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1
Seifert, Volker, and Dietmar Stolke. "Multisegmental Cervical Spondylosis: Treatment by Spondylectomy, Microsurgical Decompression, and Osteosynthesis." Neurosurgery 29, no. 4 (October 1, 1991): 498–503. http://dx.doi.org/10.1227/00006123-199110000-00002.
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Abstract Vertebral body replacement after spondylectomy, combined with microsurgical decompression and anterior plating, was performed in 22 patients as an aggressive therapeutic approach to multisegmental cervical spondylosis. The patients were 13 men and 9 women, ranging in age from 32 to 74 years. In 19 patients, the typical signs of cervical myelopathy were present. In three patients, pain was the major symptom, accompanied by moderate spastic paresis and hyperreflexia. Apart from cervical myelography and computed tomographic scanning, which was performed in 10 patients, magnetic resonance imaging was the radiological procedure of choice in 12 patients. During spondylectomy, one vertebra was removed in 14 patients, two vertebrae in seven patients, and three vertebrae in one patient. The time of postoperative follow-up ranged from 8 to 46 months, with an average interval of 21 months. In all 22 patients, satisfactory bony fusion was achieved as demonstrated by radiological control examinations. Seventeen patients (77%) were symptom free or had only minor residual symptoms. Three (14%) patients had intermittent nuchal or cervicobrachial pain, which responded well to analgesic medication or the application of a soft collar. Two (9%) patients still had myelopathic but not incapacitating symptoms. Of 15 patients who were employed before surgery, 13 returned to a full-time job. The only severe complication of surgery was a prevertebral abscess that healed without sequelae. It is concluded that aggressive surgical therapy of multisegmental cervical spondylosis by a combination of vertebrectomy, decompression (using the surgical microscope), bone grafting, and osteosynthesis is a straightforward and promising procedure for the treatment of this debilitating disease.
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Detwiler, Paul W., Randall W. Porter, Timothy R. Harrington, Volker K. H. Sonntag, and Robert F. Spetzler. "Vascular decompression of a vertebral artery loop producing cervical radiculopathy." Journal of Neurosurgery 89, no. 3 (September 1998): 485–88. http://dx.doi.org/10.3171/jns.1998.89.3.0485.
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✓ Vertebral artery tortuosity and loop formation are rare causes of cervical radiculopathy. The authors present the case of a 70-year-old man with 9 years of progressive right-sided cervical and scapular pain but no history of trauma. Computerized tomography myelography and magnetic resonance imaging revealed an ovoid mass in the right C3–4 intervertebral foramen. The patient underwent a right C-3 and C-4 hemilaminectomy and a complete C3–4 facetectomy. A pulsatile vascular structure was found compressing the right C-4 nerve root. The bone overlying the vascular structure was removed, producing decompression of the nerve root. Immediate postoperative angiography showed that this lesion was a focal vertebral artery loop. The patient's symptoms resolved after surgery, supporting the use of vascular decompression of a cervical nerve root compressed by a vertebral artery loop for the relief of radicular symptoms.
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Mizuno, Junichi, Hiroshi Nakagawa, and Yoshio Hashizume. "Analysis of Hypertrophy of the Posterior Longitudinal Ligament of the Cervical Spine, on the Basis of Clinical and Experimental Studies." Neurosurgery 49, no. 5 (November 1, 2001): 1091–98. http://dx.doi.org/10.1097/00006123-200111000-00013.
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ABSTRACT OBJECTIVE The goal of this study was to elucidate the pathophysiological features and treatment of hypertrophy of the posterior longitudinal ligament (HPLL) of the cervical spine. HPLL is defined as a pathological thickening of the posterior longitudinal ligament (PLL), causing spinal cord compression. Incomplete decompression via removal of only coexisting herniated intervertebral discs or spondylotic spurs might be performed, resulting in unsatisfactory surgical outcomes, when the PLL becomes abnormally thickened and contributes to myelopathy. METHODS Patients with HPLL who underwent cervical decompression surgery were selected. Medical records and radiographs were retrospectively reviewed, to obtain data on the pre- and postoperative clinical conditions of the patients. Autopsy cases with HPLL proven by low-energy x-ray examinations were chosen for assessment of the pathological characteristics. RESULTS Seventeen men and three women with HPLL underwent treatment via an anterior approach, with direct removal of HPLL. Nineteen patients developed myelopathy, whereas one patient developed radiculopathy. Radiologically, all HPLL cases exhibited coexisting herniated intervertebral discs and 10 exhibited small segmental ossifications of the PLL. Magnetic resonance imaging or computed tomographic myelography revealed extensive cord compression across the vertebral endplate level. The average preoperative Benzel modified Japanese Orthopaedic Association score was 10.8, and the average postoperative score was 13.2. Histological examinations revealed thickening of the PLL with proliferation of chondrocytes, together with various degenerative changes. CONCLUSION Patients with HPLL can benefit from an anterior approach with direct removal of the HPLL and associated herniated intervertebral discs or ossification of the PLL. Cervical polytomography, computed tomography, and magnetic resonance imaging are useful in establishing a diagnosis of HPLL.
