1
|
Gallagher DO, Taghlabi KM, Bondar K, Saifi C. Degenerative Cervical Myelopathy: A Concept Review and Clinical Approach. Clin Spine Surg 2024; 37:1-8. [PMID: 38285428 DOI: 10.1097/bsd.0000000000001463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 05/09/2023] [Indexed: 01/30/2024]
Abstract
STUDY DESIGN Narrative review. OBJECTIVE To provide an overview of the evaluation and diagnosis of degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA DCM describes several etiologies of degenerative, nontraumatic spinal cord impairment. Early diagnosis and intervention can decrease neurological decline. METHODS An extensive literature review was conducted. RESULTS The incidence and prevalence of DCM are increasing worldwide. Asymptomatic spinal cord compression can progress to cervical myelopathy. Static and dynamic factors contribute to spinal cord compression. Patients frequently present with decreased manual dexterity, gait instability, and neck pain. On physical exam, patients frequently present with upper motor neuron signs, a Lhermitte sign, a failed Romberg test, global proprioceptive dysfunction, and decreased pain sensation. Anatomic variation may complicate physical exam interpretation. The modified Japanese Orthopaedic Association Scale and Nurick Classification, based on functional impairment, provide diagnostic utility. Magnetic Resonance Imaging imaging is useful in narrowing the differential diagnosis, evaluating the severity of neurological impairment, and predicting disease progression. CONCLUSIONS Understanding the pathophysiology of DCM and the diagnostic utility of the signs and symptoms of DCM is critical. The decision for anterior cervical discectomy and fusion (ACDF), laminoplasty, or combined ACDF and posterior cervical fusion is individualized for each patient.
Collapse
Affiliation(s)
- Daniel O Gallagher
- Department of Education, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Kevin Bondar
- Department of Orthopedic Surgery and Sports Medicine, Houston Methodist Hospital, Houston, TX
| | - Comron Saifi
- Department of Orthopedic Surgery and Sports Medicine, Houston Methodist Hospital, Houston, TX
| |
Collapse
|
2
|
Kang KC, Jang TS, Choi SH, Kim HW. Difference between Anterior and Posterior Cord Compression and Its Clinical Implication in Patients with Degenerative Cervical Myelopathy. J Clin Med 2023; 12:4111. [PMID: 37373804 DOI: 10.3390/jcm12124111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
In degenerative cervical myelopathy (DCM), the low anteroposterior compression ratio of the spinal cord is known to be associated with a neurologic deficit. However, there is little detailed analysis of spinal cord compression. Axial magnetic resonance images of 183 DCM patients at normal C2-C3 and maximal cord compression segments were analyzed. The anterior (A), posterior (P), and anteroposterior length and width (W) of the spinal cord were measured. Correlation analyses between radiographic parameters and each section of Japanese Orthopedic Association (JOA) scores and comparisons of the patients divided by A (below or above 0, 1, or 2 mm) were performed. Between C2-C3 and maximal compression segments, the mean differences of A and P were 2.0 (1.2) and 0.2 (0.8) mm. The mean anteroposterior compression ratios were 0.58 (0.13) at C2-C3 and 0.32 (0.17) at maximal compression. The A and A/W ratio were significantly correlated with four sections and the total JOA scores (p < 0.05), but the P and P/W ratio did not demonstrate any correlations. Patients with A < 1 mm had significantly lower JOA scores than those with A ≥ 1 mm. In patients with DCM, spinal cord compression occurs mainly in the anterior part and the anterior cord length of <1 mm is particularly associated with neurologic deficits.
Collapse
Affiliation(s)
- Kyung-Chung Kang
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Kyungheedae-ro 23, Dongdaemun-gu, Seoul 130-872, Republic of Korea
| | - Tae Su Jang
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Kyungheedae-ro 23, Dongdaemun-gu, Seoul 130-872, Republic of Korea
| | - Sun-Hwan Choi
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Kyungheedae-ro 23, Dongdaemun-gu, Seoul 130-872, Republic of Korea
| | - Hee-Won Kim
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Kyungheedae-ro 23, Dongdaemun-gu, Seoul 130-872, Republic of Korea
| |
Collapse
|
3
|
Tetreault L, Kalsi-Ryan S, Benjamin Davies, Nanna-Lohkamp L, Garwood P, Martin AR, Wilson JR, Harrop JS, Guest JD, Kwon BK, Milligan J, Arizala AM, Kotter MR, Fehlings MG. Degenerative Cervical Myelopathy: A Practical Approach to Diagnosis. Global Spine J 2022; 12:1881-1893. [PMID: 35043715 PMCID: PMC9609530 DOI: 10.1177/21925682211072847] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Narrative Review. OBJECTIVES The objective of this review is to provide a stepwise approach to the assessment of patients with potential symptoms of degenerative cervical myelopathy (DCM). METHODS N/A. RESULTS DCM is an overarching term used to describe progressive compression of the cervical spinal cord by age-related changes to the spinal axis. These alterations to normal anatomy narrow the spinal canal, reduce the space available for the spinal cord, and may ultimately compress the ascending and descending neural tracts. Patients with DCM present with a wide range of symptoms that can significantly impact quality of life, including bilateral hand numbness and paresthesia, gait impairment, motor weakness of the upper and lower extremities, and bladder and bowel dysfunction. Unfortunately, DCM is often misdiagnosed, resulting in delayed assessment and management by the appropriate specialist. The proper evaluation of a patient with suspected DCM includes obtaining a detailed patient history, conducting a comprehensive neurological examination, and ordering appropriate tests to rule in or out other diagnoses. CONCLUSION This review summarizes a stepwise approach to the diagnosis of patients with DCM.
