the posterior longitudinal ligament (OPLL). A total of 87 patients with OPLL were included. Of these, 53 (Group I) had no symptoms or presented with neck pain and radiculopathy and 34 (Group II) had myelopathic symptoms. Gender, age, and history of trauma were evaluated in the two groups. The range of movement of the cervical spine was measured using plain radiographs. The number of involved segments, type of OPLL, and maximal compression ratio were analysed using CT and signal change in the spinal cord was evaluated using MRI. The patients' age was found to be significant (p = 0.001). No difference was found between gender and the range of movement in the two groups. The maximum compression of the spinal canal showed a difference (p = 0.03). The signal change of the spinal cord was different between the two groups. In patients with OPLL of the cervical spine, myelopathic symptoms are not related to the range of movement or the number of involved segments. PMID:22733951

Chang, H; Song, K-J; Kim, H-Y; Choi, B-W

2012-07-01

148

Clinical and Radiological Outcomes of Anterior Cervical Interbody Fusion Using Hydroxyapatite Spacer  

PubMed Central

Objective This is retrospective study of clinical and radiological outcomes of anterior cervical fusion using Bongros-HA™ (BioAlpha, Seongnam, Korea) which is a type of synthetic hydroxyapatite (HA) spacer to evaluate the efficacy in its clinical application and usefulness as a reliable alternative to autograft bone. Methods Twenty-nine patients were enrolled in this study and 40 segments were involved. All patients were performed anterior cervical interbody fusion using HA spacer and plating system. Indications for surgery were radiculopathy caused by soft-disc herniation or spondylosis in 18 patients, spondylotic myelopathy in 1 patient, and spinal trauma in 10 patients. Cervical spine radiographs were obtained on postoperative 1day, 1week, and then at 1, 2, 6, and 12 months in all patients to evaluate intervertebral disc height, and the degrees of lordosis. Cervical computed tomography was done at postoperative 12 month in all patients to confirm the fusion status. The mean period of clinical follow-up was 17 months. Results Complete interbody fusion was achieved in 100% of patients. Preoperative kyphotic deformities were corrected in all cases after surgery. Intervertebral disc height was well maintained during follow up period. There were no cases of graft extrusion, graft deterioration and graft fracture. Conclusion HA spacer is very efficient in achieving cervical fusion, maintaining intervertebral disc height, and restoring lordosis. When combined with the placement of a cervical plate, immediate stability can be achieved and graft related complication can be prevented.

Kim, Sung Chul; Kang, Sung Won; Kim, Se Hyuk; Cho, Ki Hong

2009-01-01

149

A Case Report of Reiter's Syndrome with Progressive Myelopathy  

PubMed Central

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.

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

2007-01-01

150

Axial Neck Pain after Cervical Laminoplasty  

PubMed Central

Objective It has been demonstrated that cervical laminoplasty is an effective and safe method of treating multi-level cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament. However, recent reports have suggested that axial neck pain is frequently encountered after cervical laminoplasty. The aim of the present study was to determine clinical significance of the C7 spinous process on axial neck pain after cervical laminoplasty. Methods A total of 31 consecutive patients that underwent cervical laminoplasty between March 2002 and December 2008 were reviewed. The authors evaluated and compared axial neck pain and lordotic angle in patients that underwent C7 spinous process preserving surgery (group 1, n = 16) and in patients in which the C7 spinous process was sacrificed (group 2, n = 15). Results Severe or moderate early axial pain occurred in 56.2% of patients in group 1 and in 86.6% in group 2. Severe or moderate late axial pain occurred in 12.5% in group 1 and in 73.3% in group 2. Eighty-Six percent of patients in group 2 and 43% in group 1 experienced aggravation of their axial neck pain during the early postoperative period. Aggravation of axial neck pain during early postoperative period was less common in group 1 but not statistically significant (p = 0.073). Sixty-six percent of patients in group 2 and 12% in group 1 had aggravated axial neck pain at late postoperative period and aggravation of late axial neck pain was significantly less common in group 1 (p = 0.002). Conclusion The present study demonstrates that C7 spinous process preserving laminoplasty decreases the incidence of aggravated axial neck pain after cervical laminoplasty.

Cho, Chul Bum; Oh, Jong Yang; Park, Hae Kwan; Lee, Kyung Jin; Rha, Hyoung Kyun

2010-01-01

151

Anterior cervical fusion with interbody cage containing ?-tricalcium phosphate augmented with plate fixation: a prospective randomized study with 2-year follow-up  

PubMed Central

A variety of bone graft substitutes, interbody cages, and anterior plates have been used in cervical interbody fusion, but no controlled study was conducted on the clinical performance of ?-tricalcium phosphate (?-TCP) and the effect of supplemented anterior plate fixation. The objective of this prospective, randomized clinical study was to evaluate the effectiveness of implanting interbody fusion cage containing ?-TCP for the treatment of cervical radiculopathy and/or myelopathy, and the fusion rates and outcomes in patients with or without randomly assigned plate fixation. Sixty-two patients with cervical radiculopathy and/or myelopathy due to soft disc herniation or spondylosis were treated with one- or two-level discectomy and fusion with interbody cages containing ?-TCP. They were randomly assigned to receive supplemented anterior plate (n = 33) or not (n = 29). The patients were followed up for 2 years postoperatively. The radiological and clinical outcomes were assessed during a 2-year follow-up. The results showed that the fusion rate (75.0%) 3 months after surgery in patients treated without anterior cervical plating was significantly lower than that (97.9%) with plate fixation (P < 0.05), but successful bone fusion was achieved in all patients of both groups at 6-month follow-up assessment. Patients treated without anterior plate fixation had 11 of 52 (19.2%) cage subsidence at last follow-up. No difference (P > 0.05) was found regarding improvement in spinal curvature as well as neck and arm pain, and recovery rate of JOA score at all time intervals between the two groups. Based on the findings of this study, interbody fusion cage containing ?-TCP following one- or two-level discectomy proved to be an effective treatment for cervical spondylotic radiculopathy and/or myelopathy. Supplemented anterior plate fixation can promote interbody fusion and prevent cage subsidence but do not improve the 2-year outcome when compared with those treated without anterior plate fixation.

Jiang, Lei-Sheng

2008-01-01

152

Wednesday, October 30, 2001 3:58–4:41 pm Concurrent Session 1A: Complex Cervical Reconstruction  

Microsoft Academic Search

Purpose of study: Cervical spondylotic radiculopathy is a common degenerative problem manifesting as neck and arm pain. The pathogenesis of spondylotic radiculopathy often relates to foraminal narrowing resulting from uncovertebral and facet joint hypertrophy as well as disc height collapse. The surgical management of foraminal stenosis includes anterior and posterior options. An anterior cervical discectomy with interbody fusion allows for

Louis Jenis; Steven Banco; John Jaquemin; Ki-Hon Lin

2002-01-01

153

Diffusion tensor imaging in the cervical spinal cord.  

PubMed

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

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

2010-10-13

154

Copper deficiency myelopathy  

Microsoft Academic Search

Acquired copper deficiency has been recognised as a rare cause of anaemia and neutropenia for over half a century. Copper\\u000a deficiency myelopathy (CDM) was only described within the last decade, and represents a treatable cause of non-compressive\\u000a myelopathy which closely mimics subacute combined degeneration due to vitamin B12 deficiency. Here, 55 case reports from the\\u000a literature are reviewed regarding their

Stephan R. JaiserGavin; Gavin P. Winston

2010-01-01

155

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

PubMed

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

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

2013-07-23

156

Cervical radiculopathy: Pain, muscle weakness and sensory loss in patients with cervical radiculopathy treated with surgery, physiotherapy or cervical collar A prospective, controlled study  

Microsoft Academic Search

This prospective, randomised study compares the efficacy of surgery, physiotherapy and cervical collar with respect to pain, motor weakness and sensory loss in 81 patients with long-lasting cervical radiculopathy corresponding to a nerve root that was significantly compressed by spondylotic encroachment, with or without an additional bulging disk, as verified by MRI or CT-myelography. Pain intensity was registered on a

L. C. G. Persson; U. Moritz; L. Brandt; C.-A. Carlsson

1997-01-01

157

Three-level anterior cervical discectomy and fusion in elderly patients with wedge shaped tricortical autologous graft: A consecutive prospective series  

PubMed Central

Background: Treatment of multilevel cervical spondylotic myelopathy/radiculopathy is a matter of debate, more so in elderly patients due to compromised physiology. We evaluated the clinical and radiological results of cervical fusion, using wedge-shaped tricortical autologous iliac graft and Orion plate for three-level anterior cervical discectomy in elderly patients. Materials and Methods: Twelve elderly patients with mean age of 69.7 years (65–76 years) were treated between April 2000 and March 2005, for three-level anterior cervical discectomy and fusion, using wedge-shaped tricortical autologous iliac graft and Orion plate. Outcome was recorded clinically according to Odom's criteria and radiologically in terms of correction of lordosis angle and intervertebral disc height span at the time of bony union. The mean follow-up was 29.8 months (12–58 months). Results: All the patients had a complete recovery of clinical symptoms after surgery. Postoperative score according to Odom's criteria was excellent in six patients and good in remaining six. Bony union was achieved in all the patients with average union time of 12 weeks (8–20 weeks). The mean of sum of three segment graft height collapse was 2.50 mm (SD = 2.47). The average angle of lordosis was corrected from 18.2° (SD = 2.59°) preoperatively to 24.9° (SD = 4.54°) at the final follow-up. This improvement in the radiological findings is statistically significant (P < 0.05). Conclusion: Cervical fusion with wedge-shaped tricortical autologous iliac graft and Orion plate for three-level anterior cervical discectomy is an acceptable technique in elderly patients. It gives satisfactory results in terms of clinical outcome, predictable early solid bony union, and maintenance of disc space height along with restoration of cervical lordosis.

Lee, Suk Ha; Oh, Kwang Jun; Yoon, Kwang Su; Lee, Sung Tae; Pandher, Dilbans S

2008-01-01

158

Metabolic and toxic myelopathies.  

PubMed

The myelopathies discussed in this article have an underlying metabolic or toxic etiology. They have many clinical, electrophysiologic, and neuropathologic similarities. Preferential involvement of the dorsal columns and/or corticospinal tracts is commonly seen. Variable degrees of peripheral nerve and/or optic nerve involvement may be present. In the presence of clinical or electrophysiologic evidence of peripheral nerve involvement, the term myeloneuropathy is commonly used. The metabolic and toxic myelopathies discussed here are divided into three categories: disorders due to an identified nutrient deficiency such as the subacute combined degeneration of cobalamin/vitamin B12 or copper deficiency, disorders that have a geographical predilection and are due to a suspected toxin such as lathyrism, and disorders due to a possible toxin but without a geographical predilection such as hepatic myelopathy (Table 1). PMID:22961187

Kumar, Neeraj

2012-09-08

159

Anterior cervical fusion with interbody cage containing beta-tricalcium phosphate augmented with plate fixation: a prospective randomized study with 2-year follow-up.  

PubMed

A variety of bone graft substitutes, interbody cages, and anterior plates have been used in cervical interbody fusion, but no controlled study was conducted on the clinical performance of beta-tricalcium phosphate (beta-TCP) and the effect of supplemented anterior plate fixation. The objective of this prospective, randomized clinical study was to evaluate the effectiveness of implanting interbody fusion cage containing beta-TCP for the treatment of cervical radiculopathy and/or myelopathy, and the fusion rates and outcomes in patients with or without randomly assigned plate fixation. Sixty-two patients with cervical radiculopathy and/or myelopathy due to soft disc herniation or spondylosis were treated with one- or two-level discectomy and fusion with interbody cages containing beta-TCP. They were randomly assigned to receive supplemented anterior plate (n = 33) or not (n = 29). The patients were followed up for 2 years postoperatively. The radiological and clinical outcomes were assessed during a 2-year follow-up. The results showed that the fusion rate (75.0%) 3 months after surgery in patients treated without anterior cervical plating was significantly lower than that (97.9%) with plate fixation (P < 0.05), but successful bone fusion was achieved in all patients of both groups at 6-month follow-up assessment. Patients treated without anterior plate fixation had 11 of 52 (19.2%) cage subsidence at last follow-up. No difference (P > 0.05) was found regarding improvement in spinal curvature as well as neck and arm pain, and recovery rate of JOA score at all time intervals between the two groups. Based on the findings of this study, interbody fusion cage containing beta-TCP following one- or two-level discectomy proved to be an effective treatment for cervical spondylotic radiculopathy and/or myelopathy. Supplemented anterior plate fixation can promote interbody fusion and prevent cage subsidence but do not improve the 2-year outcome when compared with those treated without anterior plate fixation. PMID:18301927

Dai, Li-Yang; Jiang, Lei-Sheng

2008-02-27

160

Myelopathy in Marfan's syndrome  

PubMed Central

A patient with Marfan's syndrome and a myelopathy is reported, and the association of multiple spinal arachnoid cysts noted. It is proposed that the basic connective tissue defect in Marfan's syndrome may predispose to the formation of arachnoid diverticuli and that in this case spinal cord damage was the sequel. Images

Newman, P. K.; Tilley, P. J. B.

1979-01-01

161

Improved medical and surgical management of cervical spine disease in patients with rheumatoid arthritis over 10 years  

Microsoft Academic Search

OBJECTIVES(1) To compare clinical outcome and symptomatology of rheumatoid cervical myelopathy between patients managed conservatively and surgically. (2) To determine if surgical outcome has improved since the series published from this unit in 1987. (3) To examine the role of magnetic resonance imaging (MRI) in the diagnosis of cervical myelopathy.METHODSPatients undergoing MRI of the cervical spine between 1991 and 1996

Jennifer D Hamilton; Margaret-Mary Gordon; Iain B McInnes; Robin A Johnston; Rajan Madhok; Hilary A Capell

2000-01-01

162

Sympathetic skin response in myelopathies  

Microsoft Academic Search

Autonomic dysfunctions cause significant morbidity and mortality among patients with spinal cord disorders. Sympathetic skin response (SSR), a simple, noninvasive electrophysiological technique, may be useful for assessing sympathetic functions in patients with myelopathies. Our aim was to study SSR in patients with myelopathy and correlate it with clinical features, severity of the impairment, somatosensory evoked potentials. and outcome. Thirty patients

K. P. S. Nair; A. B. Taly; G. R. Arunodaya; Shivaji Rao; T. Murali

1998-01-01

163

Cervical radiculopathy.  

PubMed

The history, pathoanatomy and pathophysiology, clinical picture, differential diagnosis, diagnostic evaluation, and treatment of cervical radiculopathy are reviewed. The review is based on a 10-year Medline literature search, review of bibliographies in textbooks, and bibliographies in articles obtained through the search. Cervical radiculopathy, although recognized early in the 20th century, was first associated with disc pathology in the mid-1930s. It is most commonly caused by disc herniation or cervical spondylosis. History and physical examination using pain location, manual muscle testing, and specialized testing (Spurling's maneuver) will usually suffice to diagnose the radiculopathy and determine the root level involved. Diagnostic imaging such as magnetic resonance imaging, computed tomography, or myelography should be used as presurgical evaluative tools or when tumor or other etiology besides disc herniation or spondylosis is suspected. Electromyography is of benefit in distinguishing various entities that clinically present similar to cervical radiculopathy and can also help to "date" the lesion. Treatment of this disorder has not been systematically studied in a controlled fashion. However, using a variety of different treatments, the radiculopathy usually improves without the need for surgery. Indications for surgery are unremitting pain despite a full trial of non-surgical management, progressive weakness, or new or progressive cervical myelopathy. Prospective studies evaluating the various treatment options would be of great benefit in guiding practitioners toward optimum cost-effective evaluation and care of the patient with cervical radiculopathy. PMID:8129590

Ellenberg, M R; Honet, J C; Treanor, W J

1994-03-01

164

Cervical spondylotic amyotrophy presenting as dropped head syndrome  

Microsoft Academic Search

We report a case of acute-onset dropped head syndrome in a 65-year-old patient in whom the diagnosis of amyotrophic lateral sclerosis (ALS) was initially proposed based on electromyographic signs of neck and shoulder muscle denervation. There were no signs of pyramidal involvement and the clinical and electromyographic signs of motor denervation never evolved beyond the neck and shoulder girdle muscles

Rechdi Ahdab; Alain Créange; Sandrine Benaderette; Jean-Pascal Lefaucheur

2009-01-01

165

Comparison of enlargement of the spinal canal after cervical laminoplasty: open-door type and double-door type  

PubMed Central

The purpose of this study was to compare the degree of enlargement of the spinal canal between two methods of cervical laminoplasty (open-door laminoplasty and double-door laminoplasty) and to determine their appropriate surgical indications based on the results. Tension-band laminoplasty (TBL, one method of open-door type) was performed in 33 patients and double-door laminoplasty (DDL) in 20 patients. The operation level ranged from C2 to C7 in all patients. The width of the spinal canal and the inclination angle of the lamina at the C5 and C6 levels were measured using a computer software program (Image J) and pre- and postoperative CT films. Concerning the degree of enlargement of the spinal canal, the mean expansion ratio at the C5 level was 148.9% in TBL and 148.2% in DDL, and there was no significant difference between them. However, at the C6 level, it was 159.0% in TBL and 140.3% in DDL, which was significantly larger in TBL than DDL (p < 0.05). The increase of inclination angle of the lamina was 11.0° in TBL and 19.0° in DDL at the C5 level, and 9.2° in TBL and 19.3° in DDL at the C6 level. At both the C5 and C6 levels, it was significantly larger in DDL than TBL (p < 0.0001). In conclusion, the appropriate surgical indications of TBL were considered to be (1) cervical spondylotic myelopathy (CSM) combined with hemilateral radiculopathy, (2) severe prominence of ossification of the posterior longitudinal ligament (OPLL), and (3) patients with tiny spinous processes who cannot undergo DDL. Those of DDL were considered to be (1) usual CSM, (2) small and slight prominence of OPLL, (3) CSM combined with bilateral radiculopathy, and (4) cervical canal stenosis combined with instability necessitating posterior spinal instrumentation surgery.

Yamada, Hironobu; Motosuneya, Takao; Watanabe, Yoshinobu; Miura, Makoto; Sakai, Hiroya; Matsushita, Takashi

2010-01-01

166

Double-door laminoplasty in managing multilevel myelopathy: technique description and literature review  

Microsoft Academic Search

Cervical laminoplasty has become a popular technique for the treatment of cervical myelopathy resulting from multilevel canal\\u000a stenosis. The goal of this technique is to increase the spinal canal space and to reconstruct the posterior bony arch at the\\u000a same time. The most common reason for laminoplasty failure is restenosis because of hinge closure. In the present report,\\u000a the authors

M. Orabi; S. Chibbaro; O. Makiese; J. F. Cornelius; B. George

2008-01-01

167

Cervical Laminectomy Width and Spinal Cord Drift Are Risk Factors for Postoperative C5 Palsy.  

PubMed

BACKGROUND:: Cervical laminectomy and fusion (CLF) is a treatment option for multilevel cervical spondylotic myelopathy. Postoperative C5 nerve palsy is a possible complication of CLF. It has been suggested that C5 nerve palsy may be due to posterior drift of the spinal cord related to a wide laminectomy trough. PURPOSE:: To test the hypothesis that excessive spinal cord drift into a wide laminectomy trough is associated with C5 palsy. STUDY DESIGN:: Retrospective case-control study. PATIENT SAMPLE:: Seventeen patients with C5 palsy, 8 patients as control group. OUTCOME MEASURES:: Spinal cord positional measurements on magnetic resonance imaging (MRI). METHODS:: All patients who underwent elective CLF for cervical spondylotic myelopathy or ossified posterior longitudinal ligament using posterior instrumentation between 2004 and 2008 were included. Patients who underwent CLF for trauma, infection, or tumors were excluded. Clinical and radiographic outcomes were assessed by chart review (minimum of 1 y follow-up). Patients who developed a new postoperative C5 nerve palsy underwent repeat MRI. The control group also underwent CLF, did not develop a neurological deficit, and received a postoperative MRI for evaluation of possible infection. MRI measurements included the width of the laminectomy trough, the distance from the posterior vertebral body or disk to the anterior spinal cord, the width of the spinal cord herniated into the laminectomy defect, and C2-7 sagittal alignment. Preoperative radiographic measurements included preoperative vertebral body diameter, spinal canal diameter, and sagittal vertical offset. RESULTS:: There were seventeen patients with C5 nerve root palsy and 8 patients without C5 nerve root palsy. There were no baseline differences in fusion levels, instrumentation used, patient age, or sex. MRI measurements revealed an increase in mean postoperative cord drift in patients with C5 palsy at C3 (4.2 vs. 2.2 mm, P=0.002), C4 (4.6 vs. 2.8 mm, P=0.056), C5 (5.1 vs. 2.4 mm, P=0.011), and C6 (5.2 vs. 2.4 mm, P=0.003). There was a significant increase in C5 laminectomy trough width among patients with postoperative C5 palsy (17.9 vs. 15.2 mm, P=0.032), but there was no difference in sagittal alignment. CONCLUSIONS:: A wider laminectomy at C5 was associated with an increased risk of postoperative C5 palsy. Increased preoperative spinal canal diameter is also associated with increased risk of C5 palsy. In addition, patients who experienced C5 nerve palsy had a significantly greater posterior spinal cord drift. Strategies to reduce postoperative laminectomy trough width and spinal cord drift may reduce the risk of postoperative C5 palsy. PMID:22425890

Radcliff, Kris E; Limthongkul, Worawat; Kepler, Chris K; Sidhu, Gursukhman D S; Anderson, D Greg; Rihn, Jeffrey A; Hilibrand, Alan S; Vaccaro, Alexander R; Albert, Todd J

2012-03-20

168

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

PubMed Central

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

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

2007-01-01

169

Multiple myeloma-associated solitary epidural amyloidoma of C2-C3 without bony connection or myelopathy: Case report and review of the literature  

Microsoft Academic Search

BackgroundA large solitary amyloidoma in the cervical epidural space without bony connection and with minimal spinal cord compression and no myelopathy, as a first manifestation of disseminated amyloidosis in a multiple myeloma patient, has not been reported previously; this case is thereby distinct from the seven prior reports in the world literature, of a solitary amyloidoma of the cervical spine.

Carl J. Belber; David L. Graham

2004-01-01

170

Outcome of cervical spine surgery in patients with rheumatoid arthritis  

PubMed Central

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.??

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

2001-01-01

171

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

PubMed Central

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

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

2012-01-01

172

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

PubMed Central

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

Aizawa, Toshimi; Ozawa, Hiroshi; Hoshikawa, Takeshi; Kusakabe, Takashi; Itoi, Eiji

2009-01-01

173

Longitudinal length of the spinal cord after cervical laminoplasty  

Microsoft Academic Search

Purpose of study: In cases of cervical myelopathy, the relationship between surgical outcome after laminoplasty and the sagittal alignment is controversial. In our cases with OPLL of unexpected poor surgical outcome, we often found a straight, tense spinal cord on postoperative magnetic resonance imaging, (MRI). So we tried to measure a longitudinal length of the cervical spinal cord (LSC) as

Toru Yokoyama; Kazumasa Ueyama; Akihiro Okada; Takashi Tomita

2002-01-01

174

Cervical myelo-radiculopathy in athetoid cerebral palsy  

Microsoft Academic Search

Cervical myelopathy complicating athetoid cerebral palsy has not been adequately highlighted in the literature. We report two cases of patients with athetoid cerebral palsy and long histories of involuntary movements who developed cervical myelo-radiculopathy. Dystonic athetoid neck movements may cause excessive axial neck rotation as well as flexion and extension movements of the spine. These repetitive exaggerated movements may result

Y. Mikawa; R. Watanabe; J. Shikata

1997-01-01

175

Nontraumatic Myelopathy Associated With Surfing  

PubMed Central

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.

Aviles-Hernandez, Israel; Garcia-Zozaya, Inigo; DeVillasante, Jorge M

2007-01-01

176

Microsurgery of the cervical spine in elderly patients Part 1: Surgery of degenerative disease  

Microsoft Academic Search

Summary The results of microsurgery for degenerative disease of the cervical spine are reported in 84 consecutive patients being 65 years of age or older at the time of surgery. Patients were suffering from either soft or hard disc disease or from advanced forms of cervical myelopathy. In 60 patients microsurgical resection of the involved cervical disc and posterior osteophytes

V. Seifert; F. M. van Krieken; M. Zimmermann; D. Stolke; S. D. Bao

1994-01-01

177

Metabolic, nutritional, and toxic myelopathies.  

PubMed

This review article identifies and describes the clinical manifestations of various metabolic, nutritional, and toxic conditions that result in symptoms of myelopathy and, in some cases, myeloneuropathy. It includes discussions of the clinical pictures that occur secondary to these causes. Familiarity with the clinical symptoms may lead to accurate diagnosis through laboratory and imaging studies and to treatment with successful identification of the underlying causes. PMID:23186901

Schwendimann, Robert N

2013-02-01

178

Myelopathy due to atlanto-axial dislocation in a patient with Down's syndrome and rheumatoid arthritis.  