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Shaffrey, Christopher I., Gregory C. Wiggins, Cynthia B. Piccirilli, Jacob N. Young, and LaVerne R. Lovell. "Modified open-door laminoplasty for treatment of neurological deficits in younger patients with congenital spinal stenosis: analysis of clinical and radiographic data." Journal of Neurosurgery: Spine 90, no. 2 (April 1999): 170–77. http://dx.doi.org/10.3171/spi.1999.90.2.0170.
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Object. Multilevel anterior cervical decompressive surgery and fusion effectively treats cervical myeloradiculopathy that is caused by severe cervical spinal stenosis, but degenerative changes at adjacent vertebral levels frequently result in long-term morbidity. The authors performed a modified open-door laminoplasty procedure in which allograft bone and titanium miniplates were used to treat cervical myeloradiculopathy in younger patients with congenital canal stenosis while maintaining functional cervical motion segments. Pre- and postoperative magnetic resonance imaging and/or computerized tomography myelography were performed to assess changes in cervical spinal canal dimensions. Pre- and postoperative flexion—extension radiographs were compared to determine the residual motion of the targeted operative segments. Methods. Twenty younger patients (average age 37.7 years) underwent modified open-door laminoplasty for treatment of myelopathy or myeloradiculopathy related to significant cervical spinal stenosis with or without associated central or lateral disc herniation or foraminal stenosis. These surgeries were performed during a 2-year period and follow-up review remains ongoing (average follow-up period 21.6 months). Reconstructive procedures were performed on an average of 4.1 levels (range three—six). Operative time averaged 186 minutes (range 93–229 minutes). Average blood loss was 305 ml (range 100–650 ml). No cases were complicated by neurological deterioration, infection, wound breakdown, graft displacement, or hardware failure. The patients' Nurick Scale grade improved from a preoperative average of 1.8 to a postoperative average of 0.5. Pre- and postoperative sagittal spinal diameter averaged 11.2 mm (8–14 mm) and 16.6 mm (13–19 mm), respectively. The sagittal compression ratio (sagittal/lateral × 100%) increased from 48% pre- to 72% postoperatively. The spinal canal area increased an average of 55% (range 19–127%). In patients in whom pre- and postoperative flexion—extension radiographs were obtained, 72.7% residual neck motion was maintained. No patient developed increased neck or shoulder pain. Neurological symptoms improved in all patients, with total relief of myelopathy in 50% and partial improvement in 50%. Conclusions. Modified open-door laminoplasty with allograft bone and titanium miniplates effectively treats neurological deficits in younger patients with congenital and spinal stenosis. Although long-term results are unknown, short-term results are good and there is a low incidence of complications.
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Colombo, N., C. Maccagnano, C. Corona, A. Beltramello, and G. Scialfa. "I traumi cervicali." Rivista di Neuroradiologia 10, no. 1 (February 1997): 63–102. http://dx.doi.org/10.1177/197140099701000107.