Collapse
Affiliation(s)
- Lindsay Tetreault
- Division of Neurology, Graduate
Medical Education, New York University
Langone, New York, NY, USA
| | | | - Benjamin Davies
- Department of Academic
Neurosurgery, University of Cambridge, Cambridge, UK
| | - Laura Nanna-Lohkamp
- Division of Neurosurgery,
Department of Surgery, University of Toronto, Toronto, ON, Canada,Division of Neurosurgery, Spinal
Program, Toronto Western Hospital, University Health
Network, Toronto, ON, Canada
| | - Philip Garwood
- Internal Medicine Resident,
Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Allan R. Martin
- Spine Neurosurgery, University of California
Davis, Davis, CA, USA
| | - Jefferson R. Wilson
- Division of Neurosurgery,
Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - James S. Harrop
- Departments of Neurological and
Orthopedic Surgery, Thomas Jefferson
University, Philadelphia, PA, USA
| | - James D. Guest
- The Miami Project to Cure
Paralysis, University of Miami, Miami, FL, USA
| | - Brian K. Kwon
- Department, of Orthopaedics, University of British
Columbia, Vancouver, BC, Canada
| | - James Milligan
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Mark R. Kotter
- Department of Academic
Neurosurgery, University of Cambridge, Cambridge, UK
| | - Michael G. Fehlings
- Division of Neurosurgery,
Department of Surgery, University of Toronto, Toronto, ON, Canada,Division of Neurosurgery, Spinal
Program, Toronto Western Hospital, University Health
Network, Toronto, ON, Canada,Michael G. Fehlings, MD, PhD, FRCSC, FACS,
Division of Neurosurgery and Spinal Program, Department of Surgery, University
of Toronto, Krembil Neuroscience Centre, Toronto Western Hospital, 399 Bathurst
Street, Suite 4WW-449, Toronto, ON M5T 2S8, Canada.
| |
Collapse
|
4
|
Rodrigues-Pinto R, Montenegro TS, Davies BM, Kato S, Kawaguchi Y, Ito M, Zileli M, Kwon BK, Fehlings MG, Koljonen PA, Kurpad SN, Guest JD, Aarabi B, Rahimi-Movaghar V, Wilson JR, Kotter MRN, Harrop JS. Optimizing the Application of Surgery for Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 10]. Global Spine J 2022; 12:147S-158S. [PMID: 35174733 PMCID: PMC8859702 DOI: 10.1177/21925682211062494] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
STUDY DESIGN Literature Review (Narrative). OBJECTIVE To introduce the number 10 research priority for Degenerative Cervical Myelopathy: Individualizing Surgery. METHODS This article summarizes the current recommendations and indications for surgery, including how known prognostic factors such as injury time, age, disease severity, and associated comorbidities impact surgical outcome. It also considers key areas of uncertainty that should be the focus of future research. RESULTS While a small proportion of conservatively managed patients may remain stable, the majority will deteriorate over time. To date, surgical decompression is the mainstay of treatment, able to halt disease progression and improve neurologic function and quality of life for most patients. Whilst this recognition has led to recommendations on when to offer surgery, there remain many uncertainties including the type of surgery, or timing in milder and/or asymptomatic cases. Their clarification has the potential to transform outcomes, by ensuring surgery offers each individual its maximum benefit. CONCLUSION Developing the evidence to better guide surgical decision-making at the individual patient level is a research priority for Degenerative Cervical Myelopathy.
Collapse
Affiliation(s)
- Ricardo Rodrigues-Pinto
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto - Hospital de Santo António, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Thiago S. Montenegro
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - So Kato
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | | | - Manabu Ito
- Department of Orthopaedic Surgery, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Mehmet Zileli
- Neurosurgery Department, Ege University, Bornova, Izmir, Turkey
| | - Brian K. Kwon
- Vancouver Spine Surgery Institute, Department of Orthopedics, The University of British Columbia, Vancouver, BC, Canada
| | - Michael G. Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, ON, Canada
| | - Paul A. Koljonen
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Shekar N. Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - James D. Guest
- Department of Neurosurgery and The Miami Project to Cure Paralysis, The Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vafa Rahimi-Movaghar
- Department of Neurosurgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Iran
| | - Jefferson R. Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, ON, Canada
| | | | - James S. Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
5
|
Hilton B, Gardner EL, Jiang Z, Tetreault L, Wilson JRF, Zipser CM, Riew KD, Guest JD, Harrop JS, Fehlings MG, Rodrigues-Pinto R, Rahimi-Movaghar V, Aarabi B, Koljonen PA, Kotter MRN, Davies BM, Kwon BK. Establishing Diagnostic Criteria for Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 3]. Global Spine J 2022; 12:55S-63S. [PMID: 35174729 PMCID: PMC8859706 DOI: 10.1177/21925682211030871] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVES To discuss the importance of establishing diagnostic criteria in Degenerative Cervical Myelopathy (DCM), including factors that must be taken into account and challenges that must be overcome in this process. METHODS Literature review summarising current evidence of establishing diagnostic criteria for DCM. RESULTS Degenerative Cervical Myelopathy (DCM) is characterised by a degenerative process of the cervical spine resulting in chronic spinal cord dysfunction and subsequent neurological disability. Diagnostic delays lead to progressive neurological decline with associated reduction in quality of life for patients. Surgical decompression may halt neurologic worsening and, in many cases, improves function. Therefore, making a prompt diagnosis of DCM in order to facilitate early surgical intervention is a clinical priority in DCM. CONCLUSION There are often extensive delays in the diagnosis of DCM. Presently, no single set of diagnostic criteria exists for DCM, making it challenging for clinicians to make the diagnosis. Earlier diagnosis and subsequent specialist referral could lead to improved patient outcomes using existing treatment modalities.