PubMed

A case of Down's syndrome in association with rheumatoid arthritis is described. The patient has spastic diplegia and atlanto-axial dislocation, probably the result of ligamentous laxity which is common in both Down's syndrome and rheumatoid arthritis. This laxity may have been enhanced by tonsillar or deep cervical infection. The myelopathy was thought to be due to the atlanto-axial dislocation. Spinal fusion may reverse the neurological abnormality in some cases. PMID:6454603

Andrews, L G

1981-06-01

179

Myelopathy but normal MRI: where next?  

Microsoft Academic Search

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

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

2008-01-01

180

Myelopathy Associated With Melorheostosis: A Case Report  

Microsoft Academic Search

Reznik M, Fried GW. Myelopathy associated with melorheostosis: a case report.A man in his mid thirties presented with lower-extremity weakness and spasticity because of a myelopathy caused by a rare disorder of bone known as melorheostosis. The primary pathology involved was compression of the cord at the cervicothoracic levels by dystrophic osseous formation within the vertebral bodies. Based on a

Mark Reznik; Guy W. Fried

2005-01-01

181

Posterior approach to the degenerative cervical spine  

Microsoft Academic Search

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

Kazuo Yonenobu; Takenori Oda

2003-01-01

182

Posterior approach to the degenerative cervical spine  

Microsoft Academic Search

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

Kazuo Yonenobu; Takenori Oda

183

Early follow-up outcomes after treatment of degenerative disc disease with the discover cervical disc prosthesis  

Microsoft Academic Search

Background contextAlthough anterior cervical decompression and fusion has been used successfully in the treatment of symptomatic radiculopathy and\\/or myelopathy, biomechanical studies have suggested possible deleterious effects of cervical fusion on adjacent level kinematics. The emergence of cervical arthroplasty as an alternative to arthrodesis may restore a more normal spinal movement and reduces a kinematic strain on adjacent segments. To date,

Junjie Du; Mo Li; Hao Liu; Hao Meng; Qizhen He; Zhuojing Luo

2011-01-01

184

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

Microsoft Academic Search

Ossification of the posterior longitudinal ligament (OPLL) in the cervical spine is considered to be uncommon in western countries, although widely known and studied in Japan. We report on 9 cases of OPLL cervical myelopathy, investigated by x-ray films and cervical CT and by somatosensory evoked potentials. The patients reported spastic tetraparesis, sensory disorders of the limbs and, in one

L. Conte; T. Tassinari; M. Trucco; O. Serrato; R. Badino

1992-01-01

185

Vitamin B12 extensive thoracic myelopathy: clinical, radiological and prognostic aspects. Two cases report and literature review.  

PubMed

The myelopathy caused by vitamin B12 deficiency is known as subacute combined degeneration. It is rare, but a well known cause of demyelination of the dorsal columns of the spinal cord. The magnetic resonance imaging is characterized by an increased signal on T2-weighted images involving the posterior columns of cervical and thoracic cord. There have been few cases in literature with extensive lesions (more than seven levels) of the thoracic spinal cord. The clinical and radiological improvements are possible if the replacement of vitamin B12 is initiated precocious. We present two rare cases of extensive thoracic myelopathy due to vitamin B12 deficiency. The first is a young woman with complete clinical recovery and important radiologic improvement after early treatment. In addition, the second case is an older man with partial response to the treatment. Those cases illustrate the importance of considering vitamin B12 deficiency in any patient, who presents with myelopathy. PMID:23468407

de Medeiros, Frederico Carvalho; de Albuquerque, Lucas Alverne Freitas; de Souza, Renata Brant; Gomes Neto, Antonio Pereira; Christo, Paulo Pereira

2013-03-07

186

Cervical spondylosis: ventral or dorsal surgery.  

PubMed

Cervical spondylosis is a result of degenerative changes of the cervical spine. Neurological symptoms of myelopathy result from the narrowing of the spinal canal, causing spinal cord compression. Surgical management of cervical stenosis requires an understanding of the interplay between multiple pathological and biomechanical factors contributing to this disease process. Surgical decompression can be addressed from a ventral, dorsal, or combined approach. The authors discuss the technical aspects of the surgical decision making process regarding the decision to approach the spine from a ventral or dorsal orientation. PMID:17204873

Witwer, Brian P; Trost, Gregory R

2007-01-01

187

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

PubMed

A Thoroughbred yearling was presented with neurological, radiographic, and myelographic abnormalities consistent with cervical vertebral stenotic myelopathy. Surgical correction was performed by using ventral cervical interbody fusion at 3 intervertebral spaces. The patient recovered uneventfully from surgery. The neurological status remained unchanged initially; however, significant improvement was noted 37 weeks postoperatively. PMID:17616065

Huggons, Nick

2007-06-01

188

Influence of minor trauma to the neck on the neurological outcome in patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine  

Microsoft Academic Search

The influence of minor trauma to the neck on the neurological outcome in patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine was evaluated retrospectively. Out of 118 patients treated in our clinic for cervical OPLL between 1976 and 1992, 27 had sustained minor trauma to the cervical spine. Of these 27 patients, 13 developed myelopathy,

S Katoh; T Ikata; N Hirai; Y Okada; K Nakauchi

1995-01-01

189

Cervical spine disorders in farm workers requiring neck extension actions  

Microsoft Academic Search

Background  Cervical extension is considered a risk factor for provoking radicular and spinal cord compromise. However, there have been\\u000a no reports on the relation between extension strain (ES) and cervical spine disorders: degenerative cervical spine disorders,\\u000a dynamic canal stenosis (DCS), and cervical myelopathy. We performed a cross-sectional study to investigate the relation.\\u000a \\u000a \\u000a \\u000a Methods  Orthopedic examinations were performed on 177 grape-growers (ES-exposed group)

Yoshiaki Takamiya; Kensei Nagata; Katsuhiro Fukuda; Akira Shibata; Tatsuya Ishitake; Takajiro Suenaga

2006-01-01

190

MRI in Vitamin B12 Deficiency Myelopathy  

Microsoft Academic Search

Background: Little is known about vitamin B 12 deficiency myelopathy's magnetic reso- nance imaging (MRI) manifestations and their relationship to the onset, evolution, and resolution of neuro - logic signs and symptoms. Methods: We present a case and review eleven additional reported cases of subacute combined degeneration of the spinal cord detected by MRI. Results: Our patient had increased T2-weighted

Eduardo R. Locatelli; Robert Laureno; Pamela Ballard; Alexander S. Mark

191

Subacute myelopathy caused by spinal venous infarction.  

PubMed Central

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

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

1987-01-01

192

Postoperative Urinary Retention Following Anterior Cervical Spine Surgery for Degenerative Cervical Disc Diseases  

PubMed Central

Background Postoperative urinary retention (POUR) may cause bladder dysfunction, urinary tract infection, and catheter-related complications. It is important to be aware and to be able to identify patients at risk of developing POUR. However, there has been no study that has investigated the incidence and risk factors for the development of POUR following anterior cervical spine surgery for degenerative cervical disc disease. Methods We included 325 patients (164 male and 161 female), who underwent anterior cervical spine surgery for cervical radiculopathy or myelopathy due to primary cervical disc herniation and/or spondylosis, in the study. We did not perform en bloc catheterization in our patients before the operation. Results There were 36 patients (27 male and 9 female) that developed POUR with an overall incidence of 11.1%. The mean numbers of postoperative in-and-out catheterizations was 1.6 times and mean urine output was 717.7 mL. Thirteen out of 36 POUR patients (36%) underwent indwelling catheterization for a mean 4.3 days after catheterization for in-and-out surgery, because of persisting POUR. Seven out of 36 POUR patients (19%) were treated for voiding difficulty, urinary tract irritation, or infection. Chi-square test showed that patients who were male, had diabetes mellitus, benign prostate hypertrophy or myelopathy, or used Demerol were at higher risk of developing POUR. The mean age of POUR patients was higher than non-POUR patients (68.5 years vs. 50.8 years, p < 0.01). Conclusions To avoid POUR and related complications as a result of anterior cervical spine surgery for degenerative cervical disc disease, we recommend that a catheter be placed selectively before the operation in at-risk patients, the elderly in particular, male gender, diabetes mellitus, benign prostate hypertrophy, and myelopathy. We recommend that Demerol not be used for postoperative pain control.

Jung, Hyun Ju; Kong, Chae-Gwan; Kim, Young-Yul; Park, Jangsu; Kim, Jong Bun

2013-01-01

193

Degenerative spondylolisthesis of the cervical spine — symptoms and surgical strategies depending on disease progress  

Microsoft Academic Search

Background  Degenerative spondylolisthesis of the cervical spine is rare. Patients show signs of progredient myelopathy, radiculopathy\\u000a and pain. Treatment strategies include ventral, dorsal and combined fusion techniques with or without repositioning and decompression.\\u000a \\u000a \\u000a \\u000a Methods  In this study, we present 16 patients with degenerative cervical spondylolisthesis. The leading symptom was severe myelopathy\\u000a in 8 patients, radiculomyelopathy in 5 patients and neck pain in

Christian Woiciechowsky; Ulrich-Wilhelm Thomale; Stefan-Nikolaus Kroppenstedt

2004-01-01

194

Cervical Spondylosis: Recognition, Differential Diagnosis, and Management  

PubMed Central

In contemporary clinical practice, the prevalence of neck pain in the general population is approximately 15%. The challenge for the primary care specialist is to be able to recognize the more serious disorders that require early referral. Additionally, it is important to have the confidence to institute specific treatment for nonurgent conditions in order to avoid unnecessary referral of patients with generally self-limiting conditions. Cervical spondylosis is a general and nonspecific term that encompasses a broad spectrum of afflictions but, for purposes of clarity, can be organized into three clinical syndromes: Type I Syndrome (Cervical Radiculopathy); Type II Syndrome (Cervical Myelopathy); and Type III Syndrome (Axial Joint Pain). It is important to remember that shoulder problems can masquerade as cervical problems, and vice versa (e.g. adhesive capsulitis, recurrent anterior subluxation, impingement syndrome, rotator cuff tear, etc.). A number of management options, including pharmaceutical, physical therapy, and psychological therapies, are available once a diagnosis has been made.

Voorhies, Rand M.

2001-01-01

195

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

PubMed

Short-latency somatosensory evoked potentials (SSEPs) were measured before and after intermittent cervical traction therapy to serve as objective indicators of therapy effectiveness. The subjects were 29 patients with myelopathy, 23 with cervical radiculopathy, 28 with cervical sprain, and 26 healthy individuals. SSEPs were recorded by stimulating the median nerve, and the negative potentials elicited from the brachial plexus (N9), neck (N11, lcN13, ucN13), and somatosensory area (N18) were measured to determine interpeak latencies and then corrected latency. As to the changes in SSEPs following traction, the N11-lcN13 and lcN13-ucN13 interpeak latencies for patients with type I and II myelopathy decreased, and the severity of myelopathy was inversely related to the degree of decrease. The ucN13-N18 interpeak latency for some patients with severe myelopathy increased. The N9-N11 and N11-lcN13 interpeak latencies for patients with cervical radiculopathy decreased, and the ucN13-N18 for patients with cervical sprain accompanied by autonomic nervous symptoms also decreased. Traction therapy might improve conduction disturbance primarily by increasing the amount of blood flow from the nerve roots to the spinal parenchyma. PMID:11956981

Hattori, Mikihiko; Shirai, Yasumasa; Aoki, Takafumi

2002-01-01

196

Long term outcome of anterior cervical discectomy and fusion using coral grafts  

Microsoft Academic Search

Background  To determine the long term efficacy of coral grafts in anterior cervical discectomy and fusion.\\u000a \\u000a \\u000a \\u000a Methods  In this prospective longitudinal study, All patients presenting with myelopathy and\\/or radiculopathy due to discal hernia\\u000a or cervical spondylosis underwent anterior cervical microdiscectomy, arthrodesis with coral, and stabilization with anterior\\u000a cervical locking plates. Clinical and radiological post-operative evaluations were performed at 2 days, 3, 6, and

Najib Ramzi; Geraldo Ribeiro-Vaz; Edward Fomekong; Frédéric E. Lecouvet; Christian Raftopoulos

2008-01-01

197

Posttraumatic pseudomenigocoele of cervical spine in a patient with skeletal fluorosis. Case report.  

PubMed

A case of fluorotic cervical compressive myelopathy precipitated by trauma is reported. The delayed neurological deterioration was due to a posttraumatic pseudomenincocele, the prompt treatment of which resulted in recovery. Posttraumatic pseudomeningocele is very rate; and certainly so in fluorosis, and thus has not been reported in the literature to date. PMID:7997344

Prasad, V S; Reddy, D R

1994-09-01

198

Hypoglossal nerve palsy from cervical spine involvement in rheumatoid arthritis: 3 case reports  

Microsoft Academic Search

Blankenship LD, Basford JR, Strommen JA, Andersen RJ. Hypoglossal nerve palsy from cervical spine involvement in rheumatoid arthritis: 3 case reports. Arch Phys Med Rehabil 2002;83:269-72. Rheumatoid arthritis (RA) involvement of the cervical spine is a well-known but perhaps underappreciated phenomenon. Neurologic complications of this involvement include pain, myelopathy, and cranial nerve (CN) palsies. However, hypoglossal nerve palsy (CN XII)

Lisa D. Blankenship; Jeffrey R. Basford; Jeffrey A. Strommen; Renee J. Andersen

2002-01-01

199

[Evoked somatosensory plexus and cervical evoked potentials in cervicobrachialgia].  

PubMed

The authors study the sensitive potential evoked from point of Erb and from cervical spine in C6-C7, obtained by stimulation of median nerve in a control group (normals) and in a greater group of 40 cases from patients affected by radiculopathie with or without discal protrusion and by myelopathie spondiloartrosic. The date supply significant informations and are (obicurred in analytique) analyzed with accuracy. PMID:6879059

Rossi, L; Ubiali, E; Merli, R; Rottoli, M R

200

Past, present, and future of cervical arthroplasty.  

PubMed

Cervical arthroplasty was developed in an attempt to maintain cervical motion and potentially to avoid or minimize adjacent-segment degeneration. If cervical arthroplasty is successful, the long-term results of surgery for cervical disc disease should improve. However, problems associated with cervical arthroplasty have been reported: these include kyphosis, heterotopic ossification-induced motion limitation, no motion preservation even at the index level, and a higher revision rate in a limited number of cases compared with anterior cervical discectomy and fusion (ACDF). In addition, for degenerative cervical disc disorders, the risk of developing adjacent segment degeneration more than 2 years after surgery is reportedly similar for ACDF and cervical arthroplasty. Cervical disc arthroplasty is an emerging motion-sparing technology and is currently undergoing evaluation in many countries as an alternative to arthrodesis for the treatment of cervical radiculopathy and myelopathy. The decision whether to use arthrodesis or arthroplasty is a difficult one. The achievement of good prosthetic performance demands exacting implantation techniques to ensure correct placement. This fact underlines the increasing importance of special instrumentation and surgical skills that involve an understanding of prosthetic lubrication, wear, and biologic effects and familiarity with currently available information regarding kinematics, basic science, testing, and early clinical results. Fortunately, a number of devices are at the late preclinical study stage or at the early clinical trial stage, and results in many cases are promising. In the near future, it is likely that new designs will be produced to replace spinal discs totally or partially in a pathologic entity-specific manner. PMID:23803346

Hyun Oh, Chang; Hwan Yoon, Seung

2013-01-01

201

Intradural tumor and concomitant disc herniation of cervical spine  

PubMed Central

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

Bapat, Mihir R; Rathi, Prasanna; Pawar, Uday; Chaudhary, Kshitij

2011-01-01

202

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

Microsoft Academic Search

Ossification of the posterior longitudinal ligament (OPLL) is a common spinal disorder that presents with or without cervical\\u000a myelopathy. Furthermore, there is evidence suggesting that OPLL often coexists with cervical disc hernia (CDH), and that the\\u000a latter is the more important compression factor. To raise the awareness of CDH in OPLL for spinal surgeons, we performed a\\u000a retrospective study on

Hai-song YangDe-yu; De-yu Chen; Xu-hua Lu; Wang-jun Yan; Wen Yuan; Yu Chen

2010-01-01

203

Comparison of CT Myelography Performed in the Prone and Supine Positions in the Detection of Cervical Spinal Stenosis  

Microsoft Academic Search

AIM: To quantify the change in the cross-sectional area of the cervical spinal cord and subarachnoid space (SAS) in the supine neutral vs prone extension positions in patients with myelopathy undergoing cervical CT myelography.MATERIAL AND METHODS: Axial CT myelgrams of 21 myelopathic patients were performed in both the supine neutral and prone extension positions. The SAS and cord cross-sectional areas

COLE BLEASE GRAHAM III; FRANZ J. WIPPOLD II; KYONGTAE T. BAE; THOMAS K. PILGRAM; ALI SHAIBANI; DANIEL K. KIDO

2001-01-01

204

Cervical Fracture  

MedlinePLUS

... Copyright 2007 American Academy of Orthopaedic Surgeons Cervical Fracture (Broken Neck) The seven bones in the neck ... connect it to the shoulders and body. A fracture, or break, in one of the cervical vertebrae ...

205

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, ...

206

Cervical spondylosis  

MedlinePLUS

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

207

Cervical dysplasia  

MedlinePLUS

... No. 99: management of abnormal cervical cytology and histology. Obstet Gynecol . 2008;112(6):1419-1444. Wright ... consensus guidelines for abnormal cervical screening: tests andcervical histology. Am Fam Physician . 2009;80:147-155.

208

[Monosegmental , degenerative, cervical discopathy treated by surgery with insertion of an intervertebral cage].  

PubMed

Monosegmental, degenerative, cervical discopathy may become symptomatic because of spinal instability or neurocompression and may present as cervicalgia, radiculopathy and myelopathy. Conservative therapy of these conditions is indicated only in case of minor symptoms. In patients with radiculopathy, this treatment may be used for a longer period of time than in individuals with myelopathy. However, the disorder may progress and lead to irreversible complaints, especially in case of myelopathy. Therefore, the surgical treatment is preferred: if conservative therapy does not improve symptoms within a short period of time and if the patient continues to suffer, surgery is clearly indicated. Only recently, novel surgical methods such as microtechniques and cage surgery were introduced. The results of these types of surgery in this indications are very favourable with respect to recovery from pain, paresis and sensory deficits, rates of fusion of the motion segment, morbidity and mortality. PMID:12212492

Wenger, Markus

2002-07-01

209

Myelopathy caused by nitrous oxide toxicity.  

PubMed

We describe a case of myeloneuropathy resulting from nitrous oxide abuse. MR imaging of the spine revealed symmetric abnormal signal in the posterior columns of the cervical cord. Myeloneuropathy is caused by inactivation of vitamin B12 by nitrous oxide. This syndrome can also be seen in patients with borderline vitamin B12 deficiency who have recently been anesthetized with nitrous oxide. PMID:9613506

Pema, P J; Horak, H A; Wyatt, R H

1998-05-01

210

Myelopathy Caused by Nitrous Oxide Toxicity  

Microsoft Academic Search

Summary: We describe a case of myeloneuropathy result- ing from nitrous oxide abuse. MR imaging of the spine revealed symmetric abnormal signal in the posterior col- umns of the cervical cord. Myeloneuropathy is caused by inactivation of vitamin B12 by nitrous oxide. This syndrome can also be seen in patients with borderline vitamin B12 deficiency who have recently been anesthetized

Peter J Pema; Holli A Horak; Robert H. Wyatt

211

Histologically proven venous congestive myelopathy without concurrent vascular malformation: Case reports and review of the literature  

PubMed Central

Background: Venous congestive myelopathy is a progressive myelopathy that is generally caused by a spinal dural arteriovenous fistula. Case Description: We report a patient with histologically confirmed venous congestive myelopathy without concurrent vascular malformations in radiological and intraoperative findings. Conclusions: The definitive underlying etiology of this congestive myelopathy was unclear. However, this case report highlights the possibility of venous congestive myelopathy with etiology other than a dural arteriovenous fistula. Further, a systematic and elaborate examination should be undertaken to explore the underlying pathology whenever this type of spinal parenchymal lesion is detected.

Matsubara, Teppei; Akutsu, Hiroyoshi; Watanabe, Shinya; Nakai, Kei; Ayuzawa, Satoshi; Matsumura, Akira

2012-01-01

212

Cervical Cancer (PDQ): Screening  

MedlinePLUS

... These are called diagnostic tests . General Information About Cervical Cancer Cervical cancer is a disease in which malignant (cancer) cells ... Cervical Cancer Prevention Cervical Cancer Treatment Screening for cervical cancer using the Pap test has decreased the number ...

213

Posterior stabilization of the cervical spine with hooks and screws. A clinical evaluation of 26 patients with traumatic, degenerative or metastatic lesions, using a new implant system  

Microsoft Academic Search

We operated on 26 patients with cervical spine disorders (13 with traumatic lesions, 3 with spinal stenosis and myelopathy, 1 with osteomyelitis and 9 with metastasis) with posterior stabilization. A new implant system (Cervi-Fix) based on rods, enabling a choice of either screw or laminar hook fixation in a free combination, was used. The system was evaluated for ease of

Christer Hildingsson; Håkan Jonsson

2001-01-01

214

Relapsing hypocupraemic myelopathy requiring high-dose oral copper replacement  

Microsoft Academic Search

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

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

2006-01-01

215

Relapsing hypocupraemic myelopathy requiring high-dose oral copper replacement  

PubMed Central

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

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

2006-01-01

216

Two-level contiguous cervical disc disease treated with peek cages packed with demineralized bone matrix: results of 3-year follow-up  

Microsoft Academic Search

Interbody cages are widely used instruments for cervical fusion operations. Long-term follow-up studies are needed to clarify\\u000a if these devices are dependable. In this prospective study, 79 patients (42 women and 37 men) with a mean age of 51 years\\u000a operated between January 2000 and December 2005 for treatment of degenerative cervical disc disease and spondylosis associated\\u000a with radiculopathy or myelopathy

K?vanç Topuz; Ahmet Çolak; Serdar Kaya; Hakan ?im?ek; Murat Kutlay; Mehmet Nusret Demircan; Murat Velio?lu

2009-01-01

217

Synovial cysts of the cervicothoracic junction causing myelopathy: report of 3 cases and review of the literature.  

PubMed

Synovial cysts are uncommon pathological entities in patients with cervical degenerative spinal disease, and there are only a few reports in the literature. Treatment typically involves decompression; however, biomechanical data indicate that laminectomies in the cervical spine also result in cervical instability, specifically within the cervicothoracic junction, supporting the use of fusion as well. The authors describe the use of fusion with decompression in the treatment of 3 patients with cervicothoracic synovial cysts that presented in an acute fashion with associated myelopathy and neurological decline, and they review the diagnostic elements, histopathology, and treatment of these cysts. All 3 of the patients did well with decompression via a posterior approach with a single-level instrumented fusion from C-7 to T-1. Each patient regained complete neurological function and had no residual neurological deficits. These results are promising, although the sample size of 3 cases is too small to make any conclusive evaluations. Future studies incorporating Class I and Class II data are imperative to make firm conclusions regarding general management of this rare entity. PMID:23815248

Bisson, Erica F; Sauri-Barraza, José-Carlos; Niazi, Toba; Schmidt, Meic H

2013-07-01

218

Cervical pharyngostomy.  

PubMed Central

The technique of cervical pharyngostomy is presented as a safe alternative procedure to the nasogastric tube for patients requiring prolonged periods of gastrointestinal decompression or tube feeding. The results in 21 cases are described. The complication rate is low and the use of cervical pharyngostomy is therefore justified in that it reduces patient discomfort and makes treatment more efficient. Images Fig. 3 Fig. 4

Farndon, J. R.; Taylor, R. M.

1977-01-01

219

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

PubMed

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

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

2013-06-13

220

Cervical cancer.  

PubMed

Squamous cell cervical cancer incidence and mortality have been reduced dramatically as a result of successful screening in many countries. The incidence of cervical adenocarcinoma continues to increase. There has been concentrated effort toward improving early detection and screening by utilizing molecular biomarker assays. The FIGO staging system for cervical cancer was revised in 2009. Fertility preservation can be offered to patients with early-stage cervical cancer through radical trachelectomy, although radical hysterectomy remains the surgical standard of care. Concurrent chemotherapy with radiation has been shown to have a survival advantage in patients with advanced-stage disease. Improvements in radiation techniques and molecular targeted therapy are the current research venues in cervical cancer. PMID:22640713

Lea, Jayanthi S; Lin, Ken Y

2012-04-24

221

Diagnosis and surgical management of cervical ossification of the posterior longitudinal ligament  

Microsoft Academic Search

Background context: The diagnosis and treatment of multilevel cervical ossification of the posterior longitudinal ligament (OPLL) is continuing to evolve as its effects become more readily recognized and surgical alternatives expand.Purpose: To review the clinical, neurodiagnostic and surgical management of OPLL. Study design\\/setting: Patients with early OPLL, often in their mid-forties, present with radiculopathy or mild\\/moderate myelopathy. Radiographically, hypertrophy of

Nancy Epstein

2002-01-01

222

Abnormalities of spinal magnetic resonance images implicate clinical variability in human T-cell lymphotropic virus type I-associated myelopathy.  