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Injury to the cervical spinal cord is a major health problem owing to its frequency and to the often devastating sequelae of serious trauma with respect to long-term disability for the patient. Cervical injuries are often reported in association with head trauma and cervical spinal cord injury appears to be a major contributing factor in acute death secondary to traffic accidents producing severe head injuries. A high incidence of neurological deficits is reported in cervical spinal trauma, but cervical injuries can escape detection in the acute phase if clinically silent or in patients unconscious from to head trauma. The most important predisposing factor in the concomitant occurrence of head and neck trauma is transmission of forces through the cranial vault to the cervical spine. Other underlying cervical spine diseases, either congenital or developmental, may also predispose to the development of cervical injuries. The spine includes bony-ligamentous structures and nervous structures. The bony-ligamentous involucre is anatomically predisposed to perform three major tasks: 1) maintenance of spinal statics; 2) mobilization in the three anatomic planes and 3) protection of nervous and vascular structures inside the spinal canal. The cervical spine is subjected to varying forces of flexion, flexion-rotation, extension and vertical compression which result in damage to the different components of the spine when they are applied beyond physiological limits. Biomechanical considerations of the different motion patterns that occur in the cervical spine are essential to understand the contribution of mechanical stresses to the development of specific spinal injuries. This chapter tackles the problem of a logical management of cervical spinal trauma based on clinical presentation to: a) identify the preferential diagnostic modality to investigate that type of injury (conventional X-Ray, Computed Tomography, Magnetic Resonance); b) interpret images, indipendently from the diagnostic modality utilized, considering the cause-effect relation between the traumatic force and the anatomic-functional structures involved by the trauma. The clinical picture may include pain, movement limitations and/or radiculo-myelopathy. Cerebral neurologic deficits can be the consequence of traumatic damage to the carotid and vertebral artery system in the neck. Evaluation of injury instability is one of the main goals of radiographic investigation. One classifies bony instability which is temporary, as opposed to disco-ligamentous instability which is permanent and usually requires surgical stabilization, and mixed instability. Conventional lateral and antero-posterior radiographs should be initially performed in patients with cervical trauma and in polytrauma and comatous patients who are difficult to assess clinically. They effectively screen vertebral fractures, vertebral body and facet dislocations and pre-vertebral soft tissue swelling. However, ligament disruption and instability can be underestimated by a normal disco-vertebral alignment. Dynamic flexion-extension views, useful to reveal such an instability, should never be performed in the acute phase particularly if fractures and neurologic deficits are present. CT scan, in addition, has several advantages: the axial plane provides an optimal view of the size and shape of the spinal canal, bony fragments and foreign bodies within the canal are very well depicted, posterior element fractures are better visualized. A preexsisting spondylotic narrow canal is well evaluated by CT as are post-traumatic disc herniations. Widening of the apophyseal joints, suggesting disruption of facet capsules and spinal instability, is best demonstrated by CT. However, CT has some limitations in evaluating ligament instability since it is performed in the neutral position and, in addition, it cannot visualize the medulla and its potential traumatic lesions. After the introduction of MRI, myelography and CT-myelography are no longer used to investigate cervical spine lesions involving cord and nerve roots. MRI should be performed in every patient presenting with neurologic deficits. The usefulness of MR is in detecting extradural compressive lesions like disc herniation and haematomas that need to be decompressed surgically. MRI can also evaluate ligamentous integrity and disk rupture. Bony fractures are revealed by MRI either by signal or morphologic alterations of vertebral bodies, but thin, linear fractures are less well identified than with CT. One of the main advantages of MRI is the direct identification of intrinsic cord pathology such as cord contusion and haemorrhage. Cord haemorrhage seems to be predictive of a complete lesion and of poor outcome. Therefore MRI is proposed to assess the prognosis of traumatic cord lesions, the best time for imaging ranging between 24 and 72 hours after injury.
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Kokmen, E., W. R. Marsh, and H. L. Baker. "Magnetic Resonance Imaging in Syringomyelia." Neurosurgery 17, no. 2 (August 1, 1985): 267–70. http://dx.doi.org/10.1227/00006123-198508000-00003.
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Abstract Myelography and myelography assisted with computed tomography have been the most commonly used radiographic methods in the study of syringomyelia. These studies have never been entirely reliable in demonstrating the syrinx cavity and its relationship to other intracranial structures. During the 1st year of operation of the magnetic resonance imaging facility, the syringomyelic cavity was demonstrated in 15 patients who all had typical clinical signs and symptoms associated with syringomyelia. Nine cases were syringomyelia with Chiari malformation. One case showed additional hydrocephalus. Four cases were idiopathic, and 1 case was remotely posttraumatic. Magnetic resonance imaging, although it is in its infancy, already promises to be the most important radiographic technique for syringomyelia because it provides an anatomically truthful visualization of the sagittal plane of the cervical cord and can demonstrate the syrinx cavity and its relationship with the cerebellar tonsils, the 4th ventricle, and other related structures.
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Doi, Kazuteru, Ken Otsuka, Yukinori Okamoto, Hiroshi Fujii, Yasunori Hattori, and Amresh S. Baliarsing. "Cervical nerve root avulsion in brachial plexus injuries: magnetic resonance imaging classification and comparison with myelography and computerized tomography myelography." Journal of Neurosurgery: Spine 96, no. 3 (April 2002): 277–84. http://dx.doi.org/10.3171/spi.2002.96.3.0277.