Collapse
Affiliation(s)
- Bryn Hilton
- Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Emma L. Gardner
- Colchester Hospital, East Suffolk and North Essex NHS Foundation Trust, Colchester, United Kingdom
| | - Zhilin Jiang
- Kings College Hospital, Kings College Hospital NHS Foundation Trust, London, United Kingdom
| | - Lindsay Tetreault
- Langone Health, Graduate Medical Education, Department of Neurology, New York University, NY, USA
| | - Jamie R. F. Wilson
- University of Nebraska Medical Center, Department of Neurosurgery, Omaha, Nebraska, USA
| | - Carl Moritz Zipser
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - K. Daniel Riew
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, NY, USA
| | - James D. Guest
- Department of Neurosurgery and The Miami Project to Cure Paralysis, The Miller School of Medicine, University of Miami, Miami, FL, USA
| | - James S. Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael G. Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ricardo Rodrigues-Pinto
- Department of Orthopaedics, Spinal Unit (UVM), Centro Hospitalar Universitário do Porto - Hospital de Santo António, Porto, Portugal
- Department of Orthopaedics, Instituto de CiM), Centro Hospital, Portugal
| | - Vafa Rahimi-Movaghar
- Department of Neurosurgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Paul A. Koljonen
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Mark R. N. Kotter
- Myelopathy.org, International Charity for Degenerative Cervical Myelopathy, United Kingdom
- Department of Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Benjamin M. Davies
- Myelopathy.org, International Charity for Degenerative Cervical Myelopathy, United Kingdom
- Department of Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Brian K. Kwon
- Department of Orthopaedics, University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia, Canada
| |
Collapse
|
6
|
Degenerative cervical myelopathy - update and future directions. Nat Rev Neurol 2020; 16:108-124. [PMID: 31974455 DOI: 10.1038/s41582-019-0303-0] [Citation(s) in RCA: 222] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2019] [Indexed: 11/09/2022]
Abstract
Degenerative cervical myelopathy (DCM) is the leading cause of spinal cord dysfunction in adults worldwide. DCM encompasses various acquired (age-related) and congenital pathologies related to degeneration of the cervical spinal column, including hypertrophy and/or calcification of the ligaments, intervertebral discs and osseous tissues. These pathologies narrow the spinal canal, leading to chronic spinal cord compression and disability. Owing to the ageing population, rates of DCM are increasing. Expeditious diagnosis and treatment of DCM are needed to avoid permanent disability. Over the past 10 years, advances in basic science and in translational and clinical research have improved our understanding of the pathophysiology of DCM and helped delineate evidence-based practices for diagnosis and treatment. Surgical decompression is recommended for moderate and severe DCM; the best strategy for mild myelopathy remains unclear. Next-generation quantitative microstructural MRI and neurophysiological recordings promise to enable quantification of spinal cord tissue damage and help predict clinical outcomes. Here, we provide a comprehensive, evidence-based review of DCM, including its definition, epidemiology, pathophysiology, clinical presentation, diagnosis and differential diagnosis, and non-operative and operative management. With this Review, we aim to equip physicians across broad disciplines with the knowledge necessary to make a timely diagnosis of DCM, recognize the clinical features that influence management and identify when urgent surgical intervention is warranted.
Collapse
|
7
|
The Effect of Surgical Decompression on Functional Balance Testing in Patients With Cervical Spondylotic Myelopathy. Clin Spine Surg 2019; 32:369-376. [PMID: 31498275 DOI: 10.1097/bsd.0000000000000889] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN A prospective cohort study. OBJECTIVE Quantify the extent of change in dynamic balance and stability in a group of patients with cervical spondylotic myelopathy (CSM) after cervical decompression surgery and to compare them with matched healthy controls. SUMMARY OF BACKGROUND DATA CSM is a naturally progressive degenerative condition that commonly results in loss of fine motor control in the hands and upper extremities and in gait imbalance. Whereas this was previously thought of as an irreversible condition, more recent studies are demonstrating postoperative improvements in balance and stability. MATERIALS AND METHODS Thirty subjects with symptomatic CSM and 25 matched asymptomatic controls between the ages of 45 and 75 years underwent functional balance testing using a 3D motion capture system to gather kinematic and spatiotemporal parameters. CSM subjects underwent testing 1 week before surgery and again 3 months postoperatively. RESULTS Patients with CSM exhibited markedly diminished balance as indicated by increased sway on a Romberg test and requiring significantly more time and a wider stance to complete tandem gait tests. The surgical intervention resulted in improved balance at the 3-month postoperative time point; however, kinematic and spatiotemporal parameters did not completely normalize to the levels observed in asymptomatic controls. CONCLUSIONS Human motion video capture can be used to robustly quantify balance parameters in the setting of CSM. Compared with healthy controls, such patients exhibited increased standing sway and poorer performance on a tandem gait task. The surgical intervention resulted in significant improvement in many of the measures of functional balance, but overall profiles had not completely returned to normal when measured 3 months after surgery. These data reinforce the importance of operative intervention in the treatment of symptomatic CSM with the goal of halting disease progress but the expectation that balance may actually improve postoperatively.
Collapse
|
8
|
Oblique corpectomy in the cervical spine. Spinal Cord 2017; 56:426-435. [PMID: 29209025 DOI: 10.1038/s41393-017-0008-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/29/2017] [Accepted: 08/18/2017] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A narrative review. OBJECTIVES A literature review of studies reporting on the application of oblique corpectomy (OC) in various pathologies of the cervical spine. SETTING UK. METHODS A search was carried out using the PubMed and Google Scholar up to 18 March 2017. Finally, 26 studies met the inclusion criteria. RESULTS A multilevel OC shows good clinical outcomes in various pathologies in the cervical spine. The clinical improvement in cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament was found to be over 70%. OC allows wide anterior decompression of the spinal cord and complete unilateral nerve root decompression. The approach carries a risk of Horner's syndrome, vertebral artery and accessory nerve injury. OC does not compromise spine stability and osteoarthrodesis with bone grafting is not necessary. Spinal motions are preserved and appear close to normal. OC can be applied in patients with a low fusion rate such as the elderly, diabetics, and heavy smokers. Furthermore, OC was found to be an optimal approach for exta-intradural tumors of the cervical spine. CONCLUSIONS OC seems to be a valid alternative for the management of multisegmental CSM in selected cases. It should not be considered a first-line treatment strategy due to the relatively high morbidity. There are no studies comparing OC without fusion to other treatment options in CSM. Therefore, rigorous prospective studies using validated outcome measures with long-term follow-up are required.