PubMed

This study investigated the role of human T-cell lymphotropic virus type I HTLV-I infection in 11 patients who developed slowly progressive myelopathy with abnormal spinal cord lesions. The authors performed clinical and neuroradiological examinations and calculated the odds that an HTLV-I-infected individual of a specific genotype, age, and provirus load has HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Anti-HTLV-I antibodies were present in both the serum and cerebrospinal fluid in all of the patients. Abnormal magnetic resonance imaging (MRI) lesions were classified as cervical to thoracic type (CT type), cervical type (C type), and thoracic type (T type). In each type, there was swelling of the spinal cords with high-intensity lesions, which were located mainly in bilateral posterior columns, posterior horns, or lateral columns. Virological and immunological analyses revealed that all patients showed a high risk of developing HAM/TSP. These 11 patients may have developed HAM/TSP, as manifested by spinal cord abnormalities shown on MRI. These MRIs implicate clinical variability of HAM/TSP, which may indicate active-early stages of HAM/TSP lesions. PMID:17613716

Umehara, Fujio; Nose, Hirohisa; Saito, Mineki; Fukuda, Michinari; Ogino, Mieko; Toyota, Tomoko; Yuhi, Tomoaki; Arimura, Kimiyoshi; Osame, Mitsuhiro

2007-06-01

223

Cervical Cancer  

MedlinePLUS

... Centers for Disease Control and Prevention’s (CDC) Inside Knowledge: Get the Facts About Gynecologic Cancer campaign. The ... the facts about gynecologic cancer, providing important “inside knowledge” about their bodies and health. What is cervical ...

224

Cervical Adenocarcinoma  

MedlinePLUS

... The most common subtype of cervical cancer, called squamous cell carcinoma, arises from the surface lining of the ectocervix, ... successful at decreasing the number of patients with squamous cell carcinoma of the cervix, it has not yet been ...

225

Cervical Cancer  

MedlinePLUS

... by an infection of the cervix, including a yeast infection, infection with the human papillomavirus (HPV), the herpes virus, or many other infections. Abnormal cells. These changes are called cervical dysplasia. The cells ...

226

Cervical Cap  

MedlinePLUS

... girl for a cervical cap. During a pelvic exam, the doctor will determine which size cap is ... About Sexually Transmitted Diseases (STDs) Breast and Pelvic Exams Female Reproductive System Emergency Contraception Birth Control Pill ...

227

Radiation myelopathy: new perspective on an old problem.  

PubMed

This article discusses recent advances in basic research that alter the view of the pathogenesis of radiation myelopathy and summarizes the available data from developmental neurobiology and preclinical studies on demyelinating diseases. These studies have produced interesting insights into oligodendrocyte development, intercellular signaling pathways, and myelination processes. Current findings suggest that administration of cytokines as platelet-derived growth factor and basic fibroblast growth factor could increase proliferation of oligodendrocyte progenitors, enhance their differentiation, up-regulate synthesis of myelin constituents, and promote myelin regeneration in the adult central nervous system (CNS). Other compounds might also be able to modulate the progression of pathogenic processes that lead to myelopathy. In addition, several possible biological prevention or treatment strategies, for example stimulation of endogenous cellular regeneration and glial cell transplantation, are discussed. Rationally designed animal experiments pursuing such strategies could further elucidate the pathogenesis of radiation-induced CNS damage. PMID:10492160

Nieder, C; Ataman, F; Price, R E; Ang, K K

1999-01-01

228

Thoracic myelopathy secondary to seizure following scoliosis surgery.  

PubMed

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

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

2011-12-02

229

Cervical Cancer Screening  

MedlinePLUS

What is cervical cancer screening? Cervical cancer screening is used to find changes in the cells of the cervix that could lead ... includes the FAQ Human Papillomavirus Infection]. How is cervical cancer screening done? Cervical cancer screening is simple and ...

230

Cervical Cancer Symptoms  

MedlinePLUS

... Foundation for Women’s Cancer Home Types of Gynecologic Cancers Cervical Cancer Diagnosis and Treatment Symptoms Symptoms Cervical cancer ... Stay Connected About Gynecologic Cancers Types of Gynecologic Cancers Cervical Cancer Screening and Prevention Primary Prevention with Cervical ...

231

Long-term outcome of acute and subacute myelopathies  

Microsoft Academic Search

We aimed to evaluate the long-term (>2 years) outcome of acute and subacute myelopathies (ASM). We systematically followed-up\\u000a consecutive patients presenting with a first episode of ASM, defined by spinal cord symptoms with an onset <3 weeks and duration\\u000a ?48 h. Patients with compressive or traumatic spinal cord lesions are excluded from this report. Our cohort consisted of 170\\u000a patients (median age 39.0 years,

S. Debette; J. de Sèze; J.-P. Pruvo; H. Zephir; F. Pasquier; D. Leys; P. Vermersch

2009-01-01

232

Correlative study of nerve root palsy and cervical posterior decompression laminectomy and internal fixation.  

PubMed

This study investigates the probable causes of nerve root palsy through the retrospective study of pre- and postoperative cervical curvature change for patients with cervical spondylosis and incidences of nerve root palsy. A consecutive series of 91 patients with cervical compressive myelopathy treated by laminectomy and internal fixation were reviewed. Nerve root palsy developed in 21 of 91 patients (23%) (group A). The other 70 patients, 41 men and 29 women, were chosen as controls (group B). A neutral lateral cervical spine radiograph was taken of all patients. The overall curvature of the cervical spine, the cervical curvature index, and the change rate were measured and compared.The pre- and postoperative change rate of cervical curvatures in groups A and B was 19.17+/-7.62 and 18.03+/-7.62, respectively. The difference was not statistically significant (P>.05). The pre- and postoperative cervical curvature index change rate in groups A and B was 17.52+/-3.46 and 12.43+/-4.12, respectively. There were statistically significant differences between the 2 groups (P<. 05). This indicated the cervical alignment of patients in group A was changed greatly by traction during operation.In this study, we found that tethering the nerve root caused C5 palsy, but excessive intraoperative traction and the use of internal fixation may be one of the most important reasons for this. The cervical curvature index change rate reflected both a change in cervical height and a change in the overall cervical curvature. It is more sensitive in reflecting the degree of cervical traction and the change of the cervical alignment. PMID:20704111

Liu, Tielong; Zou, Weiwei; Han, Yu; Wang, Yan

2010-08-11

233

Author’s reply to the letter to the editor of Hiroyuki Yoshihara concerning “C5 palsy following anterior decompression and spinal fusion for cervical degenerative diseases” by M. Hashimoto et al. (2010) Eur Spine J 19:1702–1710  

Microsoft Academic Search

We thank Dr. Yoshihara for his comments on our manuscript and below provide our responses to his remarks. It appears that cervical myelopathy is more prevalent in Japan than in the US [1]. This is partly because the Japanese people have narrower spinal canal diameter [2] and a higher incidence of patients have ossification of the posterior longitudinal ligament [3];

Mitsuhiro Hashimoto

234

[Spinal stenosis: diagnosis and treatment].  

PubMed

Spondylotic cervical myelopathy (SCM) is a radiologic entity that can match a clinical syndrome of varying degree of severity, and results from spinal canal narrowing due to physiological degeneration of the cervical spine. Clinically, cervical spinal canal narrowing can produce minimal symptoms such as non-specific neck pain, foraminal entrapment of nerve roots, or more severe, chronic myelopathy. SCM initially manifests by signs of posterior medullary tract dysfunction with subsequent pallesthesia, resulting in gait and balance disturbance. Spasticity due to lower motoneurone impairment and incontinence may appear in later stages. Once the symptoms of myelopathy occur, functional deterioration will take place sooner or later. Surgery can then be recommended and scheduled according to the severity of functional impairment and imaging. PMID:22872937

Faundez, Antonio; Genevay, Stéphane

2012-06-27

235

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

PubMed

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

Richards, O; Choi, D; Timothy, J

2011-08-04

236

Cervical Cancer  

MedlinePLUS

... DS00167 ">Cervical cancer Guidelines for sites linking to MayoClinic.com Advertisement Mayo Clinic Store Check out these best-sellers and special offers on books and newsletters from Mayo Clinic. Try Mayo Clinic Health Letter ... answers to live stronger, longer and healthier at any age ...

237

Cervical Cryotherapy  

MedlinePLUS

Cervical Cryotherapy What is cryotherapy? Cryotherapy or a freezing treatment is a safe and effective way to destroy abnormal cells that have been found on ... simple procedure to do. Why do I need cryotherapy? Your last Pap smear detected abnormal cells on ...

238

Revision cervical spine surgery using transarticular or pedicle screws under a computer-assisted image-guidance system  

Microsoft Academic Search

Background  The exact insertion of a cervical screw is technically demanding, especially when normal anatomic landmarks have been obscured\\u000a and are difficult to identify, such as in revision surgery. The purpose of this study was to evaluate the efficacy of an image-guidance\\u000a system to aid placement of transarticular and pedicular screws for revision cervical spine surgery.\\u000a \\u000a \\u000a \\u000a Methods  Ten patients with recurrent myelopathy,

Atsushi Seichi; Katsushi Takeshita; Susumu Nakajima; Toru Akune; Hiroshi Kawaguchi; Kozo Nakamura

2005-01-01

239

Cervical chemonucleolysis.  

PubMed

Forty patients with 44 cervical disc herniations were injected with 1500 to 1800 U of chymopapain from September 1988 to March 1992. After prophylactic H1-H2 receptor antagonist administration and under neuroleptanalgesia, a needle was inserted into the disk through an anterolateral approach, guided by x-ray monitoring. The discography performed before the enzyme injection confirmed the herniation in every case. The diagnosis was established by radiculography, computerized tomography (CT) scan, radiculo-CT scan, magnetic resonance imaging (MRI), or discography. Average follow up was 21.4 months (range: 3 to 43). Overall, there were 34 (85%) satisfactory results, 3 fair (7.5%), and 3 poor (7.5%) results. There were no complications, and the average hospital stay was 26 hours. Post-injection MRI performed in 18 cases confirmed the complete disappearance of the herniation in 13 cases. These data support the efficacy and innocuity of chymopapain chemonucleolysis in managing soft cervical disk herniations. PMID:7761313

Gomez-Castresana, F B; Vazquez Herrero, C; Baltes Horche, J L

1995-03-01

240

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

PubMed

Myelopathy is a rare but serious complication of radiation therapy (RT). Radiation myelopathy is white matter damage to the spinal cord developed after a certain period of application of ionizing radiation. Factors such as radiation dose and time between applications affect the occurrence as well as the severity of myelopathy. In those patients, positron emission tomography/computed tomography examination has a very important role both in the diagnosis and in the differential diagnosis of lesions. In this case report, the case of progressive paraparesis, developed in a 52-year-old female patient operated with pulmonary mucinous cystadenocarcinoma diagnosis and who received chemotherapy and RT following surgery, has been reported. PMID:23559989

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

2012-10-01

241

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

PubMed Central

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

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

2012-01-01

242

Histomorphometric study of iliac bones in cervical myelopathy with ossification of the posterior longitudinal ligament  

Microsoft Academic Search

:   To investigate whether there was any abnormal systemic bone metabolism in patients with ossification of the posterior longitudinal\\u000a ligament (OPLL), we measured various histomorphometric indices of the iliac trabecular bones in 19 patients with OPLL (14\\u000a men, 5 women). For each index, the Z-score for each patient was calculated, using the SD and mean value for non-OPLL control\\u000a group

Ikuo Aita; Atsuya Ohno; Hitoshi Amagai; Hiroyuki Hirabayashi; Koichiro Hayashi

1998-01-01

243

Lifelines: Cervical Cancer  

Cancer.gov

Lifelines: Cervical Cancer Play Pause Volume Up Volume Down Mute Unmute Fast Forward Rewind Lifelines™ Cancer Education Series: Resources for Multicultural Media Breast Cancer Cervical Cancer Colorectal Cancer

244

Quantitative assessment of myelopathy patients using motor evoked potentials produced by transcranial magnetic stimulation  

PubMed Central

Motor evoked potentials (MEPs) study using transcranial magnetic stimulation (TMS) may give a functional assessment of corticospinal conduction. But there are no large studies on MEPs using TMS in myelopathy patients. The purpose of this study is to confirm the usefulness of MEPs for the assessment of the myelopathy and to investigate the use of MEPs using TMS as a screening tool for myelopathy. We measured the MEPs of 831 patients with symptoms and signs suggestive of myelopathy using TMS. The MEPs from the abductor digiti minimi (ADM) and abductor hallucis (AH) muscles were evoked by transcranial magnetic brain stimulation. Central motor conduction time (CMCT) is calculated by subtracting the peripheral conduction time from the MEP latency. Later, 349 patients had surgery for myelopathy (operative group) and 482 patients were treated conservatively (nonoperative group). CMCTs in the operative group and nonoperative group were assessed. MEPs were prolonged in 711 patients (86%) and CMCTs were prolonged in 493 patients (59%) compared with the control patients. CMCTs from the ADM and AH in the operative group were significantly more prolonged than that in the nonoperative group. All patients in the operative group showed prolongation of MEPs or CMCTs or multiphase of the MEP wave. MEP abnormalities are useful for an electrophysiological evaluation of myelopathy patients. Moreover, MEPs may be effective parameters in spinal pathology for deciding the operative treatment.

Tanaka, Nobuhiro; Nakanishi, Kazuyoshi; Fujimoto, Yoshinori; Sasaki, Hirofumi; Kamei, Naosuke; Hamasaki, Takahiko; Yamada, Kiyotaka; Yamamoto, Risako; Izumi, Bunichiro; Ochi, Mitsuo

2009-01-01

245

Prevent Cervical Cancer  

MedlinePLUS

... professional printing [PDF-2.7MB] Cancer Home “Prevent Cervical Cancer” Infographic Prevent Cervical Cancer with the Right Test at the Right Time ... is cervical. HPV is the main cause of cervical cancer. HPV is a very common virus, passed from ...

246

Cervical intraepithelial neoplasia.  

PubMed Central

The theoretical and practical reasons for replacing the terms "cervical dysplasia" and "cervical carcinoma in situ" by the single diagnostic entity of "cervical intraepithelial neoplasia" are reviewed and the advantages and drawbacks of this newer terminology discussed. The histological characteristics and cytological features of the various grades of cervical intraepithelial neoplasia are described and the differential diagnosis of this lesion is considered. Images

Buckley, C H; Butler, E B; Fox, H

1982-01-01

247

Cervical angina.  

PubMed

Cervical angina, resembling true angina pectoris, but resulting from cervical spondylosis and nerve root compression, is also known as pseudoangina. This report describes 164 patients treated over a 22-year period. Patients included 103 men and 61 women, with ages ranging from 45 to 68 years and averaging 54 years of age. The duration of symptoms prior to definitive diagnosis averaged ten months and ranged from ten to 18 months. Most patients had consulted at least two cardiologists prior to diagnosis. The results of stress testing were abnormal in ten patients, but none underwent angiography. Symptoms common to all patients, in varying severity, included neck pain and stiffness, occipital headache, arm pain with sensory symptoms. Neurologic deficit was found in only three instances. The majority of patients responded satisfactorily to a standard nonsurgical regimen, employed for at least three months, involving the use of a hard collar, intermittent traction, isometric exercise, and a combination of anti-inflammatory and muscle relaxant medications. In cases where disability persisted, myelography was usually employed and when confirming nerve root compression, anterior disc excision and spine fusion were performed. Such treatment was required in only 38 cases and resulted in complete relief of complaints in all but five instances in which fusion failure required re-operation with ultimate success. Fusion usually was completed in three months, during which time the patient was required to wear a hard collar. PMID:2296405

Jacobs, B

1990-01-01

248

Congenital stenosis and adjacent segment disease in the cervical spine.  

PubMed

Symptomatic adjacent segment disease (ASD) after anterior cervical fusion (ACF) is reported in 25% of patients at 10 years postoperatively. Debate continues as to whether this degeneration is due to the natural history of the disk or the changed biomechanics after ACF. This study explored whether congenital stenosis predisposes patients to an increased incidence of ASD after ACF. A retrospective review of 635 patients with myelopathy or radiculopathy was performed; 364 patients had complete records for review. Patients underwent 1- to 5-level ACF (94 one-level, 145 two-level, 79 three-level, 45 four-level, and 1 five-level). Radiographs were evaluated for bony congenital stenosis using validated parameters, and ASD was measured according to Hilibrand's criteria and correlated with symptomatic ASD. Congenital stenosis was found in 21.7% of patients and radiographic ASD in 33.5%, with a significant association between these parameters. However, symptomatic ASD occurred in 11.8% of patients; no association between congenital stenosis and symptomatic ASD or myelopathy and ASD was found. Clinical results demonstrated excellent or good Robinson scores in 86.2% of patients and Odom scores in 87% of patients. Despite mostly excellent to good outcomes, symptomatic ASD is common after ACF. Although congenital stenosis appears to increase the incidence of radiographic ASD, it does not appear to predict symptomatic ASD. PMID:24093699

Eubanks, Jason David; Belding, Jon; Schnaser, Erik; Rowan, Andrew; Moffitt, Gable; Weaver, John; Reich, Michael S; Bechtel, Chris; Xie, Ke; Gande, Abhiram; Hohl, Justin; Braly, Brett; Hilibrand, Alan; Kang, James D

2013-10-01

249

Cervical laminoplasty (Hattori's method). Procedure and follow-up results.  

PubMed

Posterior decompression plus posterior reconstruction (laminoplasty) is a useful surgical method for treatment of cervical compressive myelopathy. There are many laminoplasty procedures. This paper describes the Z-shaped laminoplasty developed by Hattori in 1971, and presents a clinical follow-up of the authors' experience with 130 patients. The procedure involves grinding the laminae down with an air drill and making a Z-shaped cut into the thinned laminae without excising the laminae. This technique enlarges the spinal canal. The purpose of this technique is to decompress the spinal cord and at the same time maintain clinical stability. Postoperative results were satisfactory without any major complication. Follow-up study was conducted in 78 cases with a minimal follow-up period of more than 2 years. Satisfactory clinical results were maintained for long periods postoperatively, and the enlargement of the spinal canal was well maintained as demonstrated on follow up X-ray study. PMID:3144758

Kawai, S; Sunago, K; Doi, K; Saika, M; Taguchi, T

1988-11-01

250

Posterior Cervical Bone Screws  

Center for Biologics Evaluation and Research (CBER)

Text Version... Smith MD et al, Spine 1993: 18, 1984. Page 3. POSTERIOR CERVICAL BONE SCREWS ... Page 4. POSTERIOR CERVICAL BONE SCREWS ... More results from www.fda.gov/downloads/advisorycommittees/committeesmeetingmaterials

251

ICSN - Cervical Cancer  

Cancer.gov

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

252

Smoking and Cervical Cancer  

MedlinePLUS

Smoking and Cervical Cancer If you smoke, you have an increased chance of developing precancerous lesions of the cervix (called moderate or ... and an increase in the chance of developing cervical cancer. Smoking greatly increases your risk for dysplasia and ...

253

Cervical Radiculopathy (Pinched Nerve)  

MedlinePLUS

... Copyright 2010 American Academy of Orthopaedic Surgeons Cervical Radiculopathy (Pinched Nerve) Some people have neck pain that ... The medical term for this condition is cervical radiculopathy. Understanding your spine and how it works can ...

254

Adrenomyeloneuropathy: a neuropathologic review featuring its noninflammatory myelopathy.  

PubMed

The neuropathologic features of adrenomyeloneuropathy (AMN) are reviewed by supplementing those few previously published cases with 5 additional cases collected over the years. The endocrine involvement in AMN is briefly presented to serve as a pathogenetic backdrop and to emphasize that most of the lesions in AMN, as in adreno-leukodystrophy (ALD), are noninflammatory in the traditional sense of the word. The myeloneuropathy is emphasized, but the dysmyelinative/inflammatory demyelinative lesions also are presented. The preponderance of available data indicates that the myeloneuropathy of AMN is a central-peripheral distal (dying-back) axonopathy, as was originally proposed. The severity of the myeloneuropathy does not appear to correlate with the duration or severity of endocrine dysfunction. Microglia are the dominant participating cells in the noninflammatory myelopathy. Abnormalities in the ALD gene, which encodes a peroxisomal ABC half-transporter, do not correlate with clinical phenotypes. The relationship of the gene product, ALDP, to the peroxisomal very long chain fatty acid (VLCFA) synthetase, the activity of which is deficient in ALD/AMN, is unclear. An ALD-knockout mouse model has developed axonal degeneration, particularly in spinal cord, and is therefore more reminiscent of AMN than ALD. We continue to postulate that the fundamental defect in the myeloneuropathy of AMN is an axonal or neuronal membrane abnormality perhaps due to the incorporation of VLCFA-gangliosides, which perturbs the membrane's microenvironment and leads to dysfunction and atrophy. PMID:10749098

Powers, J M; DeCiero, D P; Ito, M; Moser, A B; Moser, H W

2000-02-01

255

Le rachis cervical rhumatoïde  

Microsoft Academic Search

Cervical spine involvement occurs in over half of patients with rheumatoid arthritis (RA). The most common abnormality is atlantoaxial dislocation, followed by atlantooccipital arthritis with cranial settling and by lesions of the lower cervical spine. Cervical spine involvement usually occurs in patients with severe RA. Pain and evidence of spinal cord injury are the main symptoms. The presence of symptoms

Agnès Bouchaud-Chabot; Frédéric Lioté

2002-01-01

256

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

PubMed

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

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

2006-09-01

257

A rat model of human T lymphocyte virus type I (HTLV-I) infection. 1. Humoral antibody response, provirus integration, and HTLV-I-associated myelopathy/tropical spastic paraparesis-like myelopathy in seronegative HTLV-I carrier rats  

PubMed Central

Human T lymphocyte virus type I (HTLV-I) can be transmitted into several inbred strains of newborn and adult rats by inoculating newly established HTLV-I-immortalized rat T cell lines or the human T cell line MT-2. The transmission efficiency exceeds 80%, regardless of strain differences or the age at transmission. The production of anti- HTLV-I antibodies significantly differs among the strains and depends on the age at the time of transmission. Rats neonatally inoculated with HTLV-I-positive rat or human cells generally become seronegative HTLV-I carriers throughout their lives, whereas adult rats inoculated with HTLV-I-positive cells at 16 wk of age become seropositive HTLV-I carriers. The HTLV-I provirus genome is present in almost all organs, regardless of whether the carriers are seronegative or seropositive. According to antibody titers to HTLV-I, there are three groups of inbred rat strains: ACI, F344, and SDJ (high responders); WKA, BUF, and LEJ (intermediate responders); and LEW (low responder). Three of three 16-mo-old seronegative HTLV-I carrier rats of the WKA strain developed spastic paraparesis of the hind legs. Neuropathological examinations revealed that the lesions were confined primarily to the lateral and anterior funiculi of the spinal cord. Both myelin and axons were extensively damaged in a symmetrical fashion, and infiltration with massive foamy macrophages was evident. The most severe lesions were at levels of the thoracic cord and continued from the cervical to the lumbar area. These histopathological features as well as clinical symptoms largely parallel findings in humans with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP). These HTLV-I carrier rats, in particular the WKA rats described above, can serve as a useful animal model for investigating virus-host interactions in the etiopathogenesis of HTLV-I-related immunological diseases, particularly HAM/TSP.

1992-01-01

258

Single Stage Circumferential Cervical Surgery (Selective Anterior Cervical Corpectomy with Fusion and Laminoplasty) for Multilevel Ossification of the Posterior Longitudinal Ligament with Spinal Cord Ischemia on MRI  

PubMed Central

Objective Anterior cervical corpectomy with fusion (ACF) or laminoplasty may be associated with substantial number of complications for treating multilevel cervical ossification of the posterior longitudinal ligament (OPLL) with significant cord compression. For more safe decompression and stabilization in multilevel cervical OPLL with prominent cord compression, we propose circumferential cervical surgery (selective ACF and laminoplasty) based on our favorable experience. Methods Twelve patients with cervical myelopathy underwent circumferential cervical surgery and all patients showed multilevel OPLL with signal change of the spinal cord on magnetic resonance imaging (MRI). A retrospective review of clinical, radiological, and surgical data was conducted. Results There were 9 men and 3 women with mean age of 56.7 years and a mean follow up period of 15.6 months. The average corpectomy level was 1.16 and laminoplasty level was 4.58. The average Japanese Orthopedic Association score for recovery was 5.1 points and good clinical results were obtained in 11 patients (92%) (p < 0.05). The average space available for the cord improved from 58.2% to 87.9% and the average Cobb's angle changed from 7.63 to 12.27 at 6 months after operation without failure of fusion (p < 0.05). Average operation time was 8.36 hours, with an estimated blood loss of 760 mL and duration of bed rest of 2.0 days. There were no incidences of significant surgical complications, including wound infection. Conclusion Although the current study examined a small sample with relatively short-term follow-up periods, our study results demonstrate that circumferential cervical surgery is considered favorable for safety and effectiveness in multilevel OPLL with prominent cord compression.

Son, Seong; Yoo, Chan Jong; Park, Chan Woo; Kim, Woo Kyung

2010-01-01

259

A meta-analysis of autograft versus allograft in anterior cervical fusion.  

