Late neurological deterioration 30 years following conservative treatment of a lower cervical spine fracture--a case report

Behçet's disease and late progressive myelopathy in a patient with severe kyphotic deformity following childhood spinal trauma: is there any connection?

A highly unusual case is presented of a patient affected by Behçet's disease and severe kyphosis in the thoracic spine, who had a history of traumatic spinal cord injury during childhood. A review of the literature is also presented. Magnetic resonance imaging showed spinal cord compression at the level of the apex of the kyphosis in the upper thoracic spine. Although there is no information indicating that the coexistence of post-traumatic spinal deformity with Behçet's disease is not just a coincidental finding, the possibility that it was the presence of Behçet's disease concomitant with the antecedent spinal trauma that may have triggered the severe kyphotic deformity cannot be ruled out.

Treatment of multilevel cervical spondylotic myeloradiculopathy with posterior decompression and fusion with lateral mass plate fixation and local bone graft

This is a retrospective review of 32 patients with multilevel cervical myelopathy treated by laminectomy and lateral mass plate fusion. The prognosis of surgically treated myelopathy is evaluated as well as prognostic factors for recovery of myelopathy. Diagnoses included cervical spondylosis or ossification of the posterior longitudinal ligament. Final follow-up was at 15.2 months (mean) postoperatively. Myelopathy was graded preoperatively and postoperatively by the system of Nurick. All patients had preoperative radiographs and magnetic resonance imaging (MRI). The presence of abnormal T2-weighted MRI signal (myelomalacia) was noted. Postoperative studies included flexion-extension radiographs to assess fusion and MRI to evaluate decompression of neural elements and resolution of myelomalacia. Severity of preoperative Nurick myelopathy, presence of myelomalacia, and age were evaluated as potential prognostic indicators for surgically treated myelopathy. Mean Nurick score improved from 2.6 (range 1-4) to 1.8 (range 0-3) postoperatively (p < 0.0001). Twenty-two patients (71%) had improvement in Nurick grade of at least one point, and nine showed no improvement. No patients had deterioration of Nurick grade. Preoperative myelomalacia was noted in 15 (47%) patients, and all 15 had residual myelomalacia postoperatively. Severe myelopathy, age, and myelomalacia had no prognostic value for improvement of myelopathy. Complications included pseudarthrosis (3%), wound infection (9%), and transient C5 palsy (6%). This study demonstrates excellent outcomes from laminectomy and fusion in multilevel cervical myelopathy. A high rate of improvement of myelopathy was observed, neurologic deterioration did not occur, and complication rates were low. Severe myelopathy and myelomalacia on preoperative MRI had no prognostic value.