Collapse
|
9
|
Dolan RT, Butler JS, O’Byrne JM, Poynton AR. Mechanical and cellular processes driving cervical myelopathy. World J Orthop 2016; 7:20-9. [PMID: 26807352 PMCID: PMC4716567 DOI: 10.5312/wjo.v7.i1.20] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 10/12/2015] [Accepted: 11/03/2015] [Indexed: 02/06/2023] Open
Abstract
Cervical myelopathy is a well-described clinical syndrome that may evolve from a combination of etiological mechanisms. It is traditionally classified by cervical spinal cord and/or nerve root compression which varies in severity and number of levels involved. The vast array of clinical manifestations of cervical myelopathy cannot fully be explained by the simple concept that a narrowed spinal canal causes compression of the cord, local tissue ischemia, injury and neurological impairment. Despite advances in surgical technology and treatment innovations, there are limited neuro-protective treatments for cervical myelopathy, which reflects an incomplete understanding of the pathophysiological processes involved in this disease. The aim of this review is to provide a comprehensive overview of the key pathophysiological processes at play in the development of cervical myelopathy.
Collapse
|
10
|
Tetreault L, Goldstein CL, Arnold P, Harrop J, Hilibrand A, Nouri A, Fehlings MG. Degenerative Cervical Myelopathy. Neurosurgery 2015; 77 Suppl 4:S51-67. [DOI: 10.1227/neu.0000000000000951] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
11
|
Park SJ, Kim SB, Kim MK, Lee SH, Oh IH. Clinical features and surgical results of cervical myelopathy caused by soft disc herniation. KOREAN JOURNAL OF SPINE 2014; 10:138-43. [PMID: 24757475 PMCID: PMC3941769 DOI: 10.14245/kjs.2013.10.3.138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 08/24/2013] [Accepted: 08/26/2013] [Indexed: 11/19/2022]
Abstract
Objective There are many causes of cervical myelopathy including trauma, degenerative conditions, tumors and demyelinating disorders. However, myelopathy caused by soft disc herniation might be seen rarely than the spondylosis caused by hard disc. Here, authors retrospectively analyzed the clinical features and results of cervical myelopathy caused by soft disc herniation. Methods From March 2010 to December 2010, 134 patients with degenerative cervical spinal disease were treated with anterior cervical discectomy and interbody fusion. Among them, 21 patients with cervical myelopathy secondary to cervical soft disc herniation were analyzed. Their clinical features, preoperative and, postoperative clinical results were evaluated by Nurick Grade and Japanese Orthopaedic Association scale (JOA) retrospectively. Preoperative clinical features including duration of myelopathy, pain intensity and postoperative clinical results including improvement rate of myelopathy and radiculopathy were retrospectively analyzed by Nurick Grade and JOA scale. We also evaluated correlation between the duration of symptom, type of the disc herniation, pain intensity and clinical outcome. Results Mean age was 49.7 and male was predominant. Gait disturbance with mild to moderate pain was most common symptom in clinical features. Severe pain was shown in only 9 cases, and the other 12 cases experienced mild to moderate pain. Mean duration of myelopathy was 1.18 month. The mean JOA scores were 11.22 before surgery and 14.2 after surgery. The mean Nurick grades were 2.78 before treatment and 1.67 after treatment. Neurologic status of mild or moderate pain group on preoperative state is worse than that of severe pain group. The patients with duration of myelopathy symptom (<1 month) showed lower clinical improvement rate than the patients with myelopathy over 1 month. Patients with median type of disc herniation showed poorer neurological status than those with paramedian type of herniation in preoperative state. Conclusion Authors reviewed the clinical features and surgical outcome of the cervical myelopathy secondary to cervical soft disc herniation. We presumed that patients of more than one month of symptom duration, mild to moderate initial symptom would be related with better postoperative improvement rate.
Collapse
Affiliation(s)
- Sung Joo Park
- Department of Neurosurgery, Kyung-Hee University College of Medicine, Seoul, Korea
| | - Sung Bum Kim
- Department of Neurosurgery, Kyung-Hee University College of Medicine, Seoul, Korea
| | - Min Ki Kim
- Department of Neurosurgery, Kyung-Hee University College of Medicine, Seoul, Korea
| | - Sung Ho Lee
- Department of Neurosurgery, Kyung-Hee University College of Medicine, Seoul, Korea
| | - In Ho Oh
- Department of Neurosurgery, Kyung-Hee University College of Medicine, Seoul, Korea
| |
Collapse
|
12
|
Hartman J. Anatomy and clinical significance of the uncinate process and uncovertebral joint: A comprehensive review. Clin Anat 2014; 27:431-40. [PMID: 24453021 DOI: 10.1002/ca.22317] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 08/11/2013] [Accepted: 08/11/2013] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The uncinate process and its associated uncovertebral articulation are features unique to the cervical spine. This review examines the morphology of these unique structures with particular emphasis on the regional anatomy, development and clinical significance. MATERIALS AND METHODS Five electronic databases were utilized in the literature search and additional relevant citations were retrieved from the references. A total of 74 citations were included for review. RESULTS This literature review found that the uncinate processes and uncovertebral articulations are rudimentary at birth and develop and evolve with age. With degeneration they become clinically apparent with compression of related structures; most importantly affecting the spinal nerve root and vertebral artery. The articulations have also been found to precipitate torticollis when edematous and be acutely damaged in severe head and neck injuries. The uncinate processes are also important in providing stability and guiding the motion of the cervical spine. CONCLUSION This review is intended to re-examine an often overlooked region of the cervical spine as not only an interesting anatomical feature but also a clinically relevant one.