PubMed

We performed a metaanalysis of one- and two-level anterior cervical interbody fusion (ACDF) on data derived from published, peer-reviewed journal articles to determine whether there is a difference in fusion rate, graft complications, or clinical outcome in patients undergoing ACDF according to whether autograft or allograft was used. ACDF is a common procedure for cervical spondylotic radiculopathy. Most published studies comparing autograft and allograft have not demonstrated any difference between grafts. The medical literature dating from 1955 was reviewed. Of 395 titles, only four studies comparing autograft with allograft in ACDF were appropriate for this analysis. The data from these studies--310 patients and 379 intervertebral levels were pooled and statistical methods were applied. For both one- and two-level ACDF, autograft demonstrated a higher rate of radiographic union and a lower incidence of graft collapse. It was not possible to ascertain whether autograft is clinically superior to allograft. Although autograft has a higher fusion rate than allograft, clinical results do not depend solely on radiographic results. The risk of graft site morbidity and patient preference should be considered when choosing the type of graft for this operation. PMID:11057533

Floyd, T; Ohnmeiss, D

2000-10-01

260

Severity score system for progressive myelopathy: development and validation of a new clinical scale.  

PubMed

Progressive myelopathies can be secondary to inborn errors of metabolism (IEM) such as mucopolysaccharidosis, mucolipidosis, and adrenomyeloneuropathy. The available scale, Japanese Orthopaedic Association (JOA) score, was validated only for degenerative vertebral diseases. Our objective is to propose and validate a new scale addressing progressive myelopathies and to present validating data for JOA in these diseases. A new scale, Severity Score System for Progressive Myelopathy (SSPROM), covering motor disability, sphincter dysfunction, spasticity, and sensory losses. Inter- and intra-rater reliabilities were measured. External validation was tested by applying JOA, the Expanded Disability Status Scale (EDSS), the Barthel index, and the Osame Motor Disability Score. Thirty-eight patients, 17 with adrenomyeloneuropathy, 3 with mucopolysaccharidosis I, 3 with mucopolysaccharidosis IV, 2 with mucopolysaccharidosis VI, 2 with mucolipidosis, and 11 with human T-cell lymphotropic virus type-1 (HTLV-1)-associated myelopathy participated in the study. The mean ± SD SSPROM and JOA scores were 74.6 ± 11.4 and 12.4 ± 2.3, respectively. Construct validity for SSPROM (JOA: r = 0.84, P < 0.0001; EDSS: r = -0.83, P < 0.0001; Barthel: r = 0.56, P < 0.002; Osame: r = -0.94, P < 0.0001) and reliability (intra-rater: r = 0.83, P < 0.0001; inter-rater: r = 0.94, P < 0.0001) were demonstrated. The metric properties of JOA were similar to those found in SSPROM. Several clinimetric requirements were met for both SSPROM and JOA scales. Since SSPROM has a wider range, it should be useful for follow-up studies on IEM myelopathies. PMID:22570090

Castilhos, R M; Blank, D; Netto, C B O; Souza, C F M; Fernandes, L N T; Schwartz, I V D; Giugliani, R; Jardim, L B

2012-05-10

261

Baguera cervical disc prosthesis  

Microsoft Academic Search

A new high performance tool, the disc prosthesis, endows the degenerative cervical rachidian pathology. It allows us to fill\\u000a the fusions’ lacunas by protecting the adjacent levels from an accelerated degeneration while preserving the anatomical and\\u000a physiological characteristics of the cervical spine, especially its mobility. At the present time, there exist several models\\u000a of cervical disc prosthesis on the market.

M. Benmekhbi; J. Mortada; G. Lungu; D. Eichler; R. Srour; J. M. Vital

2008-01-01

262

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

PubMed

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

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

2010-06-21

263

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

PubMed Central

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

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

2010-01-01

264

Cervical Radiculopathy: Surgical Treatment Options  

MedlinePLUS

... Copyright 2010 American Academy of Orthopaedic Surgeons Cervical Radiculopathy: Surgical Treatment Options When symptoms of cervical radiculopathy persist or worsen despite nonsurgical treatments, surgical options ...

265

Axial pain after posterior cervical spine surgery: a systematic review  

PubMed Central

Posterior operative approach has been the standard treatment for cervical compressive myelopathy, and axial pain after laminoplasty or laminectomy as a postoperative complication is now gradually receiving more and more attention. The objective of this study was to provide a systematic review of the current understanding of axial pain after cervical laminoplasty and laminectomy, and summarize clinical features, influence factors and preventive measures of axial pain after posterior decompressive surgery based on a review of literature published in the English language. Axial pain distributes over nuchal, periscapular and shoulder regions. Posterior surgery is not the major cause of axial pain, but axial pain can be worsened by the procedure. There are many clinical factors that influence postoperative axial pain such as age, preoperative axial pain, different surgical technique and postoperative management, but most of them are still controversial. Several surgical modifications have been innovated to reduce axial pain. Less invasive surgery, reconstruction of the extensor musculature, avoiding detachment of the semispinalis cervicis muscle and early removal of external immobilization have proved to be effective. Axial pain is under the influence of multiple factors, so comprehensive methods are required to reduce and avoid the postoperative axial pain. Because of methodological shortcomings in publications included in this systematic review, different results from different studies may be produced due to differences in study design, evaluation criteria, sample size, and incidence or severity of axial pain. More high-quality studies are necessary for drawing more reliable and convincing conclusions.

Wang, Shan-Jin; Jiang, Sheng-Dan; Jiang, Lei-Sheng

2010-01-01

266

Axial pain after posterior cervical spine surgery: a systematic review.  

PubMed

Posterior operative approach has been the standard treatment for cervical compressive myelopathy, and axial pain after laminoplasty or laminectomy as a postoperative complication is now gradually receiving more and more attention. The objective of this study was to provide a systematic review of the current understanding of axial pain after cervical laminoplasty and laminectomy, and summarize clinical features, influence factors and preventive measures of axial pain after posterior decompressive surgery based on a review of literature published in the English language. Axial pain distributes over nuchal, periscapular and shoulder regions. Posterior surgery is not the major cause of axial pain, but axial pain can be worsened by the procedure. There are many clinical factors that influence postoperative axial pain such as age, preoperative axial pain, different surgical technique and postoperative management, but most of them are still controversial. Several surgical modifications have been innovated to reduce axial pain. Less invasive surgery, reconstruction of the extensor musculature, avoiding detachment of the semispinalis cervicis muscle and early removal of external immobilization have proved to be effective. Axial pain is under the influence of multiple factors, so comprehensive methods are required to reduce and avoid the postoperative axial pain. Because of methodological shortcomings in publications included in this systematic review, different results from different studies may be produced due to differences in study design, evaluation criteria, sample size, and incidence or severity of axial pain. More high-quality studies are necessary for drawing more reliable and convincing conclusions. PMID:20941514

Wang, Shan-Jin; Jiang, Sheng-Dan; Jiang, Lei-Sheng; Dai, Li-Yang

2010-10-13

267

Ossification of the proximal thoracic ligamenta flava causing acute myelopathy in a Caucasian: case report and literature review  

Microsoft Academic Search

Study design:Case report and literature review.Objective:To illustrate that ossification of the proximal thoracic ligamenta flava can be a rare cause of acute myelopathy in a Caucasian patient and that timely surgery can lead to a good outcome.Setting:Nottingham, UK.Methods:Proximal multiple contiguous ossified thoracic ligamenta flava from T3\\/T4 to T5\\/T6 causing acute myelopathy was diagnosed in a Caucasian man based on history

D P Tokala; K S Lam; H G Prince

2007-01-01

268

Hydroxyapatite ceramics in multilevel cervical interbody fusion - is there a role?  

PubMed

The aim of this study is to evaluate the efficacy of hydroxyapatite grafts in multilevel cervical interbody fusion during the one year follow-up. A total of 86 patients with degenerative cervical disc disease underwent all together 224 cervical interbody fusion procedures in which either Smith-Robinson or Cloward type hydroxyapatite grafts were used. The surgeries included radiculopathy in 38 cases, myelopathy in 20 cases and myeloradicuopathy in 28 patients. In 65 out of 86 patients, fusion was followed by an anterior instrumentation (plating). Postoperatively, patients were followed for a mean of 15.64 (range 11-23.3) months. All patients underwent radiography to evaluate fusion and the axis curvature. Excellent clinical results (86%), described as a complete or partial relief of symptoms with full return to preop activity, were obtained in patients with radiculopathy. There were 5 grafts mobilizations and one graft fracture. Two grafts extruded in non-instrumented patients and required repeated surgery. There were other three reoperations due to the hardware problems. One year fusion rate was obtained at 86% for two-level surgery, 80.1% for three-level surgery and 74% for four-level surgery. The mean (SD) hospital stay was 3.8 (0.7) days. A hydroxyapatite cheramic can be a very effective synthetic material for multilevel cervical interbody fusion. It is characterized by a high fusion rate and a small percentage of graft-related complications, especially when fusion procedure is followed by plating. PMID:21648347

Vuki?, Miroslav; Walters, Beverly C; Radi?, Ankica; Jurjevi?, Ivana; Marasanov, Sergej M; Rozankovi?, Marjan; Jednacak, Hrvoje

2011-01-01

269

Human T Lymphotropic Virus Type I Associated Myelopathy and Myasthenia gravis: A Possible Association?  

Microsoft Academic Search

We report the first known patient with human T lymphotropic virus type I (HTLV-I) associated myelopathy (HAM) and myasthenia gravis (MG). A 50-year-old woman developed fluctuating muscle weakness with easy fatigability, transient bilateral blepharoptosis and double vision. Spastic paraparesis complicated these symptoms. Neurological assessments and specific laboratory findings revealed that the patient had definite HAM and MG. By inference from

T. Fukui; K. Sugita; H. Ichikawa; A. Negishi; H. Kasai; H. Tsukagoshi

1994-01-01

270

Patterns of non-traumatic myelopathies in Yaoundé (Cameroon): a hospital based study  

Microsoft Academic Search

BackgroundThe relative frequency of compressive and non-compressive myelopathies and their aetiologies have not been evaluated extensively in most sub-Saharan African countries. The case of Cameroon is studied.MethodsAdmission registers and case records of patients in the neurology and neurosurgery departments of the study hospital were reviewed from January 1999 to December 2006.Results224 (9.7% of all admissions) cases were non-traumatic paraplegia\\/paraparesis or

Alain Zingraff Lekoubou Looti; André Pascal Kengne; Vincent de Paul Djientcheu; Callixte T Kuate; Alfred K Njamnshi

2010-01-01

271

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

Microsoft Academic Search

We evaluated the clinical results of posterior decompression with instrumented fusion (PDF) for thoracic myelopathy due to\\u000a ossification of the posterior longitudinal ligament (OPLL). A total of 24 patients underwent PDF, and their surgical outcomes\\u000a were evaluated by the Japanese Orthopaedic Association (JOA) scores (0–11 points) and by recovery rates calculated at 3, 6,\\u000a 9 and 12 months after surgery and

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

2010-01-01

272

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

PubMed Central

Certain aspects of the clinical syndrome of dementia, cerebral atrophy, predominantly sensory neuropathy, and vacuolar myelopathy in AIDS resemble those seen in vitamin B12 deficiency. Pathologically, there are similarities not only in the changes in the spinal cord, but also in the brain and peripheral nerves. The pathogenesis of vacuolar myelopathy may be secondary to a combination of immune mediated myelin and oligodendrocyte injury, and simultaneous impairment of repair mechanisms due to a deficiency of S-adenosylmethionine (SAM). Products derived from macrophages may interfere directly with the methyl transfer cycle through the generation of reactive oxygen intermediates and reactions involving nitric oxide and peroxynitrite which may limit the supply of methionine for conversion to SAM, both by direct interaction as well as through inhibition of methionine synthase. Macrophage activation with secretion of cytokines and other biologically reactive substances within the nervous system is sustained in the late stages of HIV infection by the general effects of immune depletion, including loss of T cells (with concomitant reduction of macrophage regulatory molecules) and recurrent opportunistic infections, and may be further augmented by the local presence of the virus itself (or its surface glycoprotein gp120). This would account for the common, but not exclusive, occurrence of vacuolar myelopathy in AIDS. The ability of the virus and its products to stimulate macrophage and microglial activation may also explain the association between severity ofvacuolar myelopathy and the presence of HIV encephalitis. A similar mechanism may underlie the pathogenesis of dementia, cerebral atrophy, and peripheral neuropathy. Local factors or differential susceptibility between the central and peripheral nervous system may determine whether myelinotoxic or neurotoxic processes predominate; the prominence of myelin involvement in the spinal cord, and axonal involvement peripherally may reflect both ends of this range, with the brain manifesting a more equal balance of both processes. ??

Tan, S; Guiloff, R

1998-01-01

273

Human T Cell Lymphotropic Virus Type 1Associated Myelopathy in São Paulo, Brazil  

Microsoft Academic Search

We report epidemiologic and clinical features of human T cell lymphotropic virus type 1 (HTLV-1)-associated myelopathy\\/tropical spastic paraparesis in a Brazilian cohort of 86 patients from a university hospital. Cerebrospinal fluid (CSF) abnormalities and magnetic resonance imaging (MRI) findings were correlated with neurologic signs and symptoms. The patients’ mean age at disease onset was 43.2 years and the female to

Antonio C. P. Milagres; Maria Lúcia S. G. Jorge; Paulo E. Marchiori; Aluisio A. C. Segurado

2002-01-01

274

Widespread active inflammatory lesions in a case of HTLV-I-associated myelopathy lasting 29 years  

Microsoft Academic Search

An autopsy case of human T-lymphotropic virus type I (HTLV-I)-associated myelopathy (HAM) of 29 years’ duration is reported. The patient had no history of surgery or blood transfusion and likely contracted HTLV-I sexually while traveling in an endemic area. At age 45, the patient began to experience gait disturbance; he later developed spastic tetraparesis. Autopsy revealed marked gross spinal cord atrophy,

Yasushi Iwasaki; Koichi Sawada; Ikuko Aiba; Eiichiro Mukai; Mari Yoshida; Yoshio Hashizume; Gen Sobue

2004-01-01

275

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

Microsoft Academic Search

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

M S Bang; S J Kim

2009-01-01

276

Transverse myelopathy in systemic lupus erythematosus: an analysis of 14 cases and review of the literature  

Microsoft Academic Search

OBJECTIVETo give a comprehensive review of transverse myelopathy (TM), a rare but serious condition reported in 1–2% of patients with systemic lupus erythematosus (SLE).METHODS14 patients with SLE and TM were evaluated and 91 additional cases published in the English and German literature reviewed.RESULTSTM presented either as the initial manifestation or within five years of the diagnosis of SLE. Most patients

Birgit Kovacs; Thomas L Lafferty; Lawrence H Brent; Raphael J DeHoratius

2000-01-01

277

Schistosomal myelopathy in childhood: magnetic resonance imaging findings in 26 cases  

Microsoft Academic Search

Magnetic resonance image findings of 26 children (16 males, average age 9,4y) with schistosomal myelopathy are described. All children lived in Pernambuco state, Brazil - an endemic area of mansoni schistosomiasis. Imaging abnormalities were identified in 92.3% children. The most frequent findings were: (1) enlargement of the spinal cord at thoracic level, usually below T8, in 23\\/24 (96%) of patients;

Adelia Maria de Miranda Henriques-Souza; Marcelo Moraes Valença

278

The Efficacy and Persistence of Selective Nerve Root Block under Fluoroscopic Guidance for Cervical Radiculopathy  

PubMed Central

Study Design Retrospective study. Objectives To investigate the outcomes of fluoroscopically guided selective nerve root block as a nonsurgical treatment for cervical radiculopathy. Overview of Literature Only a few studies have addressed the efficacy and persistence of cervical nerve root block. Methods This retrospective study was conducted on 28 consecutive patients with radicular pain due to cervical disc disease or cervical spondylosis. Myelopathy was excluded. Cervical nerve root blocks were administered every 2 weeks, up to 3 times. Outcomes were measured by comparing visual analogue scale (VAS) scores, patient satisfaction, and medication usage before the procedure and at 1 week and 3, 6, and 12 months after the procedure. In addition, complications associated with the procedure and need for other treatments were evaluated. Results The average preoperative VAS score was 7.8 (range, 5 to 10), and this changed to 2.9 (range, 1 to 7) at 3 months and 4.6 (range, 2 to 7) at 12 months. Patient satisfaction was 71% at 3 months and 50% at 12 months. Five patients used medication at 3 months, whereas 13 used medication at 12 months. Average symptom free duration after the procedure was 7.8 months (range, 1 to 12 months). Two patients were treated surgically. Only two minor complications were noted; transient ptosis with Horner's syndrome and transient causalgia. Conclusions Although selective nerve root block for cervical radiculopathy is limited as a definitive treatment, it appears to be useful in terms of providing relief from radicular pain in about 50% of patients at 12 months.

Chung, Jae-Yoon; Seo, Hyoung-Yeon; Kim, Sung-Kyu; Cho, Kyu-Jin

2012-01-01

279

Cervical spine injury.  

PubMed

Once a child is determined to be at risk of having a cervical spine injury, clinicians must take appropriate precautions to avoid potential worsening of neurologic deficits. Occasionally these decisions are made in the absence of adequate cervical spine imaging when dealing with a child's unstable airway or other life-threatening injuries. Furthermore, clinicians have to make decisions regarding appropriate diagnostic testing to evaluate for potential injury. Decisions regarding testing should take into consideration the clinical presentation of the patient, aiming to order appropriate testing for those at risk and avoid unnecessary testing for those without signs of cervical spine injury. PMID:24093899

Leonard, Julie C

2013-08-20

280

Clinical presentation of a patient with thoracic myelopathy at a chiropractic clinic  

PubMed Central

Introduction The purpose of this case report is to describe the clinical presentation, examination findings, and management decisions of a patient with thoracic myelopathy who presented to a chiropractic clinic. Case Report/Methods After receiving a diagnosis of a diffuse arthritic condition and kidney stones based on lumbar radiograph interpretation at a local urgent care facility, a 45-year-old woman presented to an outpatient chiropractic clinic with primary complaints of generalized low back pain, bilateral lower extremity paresthesias, and difficulty walking. An abnormal neurological examination result led to an initial working diagnosis of myelopathy of unknown cause. The patient was referred for a neurological consult. Results Computed tomography revealed severe multilevel degenerative spondylosis with diffuse ligamentous calcification, facet joint hypertrophy, and disk protrusion at T9-10 resulting in midthoracic cord compression. The patient underwent multilevel spinal decompressive surgery. Following surgical intervention, the patient reported symptom improvement. Conclusion It is important to include a neurologic examination on all patients presenting with musculoskeletal complaints, regardless of prior medical attention. The ability to recognize myelopathy and localize the lesion to a specific spinal region by clinical examination may help prioritize diagnostic imaging decisions as well as facilitate diagnosis and treatment.

Gay, Charles W.; Bishop, Mark D.; Beres, Jacqueline L.

2012-01-01

281

What Is Cervical Cancer?  

MedlinePLUS

... About 80% to 90% of cervical cancers are squamous cell carcinomas. These cancers develop in the squamous cells that ... up of cells that are like squamous cells. Squamous cell carcinomas most often begin where the exocervix joins the ...

282

The cervical cap (image)  

MedlinePLUS

The cervical cap is a flexible rubber cup-like device that is filled with spermicide and self-inserted over the cervix ... left in place several hours after intercourse. The cap is a prescribed device fitted by a health ...

283

Cervical Cancer Other Characteristics  

Cancer.gov

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

284

Cervical cancer screening  

Microsoft Academic Search

Although primary prevention of human papillomavirus (HPV) infections that are causally associated with invasive cervical cancer\\u000a may be within our grasp, it is unlikely that these approaches will replace existing cervical cancer screening strategies for\\u000a many years. Experts agree and data support periodic cytology screening for young-adult women using one of several technologies.\\u000a Recent analyses of cost-effectiveness suggest that the

Dorothy J. Wiley; Bradley J. Monk; Emmanuel Masongsong; Kristina Morgan

2004-01-01

285

[Personal experience with surgical treatment of degenerative diseases of the cervical spine using an anterior approach].  

PubMed

In 1995 to 1999 the authors operated on account of cervical spondylosis, using an anterior approach and methylmethacryl filling of the intervertebral space 57 patients. The mean period of hospitalization was 6.2 days (4-9 days). The clinical condition was evaluated 1, 3, 6, and 12 months after surgery. In 55 patients also X-ray pictures were evaluated. One year after surgery in a group of 14 patients with radiculipathy complete restoration of the condition occurred in 13 patients, improvement was recorded in one patient. In a group of 4 patients with myelopathy the condition did not change in two patients and in two deterioration was recorded. In a group of 39 patients with radiculo- and myelopathy improvement of the condition was recorded in 30 and the condition was unaltered in 9 patients. X-ray examination revealed bridging of the intervertebral space in 11 patients, mobility in the operated segment in 8 and a slight shift of the graft in three instances. The submitted results are comparable with those of other authors. PMID:11367609

Levkus, P; Výrostko, J; Kat'uch, M; Kollová, A; Ménová, K; Kotusová, B

2001-03-01

286

[Cervical discopathy, cervical migraine and vertebrobasilar arterial insufficiency: Clinical correlations].  

PubMed

The pathogenesis of cervical migraine may suggest that a connection exists between it and cervical discopathy and also vertebrobasilar arterial insufficiency. This correlation was studied in a group of 103 patients subjected to clinical observations. In 83 of them cervical discopathy was found, in 69 cervical migraine and in 40 vertebrobasilar insufficiency were present. Among those with discopathy migraine was present in 63.6% of cases, and vertebrobasilar insufficiency in 31%. In patients with cervical migraine degenerative changes of the type of cervical discopathy were present in 90% of cases, although in only 56.5% of cases clinical signs were present connected with these changes. Vertebrobasilar insufficiency was present in 45% of patients with cervical migraine, that is more frequently than in discopathy. In the group with vertebrobasilar insufficiency radiological changes in the cervical spine were present in 77.5% of cases and the same proportion of patients in this group had cervical migraine. These numbers confirm the connection between cervical migraine and radiological changes and clinical manifestations of discopathy, and they indicate also that cervical migraine may be a successive stage of vascular changes leading to circulatory failure in the area supplied by vertebral arteries. This failure may have a different course and pathological mechanism. In 12.5% of patients in this group no cervical migraine or radiological changes were demonstrated. The term "cervical migraine" seems inappropriate since this type of headache has another substrate and mechanism than true migraine. PMID:714220

Domza?, T; Zaleska, B; Kwasucki, J

287

Manipulation of the cervical spine  

Microsoft Academic Search

In New Zealand, a new approach to manual therapy of the cervical spine has integrated physiotherapy and osteopathy techniques. The combination of the philosophies of these two professions has added a new dimension to the management of cervical spine pain. Emphasis is placed on issues of safety, such as the degree of cervical rotation and comfort for both the patient

W. A Hing; D. A Reid; M Monaghan

2003-01-01

288

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

PubMed

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

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

2013-02-13

289

Cervical hibernoma and lipoblastomatosis.  

PubMed

Lipoblastoma and lipoblastomatosis are rare benign soft-tissue tumoral lesions resembling fetal adipose tissue. A total of 16 cases of lipoblastoma of the neck were reported in the literature, and only 3 were described in the posterior side of the neck. Hibernoma is a rare benign adipose tumor composed of brown fat cells and only about ten cases occurring in the cervical area have been reported. We reported two rare cases of adipose tissue tumors. The first case was a male infant aged 12 months who had a cervical mass on the posterior side of the neck. He underwent a complete resection of the lesion and the pathologic study revealed lipoblastomatosis. The second case was a 36-year-old man with an anterior cervical mass, which moved with swallowing. A resection was made and the histological analysis showed hibernoma. PMID:23579754

Nardi, Carlos Eduardo Molinari; Barreto, Leonardo; Carvalho, Leda Viegas de; Guimarães, André Vicente

2013-03-01

290

Acute myelopathy selectively involving lumbar anterior horns following intranasal insufflation of ecstasy and heroin  

PubMed Central

We report a patient who developed acute myelopathy after intranasal insufflation of amphetamines and heroin. The functional prognosis was very poor; after 4 months, she remained paraplegic. MRI imaging showed selective T2 hyperintensity and intense enhancement confined to the spinal anterior horns and lumbar nerve roots and plexus. This unique MRI pattern, together with neurophysiological data, suggests that the pathological process at the first primary affected spinal anterior horns (SAH), conditioning motoneuron cell death, and then nerve roots and lumbar plexus as a consequence of wallerian degeneration

Riva, Nilo; Riva, Nilo; Morana, Paolo; Cerri, Federica; Gerevini, Simonetta; Amadio, Stefano; Formaglio, Fabio; Comi, Giancarlo; Comola, Mauro; Del Carro, Ubaldo

2009-01-01

291

Early treatment causes clinicoradiological reversal of myelopathy due to vitamin B12 deficiency.  

PubMed

Vitamin B12 deficiency has a wide spectrum of clinical presentation with a variety of neurological symptoms and signs. As a result, many patients lack classic features of advanced severe deficiency. Early diagnosis and treatment are crucial in order to prevent the irreversible damage to the nervous system. We describe a 25-year-old man, who presented with predominant sensory symptoms without any signs on clinical evaluation. His serum vitamin B12 levels were low and neuroimaging revealed myelopathy. The patient was treated promptly with cyanocobalamin injections, which lead to a rapid resolution of symptoms and radiological abnormalities. PMID:23715834

Verma, Rajesh; Kori, Prakash; Patil, Tushar B; Praharaj, Heramba Narayan

2013-05-27

292

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

PubMed Central

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-door laminoplasty.

