Computed tomography of the spinal canal and cord

Intraoperative ultrasonic evaluation of spinal cord motion

The spinal canals of 11 patients with various pathological conditions, both benign and malignant, were examined intraoperatively using real-time ultrasonography. The spinal cords in eight of these patients with lesions causing cord compression were seen to oscillate rhythmically over each mass with a frequency corresponding to the patient's arterial pulsations. The majority of the observed motion was transmitted or extrinsically induced from compression of the anterior spinal artery. In one case, after resection of an anterior cervical neurofibroma, these oscillations diminished markedly. Spinal cord motion, as described, has important implications for neurosurgery, since it contradicts the previously held belief that oscillations of the spinal cord or dura mater imply a "free" or noncompressed spinal cord. Furthermore, spinal cord motion may play a role in the degradation of computerized tomography images of the cord, since these movements are maximized at the areas with the most severe pathology.

Computed tomography of the spine and spinal cord; limitations and applications

The author presents a comprehensive review of the literature on spinal computerized tomography in the evaluation of spinal fractures and fracture-dislocations, degenerative processes with bony encroachment into the spinal canal, disc protrusion, cystic degeneration of the cord, communicating hydro-syringomyelia, intra- and extramedullary neoplasms and congenital malformations. Critical analysis of all published data and additional personal experience gained over the past three years make it possible to better define the clinical applications and practical limitations of spinal CT scans.

Spinal neurological complications of achondroplasia. Results of surgical treatment

Spinal neurological complications caused the admission of 17 patients with achondroplasia to the UCLA affiliated hospitals between 1955 and 1979. These patients constituted 41% of all achondroplastic patients admitted during that period. The spinal stenotic syndromes could be divided into three groups: Group I: thoracolumbar stenosis (10 patients); Group II: foramen magnum and upper cervical stenosis (five patients); and Group III: generalized spinal stenosis (two patients). Eleven patients underwent a total of 18 decompressive operative procedures for treatment of paraparesis, quadriparesis, sensory deficits, and sphincter dysfunction. Excellent results were obtained with patients in Group I and II, 77% of whom were ambulatory and continent postoperatively. Two patients in Group III fared less well, showing steady neurological deterioration despite multiple operative procedures. The spectrum of spinal neurological manifestations secondary to achondroplasia is reviewed. Problems with conventional radiological studies and the potential role of computerized tomographic analysis of such patients are discussed. Recommendations for surgical technique are made. Early recognition, prompt clinical evaluation, and safe and accurate radiological analysis of spinal neurological complications of achondroplasia will allow appropriate decompressive surgical procedures to be performed. Excellent results may be anticipated in the reversal and prevention of neurological deficit secondary to achondroplasia with such an approach.

Computed tomography of the cervical spine and spinal cord

A number of cases are presented to illustrate the diagnostic effectiveness of computed tomography in the cervical spine and spinal cord, specifically in syringomyelia, spinal stenosis, and fractures. Certain limitations in the examination are also presented, and problems related to interpretation, particularly in regard to spinal stenosis, are discussed.