Collapse
Affiliation(s)
- Jeffrey Hartman
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada, S7N 5E5
| |
Collapse
|
13
|
Abstract
The differential of cervical spondylotic myelopathy (CSM) is broad and includes multiple conditions that can cause and mimic myelopathy. In adults older than 55 years of age, CSM is the most common cause of myelopathy. This article summarizes the pathophysiology, clinical presentation, differential diagnosis, diagnostic evaluation, and natural history of CSM. Available treatment options and their complications are reviewed.
Collapse
Affiliation(s)
- Michel Toledano
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
| | | |
Collapse
|
14
|
The natural history and clinical syndromes of degenerative cervical spondylosis. Adv Orthop 2011; 2012:393642. [PMID: 22162812 PMCID: PMC3227226 DOI: 10.1155/2012/393642] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 09/08/2011] [Accepted: 09/26/2011] [Indexed: 11/18/2022] Open
Abstract
Cervical spondylosis is a broad term which describes the age related chronic disc degeneration, which can also affect the cervical vertebrae, the facet and other joints and their associated soft tissue supports. Evidence of spondylitic change is frequently found in many asymptomatic adults. Radiculopathy is a result of intervertebral foramina narrowing. Narrowing of the spinal canal can result in spinal cord compression, ultimately resulting in cervical spondylosis myelopathy. This review article examines the current literature in relation to the cervical spondylosis and describes the three clinical syndromes of axial neck pain, cervical radiculopathy and cervical myelopathy
Collapse
|
15
|
Fish DE, Gerstman BA, Lin V. Evaluation of the Patient with Neck Versus Shoulder Pain. Phys Med Rehabil Clin N Am 2011; 22:395-410, vii. [DOI: 10.1016/j.pmr.2011.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
16
|
Comparison of magnetic resonance imaging and computed tomogram-myelography for evaluation of cross sections of cervical spinal morphology. Spine (Phila Pa 1976) 2011; 36:50-6. [PMID: 20581762 DOI: 10.1097/brs.0b013e3181cb469c] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Comparison of magnetic resonance imaging (MRI) and computed tomography-myelography (CTM) for cervical intracanalar dimensions. OBJECTIVE To compare the capability and reproducibility of MRI and CTM in measuring the cross-sectional morphology of intracanalar lesions of the cervical spine. SUMMARY OF BACKGROUND DATA The relative advantages and disadvantages of MRI and CTM in measuring cervical intracanalar dimensions are poorly understood. METHODS MRI and CTM were used to measure cervical disc levels in 45 subjects with various cervical spinal diseases. Measurements included dural area, dural anteroposterior (A-P) diameter, dural right-left (RL) diameter, cord area, cord anteroposterior (A-P) diameter, cord right-left (RL) diameter and cerebrospinal fluid (CSF) space (anterior and posterior). Each section was graded by 2 orthopedic surgeons for degree of stenosis (Grades, 0-3), and the intra- and interobserver reproducibility of these measurements (intraclass correlation coefficients: ICC) was assessed. RESULTS In both CTM and MRI, intra- and interobserver reproducibility (ICC) ranged from 0.702 to 0.989, suggesting that both imaging methods are reproducible. Importantly, CTM measurements of dural area, dural A-P diameter, dural RL diameter, and CSF space (anterior and posterior) were slightly, but significantly (P < 0.001), larger than MRI measurements. In contrast, MRI measurements of cord area, cord A-P diameter, and cord RL diameter were slightly, but significantly (P < 0.001), larger than CTM measurements. Degree of stenosis was significantly more severe in MRI than in CTM. CONCLUSION Both CTM and MRI provided reproducible measurements of cervical intracanalar dimensions. Measurements of dura were slightly larger in CTM, whereas measurements of spinal cord were slightly larger in MRI, making stenosis more severe in MRI than in CTM. The clinical relevance of these slight differences requires further examination.
Collapse
|
17
|
Abstract
BACKGROUND Cervical spondylosis is part of the aging process and affects most people if they live long enough. Degenerative changes affecting the intervertebral disks, vertebrae, facet joints, and ligamentous structures encroach on the cervical spinal canal and damage the spinal cord, especially in patients with a congenitally small cervical canal. Cervical spondylotic myelopathy (CSM) is the most common cause of myelopathy in adults. REVIEW SUMMARY The anatomy, pathophysiology, clinical presentation, differential diagnosis, diagnostic investigation, natural history, and treatment options for CSM are summarized. Patients present with signs and symptoms of cervical spinal cord dysfunction with or without cervical nerve root injury. The condition may or may not be accompanied by pain in the neck and/or upper limb. The differential diagnosis is broad. Imaging, typically with magnetic resonance imaging, is the most useful diagnostic tool. Electrophysiologic testing can help exclude alternative diagnoses. The effectiveness of conservative treatments is unproven. Surgical decompression improves neurologic function in some patients and prevents worsening in others, but is associated with risk. CONCLUSIONS Neurologists should be familiar with this very common condition. Patients with mild signs and symptoms of CSM can be monitored. Surgical decompression from an anterior or posterior approach should be considered in patients with progressive and moderate to severe neurologic deficits.