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

2009-01-01

293

Cervical motion segment replacement  

Microsoft Academic Search

When symptoms bring to light a cervical spine degenerative disc process that requires surgical intervention, a symptom relieving procedure such as decompression, followed by functional restoration, arthroplasty, offers the benefit of prophylaxis of accelerated spondylosis at the operated level. In addition, by altering the biomechanical stress factors at adjacent levels, theoretically it should offer prophylactic benefit at these levels as

Vincent E. Bryan Jr; J Goffin; A Casey; P Kehr; K Liebig; C Logroscino; F Van Calenbergh; J van Loon; Universitaire Ziekenhuizen

2002-01-01

294

5. Cervical facet pain.  

PubMed

More than 50% of patients presenting to a pain clinic with neck pain may suffer from facet-related pain. The most common symptom is unilateral pain without radiation to the arm. Rotation and retroflexion are frequently painful or limited. The history should exclude risk factors for serious underlying pathology (red flags). Radiculopathy may be excluded with neurologic testing. Direct correlation between degenerative changes observed with plain radiography, computerized tomography, and magnetic resonance imaging and pain has not been proven. Conservative treatment options for cervical facet pain such as physiotherapy, manipulation, and mobilization, although supported by little evidence, are frequently applied before considering interventional treatments. Interventional pain management techniques, including intra-articular steroid injections, medial branch blocks, and radiofrequency treatment, may be considered (0). At present, there is no evidence to support cervical intra-articular corticosteroid injection. When applied, this should be done in the context of a study. Therapeutic repetitive medial branch blocks, with or without corticosteroid added to the local anesthetic, result in a comparable short-term pain relief (2 B+). Radiofrequency treatment of the ramus medialis of the cervical ramus dorsalis (facet) may be considered. The evidence to support its use in the management of degenerative cervical facet joint pain is derived from observational studies (2 C+). PMID:20415728

van Eerd, Maarten; Patijn, Jacob; Lataster, Arno; Rosenquist, Richard W; van Kleef, Maarten; Mekhail, Nagy; Van Zundert, Jan

295

Thoracic spinal stenosis and myelopathy: report of two rare cases and review of the literature.  

PubMed

The authors report two cases of thoracic spinal canal stenosis (SCS) and myelopathy. One is extremely unusual because of degenerative changes occurred in the upper thoracic spine. The other because of its multiple etiology among which calcification and ossification of the ligamentum flavum (OLF) in a Caucasian man. Both patients presented with an history of slowly progressive spastic paraparesis. In the first case computed tomography (CT) scans and magnetic resonance (MR) images revealed hypertrophy of the legamentum flavum and laminae causing compression of the spinal cord at T2-T3. In the second case diagnostic imaging showed three levels of stenosis in the lower thoracic spine due to degenerative changes, calcification and OLF with cord damage at T9-T10. A decompressive laminectomy and medial facetectomy was performed in both patients. The ligamentum flavum, hypertrophied and infolded in the first case and calcified and ossified in the second, was removed with careful dissection of the dural adhesions. Both patients showed a rapid post-operative recovery and regained autonomous walking within 1 month of surgery. Thoracic spinal cord stenosis is a rare and complex disorder because of differential diagnosis, neuroimaging features and treatment options. Regardless of its cause, prompt surgical decompression plays a key role in improving the functional outcome of myelopathy. PMID:23111299

Amato, V; Giannachi, L; Irace, C; Corona, C

2012-12-01

296

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

ClinicalTrials.gov

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

2013-06-14

297

Genome-wide association analysis reveals a SOD1 mutation in canine degenerative myelopathy that resembles amyotrophic lateral sclerosis  

Microsoft Academic Search

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

Tomoyuki Awano; Gary S. Johnson; Claire M. Wade; Martin L. Katz; Gayle C. Johnson; Jeremy F. Taylor; Michele Perloski; Tara Biagi; Izabella Baranowska; Sam Long; Philip A. March; Natasha J. Olby; G. Diane Shelton; Shahnawaz Khan; Dennis P. O'Brien; Kerstin Lindblad-Toh; Joan R. Coates

2009-01-01

298

Daily C ontrolled Physiotherapy I ncreases S urvival Time in D ogs w ith S uspected Degenerative Myelopathy  

Microsoft Academic Search

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

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

299

Myelopathy secondary to ossification of the posterior longitudinal ligament of the thoracic spine treated by anterior decompression and bony fusion  

Microsoft Academic Search

We examined the utility of anterior decompression and bony fusion via the extrapleural approach in the treatment of thoracic myelopathy secondary to ossification of the posterior longitudinal ligament (OPLL). Patient outcome and complications were analyzed in 48 patients treated with this procedure, with a follow-up of at least 2 years. The Japanese Orthopaedic Association score was used to evaluate the

Y Fujimura; Y Nishi; M Nakamura; M Watanabe; M Matsumoto

1997-01-01

300

Postcoital bleeding due to cervical endometriosis.  

PubMed

Endometriosis of the uterine cervix is a rare lesion that is generally asymptomatic in gynaecological practice. We present a case with postcoital bleeding due to a cervical mass mimicking cervical polyp or fibroma which was histologically proven as cervical endometriosis later. Cervical endometriosis should be considered in the differential diagnosis of cervical masses with postcoital bleeding. PMID:23376669

Seval, Mehmet Murat; Cavkaytar, Sabri; Atak, Zeliha; Guresci, Servet

2013-01-31

301

Change in Angular Alignment is Associated With Early Dysphagia After Anterior Cervical Diskectomy and Fusion.  

PubMed

STUDY DESIGN:: Retrospective analysis of a prospective cohort. OBJECTIVE:: Change in cervical angular alignment may be associated with dysphagia. SUMMARY OF BACKGROUND DATA:: Bony deformities of the cervical spine may be associated with secondary contractures in soft tissues in the neck. Acute surgical deformity correction result in changes in soft tissue tension in the anterior neck, resulting in dysphagia. METHODS:: The study population included patients undergoing one and two level elective anterior cervical discectomy and fusion for cervical myelopathy or radiculopathy. Preoperative and postoperative radiographs at two weeks were measured by a blinded observer for c2-c7 endplate angle, c2-c7 posterior vertebral body length, and occipital condyle plumb line distance on upright lateral radiographs at 2, 6, and 12 weeks postoperatively. Patients were prospectively queried about dysphagia incidence and severity using a numeric rating scale. Multiple linear regression analysis was used to determine the effect of change in radiographic parameters controlling for demographic characteristics. RESULTS:: The study population included 25 patients with complete radiographs. The mean change in C2-C7 angle was -0.6 degrees (Standard Deviation (SD) 9), the mean change in C2-C7 length was 1.7 mm (SD 26), the mean change in occipital condyle plumb line distance was 2,3 mm (SD 20).Mulitple linear regression analysis was performed including operative time, age, gender, number of levels, and change in radiographic parameters as independent variables and using dysphagia score as the dependent variable. The change in C2-C7 angle and operative time were the only statistically significant predictors of change in dysphagia score at 2 and 6 weeks postoperatively. CONCLUSION:: These results indicate that lordotic change in spinal alignment and longer operative time are associated with increased postoperative dysphagia. Surgeons should counsel patients in whom a large angular correction is expected about the possibility for postoperative dysphagia. Furthermore, future studies on dysphagia incidence should include radiographic alignment as an independent predictor of dysphagia. PMID:23511647

Radcliff, Kristen E; Bennett, Jonathan; Stewart, Robert J; Kepler, Chris K; Sidhu, Gursukhman S; Hilibrand, Alan S; Kane, Justin; Albert, Todd J; Vaccaro, Alexander R; Rihn, Jeffrey A

2013-03-18

302

Leprotic cervical spondylodiscitis.  

PubMed

Leprosy is a chronic infectious disease caused by the Mycobacterium leprae that leads to leprotic neuropathy involving the peripheral nerve and several characteristic skin lesions. Skeletal involvement can occur in peripheral joints, such as the wrist and the ankle. However, there is no report of an axial leprotic lesion involving the spine or paraspinal soft tissue. The authors report the first case of a leprotic cervical lesion involving the axial skeletal system. A 48-year-old male presented with neck pain and severe pain in the right suprascapular area and left arm. Preoperative MRI of the cervical spine revealed signal changes in the prevertebral soft tissue at the level of the C3, 4, 5 vertebral bodies. There were a lower signal intensity on T1-weighted image and high signal intensity on T2WI of the bone marrow at the level of the C5 and C6 vertebral bodies, and a C5/6 segmental ossification of the posterior longitudinal ligament. There were herniated cervical disc on the left C5/6 with C6 root and the right side of C6/7 with a C7 root compression. He was previously diagnosed with leprosy when he was 14 years old and received treatment intermittently over the course of 7 years. But patient did not disclose his past history. Surgical intervention was conducted using an anterior cervical approach. An incision was made in the anterior longitudinal ligament at C5/6, and a pinkish gray friable gelatinous material was observed on the C5/6 disc and on the anterior lower one-third surface of the C5 vertebral body. Specimens were obtained and subjected to pathological evaluation and microbiological culture. After C5/6 and C6/7 discectomies, nerve root decompression and autologous iliac bone grafting were performed at the C5/6 and C6/7 levels. The C5-6-7 vertebrae were fixed with an Atlantis cervical locking plate and a screw system. The pathological report indicated chronic inflammation with heavy plasma cell infiltration on the specimen. We sent the specimens to the Institute of Hansen's Disease, and polymerase chain reaction for leprosy tested positive. After surgery, his pain disappeared and he was given a prescription for antileprotic drugs. The authors describe the first case of leprotic cervical spondylodiscitis that was operatively treated in a 48-year-old patient with known leprosy history since his 14 years old. PMID:20372941

Kim, Sang Jin; Lee, Tae Hoon; Shin, Jun Jae; Chae, Gue Tae

2010-04-07

303

Cervical Spondylosis (Arthritis of the Neck)  

MedlinePLUS

... to a cervical disk herniation, also known as radiculopathy or a "pinched nerve." Epidural injection in the ... orthoinfo.aaos.org/topic.cfm?topic=A00575) Cervical Radiculopathy (Pinched Nerve) Cervical Radiculopathy (Pinched Nerve) (http://orthoinfo. ...

304

Cervical and Thoracic Spine Injuries  

Microsoft Academic Search

\\u000a Cervical spine injuries are very common in contact sports such as wrestling, football, hockey, and rugby. It has been estimated\\u000a that up to 15% of football athletes suffer from some cervical spine injury. The National Center for Catastrophic Sports Injury\\u000a reported over the 12-yr period between 1982 and 1994 there were 450 catastrophic injuries, and 75% involved the cervical spine

Pierre d’Hemecourt; Jessica Flynn Deede

305

Synthetic cervical mucus formulation  

Microsoft Academic Search

A synthetic formulation has been developed with viscosity, spinnbarkeit, and pH comparable to that reported for human cervical mucus. The formulation contains guar gum crosslinked with borate ion, mucin (dried porcine gastric), and a mixed preservative system in pH 7.4, 0.1M phosphate buffer. The guar gum source, mucin concentration, and method of preparation were shown to be critical factors in

Br??d T Burruano; Roger L Schnaare; Daniel Malamud

2002-01-01

306

Recurrent cervical cancer  

Microsoft Academic Search

Opinion statement  There are limited treatment options for patients with recurrent cervical carcinoma. Because of low response rates and a negligible\\u000a impact on long-term survival, the use of chemotherapy in patients with unresectable recurrent disease should be considered\\u000a palliative. Generally, radiation therapy in previously irradiated patients is considered palliative. For patients who develop\\u000a recurrent disease after definitive surgery who have not

Mario M. Leitao; Dennis S. Chi

2002-01-01

307

Cervical Primitive Neuroectodermal Tumor  

Microsoft Academic Search

Background.Primitive neuroectodermal tumors (PNETs) are rare and potentially aggressive malignancies.Case. A 24-year-old woman in her eighth week of pregnancy presented with a cervical mass. Tissue biopsy demonstrated poorly differentiated carcinosarcoma with neuroendocrine features. Immunohistochemical studies confirmed the diagnosis of PNET. Treatment included alternating courses of cyclophosphamide, adriamycin, vincristine (CAV) and ifosfamide, etoposide (IE). A radical hysterectomy with bilateral ovarian transposition

Anne S. Tsao; Lawrence M. Roth; Alan Sandler; Jean A. Hurteau

2001-01-01

308

Disparities and Cervical Cancer  

Microsoft Academic Search

\\u000a Cervical cancer became a preventable disease with the introduction of the Papanicolaou smear (Pap smear) in the 1940s. Trend\\u000a data show that incidence rates have decreased steadily over the past several decades in both white and African American women\\u000a living in the United States (American Cancer Society 2007). Mortality rates have declined steadily over the past several decades\\u000a as well

Marcela del Carmen; Teresa Diaz-Montez

309

Traumatic cervical artery dissection.  

PubMed

Traumatic cervical artery dissection (TCAD) is a complication of severe blunt head or neck trauma, the main cause being motor vehicle accidents. TCAD are increasingly recognized, and incidences of up to 0.86% for internal carotid and 0.53% for traumatic vertebral artery dissections (TVAD) among blunt trauma victims are reported. Diagnostic evaluation for TCAD is mandatory in the presence of (1) hemorrhage of potential arterial origin originating from the nose, ears, mouth, or a wound; (2) expanding cervical hematoma; (3) cervical bruit in a patient >50 years of age; (4) evidence of acute infarct at brain imaging; (5) unexplained central or lateralizing neurological deficit or transient ischemic attack, or (6) Horner syndrome, neck or head pain. In addition, a number of centers screen asymptomatic patients with blunt trauma for TCAD. Catheter angiography is the standard of reference for diagnosis of TCAD. Color duplex ultrasound, computed tomographic, and magnetic resonance angiography are noninvasive screening alternatives, but each method has its diagnostic limitations compared to catheter angiography. Anticoagulants and antiplatelet drugs may prevent ischemic stroke, but bleeding from traumatized tissues may offset the benefits of antithrombotic treatment. Endovascular therapy of dissected vessels, thrombarterectomy, direct suture of intimal tears, and extracranial-intracranial bypass should be considered in exceptional cases. Neurological outcome is probably worse in TCAD compared to spontaneous CAD, although it is unclear whether this is due to dissection-induced ischemic stroke or associated traumatic lesions. PMID:17290111

Nedeltchev, Krassen; Baumgartner, Ralf W

2005-01-01

310

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

PubMed Central

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

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

2013-01-01

311

Solitary osteochondroma of the thoracic spine with compressive myelopathy; a rare presentation.  

PubMed

A 19-year-old man presented with a 5-year history of back pain radiating to the lower extremities and paresthesis of the toes during the last year. Plain X-ray revealed a large cauliflower shaped exophytic mass at the level of T8, T9 and T10 vertebrae. Computed tomography (CT) and magnetic resonance imaging (MRI) showed an abnormal bony mass arising from the posterior arch of T9 with protrusion to the spinal canal and marked cord compression. The cortex and medulla of the lesion had continuity with those of the T9 vertebra. Surgical en bloc resection was performed and the patient's symptoms resolved. The histopathologic diagnosis was osteochondroma. In patients with symptoms of myelopathy, in addition to more common etiologies, one should also be aware of rare entities such as osteochondroma. PMID:24046783

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

2013-05-20

312

Steroid-responsive paraneoplastic demyelinating neuropathy and myelopathy associated with breast carcinoma.  

PubMed

Paraneoplastic myeloneuropathy has rarely been reported with breast cancer. We report the case of a 59-year-old woman who presented with a peripheral neuropathy and cranial involvement and later developed a myelopathy. The neuropathy was found to be electrophysiologically and histologically demyelinating in nature. Magnetic resonance imaging studies failed to identify any structural brain or spinal cord abnormalities. The patient was diagnosed with breast carcinoma 4 months after initial presentation and underwent resective surgery, radiotherapy, and hormonotherapy. Paraneoplastic antibodies (anti-Hu, anti-Yo, anti-Ri, anti-CV2, anti-Ma, and anti-amphiphysin) were all negative. Her condition did not progress further after cancer treatment. Partial neurologic improvement occurred with oral steroid therapy, with subsequent deterioration on treatment withdrawal. PMID:19169093

Rajabally, Yusuf A; Qaddoura, Bassel; Abbott, Richard J

2008-12-01

313

Neurological complications of endemic skeletal fluorosis, with special emphasis on radiculo-myelopathy.  

PubMed

The results of surveys carried out between 1976 and 1985 in the fluorosis-endemic area of the Ethiopian Rift Valley is summarised, with emphasis on the neurological complications resulting from the crippling osteofluorosis. The neurological manifestations in the forms of myelopathy with and without radiculopathy (respectively 72% and 28%) occurred after exposure to high fluoride (greater than 4 ppm) for longer than 10 years. These deficits were clearly found to be a consequence of fluoride deposition in bones, resulting in generalised sclerosis and osteophytosis, with reduction in the diameter of the intervertebral foramina and of the spinal conal. Advanced osteosclerosis commonly causes severe spastic quadriparesis in flexion, accompanied by distressing spasms and urinary incontinence. The dilemma of these medical problems in relation to the agro-industrial economic developments of the Ethiopian Rift Valley is discussed. PMID:2172892

Haimanot, R T

1990-05-01

314

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

PubMed

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

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

2011-05-30

315

Microsurgical anterior decompression and internal fixation with iliac bone graft and titanium plates for treatment of cervical intervertebral disc herniation.  

PubMed

42 cervical interbody fusions with iliac bone graft and titanium plate fixation were performed between October 1991 and March 1994. The mean follow up period in this study was 10.7 months. In 32 cases fusion was done for 1 and in 10 cases for 2 segments. 2 different types of plates were used. In 25 cases micro-osteosynthesis plates and screws with 2.7 mm diameter were used, and in 17 cases cervical H-plates and screws with 3.5 mm diameter. A favourable outcome was achieved in 31 of 42 cases (74%). Satisfactory pain relief was achieved in 90%. For radicular motor deficit good results were obtained in 84% and for cervical myelopathy in 54%. The 2 different types of plates showed a remarkable difference in the clinical outcome. The results were regarded favourable in 15 of 25 microplate fusions (60%) and in 16 of 17 H-plate fusions (94%). Compression of the bone graft was seen in 5 patients of the micro plate group, however, radiological signs for fusion were present in all 42 cases at follow up. Major surgical complications, damage to neural structures or neurological deterioration did not occur in this study. Plate fixation in cervical interbody fusions seems to be a safe procedure and may reduce graft related complications at the fusion site if the plates and screws are sufficiently well proportioned. A favourable impact upon the results for cervical interbody fusion might be expected and should be further investigated in a long term follow up study. PMID:8748783

Muhlbauer, M; Saringer, W; Aichholzer, M; Sunder-Plassmann, M

1995-01-01

316

Cervical SNAGs: a biomechanical analysis  

Microsoft Academic Search

A sustained natural apophyseal glide (SNAG) is a mobilization technique commonly used in the treatment of painful movement restrictions of the cervical spine. In the manual therapy literature, the biological basis and empirical efficacy of cervical SNAGs have received scant attention. In particular, an examination of their potential biological basis in order to stimulate informed discussion seems overdue. This paper

A. Hearn; D. A. Rivett

2002-01-01

317

Skin Relapse from Cervical Cancer  

Microsoft Academic Search

Background. Cutaneous lymphangitis carcinomatosis from cervical carcinoma is a very rare form of tumor metastatization; only anecdotal cases are reported in the literature. Most of the patients with skin relapse experienced metastasis as a single or multiple nodules.Case. A case of cutaneous lymphangitis carcinomatosis mimicking contact dermatitis was diagnosed at our institution in a patient affected by cervical carcinoma stage

Innocenza Palaia; Roberto Angioli; Giuseppe Cutillo; Natalina Manci; Pierluigi Benedetti Panici

2002-01-01

318

Optimal Positioning for Cervical Immobilization  

Microsoft Academic Search

Study objective: We hypothesized that optimal positioning of the head and neck to protect the spinal cord during cervical spine immobilization can be determined with reference to external landmarks. In this study we sought to determine the optimal position for cervical spine immobilization using magnetic resonance imaging (MRI) and to define this optimal position in a clinically reproducible fashion. Methods:

Robert A. De Lorenzo; James E. Olson; Mike Boska; Renate Johnston; Glenn C. Hamilton; James Augustine

1996-01-01

319

Fusion of the occiput to the upper cervical spine. A review of 37 cases.  

PubMed

This is the first report of a large series of patients undergoing preoperative traction to reduce spinomedullary compression from cranial settling. In all cases, an attempt was made to reduce the malalignment with Gardner-Wells or halo traction before posterior fusion. One patient required an anterior retropharyngeal decompression of the odontoid performed as a one-stage procedure at the time of the posterior operation, and two required subsequent anterior transoral-transpharyngeal resection of the odontoid. From 1974 to 1989, 37 patients underwent posterior occipital cervical arthrodesis. All cases presented with neurologic deficit, and most had signs of brain stem compression, such as L'hermitte's sign or Ondine's curse. The most common cause of basilar impression was rheumatoid arthritis, neoplastic destruction, previously failed C1-C2 fusion, or Down's syndrome. Mean postoperative follow-up was 2 years and 10 months; the patients with less than 2 years' follow-up were followed until successful fusion. Eight of 9 patients with L'hermitte's sign or Ondine's curse and 10 of 12 patients with intractable occipital pain were relieved of their symptoms after reduction and triple-wire stabilization-fusion. Eighteen of 25 patients with long tract signs improved after surgery. Interestingly, 14 (93.3%) of 15 patients with myelopathy improved when successful preoperative reduction of their deformity occurred, whereas only 4 (40%) of 10 patients with fixed basilar impression improved (chi 2 = 8.57, P = .014). Symptoms such as Ondine's curse, L'hermitte's sign, intractable occipital headache, and myelopathy are usually relieved by skeletal traction and posterior fusion without need of an additional transmucosal anterior procedure.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1801259

McAfee, P C; Cassidy, J R; Davis, R F; North, R B; Ducker, T B

1991-10-01

320

Polyetheretherketone (PEEK) Spacers for Anterior Cervical Fusion: A Retrospective Comparative Effectiveness Clinical Trial  

PubMed Central

Background: Anterior cervical decompression and fusion (ACDF) is the standard surgical treatment for radiculopathy and myelopathy. Polyetheretherketone (PEEK) has an elasticity similar to bone and thus appears well suited for use as the implant in ACDF procedures. The aim of this study is to examine the clinical and radiographic outcome of patients treated with standing alone PEEK spacers without bone morphogenic protein (BMP) or plating and to examine the influence of the different design of the two spacers on the rate of subsidence and dislocation. Methods: This retrospective comparative study reviewed 335 patients treated by ACDF in a specialized urban hospital for radiculopathy or myelopathy due to degenerative pathologies. The Intromed PEEK spacer was used in 181 patients from 3/2002 to 11/2004, and the AMT SHELL spacer was implanted in 154 patients from 4/2004 to 12/2007. The follow-up rate was 100% at three months post-op and 82.7% (277 patients) at one year. The patients were assessed with the Japanese Orthopedic Association (JOA) questionnaire and radiographically. Results: At the one-year follow-up there were 118/277 patients with an excellent clinical outcome on the JOA, 112/277 with a good outcome, 20/277 with a fair outcome, and 27/277 with a poor outcome. Subsidence was observed in 13.3% of patients with the Intromed spacer vs 8.4% of the patients with the AMT SHELL. Dislocation of the spacer was observed in 10 of the 181 patients with Intromed spacers but in none of the 154 patients with Shell spacers. Conclusion: The study demonstrates that ACDF with standing alone PEEK cages leads to excellent and good clinical outcomes. The differences we observed in the subsidence rate between the two spacers were not significant and cannot be related to a single design feature of the spacers.

Lemcke, Johannes; Al-Zain, Ferass; Meier, Ullrich; Suess, Olaf

2011-01-01

321

Fractures of the cervical spine  

PubMed Central

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.

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

2013-01-01

322

An autopsy case of human T lymphotropic virus type I-associated myelopathy (HAM) with a duration of 28 years  

Microsoft Academic Search

An autopsy case of human T lymphotropic virus I-associated myelopathy (HAM) of a duration of 28 years in a 61-year-old man with serological confirmation of HTLV-I infection was reported. The spinal cord was grossly atrophic. There was severe symmetrical degeneration of the lateral funiculi, particularly of the bilateral pyramidal tracts, involving all levels of the spinal cord, but anterior horn

S. Sasaki; T. Komori; S. Maruyama; M. Takeishi; Y Iwasaki

1990-01-01

323

Pathological mechanisms of human T-cell lymphotropic virus type I-associated myelopathy (HAM\\/TSP)  

Microsoft Academic Search

The recent studies have greatly improved our understanding of the pathological mechanisms of human T cell lymphotropic virus\\u000a type I (HTLV-I)-associated myelopathy\\/tropical spastic paraparesis (HAM\\/TSP). The pathological mechanisms of HAM\\/TSP based\\u000a on the histopathological, immunological, and molecular analysis with emphasis on the longitudinal alterations of the disease\\u000a will be discussed. Immunohistological examination revealed the existence and the activation both of

Mitsuhiro Osame

2002-01-01

324

Modulation of T Cell Responses in HTLV1 Carriers and in Patients with Myelopathy Associated with HTLV1  

Microsoft Academic Search

Objective: Human T lymphotropic virus-type 1 (HTLV-1) activates the immune system leading to a persistent and exacerbated T-cell response with increased production of IFN-? and TNF-?. Overproduction of pro-inflammatory cytokines is correlated with the development of HTLV-1-associated myelopathy\\/tropical spastic paraparesis (HAM\\/TSP), although some HTLV-1 carriers also show high levels of these cytokines. In this study, the ability of regulatory cytokines

Silvane B. Santos; Aurélia F. Porto; André Luiz Muniz; Tania Luna; Márcia C. Nascimento; Jaqueline B. Guerreiro; Jamary Oliveira-Filho; Daniel J. Morgan; Edgar M. Carvalho

2006-01-01

325

Histone deacetylase-mediated transcriptional activation reduces proviral loads in HTLV1-associated myelopathy\\/tropical spastic paraparesis patients  

Microsoft Academic Search

Epigenetic modifications of chromatin may play a role in maintaining viral latency and thus persistence of the hu- man T-lymphotropic virus type 1 (HTLV- 1), which is responsible for HTLV-asso- ciated myelopathy\\/tropical spastic paraparesis (HAM\\/TSP).Amajor determi- nant of disease progression is increased peripheral blood proviral load (PVL), possibly via the accumulation of in- fected cells in the central nervous sys-

Agnes Lezin; Nicolas Gillet; Stephane Olindo; Nathalie Grandvaux; Olivier Verlaeten; Gildas Belrose; Marcelo de Carvalho Bittencourt; John Hiscott; Becca Asquith; Arsene Burny; Didier Smadja; Raymond Cesaire; Luc Willems; Hôpital St Luc

2007-01-01

326

Cervical foraminal selective nerve root block: a 'two-needle technique' with results  

PubMed Central

Several techniques have been described for selective nerve root blocks. We describe a novel ‘two-needle technique’, performed through the postero-lateral route with the patient in lateral position under C-arm guidance. The aim of the current study is to highlight the effectiveness and safety of cervical selective nerve root block for radiculopathy using this technique. We present results of a retrospective 2-year follow-up study of 33 injections carried out on 33 patients with radiculopathy due to cervical disc disease and or foraminal stenosis using this procedure. Patients with myelopathy, gross motor weakness and any other pathology were excluded. The outcome was measured comparing ‘Visual Analogue Score’ (VAS) and ‘Neck Disability Index’ (NDI) before the procedure with those at 6 weeks and 12 months after the procedure. Thirty patients were included in the final analysis. Average pre-operative VAS score was 7.4 (range 5–10), which improved to 2.2 (range 0–7) at 6 weeks and 2.0 (range 0–4) at 1 year and the mean NDI score prior to intervention was 66.9 (range 44–84), which improved to 31.7 (range 18–66) at 6 weeks and 31.1 (range 16–48) at 1 year. The improvements were statistically significant. Patients with involvement of C6 or C7 nerve roots responded slightly better at 6 weeks with regards to VAS improvement. Mean duration of radiation exposure during the procedure was 27.8 s (range 10–90 s). Only minor complications were noted—transient dizziness in two and transient nystagmus in one patient. Our ‘two-needle technique’ is a new, safe and effective non-surgical treatment for cervical radiculopathy.

Gowda, Veda

2008-01-01

327

Radiological cervical arthritis in populations.  

PubMed Central

The prevalence of cervical rheumatoid arthritis and its relationship to rheumatoid serum factors and erosive arthritis in peripheral joints has been studied in radiographs of the cervical spine and of the hands and feet drawn from 12 population samples. The changes were graded in accordance with the Atlas of Standard Radiographs of Arthritis. Rheumatoid arthritis of the cervical spine (grades 2-4) was observed in 4.1% of males and 4.7% of females aged 15 and over. Prevalence was greatest in those born before 1900, 15% of whom were affected. There was a significant association with the sheep cell agglutination test but not with the bentonite flocculation test, though the latter correlated well with erosive arthritis in the joints of the hands and feet. Arthritis of the cervical spine showed a significant correlation with both seropositive and seronegative erosive arthritis in the peripheral joints. A significantly higher prevalence of cervical arthritis than expected was noted in two population samples, one in Germany and the other in West Africa, though in neither was there a high prevalence of peripheral arthritis. The German population had relatively high antistreptolysin titres. A low prevalence of cervical arthritis was noted in populations in Czechoslovakia and in Arizona. 'Congenital' block vertebra had a prevalence of 0.9% in persons born before 1935, but none was observed in those born since. The figures suggest that environmental influences predisposing to cervical arthritis and block vertebra have changed in the last 40 years.

Lawrence, J S

1976-01-01

328

“Double cervical rib with uncommon presentation”  

Microsoft Academic Search

Double or Bilateral cervical ribs. Pseudo arthrosis of cervical rib with first rib causing neurovascular complication is a\\u000a rare congenital anomaly. We report a case of young man who presented with intermittent claudication in the right hand and\\u000a involvement of peripheral nerves. He had bilateral cervical ribs. Left side cervical rib was small. Right side cervical rib\\u000a had pseudo arthrosis

Mahadev Dixit; Mohan Gan; Narendra Nishanimath; Bhaskar Venkatakrishnaiah Bhagyalakshmi; Prashant Sajjan; Aruneshwari Dayal

2010-01-01

329

Studying Biomarkers in Diagnosing Cervical Lesions in Patients With Abnormal Cervical Cells  

ClinicalTrials.gov

Atypical Endocervical Glandular Cell of Undetermined Significance; Atypical Endometrial Hyperplasia; Atypical Glandular Cell of Undetermined Significance; Cervical Cancer; Cervical Intraepithelial Neoplasia Grade 2; Cervical Intraepithelial Neoplasia Grade 3; Human Papilloma Virus Infection

2013-08-01

330

Anterior Cervical Arachnoid Cyst  

PubMed Central

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

Sharifi, Give

2013-01-01

331

Anterior cervical arachnoid cyst.  

PubMed

This report is composed of two patients with anteriorly located cervical intradural arachnoid cyst and review of 24 cases in Englishlanguage literature. Both of our patients were in the first two decades of life with neck pain and motor weakness. With suspicious diagnosis of anterior arachnoid cyst surgery was carried out in both cases, though laminectomy in one and laminoplasty in the other. The cyst wall was widely fenestrated with subsequent subtotal excision of the cyst. Both cases had good long-term outcome. The review disclosed male predominance. 73% of the patients were diagnosed within the first two decades of life. Neck pain and motor weakness were the dominant signs and symptoms of this pathology. Magnetic resonance imaging showing a cerebrospinal fluid (CSF) containing cyst was the best mode of diagnosis. Wide cyst fenestration with waying CSF into subarachnoid cyst was the most appropriate and applied surgery with optimal outcome. PMID:23741550

Rahimizadeh, Abolfazl; Sharifi, Give

2013-05-22

332

Cervical Cancer Prevention Clinical Trials  

Cancer.gov

Programs and Projects Cervical Cancer Clinical Trials Ongoing Phase I/II Prevention Trials Funded and Monitored by the Breast and Gynecologic Cancer Research Group (BGCRG) Principal Investigator Funding Mechanism Title of Award

333

Spinal surgery -- cervical - series (image)  

MedlinePLUS

The cervical spinal column is made up of vertebral bodies which protect the spinal cord. ... processes on the vertebral bodies (osteophytes), which compress spinal nerves, trauma, and narrowing (stenosis) of the spinal ...

334

Posterior Hybrid Technique for Ossification of the Posterior Longitudinal Ligament Associated With Segmental Instability in the Cervical Spine.  

PubMed

STUDY DESIGN:: Retrospective case series. OBJECTIVE:: To discuss the indications for a posterior hybrid technique for ossification of the posterior longitudinal ligament (OPLL) associated with segmental instability in the cervical spine and evaluate its effectiveness and safety. SUMMARY OF BACKGROUND DATA:: Dynamic factors have been shown to play an important role in the progression of ossification and OPLL myelopathy. Laminoplasty has been widely used to treat cervical OPLL, but progressive kyphosis and progression of ossified lesions are often detected in long-term follow-up. METHODS:: Fifteen patients were treated by a posterior hybrid technique including laminoplasty and lateral mass screw fixation at unstable levels. Preoperatively, the extent and type of OPLL, spinal cord compression, and presence of high-intensity zones (HIZ) were investigated by X-ray, computed tomography, and magnetic resonance imaging. Segmental instability in the cervical spine was investigated by dynamic X-ray. Postoperatively, clinical outcomes were evaluated with the Japanese Orthopaedic Association (JOA) scoring system and visual analogue scale scores for neck pain. Radiological results included cervical alignment and progression of OPLL. RESULTS:: A total of 17 intervertebral levels in 15 patients (11 mixed-type and 4 continuous-type OPLL) had segmental instability, which was consistent with the presence of HIZ levels in 10 (66.7%) patients. Neurological function as evaluated by JOA scores was significantly improved 6 months postoperatively and well maintained 4 years postoperatively. Neck pain was significantly improved 4 years postoperatively. No patients developed progressive kyphosis or progression of ossified lesions during the follow-up. Only 1 patient developed unilateral C5 palsy and completely recovered 2 months later. CONCLUSIONS:: This hybrid posterior technique appears to be effective and safe in the treatment of selected patients with OPLL associated with segmental instability. The potential benefits of this technique include a stable environment for spinal cord recovery and prevention of progressive kyphosis and OPLL. PMID:22576720

Chen, Yu; Wang, Xinwei; Chen, Deyu; Miao, Jinghao; Liao, Xinyuan; Yu, Fengbin

2012-05-10

335

Infections of the Cervical Spine  

Microsoft Academic Search

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

Luca Denaro; Umile Giuseppe Longo; Vincenzo Denaro

336

[Somatosensitive and motor evoked potentials in HTLV-I associated myelopathy].  

PubMed

This study investigated 63 patients with HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP) by somatosensitive evoked potentials (SEPs) and 42 of them by motor evoked potentials (MEP). All the patients had typical clinical history of HAM, serum samples tested positive for antibodies to HTLV-I screened for Particle Agglutination, ELISA and complemented by Western blot test. In patients studied by SEPs of lower limbs 51/63 (81 %) were abnormal and 11 of them (17.5%) were abnormal in upper limbs also. In patients studied by MEP 37/42 were abnormal, 34/42 (81%) in lower limbs and 25/42 (59.5%) in upper limbs. A high percent of the population studied had abnormalities of the corticospinal tracts on the four limbs at the PEM, without abnormalities in upper limbs by SEPs, showing the correlation between central motor conduction time in upper limbs and the clinical severity of HAM/TSP (p < 0.01). It was not found correlation between time of disease and the results of the SEPs and MEP (p = 0.69). PMID:16172717

Andrade, Daniela Oliveira de

2005-09-09

337

Reduced Foxp3 expression with increased cytomegalovirus-specific CTL in HTLV-I-associated myelopathy.  

PubMed

Human T-lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) patients show high immune responses to HTLV-I. However, it is unclear whether the cytotoxic T lymphocyte (CTL) responses to other chronic viruses also increase. We investigated the responses in the peripheral blood by using HLA-A*0201/peptide pentamers. The frequency of cytomegalovirus (CMV)-specific CTL tended to be higher in HAM/TSP patients than in healthy controls (HCs). The frequency of CMV-specific CTL positively correlated with that of HTLV-I Tax-specific CTL. The frequency of Foxp3+ cells in CD4+ lymphocytes tended to be higher in HAM/TSP patients than in ACs and HCs. The expression level of Foxp3 was lower in HAM/TSP patients than in HCs and was inversely correlated with the CMV-specific CTL frequency. A percentage of Foxp3+ cells showed a positive correlation with the HTLV-I proviral load. These results suggest that a decrease in the Foxp3 expression may contribute to the high immune response to CMV and that the Foxp3+ regulatory T cells may play a role in the immune surveillance of HTLV-I. PMID:18639344

Hayashi, Daisuke; Kubota, Ryuji; Takenouchi, Norihiro; Tanaka, Yuetsu; Hirano, Ryuki; Takashima, Hiroshi; Osame, Mitsuhiro; Izumo, Shuji; Arimura, Kimiyoshi

2008-07-18

338

Etanercept-Induced Myelopathy in a Pediatric Case of Blau Syndrome  

PubMed Central

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-?) biologic agents, such as etanercept, play an important role. Among the major adverse effects of TNF-? 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.

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

2011-01-01

339

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

PubMed

The epidemiology of tropical spastic paraparesis/human T lymphotropic virus I (HTLV-I)-associated myelopathy (TSP/HAM) is frequently inconsistent and suggests environmental factors in the etiology of these syndromes. The neuropathology corresponds to a toxometabolic or autoimmune process and possibly not to a viral disease. Some logical hypotheses about the etiology and physiopathology of TSP and HAM are proposed. Glutamate-mediated excitotoxicity, central distal axonopathies, cassava, lathyrism and cycad toxicity may explain most cases of TSP. The damage caused to astrocytes and to the blood-brain barrier by HTLV-I plus xenobiotics may explain most cases of HAM. Analysis of the HTLV-I/xenobiotic ratio clarifies most of the paradoxical epidemiology of TSP and HAM. Modern neurotoxicology, neuroimmunology and molecular biology may explain the neuropathology of TSP and HAM. It is quite possible that there are other xenobiotics implicated in the etiology of some TSP/HAMs. The prevention of these syndromes appears to be possible today. PMID:14689037

Zaninovic', V

2003-12-18

340

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

PubMed

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. © 2013 Wiley Periodicals, Inc. PMID:24043596

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

2013-09-16

341

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

Microsoft Academic Search

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

Constantine Constantoyannis; Demetres Konstantinou; Harry Kourtopoulos; Nicolas Papadakis

2002-01-01

342

Use of cervical spine manipulation under anesthesia for management of cervical disk herniation, cervical radiculopathy, and associated cervicogenic headache syndrome  

Microsoft Academic Search

Objective: To demonstrate the benefits of cervical spine manipulation with the patient under anesthesia as an approach to treating a patient with chronic cervical disk herniation, associated cervical radiculopathy, and cervicogenic headache syndrome. Clinical Features: The patient had neck pain with radiating paresthesia into the right upper extremity and incapacitating headaches and had no response to 6 months of conservative

James Herzog

1999-01-01

343

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 ...

344

Cervical Cancer Rates by Race and Ethnicity  

MedlinePLUS

... Doing Related Links Inside Knowledge Campaign Survivor Stories Television Public Service ... Cancer Rates by Race and Ethnicity The rate of women getting cervical cancer or dying from cervical cancer ...

345

21 CFR 884.3200 - Cervical drain.  

Code of Federal Regulations, 2013 CFR

...AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Obstetrical and Gynecological Prosthetic Devices § 884.3200 Cervical drain. (a) Identification. A cervical drain is a device designed to provide...

2013-04-01

346

Dysphagia and hypervitaminosis A: Cervical hyperostosis  

Microsoft Academic Search

Vertebral hyperostosis typically predominates at the thoracic spine and causes only minor symptoms. Involvement of the cervical spine may cause dysphagia due to pressure on the esophagus. We report three cases of dysphagia revealing cervical hyperostosis.

Daniel Wendling; Chafika Hafsaoui; Jean-Marie Laurain; Michel Runge; Nadine Magy-Bertrand; Clément Prati

2009-01-01

347

Cervical Spinal Epidural Hematoma Following Cervical Posterior Laminoforaminotomy  

PubMed Central

A 65-year-old man who had lateral cervical disc herniation underwent cervical posterior laminoforaminotomy at C5-6 and C6-7 level right side. During the operation, there was no serious surgical bleeding event. After operation, he complained persistent right shoulder pain and neck pain. Repeated magnetic resonance image (MRI) showed diffuse cervical epidural hematoma (EDH) extending from C5 to T1 level right side and spinal cord compression at C5-6-7 level. He underwent exploration. There was active bleeding at muscular layer. Muscular active bleeding was controlled and intramuscular hematoma was removed. The patient's symptom was reduced after second operation. Symptomatic postoperative spinal EDH requiring reoperation is rare. Meticulous bleeding control is important before wound closure. In addition, if patient presents persistent or aggravated pain after operation, rapid evaluation using MRI and second look operation is needed as soon as possible.

Choi, Jeong Hoon; Lee, Sang-Ho

2013-01-01

348

Low-back pain in HTLV-I-associated myelopathy\\/tropical spastic paraparesis: nociceptive or neuropathic?  

Microsoft Academic Search

Study design:Cross-sectional.Objectives:To describe characteristics of low-back pain in human T-cell lymphotropic virus type I (HTLV-I)-associated myelopathy\\/tropical spastic paraparesis (HAM\\/TSP) patients and to identify its neuropathic and\\/or non-neuropathic pain components.Setting:A reference center for the care of patients with HAM\\/TSP in Rio de Janeiro, Brazil.Methods:A total of 90 patients with HAM\\/TSP referred by tertiary care centers were consecutively assessed. The patients were

Í R Tavares; A C Franzoi; A Q-C Araújo

2010-01-01

349

HPV and cervical cancer: screening or vaccination?  

Microsoft Academic Search

Following the demonstration of the superior validity of human papillomavirus (HPV) tests in screening for cervical cancer and the arrival of highly efficacious HPV 16 and 18 vaccines, cervical cancer prevention enters a time of sustainable introduction in developing countries. Multidisciplinary efforts and novel protocols are being developed, and challenging situations are being faced to make cervical cancer, still the

F X Bosch; X Castellsagué; S de Sanjosé

2008-01-01

350

Cervical spine curvature during simulated whiplash  

Microsoft Academic Search

Objective. To develop a new method to describe cervical spine curvature and evaluate the potential for injury in the upper and lower cervical spine during simulated whiplash. Design. A method was developed to integrate the upper and lower cervical spine rotations and describe the spine curvature. Background. In vivo and in vitro whiplash simulations have documented the development of an

Manohar M. Panjabi; Adam M. Pearson; Shigeki Ito; Paul C. Ivancic; Jaw-Lin Wang

2004-01-01

351

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

PubMed Central

Objective: To observe the urodynamic profile of the patients following non-traumatic myelopathies (NTMs) with neurogenic bladder. Setting: Neurological rehabilitation department of university tertiary research hospital. Materials and Methods: Seventy-nine patients (44 men) with monophasic NTM, with the age range 8-65 years (31.0 ± 16.0 years), were admitted for inpatients’ rehabilitation. Length of stay in rehabilitation ranged from 6 to 120 days (32.0 ± 24.8 days). Fifty-six patients (70.9%) had spinal lesion above D10, 17 had lesion between D10 and L2 (21.5%), and 6 (7.6%) had cauda equina syndrome. All patients had neurogenic bladder with urinary complaints. Urodynamic study (UDS) was performed in all patients. Results: UDS showed 71.4% patients (40/56) had neurogenic detrusor overactivity (NDO) with or without sphincter dyssynergy (DSD) with lesion above D10; only 52.9% patients (9/17) had NDO with or without DSD detrusor with lesion between D10 and L2; and majority (5/6 patients) had underactive detrusor in the cauda equina group. Bladder management was based on the UDS findings. No significant correlation was found (P > 0.05) between detrusor behavior and the level, severity (ASIA Impairment Scale) of spinal injury, or gender using chi-square test. Conclusions: Neurogenic bladder following NTM was observed in all patients. UDS suggested predominantly NDO in lesions above D10 and mixed pattern in between D10 and L2 lesions. No significant correlation was found between detrusor behavior and the level or severity of NTM in the study.

Gupta, Anupam; Taly, Arun B

2013-01-01

352

[Case of recurrent delayed radiation myelopathy with 5-year remission interval].  

PubMed

We report a 47-year-old woman with relapsed delayed radiation myelopathy (DRM), occurring 5 years and 10 years after radiation therapy for nasopharyngeal carcinoma at 37 years old. Sensations of pain and temperature had been disturbed in the right leg since 42 years old. MRI showed Gadolinium-enhanced lesion as a ring-like-enhancement of the spinal cord at C1-2 on T1-weighted image (T1WI), with high signal area and swelling of the spinal cord at the upper C1 to C6 areas on T2-weighted image. We diagnosed her as having DRM after considering the differential diagnosis, e.g., multiple sclerosis, spinal tumor and other neurological diseases. Her sensory symptoms quickly improved following therapy with prednisolone and warfarin. Although she remained healthy for a few years, dysesthesia of the neck on the right side appeared 5 years later after the first clinical occurrence. At this time, MRI demonstrated Gadolinium-enhanced lesion as a ring-like enhancement of the spinal cord at C2 on T1WI. but the area also differed from that of previous lesion; a high signal area and swelling of the spinal cord was also seen on FLAIR image of the medulla and upper C1 to C6. For recurrence of DRM, we administered prednisolone and warfarin. Thereafter, the patient recovered and the spinal cord lesion on MRI decreased markedly. The clinical course demonstrated that administration of prednisolone and warfarin might be effective for relapsed DRM. PMID:20593664

Tsukagoshi, Setsuki; Ikeda, Masaki; Tano, Shinobu; Obayashi, Kai; Fujita, Yukio; Okamoto, Koichi

2010-06-01

353

HPV vaccination and cervical cancer.  

PubMed

Cervical cancer is the third most common cancer in women worldwide and often affects women under 40 years with young families. Vaccination against the human papillomavirus (HPV) is a major advance, since it offers primary prevention against the infectious agent that is the main cause of the disease. Two prophylactic vaccines have shown great promise in clinical trials. One of these (Gardasil(®)) contains all four HPV types, offering protection against genital warts (types 6 and 11) as well as cervical cancer (types 16 and 18). The other (Cervarix(®)) contains types 16 and 18, targeting cervical cancer alone, but also has a degree of cross-protection against types 31 and 45, which could significantly increase the level of protection. Adolescent girls remain the primary target of vaccination programmes, but the issues of vaccinating boys and older women are increasingly debated. PMID:22890794

Szarewski, Anne

2012-12-01

354

Cervical Whiplash: Considerations in the Rehabilitation of Cervical Myofascial Injury  

PubMed Central

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

Ameis, Arthur

1986-01-01

355

Cervical spine in Treacher Collins syndrome.  

PubMed

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

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

2012-05-01

356

Percutaneous cervical nucleoplasty in the treatment of cervical disc herniation.  

PubMed

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) > or =11 degrees or horizontal displacement (HD) > or =3 mm was considered to be radiographically unstable. In the results of this study, puncture of the needle into the disc space was accurately performed under X-ray guidance in all cases. There was one case where the Perc-D Spine Wand had broken in the disc space during the procedure. The partial Perc-D Spine Wand, which had broken in the disc space could not be removed by the percutaneous cervical discectomy and thus remained there. There were no recurrent cases or complications in our series. Macnab standard results were excellent in 62 cases, good in 41 cases and fair in 23 cases. The rate of excellent and good was 83.73%. The VAS scores demonstrated statistically significant improvement in PCN at the 2-week, 1, 3, 6, and 12-month follow-up visits when compared to preoperational values (P < 0.01). There were no cases of instability following the PCN procedure. There was no significant difference in stability either preoperatively or postoperatively (P > 0.05). Our findings confirm that PCN for the treatment of cervical disc herniation results in a good outcome without any tampering of the stability of the cervical spine. Hence, PCN as a procedure is safe, minimally invasive, less traumatic, requiring less time with an excellent clinical outcome. PCN should be performed for those patients who fail conservative medical management including medication, physical therapy, behavioral management, psychotherapy, and who are unwilling to undergo a more invasive technique such as spinal surgery. PMID:18830638

Li, Jian; Yan, Deng-lu; Zhang, Zai-Heng

2008-10-01

357

Percutaneous cervical nucleoplasty in the treatment of cervical disc herniation  

PubMed Central

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

Li, Jian; Zhang, Zai-Heng

2008-01-01

358

Cervical Remodeling during Pregnancy and Parturition  

PubMed Central

Appropriate and timely cervical remodeling is key for successful birth. Premature cervical opening can result in preterm birth which occurs in 12.5% of pregnancies. Research focused on the mechanisms of term and preterm cervical remodeling is essential to prevent prematurity. This review highlights recent findings that better define molecular processes driving progressive disorganization of the cervical extracellular matrix. This includes studies that redefine the role of immune cells and identify diverse functions of the cervical epithelia and hyaluronan in remodeling. New investigations proposing that infection-induced premature cervical remodeling is distinct from the normal process are presented. Recent advances in our understanding of term and preterm cervical remodeling provide new directions for investigation and compel investigators to reevaluate currently accepted models.

Timmons, Brenda; Akins, Meredith; Mahendroo, Mala

2010-01-01

359

A review of prognostic factors for surgical outcome of ossification of the posterior longitudinal ligament of cervical spine  

PubMed Central

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.

Li, Hai; Jiang, Lei-Sheng

2008-01-01

360

Cervical cancer screening in Greece  

Microsoft Academic Search

The aim of this study was to describe the state of the art in cervical cancer screening in Greece by presenting the two regionally organised screening programmes that currently operate in the country. Both programmes were initiated in 1991 and are partly funded by the European Union. The Ormylia screening programme covers the population of Halkidiki (Northern Greece), a predominantly

E Riza; P Kyriakogianni-Psaropoulou; E Koumantakis; H Symiakaki; I Garas; A Linos

2000-01-01

361

Data Analysis in Cervical Trauma.  