Collapse
|
18
|
Song KJ, Choi BW, Kim SJ, Kim GH, Kim YS, Song JH. The relationship between spinal stenosis and neurological outcome in traumatic cervical spine injury: an analysis using Pavlov's ratio, spinal cord area, and spinal canal area. Clin Orthop Surg 2009; 1:11-8. [PMID: 19884992 PMCID: PMC2766695 DOI: 10.4055/cios.2009.1.1.11] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Accepted: 06/17/2008] [Indexed: 12/18/2022] Open
Abstract
Background This study examined the relationship between four radiological parameters (Pavlov's ratio, sagittal diameter, spinal cord area, and spinal canal area) in patients with a traumatic cervical spine injury, as well as the correlation between these parameters and the neurological outcome. Methods A total of 212 cervical spinal levels in 53 patients with a distractive-extension injury were examined. The following four parameters were measured: Pavlov's ratio on the plain lateral radiographs, the sagittal diameter, the spinal cord area, and the spinal canal area on the MRI scans. The Pearson correlation coefficients between the parameters at each level and between the levels of each parameter were evaluated. The correlation between the radiological parameters and the spinal cord injury status classified into four categories, A (complete), B (incomplete), C (radiculopathy), and D (normal) was assessed. Results The mean Pavlov's ratio, sagittal diameter, spinal cord area and spinal canal area was 0.84, 12.9 mm, 82.8 mm2 and 236.8 mm2, respectively. An examination of the correlation between the radiological spinal stenosis and clinical spinal cord injury revealed an increase in the values of the four radiological parameters from cohorts A to D. Pavlov's ratio was the only parameter showing statistically significant correlation with the clinical status (p = 0.006). Conclusions There was a correlation between the underlying spinal stenosis and the development of neurological impairment after a traumatic cervical spine injury. In addition, it is believed that Pavlov's ratio can be used to help determine and predict the neurological outcome.
Collapse
Affiliation(s)
- Kyung-Jin Song
- Department of Orthopedic Surgery, College of Medicine, Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea
| | | | | | | | | | | |
Collapse
|
19
|
Braga-Baiak A, Shah A, Pietrobon R, Braga L, Neto AC, Cook C. Intra- and inter-observer reliability of MRI examination of intervertebral disc abnormalities in patients with cervical myelopathy. Eur J Radiol 2008; 65:91-8. [PMID: 17532165 DOI: 10.1016/j.ejrad.2007.04.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2006] [Revised: 03/19/2007] [Accepted: 04/12/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE Intervertebral cervical disc herniation (CDH) is a relatively common disorder that can coexist with degenerative changes to worsen cervicogenic myelopathy. Despite the frequent disc abnormalities found in asymptomatic populations, magnetic resonance imaging (MRI) is considered excellent at detecting cervical spine myelopathy (CSM) associated with disc abnormality. The objective of this study was to investigate the intra- and inter-observer reliability of MRI detection of CSM in subjects who also had co-existing intervertebral disc abnormalities. MATERIALS AND METHODS Seven experienced radiologists reviewed twice the MRI of 10 patients with clinically and/or imaging determined myelopathy. MRI assessment was performed individually, with and without operational guidelines. A Fleiss Kappa statistic was used to evaluate the intra- and inter-observer agreement. RESULTS The study found high intra-observer percent agreement but relatively low Kappa values on selected variables. Inter-observer reliability was also low and neither observation was improved with operational guidelines. We believe that those low values may be associated with the base rate problem of Kappa. CONCLUSION In conclusion, this study demonstrated high intra-observer percent agreement in MR examination for intervertebral disc abnormalities in patients with underlying cervical myelopathy, but differing levels of intra- and inter-observer Kappa agreement among seven radiologists.
Collapse
Affiliation(s)
- Andresa Braga-Baiak
- Center for Excellence in Surgical Outcomes, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | | | | | | | | | | |
Collapse
|
20
|
Kim YJ, Oh SH, Yi HJ, Kim YS, Ko Y, Oh SJ. Myelopathy caused by soft cervical disc herniation : surgical results and prognostic factors. J Korean Neurosurg Soc 2007; 42:441-5. [PMID: 19096586 DOI: 10.3340/jkns.2007.42.6.441] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Accepted: 11/12/2007] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the surgical results and prognostic factors for patients with soft cervical disc herniation with myelopathy. METHODS During the last 7 years, 26 patients with cervical discogenic myelopathy were undertaken anterior discectomy and fusion. Clinical and radiographic features were reviewed to evaluate the surgical results and prognostic factors. The clinical outcome was judged using two grading systems (Herkowitz's scale and Nurick's grade). RESULTS Male were predominant (4:1), and C5-6 was the most frequently involved level. Gait disturbance, variable degree of spasticity, discomfort in chest and abdomen, hand numbness were the most obvious signs. Magnetic resonance(MR) images showed that central disc herniation was revealed in 16 cases, and accompanying cord signal changes in 4. Postoperatively, 23 patients showed favorable results (excellent, good and fair) according to Herkowitz's scale. CONCLUSION Anterior cervical discectomy and fusion effectively reduced myelopathic symptoms due to soft cervical disc herniation. The authors assured that the shorter duration of clinical attention, the lesser the degree of myelopathy and better outcome in discogenic myelopathy.
Collapse
Affiliation(s)
- Young-Jin Kim
- Department of Neurosurgery , Dankook University, College of Medicine, Cheonan, Korea
| | | | | | | | | | | |
Collapse
|
21
|
Rao RD, Currier BL, Albert TJ, Bono CM, Marawar SV, Poelstra KA, Eck JC. Degenerative cervical spondylosis: clinical syndromes, pathogenesis, and management. J Bone Joint Surg Am 2007; 89:1360-78. [PMID: 17575617 DOI: 10.2106/00004623-200706000-00026] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Raj D Rao
- Department of Orthopaedic Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA
| | | | | | | | | | | | | |
Collapse
|
22
|
da Costa RC, Parent JM, Partlow G, Dobson H, Holmberg DL, Lamarre J. Morphologic and morphometric magnetic resonance imaging features of Doberman Pinschers with and without clinical signs of cervical spondylomyelopathy. Am J Vet Res 2006; 67:1601-12. [PMID: 16948609 DOI: 10.2460/ajvr.67.9.1601] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare morphologic and morphometric features of the cervical vertebral column and spinal cord of Doberman Pinschers with and without clinical signs of cervical spondylomyelopathy (CSM; wobbler syndrome) detected via magnetic resonance imaging (MRI). ANIMALS 16 clinically normal and 16 CSM-affected Doberman Pinschers. PROCEDURES For each dog, MRI of the cervical vertebral column (in neutral and traction positions) was performed. Morphologically, MRI abnormalities were classified according to a spinal cord compression scale. Foraminal stenosis and intervertebral disk degeneration and protrusion were also recorded. Morphometric measurements of the vertebral canal and spinal cord were obtained in sagittal and transverse MRI planes. RESULTS 4 of 16 clinically normal and 15 of 16 CSM-affected dogs had spinal cord compression. Twelve clinically normal and all CSM-affected dogs had disk degeneration. Foraminal stenosis was detected in 11 clinically normal and 14 CSM-affected dogs. Vertebral canal and spinal cord areas were consistently smaller in CSM-affected dogs, compared with clinically normal dogs. In neutral and traction positions, the intervertebral disks of CSM-affected dogs were wider than those of clinically normal dogs but the amount of disk distraction was similar between groups. CONCLUSIONS AND CLINICAL RELEVANCE The incidence of intervertebral disk degeneration and foraminal stenosis in clinically normal Doberman Pinschers was high; cervical spinal cord compression may be present without concurrent clinical signs. A combination of static factors (ie, a relatively stenotic vertebral canal and wider intervertebral disks) distinguished CSM-affected dogs from clinically normal dogs and appears to be a key feature in the pathogenesis of CSM.
Collapse
Affiliation(s)
- Ronaldo C da Costa
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | | | | | | | | | | |
Collapse
|
23
|
Kukurin GW. The Amelioration of Symptoms in Cervical Spinal Stenosis with Spinal Cord Deformation Through Specific Chiropractic Manipulation: A Case Report with Long-Term Follow-Up. J Manipulative Physiol Ther 2004; 27:e7. [PMID: 15195045 DOI: 10.1016/j.jmpt.2004.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To describe the chiropractic management of a patient with paresthesia on the entire left side of her body and magnetic resonance imaging (MRI)-documented cervical spinal cord deformation secondary to cervical spinal stenosis. CLINICAL FEATURES A 70-year-old special education teacher had neck pain, headaches, and burning paresthesia on the entire left side of her body. These symptoms developed within hours of being injured in a side-impact motor vehicle accident. Prior to her visit, she had been misdiagnosed with a cerebrovascular accident. INTERVENTION AND OUTCOMES Additional diagnostic studies revealed that the patient was suffering from cervical spinal stenosis with spinal cord deformation. Two manipulative technique systems (Advanced Biostructural Therapy and Atlas Coccygeal Technique) unique to the chiropractic profession and based on the theory of relief of adverse mechanical neural tension were administered to the patient. This intervention provided complete relief of the patient's complaints. The patient remained symptom-free at long-term follow-up, 1 year postaccident. CONCLUSION There is a paucity of published reports describing the treatment of cervical spinal stenosis through manipulative methods. Existing reports of the manipulative management of cervical spondylosis suggest that traditional manual therapy is ineffective or even contraindicated. This case reports the excellent short-term and long-term response of a 70-year-old patient with MRI-documented cervical spinal stenosis and spinal cord deformation to less traditional, uniquely chiropractic manipulative techniques. This appears to be the first case (reported in the indexed literature) that describes the successful amelioration of the symptoms of cervical spinal stenosis through chiropractic manipulation. More research into the less traditional chiropractic systems of spinal manipulation should be undertaken.
Collapse
|
24
|
Abstract
In some cases neither the clinical pattern nor the findings of magnetic resonance imaging (MRI) can help to determine the cause of a cervical myelopathy. The differential diagnosis of such cases as a rule includes spondylotic myelopathy, a solitary focus of multiple sclerosis and an intramedullary tumour in early stage. Worsening of signs and symptoms due to the circumscribed lesion of the spinal cord can require surgical treatment, even if no certain diagnosis could be stated thus far. The question is how to choose a surgical procedure which is beneficial for all three kinds of spinal cord pathology in their initial stage, which at the same time does not jeopardise spine and spinal cord and allows secondary surgery if needed after the precise nature of the lesion has been assessed. Ventral decompression and fusion with or without dorsal decompression seems to be a convincing procedure.