National Technical Information Service (NTIS)

The cervical spine in lateral view is discussed and a method based on digital statistical analysis is used to reproduce quantitative data of the curvature. Part I is a study based on the lateral view in the neutral position in 142 aviators. The radiograms...

L. A. Levin H. T. Andersen L. E. Kazarian P. Hayes H. U. Sverdrup

1989-01-01

362

Genetic events in cervical carcinoma  

SciTech Connect

Cervical carcinoma is the fifth most common cancer world-wide and the second major cause of cancer related death in women. Recent studies have suggested that chromosome 10, particularly the short arm, may be significant in the pathogenesis of the disease. The relationship has not, however, been investigated directly in cervical tumor material. We analyzed 21 paired blood and tumor samples from patients with cervical carcinoma for allele loss on chromosome 10. Ten polymorphic loci spanning the length of chromosome 10 were used including 4 RFLPs and 4 microsatellite markers. Tumor samples were carefully dissected to remove the majority of contaminating normal tissue. Twenty of the 21 pairs were heterozygous for at least one locus. Loss of heterozygosity for one or more chromosome 10 loci was observed in 5 out of the 20 informative cases (25%). One sample showed the apparent loss of an entire copy of chromosome 10. In 3 cases allele loss was confined to loci on the short arm of chromosome 10. We are currently using further markers mapped to chromosome 10p to define the shortest consistent region of allele loss. We suggest that this region may contain one or more tumor suppressor genes involved in the development and/or progression of cervical carcinoma.

Sarkar, S.; Tai, C.C.; Mowatt, J. [Univ. of Cambridge (United Kingdom)] [and others

1994-09-01

363

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

Microsoft Academic Search

There have been few reports describing substances related to oxidative and intermediary metabolism in the cerebrospinal fluid\\u000a (CSF) in patients with spinal degenerative disorders. This study investigated whether the concentrations of metabolites in\\u000a the CSF differed between patients with spinal degenerative disorders and controls, and whether the concentrations of these\\u000a metabolites correlated with the severity of symptoms. CSF samples were

Hideki Nagashima; Yasuo Morio; Shunsuke Meshitsuka; Koji Yamane; Yoshiro Nanjo; Ryota Teshima

2010-01-01

364

Aquaporin-4 Antibodies Are Not Related to HTLV-1 Associated Myelopathy  

PubMed Central

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

von Glehn, Felipe; Jarius, Sven; Penalva de Oliveira, Augusto C.; Brandao, Carlos Otavio; Farias, Alessandro S.; Damasceno, Alfredo; Casseb, Jorge; Moraes, Adriel S.; Longhini, Ana Leda F.; Wandinger, Klaus-Peter; Damasceno, Benito P.; Wildemann, Brigitte; Santos, Leonilda M. B.

2012-01-01

365

Efficacy of Sphaeranthus indicus and cream of Lawsonia inermis in cervical erosion with cervicitis  

Microsoft Academic Search

AimTo compare the efficacy and safety of Sphaeranthus indicus Linn, and cream of Lawsonia inermis Linn and Plumbi oxidum with placebo in the healing of erosion and relief of symptoms in cervical erosion with cervicitis.

Shabana Hashmi; Wajeeha Begum; Arshiya Sultana

2011-01-01

366

Pulsed radiofrequency of cervical medial branches for treatment of whiplash-related cervical zygapophysial joint pain  

Microsoft Academic Search

BackgroundThe aim of this study is to assess the efficacy of pulsed RF lesioning of cervical medial branches in patients with whiplash-related chronic cervical zygapophysial joint pain in whom other conservative treatments failed.

Po-Chou Liliang; Kang Lu; Ching-Hua Hsieh; Chia-Yi Kao; Kuo-Wei Wang; Han-Jung Chen

2008-01-01

367

Hospital Stays for Cervical Cancer, 2004. Statistical Brief No. 22.  

National Technical Information Service (NTIS)

Cervical cancer is preventable and curable if detected early. Timely cervical cancer screening through Papanicolaou (Pap) tests has been recognized as the most effective way to identify the earliest signs of cervical cancer. Although the number of women n...

A. Elixhauser C. A. Russo M. Milenkovic

2007-01-01

368

Cervical Cancer Overlooked in Less-Developed Nations  

MedlinePLUS

... August 13, 2013 Related MedlinePlus Pages Cervical Cancer International Health Women's Health TUESDAY, Aug. 13 (HealthDay News) -- Cervical ... rights reserved. More Health News on: Cervical Cancer International Health Women's Health Recent Health News Page last updated ...

369

Cervical enamel: a danger zone.  

PubMed

The British Standards Institutions's document (1974) recommending toothpaste specifications states that 'There is no evidence that any toothpaste ever produces a level of abrasion causing harm to dental enamel'. This paper questions the assumption that the enamel crown, especially at the cervical margin, is able to cope with modern dietary insult and a 'good' oral hygiene regimen, regardless of the enamel abrasivity of the dentifrice used. Once the enamel crown is breached the underlying dentine is sensitive and vulnerable to physical damage. In this work the potential rates of erosive and abrasive loss are related to the thickness of the protective enamel and to the relevance of fluoride treatments for adults. It is suggested that improvements in dental care and an increased tooth life expectancy now make the loss of tooth tissues at the cervical margin more important than is apparent at first sight. PMID:291708

Davis, W B

1979-10-01

370

Cervical spine curvature during simulated whiplash  

Microsoft Academic Search

Objective. To develop a new method to describe cervical spine curvature and evaluate the potential for injury in the upper and lower cervical spine during simulated whiplash.Design. A method was developed to integrate the upper and lower cervical spine rotations and describe the spine curvature.Background. In vivo and in vitro whiplash simulations have documented the development of an S-shape curvature

Manohar M. Panjabi; Adam M. Pearson; Shigeki Ito; Paul C. Ivancic; Jaw-Lin Wang

2004-01-01

371

Cervical Squamous Cell Carcinoma and Adenocarcinoma  

Cancer.gov

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

372

Imaging of endometrial and cervical cancer  

Microsoft Academic Search

In this article we review the ever increasing role of imaging in endometrial and cervical cancer. Magnetic resonance imaging\\u000a (MRI) has emerged as the most widely used technique in the management of women with gynaecological cancer. In endometrial\\u000a cancer, MRI is reliable in identifying myometrial and cervical invasion and extra-uterine disease, thereby informing preoperative\\u000a surgical planning. In cervical cancer, MRI

Shilpa Patel; Sidath H. Liyanage; Anju Sahdev; Andrea G. Rockall; Rodney H. Reznek

2010-01-01

373

Molecular Genetics of Cervical Cancer  

Microsoft Academic Search

The carcinoma of the uterine cervix is the second most common cancer among women worldwide, with its higher incidence in developing\\u000a countries (1). Strong clinical and experimental evidence demonstrated that the high-risk (HR) types of human papilloma virus (HPV) play\\u000a a central role in causing cervical cancer, although a role of multiple risk factors has been suggested too. Not only

Valeria Masciullo; Antonio Giordano

374

Human T-lymphotropic virus type 1-associated myelopathy/tropical spastic paraparesis: Viral load and muscle tone are correlated  

PubMed Central

Human T-lymphotropic virus type 1 (HTLV-1) infections are associated with varying degrees of HTLV-1 viral load and spasticity. Increased viral load is associated with higher risk of developing HTLV-1–associated myelopathy/tropical spastic paraparesis (HAM/TSP). The authors performed a cross-sectional study of 24 people with HAM/TSP in Lima, Perú, to determine if higher HTLV-1 viral load was correlated with increased muscle tone, measured with a device providing quantitative spasticity assessment (QSA). Median HTLV-1 viral load was 17.0 copies/100 peripheral blood mononuclear cells and QSA value was 39.9 Newton-meters/radian. HTLV-1 viral load was significantly correlated with QSA value (Spearman rho = .48, P = .02), suggesting viral load may play a role in expression of symptomatic neurologic disease. Longitudinal studies are needed to determine if treatments that reduce viral load will reduce muscle tone.

Zunt, JR; Montano, SM; Beck, I; Alarcon, JOV; Frenkel, LM; Bautista, CT; Price, R; Longstreth, WT

2009-01-01

375

Cervical epidural steroid injections in the management of cervical radiculitis: interlaminar versus transforaminal. A review  

Microsoft Academic Search

There has been recent concern regarding the safety of cervical epidural steroid injections. The decision to proceed with treatment\\u000a requires balancing the risk and benefits. This article is an in depth review of the efficacy, complications, and technique\\u000a of both interlaminar and transforaminal cervical epidural steroid injections in the management of cervical radiculitis.

Christopher W. Huston

2009-01-01

376

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

Microsoft Academic Search

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

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

1995-01-01

377

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

Microsoft Academic Search

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

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

2008-01-01

378

Multimodality evaluation of cervical tumors  

NASA Astrophysics Data System (ADS)

Clinical signs of radiotherapy failure are often not present until well after treatment has been completed. Methods which could predict the response of tumors either before or early into the radiotherapy schedule would have important implications for patient management. Recent studies performed at our institution suggest that MR perfusion imaging maya be useful in distinguishing between individuals who are likely to benefit from radiation therapy and those who are not. Because MR perfusion imaging reflects tissue vascularity as well as perfusion, quantitative positron emission tomographic (PET) blood flow studies were performed to obtain an independent assessment of tumor perfusion. MR perfusion and PET quantitative blood flow studies were acquired on four women diagnosed with advanced cervical cancer. The MR perfusion studies were acquired on a 1 cm sagittal slice through the epicenter of the tumor mass. Quantitative PET blood flow studies were performed using an autoradiographic technique. The PET and MRI were registered using a manual interactive routine and the mean blood flow in the tumor was compared to the relative signal intensity in a corresponding region on the MR image. The mean blood flow in the cervical tumors ranged form 30-48 ml/min/100 grams. The observed blood flow values are consistent with the assumed relationship between MR contrast enhancement and the distribution of tissue perfusion. The information offered by these studies provides an additional window into the evaluation of the response of cervical tumors to radiation therapy.

Madsen, Mark T.; Mayr, Nina A.; Yuh, William T.; Ehrhardt, James C.; Magnotta, Vincent A.; Ponto, Laura L.; Vannier, Michael W.; Hichwa, Richard D.

1997-05-01

379

Cervical aortic arch with aneurysm formation.  

PubMed

Cervical aortic arch is a very rare anomaly presented as a pulsatile mass on the neck and usually with symptoms of dysphagia, cough and hoarseness. Rarer than the cervical aortic arch, is the aneurysm formation and, despite the equal sex distribution of cervical aortic arch, aneurysm formation always occurs in young females with only nine cases reported. We report herein a 24-year-old woman, diagnosed as cervical aortic arch with aneurysm formation due to basophilic degeneration, treated successfully with surgical intervention. To our knowledge no similar case has been reported. PMID:9845153

Farsak, B; Yilmaz, M; Kaplan, S; Böke, E

1998-10-01

380

Degenerative cervical spondylolisthesis: a systematic review  

Microsoft Academic Search

Purpose  Degenerative cervical spondylolisthesis has received insufficient attention, in contrast to degenerative lumbar spondylolisthesis.\\u000a In fact, degenerative cervical spondylolisthesis may be more common than previously thought.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  In order to provide appropriate guidelines for the treatment of degenerative cervical spondylolisthesis, a systematic review\\u000a of degenerative cervical spondylolisthesis was performed. An English literature search from January 1947 to November 2010\\u000a was completed with

Sheng-Dan Jiang; Lei-Sheng Jiang; Li-Yang Dai

2011-01-01

381

Unusual complication of cervical tuberculous lymphadenopathy.  

PubMed

Lymphadenopathy is the most common form of extrapulmonary tuberculosis; cervical region being the most frequent site. Yet, tuberculous cervical lymphadenopathy is rarely associated with Internal Jugular Vein (IJV) thrombosis. We report right IJV thrombosis with isolated cervical tuberculous lymphadenopathy in a 22-year-old woman. Anti-tuberculous treatment resulted in complete regression of lymphadenopathy but anticoagulation treatment failed to restore the caliber of thrombosed IJV to normal. Thrombosis of adjacent IJV is a potential complication of delay in diagnosis and treatment of cervical lymphnode tuberculosis. PMID:21434555

Gowrinath, K; Nizamiz, Mohammed Ismail; Kumar, B E Phanil; Suneetha, P; Kishor, V H

2011-01-01

382

Factors affecting sagittal malalignment due to cage subsidence in standalone cage assisted anterior cervical fusion  

PubMed Central

Fusion of cervical spine in kyphotic alignment has been proven to produce an acceleration of degenerative changes at adjacent levels. Stand-alone cages are reported to have a relatively high incidence of implant subsidence with secondary kyphotic deformity. This malalignment may theoretically lead to adjacent segment disease in the long term. The prospective study analysed possible risk factors leading to cage subsidence with resulting sagittal malalignment of cervical spine. Radiographic data of 100 consecutive patients with compressive radiculo-/myelopathy due to degenerative disc prolapse or osteophyte formation were prospectively collected in those who were treated by anterior cervical discectomy and implantation of single type interbody fusion cage. One hundred and forty four implants were inserted altogether at one or two levels as stand-alone cervical spacers without any bone graft or graft substitute. All patients underwent standard anterior cervical discectomy and the interbody implants were placed under fluoroscopy guidance. Plain radiographs were obtained on postoperative days one and three to verify position of the implant. Clinical and radiographic follow-up data were obtained at 6 weeks, 3 and 6 months and than annually in outpatient clinic. Radiographs were evaluated with respect to existing subsidence of implants. Subsidence was defined as more than 2 mm reduction in segmental height due to implant migration into the adjacent end-plates. Groups of subsided and non-subsided implants were statistically compared with respect to spacer distance to the anterior rim of vertebral body, spacer versus end-plate surface ratio, amount of bone removed from adjacent vertebral bodies during decompression and pre- versus immediate postoperative intervertebral space height ratio. There were 18 (18%) patients with 19 (13.2%) subsided cages in total. No patients experienced any symptoms. At 2 years, there was no radiographic evidence of accelerated adjacent segment degeneration. All cases of subsidence occurred at the anterior portion of the implant: 17 cases into the inferior vertebra, 1 into the superior and 1 into both vertebral bodies. In most cases, the process of implant settling started during the perioperative period and its progression did not exceed three postoperative months. There was an 8.7° average loss of segmental lordosis (measured by Cobb angle). Average distance of subsided intervertebral implants from anterior vertebral rim was found to be 2.59 mm, while that of non-subsided was only 0.82 mm (P < 0.001). Spacer versus end-plate surface ratio was significantly smaller in subsided implants (P < 0.001). Ratio of pre- and immediate postoperative height of the intervertebral space did not show significant difference between the two groups (i.e. subsided cages were not in overdistracted segments). Similarly, comparison of pre- and postoperative amount of bone mass in both adjacent vertebral bodies did not show a significant difference. Appropriate implant selection and placement appear to be the key factors influencing cage subsidence and secondary kyphotisation of box-shaped, stand-alone cages in anterior cervical discectomy and fusion. Mechanical support of the implant by cortical bone of the anterior osteophyte and maximal cage to end-plate surface ratio seem to be crucial in the prevention of postoperative loss of lordosis. Our results were not able to reflect the importance of end-plate integrity maintenance; the authors would, however, caution against mechanical end-plate damage. Intraoperative overdistraction was not shown to be a significant risk factor in this study. The significance of implant subsidence in acceleration of degenerative changes in adjacent segments remains to be evaluated during a longer follow-up.

Suchomel, Petr

2007-01-01

383

Factors affecting sagittal malalignment due to cage subsidence in standalone cage assisted anterior cervical fusion.  

PubMed

Fusion of cervical spine in kyphotic alignment has been proven to produce an acceleration of degenerative changes at adjacent levels. Stand-alone cages are reported to have a relatively high incidence of implant subsidence with secondary kyphotic deformity. This malalignment may theoretically lead to adjacent segment disease in the long term. The prospective study analysed possible risk factors leading to cage subsidence with resulting sagittal malalignment of cervical spine. Radiographic data of 100 consecutive patients with compressive radiculo-/myelopathy due to degenerative disc prolapse or osteophyte formation were prospectively collected in those who were treated by anterior cervical discectomy and implantation of single type interbody fusion cage. One hundred and forty four implants were inserted altogether at one or two levels as stand-alone cervical spacers without any bone graft or graft substitute. All patients underwent standard anterior cervical discectomy and the interbody implants were placed under fluoroscopy guidance. Plain radiographs were obtained on postoperative days one and three to verify position of the implant. Clinical and radiographic follow-up data were obtained at 6 weeks, 3 and 6 months and than annually in outpatient clinic. Radiographs were evaluated with respect to existing subsidence of implants. Subsidence was defined as more than 2 mm reduction in segmental height due to implant migration into the adjacent end-plates. Groups of subsided and non-subsided implants were statistically compared with respect to spacer distance to the anterior rim of vertebral body, spacer versus end-plate surface ratio, amount of bone removed from adjacent vertebral bodies during decompression and pre- versus immediate postoperative intervertebral space height ratio. There were 18 (18%) patients with 19 (13.2%) subsided cages in total. No patients experienced any symptoms. At 2 years, there was no radiographic evidence of accelerated adjacent segment degeneration. All cases of subsidence occurred at the anterior portion of the implant: 17 cases into the inferior vertebra, 1 into the superior and 1 into both vertebral bodies. In most cases, the process of implant settling started during the perioperative period and its progression did not exceed three postoperative months. There was an 8.7 degrees average loss of segmental lordosis (measured by Cobb angle). Average distance of subsided intervertebral implants from anterior vertebral rim was found to be 2.59 mm, while that of non-subsided was only 0.82 mm (P < 0.001). Spacer versus end-plate surface ratio was significantly smaller in subsided implants (P < 0.001). Ratio of pre- and immediate postoperative height of the intervertebral space did not show significant difference between the two groups (i.e. subsided cages were not in overdistracted segments). Similarly, comparison of pre- and postoperative amount of bone mass in both adjacent vertebral bodies did not show a significant difference. Appropriate implant selection and placement appear to be the key factors influencing cage subsidence and secondary kyphotisation of box-shaped, stand-alone cages in anterior cervical discectomy and fusion. Mechanical support of the implant by cortical bone of the anterior osteophyte and maximal cage to end-plate surface ratio seem to be crucial in the prevention of postoperative loss of lordosis. Our results were not able to reflect the importance of end-plate integrity maintenance; the authors would, however, caution against mechanical end-plate damage. Intraoperative overdistraction was not shown to be a significant risk factor in this study. The significance of implant subsidence in acceleration of degenerative changes in adjacent segments remains to be evaluated during a longer follow-up. PMID:17221174

Barsa, Pavel; Suchomel, Petr

2007-01-13

384

Congestive myelopathy (Foix-Alajouanine Syndrome) due to intradural arteriovenous fistula of the filum terminale fed by anterior spinal artery: Case report and review of literature  

PubMed Central

Spinal arteriovenous fistulas are rare entities. They often present with congestive myelopathy but are infrequently diagnosed as the cause of the patients’ symptoms. Only one such case has been described previously in Indian literature. We describe one such case who presented to us after a gap of 3 years since symptom onset and following a failed laminectomy where the cause was later diagnosed to be an intradural fistula in the filum terminale fed by the anterior spinal artery and review the available literature.

Krishnan, Prasad; Banerjee, Tapas Kumar; Saha, Manash

2013-01-01

385

Clustering of HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) and infective dermatitis associated with HTLV-1 (IDH) in Salvador, Bahia, Brazil.  

PubMed

Fifteen families with clustering of infective dermatitis associated with HTLV-1 (IDH) and/or HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) were observed among 28 families of IDH index cases, 93% of them occurring in two generations. With the exception of two mothers of children with IDH, all the mothers with HAM/TSP had at least one child with HAM/TSP. This is the first report of such clustering involving many families. PMID:23932323

Silva, José Lucas Sena da; Primo, Janeusa Rita L; de Oliveira, Maria de Fátima S P; Batista, Everton da Silva; Moreno-Carvalho, Otávio; Farré, Lourdes; Bittencourt, Achiléa L

2013-08-06

386

Traumatic cervical syringomyelia related to birth injury  

Microsoft Academic Search

A rare case of cervical syringomyelia related to breech delivery is reported. The initial diagnosis was bilateral brachial plexus palsy due to birth injury, which was revealed by magnetic resonance imaging (MRI) to be traumatic syringomyelia. The usefulness of MRI in the early diagnosis of cervical cord birth injury, especially in differentiating between brachial plexus palsy due to birth injury

Nobuhito Morota; Keizo Sakamoto; Norio Kobayashi

1992-01-01

387

How will HPV vaccines affect cervical cancer?  

Microsoft Academic Search

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

Richard Roden; T.-C. Wu

2006-01-01

388

Vaccination to prevent and treat cervical cancer  

Microsoft Academic Search

Human papillomaviruses (HPVs) are the primary etiologic agents of cervical cancer. Thus, cervical cancer and other HPV-associated malignancies might be prevented or treated by HPV vaccines. Transmission of papillomavirus may be prevented by the generation of antibodies to capsid proteins L1 and L2 that neutralize viral infection. However, because the capsid proteins are not expressed at detectable levels by infected

Richard B. S Roden; Morris Ling; T.-C Wu

2004-01-01

389

Convergence of cervical and trigeminal sensory afferents.  

PubMed

Cranial nociceptive perception shows a distinct topographic distribution, with the trigeminal nerve receiving sensory information from the anterior portions of the head, the greater occipital nerve, and branches of the upper cervical roots in the posterior regions. However, this distribution is not respected during headache attacks, even if the etiology of the headache is specific for only one nerve. Nociceptive information from the trigeminal and cervical territories activates the neurons in the trigeminal nucleus caudalis that extend to the C2 spinal segment and lateral cervical nucleus in the dorsolateral cervical area. These neurons are classified as multimodal because they receive sensory information from more than one afferent type. Clinically, trigeminal activation produces symptoms in the trigeminal and cervical territory and cervical activation produces symptoms in the cervical and trigeminal territory. The overlap between the trigeminal nerve and cervical is known as a convergence mechanism. For some time, convergence mechanisms were thought to be secondary to clinical observations. However, animal studies and clinical evidence have expanded our knowledge of convergence mechanisms. In this paper, the role of convergence mechanisms in nociceptive physiology, physiopathology of the headaches, clinical diagnosis, and therapeutic conduct are reviewed. PMID:12946291

Piovesan, Elcio J; Kowacs, Pedro A; Oshinsky, Michael L

2003-10-01

390

Human papillomavirus testing in primary cervical screening  

Microsoft Academic Search

Several studies have examined the role of tests for human papillomavirus (HPV) in screening for cervical cancer but as yet the relevance is unclear. We looked at HPV testing for types 16, 18, 31, and 33 on material taken at the time of a cervical smear in 2009 eligible women having routine screening. Women with any degree of dyskaryosis or

J. Cuzick; A. Szarewski; G. Terry; A. Hanby; P. Maddox; M. Anderson; S. J. Steele; J. Guillebaud; C. Kocjean

1995-01-01

391

Cervical arterial dysfunction assessment and manual therapy  

Microsoft Academic Search

In this paper, we present a clinical overview of cervical arterial dysfunction (CAD) for manual therapists who treat patients presenting with cervical pain and headache syndromes. An overview of vertebrobasilar arterial insufficiency (VBI) is given, with reference to assessment procedures recommended by commonly used guidelines. We suggest that the evidence supporting contemporary practice is limited and present a more holistic,

Roger Kerry; Alan J. Taylor

2006-01-01

392

Biomechanics of Upper Cervical Spine Injuries.  

National Technical Information Service (NTIS)

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

M. Panjabi

1993-01-01

393

Cervical Cancer: Screening and Therapeutic Perspectives  

Microsoft Academic Search

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

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

2008-01-01

394

Risk of cervical cancer after HPV vaccination.  

PubMed

It will likely be more than 20 years before there is unequivocal evidence available that HPV vaccination decreases the incidence of invasive cervical cancer. However, existing data strongly suggests that as many as 440,000 cervical cancer cases and 220,000 deaths due to this malignancy will be prevented with the establishment of an effective worldwide HPV immunization program. PMID:23016781

Markman, Maurie

2013-01-01

395

New insights into cervical cancer screening  

PubMed Central

Worldwide, cervical cancer is a leading cause of cancer related morbidity and mortality. For over 50 years, cervical cytology has been the gold standard for cervical cancer screening. Because of its profound effect on cervical cancer mortality in nations that have adopted screening programs, the Pap smear is widely accepted as the model screening test. Since its introduction, many studies have analyzed the Pap smear and found that it is not without its shortcomings including low sensitivity for detection of cervical intraepithelial neoplasia 2/3. Additionally, the discovery of infection with the human papillomavirus (HPV) as a necessary step in the development of cervical cancer has led to the development of HPV testing as an adjunct to cytology screening. More recently, researchers have compared HPV testing and cytology in the primary screening of cervical cancer. In this review, we will discuss cytologic testing limitations, the role of HPV DNA testing as an alternative screening tool, the impact of the HPV vaccine on screening, and future directions in cervical cancer screening.

Boone, Jonathan D.; Erickson, Britt K.

2012-01-01

396

Coral grafts used in cervical interbody fusions  

Microsoft Academic Search

Along this study, we evaluate an osseous substitute, natural Coral used in the lower cer-vical spine interbody fusions. We reviewed, in a retrospective study, 66 cases of lower cervical discopathies treated by radiculo-medullar decompression, coral arthrodesis and anterior osteosynthesis.

K. Ghiamphy; F. Gosset; P. Kehr

1999-01-01

397

Cervical radiculopathy: current diagnostic and treatment options.  

PubMed

Cervical nerve root compression, in contrast to nerve root irritation, results in an objective neurologic deficit of the affected nerve root. The purpose of this article is to highlight current diagnostic and treatment options that have proven efficient and safe in managing cervical root compression. The natural history of cervical disc disease and the clinical patterns and causes of cervical radiculopathy are reviewed. Electromyography and reformatted mutiplanar CT scans in addition to MRI are valuable diagnostic modalities. Although anterior cervical discectomy and interbody fusion remains the gold standard of treatment, microendoscopic foraminotomies and discectomies done from posterior and anterior approaches are effective and safe. The role of disc arthroplasty in the treatment of radiculopathy is evolving. PMID:19327260

Nasca, Richard J

2009-01-01

398

Delayed post-traumatic spinal cord infarction in an adult after minor head and neck trauma: a case report  

PubMed Central

Introduction Delayed post-traumatic spinal cord infarction is a devastating complication described in children. In adults, spinal cord ischemia after cardiovascular interventions, scoliosis correction, or profound hypotension has been reported in the literature. However, delayed spinal cord infarction after minor head trauma has not been described yet. Case presentation We report the case of a 45-year-old Hispanic man who had a minor head trauma. He was admitted to our hospital because of paresthesias in his hands and neck pain. A radiological workup showed cervical spinal canal stenosis and chronic cervical spondylotic myelopathy. Twelve hours after admission, our patient became unresponsive and, despite full resuscitation efforts, died. The autopsy revealed spinal cord necrosis involving the entire cervical spinal cord and upper thoracic region. Conclusions This case illustrates the extreme fragility of spinal cord hemodynamics in patients with chronic cervical spinal canal stenosis, in which any further perturbations, such as cervical hyperflexion related to a minor head injury, can have catastrophic consequences. Furthermore, the delayed onset of spinal cord infarction in this case shows that meticulous maintenance of blood pressure in the acute post-traumatic period is of paramount importance, even in patients with minimal post-traumatic symptoms.

2012-01-01

399

[The incidence of cervical dystocia and disorders of cervical involution in the post partum cow].  

PubMed

The aim of this study was to obtain information on the frequency of cervical dystocia and involution disorders of the canalis cervicalis after difficult dystocia and to characterise factors possibly influencing these pathological conditions. Therefore 317 difficult births in the cow (extraction: 123; foetotomy: 82; caesarean section: 112) and the involution of the cervical canal were documented during the first ten days post partum. In total a cervical dystocia could be diagnosed 53 times (16.7% related to the total number of births). This kind of birth disorder is regularly followed by a caesarean section (p < 0.001). Animals who show a narrowness in the cervix were older than the cows without cervical dystocia (p < 0.05). The same correlation could be detected for the number of births. Animals with delivery problems associated with the cervix had already given birth to more calves than cows who were not affected by cervical disorders (p < 0.01). 58 cows developed a disorder of the cervical involution (18.3% related to the total number of deliveries). This puerperal disorder can be frequently observed after foetotomy (p < 0.001). A correlation between the incidence of disorders of cervical involution and the age or the parity of the animals could not be detected. In the same way, cows with a diagnosis of a cervical dystocia did not develop more frequently disorders of cervical involution than animals who showed a physiological dilation of the cervical canal intra partum. PMID:14746054

Wehrend, A; Bostedt, H

2003-12-01

400

Multiple HPV infection in cervical cancer screened by HPVDNAChip™  

Microsoft Academic Search

This study determined the distribution of high-risk HPV type infection in cervical cancer using newly developed oligonucleotide chips (HPVDNAChips™). The study subjects included 80 cases of cervical neoplasia and 746 controls with a normal Pap smear. For HPV genotyping, the commercially available HPVDNAChips™ was used. The risk of cervical cancer was increased in women with a family history of cervical

Sang Ah Lee; Daehee Kang; Sang Soo Seo; Jeongmi Kim Jeong; Keun Young Yoo; Yong Tark Jeon; Jae Weon Kim; Noh Hyun Park; Soon Beom Kang; Hyo Pyo Lee; Yong Sang Song

2003-01-01

401

Cervical characteristics of Noonan syndrome.  

PubMed

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

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

2013-05-01

402

Cervical cytology biobanking in Europe.  

PubMed

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

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

403

DNA vaccines for cervical cancer  

PubMed Central

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

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

2010-01-01

404

Functional cervical myelography with iohexol.  

PubMed

Thirty patients underwent functional cervical myelography, i.e. radiographs in the lateral view were obtained in extension as well as in flexion of the neck. Sagittal tomography was performed in both positions. Widening of the subarachnoid space and decreased sagittal diameter of the spinal cord due to shortening were demonstrated in the lateral view in flexion. In some cases with advanced narrowing or spinal block in extension, such widening in flexion resulted in better diagnostic images by providing passage of the contrast medium caudally. Although iohexol (Omnipaque, Nyegaard & Co., Oslo) was regularly forced into the posterior cranial fossa by the movements, the frequency of side effects was approximately the same as in our former trials with iohexol in conventional cervical myelography. EEG changes occurred in two patients (7%). A sitting position for 3-4 min after the examination followed by an elevated head end of the bed was probably important for preventing side effects from the contrast medium. Specific questioning revealed twice as many subjective side effects as reported after general questions alone. PMID:4010921

Nakstad, P; Aaserud, O; Ganes, T; Nyberg-Hansen, R

1985-01-01

405

HLA and susceptibility to cervical neoplasia.  

PubMed

The association between cervical neoplasia and certain HLA phenotypes observed in different studies has not been consistent. By serological typing, the association between HLA antigens, cervical carcinoma and cervical intraepithelial neoplasia (CIN) was studied in a group of 172 and 116 patients, respectively. We demonstrated an increased frequency of B63 in patients with HPV types other than HPV 16 or 18, and B55 in patients that were negative for all HPV types. The association between cervical carcinoma and DQ3, described in various populations, was not observed in the present study. However, we confirmed other previously observed associations between cervical cancer and class II antigens, i.e., a positive correlation with DR15 irrespective of the HPV status, with DR3 in patients harboring HPV types other than HPV 16 or 18, and with DR11 among HPV 16 positive patients. In contrast, a negative correlation between DR13 and HPV positive cervical cancer was observed which suggests protection of this antigen against HPV-associated cervical cancer. A slight increase of DR15 and DQ4 antigens was observed in CIN patients, suggesting that these specific HLA antigens may be important in determining the risk of CIN. PMID:10363725

Krul, E J; Schipper, R F; Schreuder, G M; Fleuren, G J; Kenter, G G; Melief, C J

1999-04-01

406

Minimally invasive approaches to the cervical spine.  

PubMed

Minimally invasive approaches and operative techniques are becoming increasingly popular for the treatment of cervical spine disorders. Minimally invasive spine surgery attempts to decrease iatrogenic muscle injury, decrease pain, and speed postoperative recovery with the use of smaller incisions and specialized instruments. This article explains in detail minimally invasive approaches to the posterior spine, the techniques for posterior cervical foraminotomy and arthrodesis via lateral mass screw placement, and anterior cervical foraminotomy. Complications are also discussed. Additionally, illustrated cases are presented detailing the use of minimally invasive surgical techniques. PMID:22082636

Celestre, Paul C; Pazmiño, Pablo R; Mikhael, Mark M; Wolf, Christopher F; Feldman, Lacey A; Lauryssen, Carl; Wang, Jeffrey C

2011-10-13

407

Modified transcorporeal anterior cervical microforaminotomy for cervical radiculopathy: a technical note and early results  

Microsoft Academic Search

A prospective analysis of the first twenty patients operated for cervical radiculopathy by a new modification of transcorporeal\\u000a anterior cervical foraminotomy technique. To evaluate early results of a functional disc surgery in which decompression for\\u000a the cervical radiculopathy is done by drilling a hole in the upper vertebral body and most of the disc tissue is preserved.\\u000a Earlier approaches to

Gun Choi; Sang-Ho Lee; Arun Bhanot; Yu Sik Chae; Byungjoo Jung; Seungcheol Lee

2007-01-01

408

Cervical Radiculopathy due to Cervical Degenerative Diseases : Anatomy, Diagnosis and Treatment  

PubMed Central

A cervical radiculopathy is the most common symptom of cervical degenerative disease and its natural course is generally favorable. With a precise diagnosis using appropriate tools, the majority of patients will respond well to conservative treatment. Cervical radiculopathy with persistent radicular pain after conservative treatment and progressive or profound motor weakness may require surgery. Options for surgical management are extensive. Each technique has strengths and weaknesses, so the choice will depend on the patient's clinical profile and the surgeon's judgment.

Kim, Kyoung-Tae

2010-01-01

409

Cervicitis  

MedlinePLUS

... not-for-profit organization and proceeds from Web advertising help support our mission. Mayo Clinic does not ... of the non-Mayo products and services advertised. Advertising and sponsorship policy Advertising and sponsorship opportunities About ...

410

Zidovudine plus lamivudine in Human T-Lymphotropic Virus type-I-associated myelopathy: a randomised trial  

PubMed Central

Background No therapies have been proven to persistently improve the outcome of HTLV-I-associated myelopathy. Clinical benefit has been reported with zidovudine and with lamivudine in observational studies. We therefore conducted a randomised, double blind, placebo controlled study of six months combination therapy with these nucleoside analogues in sixteen patients. Results Primary outcomes were change in HTLV-I proviral load in PBMCs and clinical measures. Secondary endpoints were changes in T-cell subsets and markers of activation and proliferation. Six patients discontinued zidovudine. No significant changes in pain, bladder function, disability score, gait, proviral load or markers of T-cell activation or proliferation were seen between the two arms. Active therapy was associated with an unexplained decrease in CD8 and non-T lymphocyte counts. Conclusion Failure to detect clinical improvement may have been due irreversible nerve damage in these patients with a long clinical history and future studies should target patients presenting earlier. The lack of virological effect but may reflect a lack of activity of these nucleoside analogues against HTLV-I RT in vivo, inadequate intracellular concentrations of the active moiety or the contribution of new cell infection to maintaining proviral load at this stage of infection may be relatively small masking the effects of RT inhibition.

Taylor, Graham P; Goon, Peter; Furukawa, Yoshitaka; Green, Hannah; Barfield, Anna; Mosley, Angelina; Nose, Hirohisa; Babiker, Abdel; Rudge, Peter; Usuku, Koichiro; Osame, Mitsuhiro; Bangham, Charles RM; Weber, Jonathan N

2006-01-01

411

Genome-wide association analysis reveals a SOD1 mutation in canine degenerative myelopathy that resembles amyotrophic lateral sclerosis  

PubMed Central

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.

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.

2009-01-01

412

Genome-wide association analysis reveals a SOD1 mutation in canine degenerative myelopathy that resembles amyotrophic lateral sclerosis.  

PubMed

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

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

2009-02-02

413

HTLV-I-associated myelopathy/tropical spastic paraparesis in Brazil: a nationwide survey. HAM/TSP Brazilian Study Group.  

PubMed

To study the epidemiology of HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in Brazil, we conducted a nationwide survey between March 1994 and April 1995. Five centers from three regions of the country participated, enrolling 163 patients. Most patients came from the northeastern and southeastern regions (93.2%). Most enrollees were white women, 42.9% and 64.4%, respectively. The most common risk factors for infection included a history of venereal diseases (30.6%) and blood transfusion (21.6%). The median age at the beginning of the disease was 42 years. The main neurologic findings were spastic paraparesis, widespread brisk tendon jerks, bilateral Babinski's sign, and bladder dysfunction. Some interregional differences reached statistical significance. The ratio of females over males increased from south to north. In addition, in both southern and southeastern regions, whites prevailed, whereas in the northeast, mulattos predominated. This follows the normal distribution of the population in these regions. A significantly higher rate of venereal diseases was found in the southeast compared with the other regions studied. A history of intravenous drug use was more frequent among patients as the sample moves south. Finally, a fluctuating course of the disease was proportionally more frequent in the southern region. PMID:9859969

Araújo, A Q; Andrade-Filho, A S; Castro-Costa, C M; Menna-Barreto, M; Almeida, S M

1998-12-15

414

Congenital narrowing of the cervical spinal canal.  

PubMed Central

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

Kessler, J T

1975-01-01

415

Cervical Exercise: The Backbone of Spine Treatment  

MedlinePLUS

North American Spine Society Public Education Series Cervical Exercise: The Backbone of Spine Treatment How important is ... physician before starting any exercises. The Importance of Exercise for the Neck Spine experts agree that physical ...

416

Cervical Cancer Incidence and Mortality Rates  

Cancer.gov

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

417

Sonographic demonstration of cervical esophageal web.  

PubMed

We report a case of esophageal web demonstrated with sonography in a 45-year-old woman with dysphagia. The esophageal web was incidentally detected as a circumferential hypoechoic membrane on sonograms of the cervical esophagus. PMID:16547989

Rokade, Muktachand Laxman

418

New Chemotherapy Drug for Advanced Cervical Cancer  

Cancer.gov

In this clinical trial, women with cervical cancer that has recurred or demonstrated resistance to previous chemotherapy and that cannot be treated surgically will be treated with the drug ixabepilone.

419

Internet-Based Cervical Cancer Screening Program.  

National Technical Information Service (NTIS)

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

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

2008-01-01

420

Cervical Cancer Prevention and Screening: Financial Issues  

MedlinePLUS

... ensure coverage of cervical cancer screening for private health insurance Twenty-six states and the District of Columbia ... large employers. Women who have self-insured based health insurance should check with their health plans to see ...

421

Cervical cancer in India and HPV vaccination  

PubMed Central

Cervical cancer, mainly caused by Human Papillomavirus infection, is the leading cancer in Indian women and the second most common cancer in women worldwide. Though there are several methods of prevention of cervical cancer, prevention by vaccination is emerging as the most effective option, with the availability of two vaccines. Several studies have been published examining the vaccine's efficacy, immunogenicity and safety. Questions and controversy remain regarding mandatory vaccination, need for booster doses and cost-effectiveness, particularly in the Indian context.

Kaarthigeyan, K.

2012-01-01

422

Recruitment Strategies for Cervical Cancer Prevention Study  

Microsoft Academic Search

Objective. The aim of this study was to describe recruitment strategies for a single-visit cervical cancer prevention study.Methods. From January through December 1999, low-income, predominantly Latino women were recruited to participate in a single-visit cervical cancer prevention study. For the first 6 months, all women who had ever visited one of two community-based study clinics were invited to participate (clinic

W. R. Brewster; H. Anton-Culver; A. Ziogas; J. Largent; S. Howe; F. A. Hubbell; A. Manetta

2002-01-01

423

Ethical Dilemmas of Cervical Cancer Screening  

PubMed Central

Cervical screening presents several ethical dilemmas to family physicians. The author reviews the risks associated with screening, costs versus benefits of running a screening program, and the issues surrounding patient autonomy and patient coercion. Is saving one life worthwhile, and at what cost? Cervical screening programs are imperative in family practice, but only if harm to the patient is minimized and ethical objections are addressed.

Snadden, David

1992-01-01

424

[Direct cervical myelography using iotrolan 300].  

PubMed

A prospective study of direct cervical myelography with Iotrolan 300 showed the following advantages: 1. Clear differentiation of the nerve roots. 2. Increased retention of contrast in the cervical region. 3. Improved contrast compared with conventional contrast media. 4. Optimal contrast temperature was found to be between 20 and 22 degrees C. 5. Reduction in non-specific and central nervous system complications. PMID:1847546

Volle, E; Hedde, J P; Gormanns, R

1991-02-01

425

Cervical meningocele in association with spinal abnormalities  

Microsoft Academic Search

Case report This case report presents a newborn baby girl, who was diagnosed at birth with a mid-cervical meningocele. Further radiographic workup by MRI revealed co-existing thoracic diplomyelia and bilateral tethered cords. At birth the patient was found to be neurologically intact. Surgery was performed at 4 months of age, the patient undergoing simultaneous repair of the cervical meningocele, exploration of

Carlos H. Feltes; Kostas N. Fountas; Vassilios G. Dimopoulos; Ana I. Escurra; Angel Boev; Effie Z. Kapsalaki; JoeSam Robinson; E. Christopher Troup

2004-01-01

426

Tonsillar remnants and painful cervical lymphadenopathy  

Microsoft Academic Search

Cervical lymphadenitis is a common accompaniment of acute recurrent and chronic tonsillitis, which usually settles following medical treatment and\\/or tonsillectomy.Occasionally, painful cervical lymphadenitis affecting the jugulodigastric node persists despite apparently adequate treatment.We present a case series of seven patients where earache and\\/or painful jugulodigastric lymphadenitis were the predominant persistent symptoms in young adults (mean age of 34.5). A CT scan

Kamarjit S Mangat; Sunil N Dutt; Swarup V Chavda; Ahmes L Pahor

2003-01-01

427

Cervical myositis ossificans traumatica: a rare location  

Microsoft Academic Search

.   An unusual case of myositis ossificans traumatica lesion located in the paraspinal region is reported. Despite the contiguity\\u000a of the lesion with the cervical vertebrae and ominous appearance of the biopsy material, the history of antecedent trauma\\u000a and computed tomography findings allowed preoperative accurate diagnosis. To our knowledge, myositis ossificans traumatica\\u000a located in the cervical paraspinal region is very

T. Baysal; O. Baysal; K. Sarac; N. Elmali; R. Kutlu; Y. Ersoy

1999-01-01

428

Unilateral Pallidal Stimulation in Cervical Dystonia  

Microsoft Academic Search

Cervical dystonia (spasmodic torticollis) is a focal dystonia of the cervical region. Various treatment modalities have been performed with variable success rates. We present a 42-year-old woman complaining of involuntary head rotation for the last 3 years. Different medical treatments had been used for 3 years. Botulinum toxin injections resulted in temporary and moderate improvement for periods of 3–4 months.

Mehmet Zileli; Berna Zileli

1999-01-01

429

Cervical spinal cord injury in sapho syndrome.  

PubMed

Cervical spinal fracture and pseudarthrosis are previously described causes of spinal cord injury (SCI) in patients with spondylarthropathy. SAPHO (Synovitis Acne Pustulosis Hyperostosis Osteitis) syndrome is a recently recognized rheumatic condition characterized by hyperostosis and arthro-osteitis of the upper anterior chest wall, spinal involvement similar to spondylarthropathies and skin manifestations including palmoplantar pustulosis and pustular psoriasis. We report the first case of SAPHO syndrome disclosed by SCI related to cervical spine ankylosis. PMID:10338354

Deltombe, T; Nisolle, J F; Boutsen, Y; Gustin, T; Gilliard, C; Hanson, P

1999-04-01

430

Multifactorial Etiology of Cervical Cancer: A Hypothesis  

PubMed Central

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

Haverkos, Harry W.

2005-01-01

431

Conservative Treatment in Early Cervical Cancer  

PubMed Central

Purpose of review: The aim of this study was to describe fertility preservation methods to improve quality of life of early stages of cervical cancer. Recent finding: Although definite treatment of early stages of cervical cancer including stages IA,IB1 and IIA non-bulky is radial hysterectomy, this method is used in perimenopousal period in which fertility preservation is not important. Whenever fertility preservation is so important, some methods like radical trachelectomy and laparoscopic lymphadenectomy are used to rule out lymphatic metastases. Summary: If any visible lesion on cervix is found, pelvic MRI is helpful and during operation, trachelectomy samples are sent for frozen section and margin study. Radical trachelectomy is done vaginal or abdominal. Overall relapse rate of cervical cancer in radical trachelectomy and radical hysterectomy is the same. Complications of radical trachelectomy include chronic vaginal discharge, abnormal uterine bleeding, dysmenorrhea, inflammation and ulcer due to cercelage, amenorrhea, cervical stenosis and pregnancy complications following trachelectomy including 2nd trimester abortion and premature labor following cervical prematurity.The best and preferred method of labor is cesarean section. Neoadjuant chemotherapy followed by radical trachelectomy in large cervical lesions is a suitable treatment. Ultraconservative operations like large cold knife conization, simple trachelectomy with laparoscopic lymphadenectomy and sentinel lymph node mapping are suitable for very small lesions.

Karimi-Zarchi, Mojgan; Mousavi, Azamsadat; Gilani, Mitra Modares; Barooti, Esmat; Miratashi-Yazdi, Ashrafosadat; Dehghani, Atefe

2013-01-01

432

Down syndrome. Cervical spine abnormalities and problems.  

PubMed

A review of the radiographs of 34 individuals with Down syndrome (DS), between 5 and 21 years of age, demonstrated subluxation of atlantoaxial instability (C1-C2) greater than 5 mm in three of the 34 individuals (9 percent). This is in general agreement with previously reported ranges of 10 to 20 percent. A review of the cervical spine radiographs of adults with DS, between 26 and 42 years of age, showed no subluxation but significant degenerative changes of the cervical spine with spur formation, narrowing of foramina, narrowing of the disc inner space, and osteophyte formation. In both the DS child and the DS adult, the cervical spine may be an area of significant potential problems. In all cases any complaints of cervical pain or historical/clinical findings suggestive of neurologic involvement should initiate evaluation of the cervical spine. Baseline radiographic studies of the cervical spine are indicated in all DS children older than 5 years of age and should be considered in all DS adults, particularly those 30 years of age and older. PMID:2970908

Van Dyke, D C; Gahagan, C A

1988-09-01

433

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

Microsoft Academic Search

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

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

2005-01-01

434

Is there an interaction between cervical length and cervical microbiology in the pathogenesis of preterm labour?  

PubMed

Transvaginal ultrasound of the cervix is increasingly used to estimate cervical length during pregnancy. Initially used to determine a possible need for cervical suture, the technique has been shown to be of value in the prediction of preterm delivery In addition, bacterial vaginosis has been shown to be associated with an increased risk of preterm delivery. We hypothesised that shortening of the cervix and potential cervical pathogens, in particular the presence of bacterial vaginosis, act synergistically in the pathogenesis of premature labour. Three hundred and sixteen women were recruited for prospective longitudinal follow-up, with both transvaginal ultrasound and cervical bacteriology performed at approximately 18 and 28 weeks gestation. A strong correlation was found between a shortened cervix and preterm delivery (p<0.02 at 18 weeks; p<0.001 at 28 weeks). Women with both a short cervix and cervical pathogens had the highest risk of preterm delivery (43%), although not significantly greater than a short cervix with normal cervical flora (31% preterm delivery). In the presence of a normal cervical length, preterm delivery rates in the presence of normal flora and potential cervical pathogens were much lower (9% and 5% respectively). PMID:11453267

Dowd, J; Permezel, M; Garland, S; de Crespigny, L

2001-05-01

435

Evaluation of Langerhans' Cells in the Cervical Epithelium of Women with Cervical Intraepithelial Neoplasia  

Microsoft Academic Search

Objective. Cervical infection with human papillomavirus (HPV) results in a more permissive environment for malignant transformation. In squamous epithelia the Langerhans' cell (LC) is responsible for antigen presentation. Studies that use S-100 immunostaining demonstrate low LCs in cervical intraepithelial neoplasia (CIN) while those that use other methods have shown normal numbers of LCs. This observation led us to postulate that

Joseph P. Connor; Karen Ferrer; John P. Kane; Jeffrey M. Goldberg

1999-01-01

436

Cervical and mediastinal hematoma: presentation of an asymptomatic cervical parathyroid adenoma: case report and literature review  

Microsoft Academic Search

The spontaneous rupture with extracapsular hemorrhage of a cervical parathyroid adenoma is a rare cause of cervical and mediastinal hematoma. We describe this case to emphasize that a failure to consider this diagnosis may result in delayed operative intervention with potentially fatal complications.

Michele Tonerini; Eugenio Orsitto; Luisa Fratini; Alessandra Tozzini; Andrea Chelli; Stefano Santi; Mauro Rossi

2004-01-01

437

75 FR 54345 - Determination of Regulatory Review Period for Purposes of Patent Extension; BRYAN CERVICAL DISC...  

Federal Register 2010, 2011, 2012, 2013

...skeletally mature patients for reconstruction of the disc from C3 to C7 following single-level discectomy for intractable radiculopathy and/or myelopathy. Subsequent to this approval, the Patent and Trademark Office received a patent term restoration...

2010-09-07

438

Genetic and phylogenetic analyses of human T-cell lymphotropic virus type I variants from Melanesians with an without spastic myelopathy  

Microsoft Academic Search

Molecular variants of human T-cell lymphotropic virus type I (HTLV-I) have been isolated recently from lifelong residents\\u000a of remote Melanesian populations, including a Solomon Islander with tropical spastic paraparesis\\/HTLV-I-associated myelopathy\\u000a (TSP\\/HAM) or HTLV-I myeloneuropathy. To clarify the genetic heterogeneity and molecular epidemiology of disease-associated\\u000a strains of HTLV-I, we enzymatically amplified, then directly sequenced representative regions of thegag, pol, env, andpX

Vivek R. Nerurkar; Ki-Joon Song; Rebecca R. Melland; Richard Yanagihara

1994-01-01

439