Collapse
Affiliation(s)
- M Payer
- Spine Unit, Klinik Wilhelm Schulthess, Zürich, Switzerland.
| | | | | |
Collapse
|
25
|
Rao R. Neck pain, cervical radiculopathy, and cervical myelopathy: pathophysiology, natural history, and clinical evaluation. J Bone Joint Surg Am 2002; 84:1872-81. [PMID: 12377921 DOI: 10.2106/00004623-200210000-00021] [Citation(s) in RCA: 155] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Raj Rao
- An Instructional Course Lecture, American Academy of Orthopaedic Surgeons, USA
| |
Collapse
|
26
|
Blease Graham C, Wippold FJ, Bae KT, Pilgram TK, Shaibani A, Kido DK. Comparison of CT myelography performed in the prone and supine positions in the detection of cervical spinal stenosis. Clin Radiol 2001; 56:35-9. [PMID: 11162695 DOI: 10.1053/crad.2000.0569] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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 were then measured at the disk spaces and mid-pedicle levels from C2 to T1 in both the supine and prone positions using a public domain NIH Image program, version 156b18. Mean area measurements in both positions were then compared for each level examined. RESULTS Mean SAS cross-sectional area in the prone position was notably reduced compared with the supine position at C4-C5 [128.8 mm2 vs 168.1 mm2 (P<.05)], and C5-C6 [98.8 mm2 vs 143.2 mm2 (P<.05)] disk levels. The mean cord cross-sectional area failed to change significantly with positioning. CONCLUSIONS Prone myelography may demonstrate a greater degree of cervical spine stenosis compared with CT myelography performed in the supine position in myelopathic patients. Imaging with the patient prone with neck extended in both myelography and CTM may improve precision in the results of measurements of the stenotic spinal canal when comparing these two methods. Blease Graham III, C. (2001). Clinical Radiology56, 35-39.
Collapse
Affiliation(s)
- C Blease Graham
- M.D. Mallinckrodt Institute of Radiology, Washington University Medical Center, 510 South Kingshighway Boulevard, St. Louis, MO 63110, USA
| | | | | | | | | | | |
Collapse
|
27
|
A review of biomechanics of the central nervous system. Part 1: Spinal canal deformations caused by changes in posture. J Manipulative Physiol Ther 2000; 23:217-220. [PMID: 10771508 DOI: 10.1016/s0161-4754(00)90253-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
28
|
Harrison DE, Cailliet R, Harrison DD, Troyanovich SJ, Harrison SO. A review of biomechanics of the central nervous system--Part I: spinal canal deformations resulting from changes in posture. J Manipulative Physiol Ther 1999; 22:227-34. [PMID: 10367759 DOI: 10.1016/s0161-4754(99)70049-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To discuss how the spinal cord deforms as a result of changes in posture or biomechanical alterations of the spine. DATA COLLECTION A hand search of available reference texts and a computer search of literature from the Index Medicus sources were collected, with special emphasis placed on spinal canal changes caused by various postural rotations and translations of the skull, thorax, and pelvis. RESULTS All spinal postures will deform the spinal canal. Flexion causes a small increase in canal diameter and volume as the vertebral lamina are separated. Extension causes a small decrease in canal diameter and volume as the vertebral lamina are approximated. Lateral bending and axial rotation cause insignificant changes in spinal canal diameter and volume in cases without stenosis. CONCLUSIONS Rotations of the global postural components, head, thoracic cage, and pelvis cause changes in the diameter of the spinal canal and intervertebral foramen. These changes are generally a reduction of less than 1.5 mm in extension, compared with a small increase in flexion of approximately 1 mm. These small changes do not account for the clinical observation of patients having increased neurologic signs and symptoms in flexion.
Collapse
Affiliation(s)
- D E Harrison
- Department of Rehabilitation & Physical Medicine, University of Southern California Medical School, Pacific Palisades, USA
| | | | | | | | | |
Collapse
|
29
|
Abstract
To provide a comprehensive review of the presentation, evaluation, differential diagnosis, treatment and return-to-play criteria which can be useful to the clinician caring for athletes with cervical radiculopathy. A review of the literature on cervical radiculopathy and sports injuries of the cervical spine was performed. This information was used in conjunction with the author's clinical experience to present a literature based approach to the diagnosis and treatment of cervical radiculopathy in athletic individuals. There was limited scientific literature on the evaluation and treatment of cervical radiculopathy in athletes. Many studies reported on the evaluation and treatment of the "burner" or "stinger" in the younger athlete which may represent a cervical radiculopathy in many of these cases. A nonoperative treatment plan using a logical step-wise approach is successful in the vast majority of these patients. Using the history and a detailed physical examination, along with imaging and other diagnostic studies when necessary, a proper diagnosis of cervical radiculopathy can be made. Once a discrete diagnosis is made, then a systematic approach to the treatment and rehabilitation can be implemented to optimize a safe return to competition.
Collapse
Affiliation(s)
- G A Malanga
- Department of Physical Medicine and Rehabiliation, Kessler Institute of Rehabilitation, West Orange, NJ, USA
| |
Collapse
|
30
|
|
31
|
Abstract
OBJECTIVE To correlate the findings on computed tomographic myelography (CTM) with surgically and pathologically proven prolapsed cervical disks, mention other pertinent cross-sectional imaging studies, and note the clinical relevance of certain CTM features. DESIGN We retrospectively reviewed the medical and radiologic records of Mayo patients with suspected degenerative cervical disk disease during a 4-year period. MATERIAL AND METHODS Between January 1986 and December 1989, 734 patients with possible cervical disk disease underwent assessment by CTM. An extruded disk was noted in 297 of these patients. In this study group, magnetic resonance (MR) imaging was also done in 28 patients and plain computed tomography was performed in 14, and we summarized those findings. RESULTS Of the 297 study patients, 280 had a cervical radiculopathy and 17 had a myelopathy. CTM identified more than 90% of the extruded cervical disks. CTM could not distinguish between an osteophytic cartilaginous cap and a disk, and CTM could not identify the source of a cervical radiculopathy in 102 patients. Although only a few imaging studies other than CTM were performed, those modalities were less sensitive in the detection of prolapsed disks. CONCLUSION Imaging of cervical disk prolapse continues to be difficult, and the results are not always specific. CTM is the most sensitive imaging examination, but the number of MR studies in the current series of patients was insufficient for a reasonable comparison between the two modalities.
Collapse
Affiliation(s)
- O W Houser
- Department of Diagnostic Radiology, Mayo Clinic Rochester, MN 55905, USA
| | | | | | | | | |
Collapse
|