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Object. The authors describe a new magnetic resonance (MR) imaging technique to demonstrate the status of the cervical nerve roots involved in brachial plexus injury. They discuss the accuracy and reproducibility of a MR imaging—derived classification for diagnosis of nerve root avulsion compared with those of myelography combined with computerized tomography (CT) myelography. Methods. The overlapping coronal—oblique slice MR imaging procedure was performed in 35 patients with traumatic brachial plexus injury and 10 healthy individuals. The results were retrospectively evaluated and classified into four major categories (normal rootlet, rootlet injuries, avulsion, and meningocele) after confirming the diagnosis by surgical exploration with or without spinal evoked potential (EP) measurements and by referring to myelography and CT myelography findings. The reliability and reproducibility of the MR imaging—based classification was prospectively assessed by eight independent observers, and its diagnostic accuracy was compared with that of traditional myelography/CT myelography classification, correlated with surgical and spinal EP findings in another 50 cervical roots in 10 patients with traumatic brachial plexus injury. Conclusions. In the retrospective study in which MR imaging and myelography/CT myelography findings involving 175 cervical roots in 35 patients were compared, the sensitivity of detection of the cervical nerve root avulsion was the same (92.9%) with both modalities. In the prospective study, interobserver reliability and intraobserver reproducibility showed that there was no statistically significant difference between MR imaging and myelography/CT myelography and that their accuracy for detecting cervical root avulsion was the same as that in the retrospective study. The overlapping coronal—oblique slice MR imaging technique is a reliable and reproducible method for detecting nerve root avulsion. The information provided by this modality enabled the authors to assess the roots of the brachial plexus and provided valuable data for helping to decide whether to proceed with exploration, nerve repair, primary reconstruction, or other imaging modalities.
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Al-Mefty, Ossama, Louis H. Harkey, Troy H. Middleton, Robert R. Smith, and John L. Fox. "Myelopathic cervical spondylotic lesions demonstrated by magnetic resonance imaging." Journal of Neurosurgery 68, no. 2 (February 1988): 217–22. http://dx.doi.org/10.3171/jns.1988.68.2.0217.
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✓ Eighteen cases are presented in which magnetic resonance (MR) imaging demonstrated two types of lesions in patients with cervical spondylotic myelopathy. In the first type, localized spinal cord changes at the level of compression, consistent with myelomalacia, were revealed best with T2-weighted images as high-intensity spinal cord signals. In the second type, lesions consistent with either cystic necrosis or secondary syrinx were noted locally, and/or extending longitudinally up, and/or down inside the spinal cord. These latter lesions were best revealed as low-intensity signals on T1-weighted MR images and as a signal-void sign (moving fluid) on proton-density or T2-weighted MR images. It is suggested that segmental lesions at the level of the spondylotic bar represent early proton changes from pressure in and around the same zones that evolve into gray-matter enhancement regions shown as “snake-eyes” on delayed computerized tomography (CT) after myelography. The longitudinal lesions are thought to be the same pencil-shaped zones of cystic necrosis evolving into a secondary syrinx in the late stages (and usually found in the anterior portion of the dorsal columns during delayed CT after myelography). As spinal MR imaging continues to improve, these lesions will be demonstrated more clearly within the cord substance.
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Carvalho, Gustavo Adolpho, Guido Nikkhah, Cordula Matthies, Götz Penkert, and Madjid Samii. "Diagnosis of root avulsions in traumatic brachial plexus injuries: value of computerized tomography myelography and magnetic resonance imaging." Journal of Neurosurgery 86, no. 1 (January 1997): 69–76. http://dx.doi.org/10.3171/jns.1997.86.1.0069.
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✓ Surgical management and prognosis of traction injuries of the brachial plexus depend on the accurate diagnosis of root avulsion from the spinal cord. Myelography, computerized tomography (CT) myelography, and recently magnetic resonance (MR) imaging have become the main radiological methods for preoperative diagnosis of cervical root avulsions. Most of the previous studies on the accuracy of CT myelography and MR imaging studies have correlated the radiological findings with the extraspinal surgical findings at brachial plexus surgery. Surgical experience shows that in many cases extraspinal findings diverge from intradural determinations. Consequently, only correlation with the intradural surgical findings will allow assessment of the factual accuracy of CT myelography and MR imaging studies. In a prospective study, 135 cervical roots (C5–8) were evaluated by CT myelography and/or MR imaging and further explored intradurally via a hemilaminectomy. The accuracy of the preoperative CT myelography—based diagnosis in relation to the intraoperative findings was 85%. On the other hand, MR imaging demonstrated an accuracy of only 52%. The most common reasons for false-positive or false-negative findings were: 1) partial rootlet avulsion; 2) intradural fibrosis; and 3) dural cystic lesions. Computerized tomography myelography scans using 1- to 3-mm axial slices prove to be the most reliable method to evaluate preoperatively the presence of complete or partial root avulsion in traumatic brachial plexus injuries. Because extradural judgment of cervical root avulsion can be unreliable, accurate assessment of intraspinal root avulsion enormously simplifies the decision concerning the choice of donor nerves for transplantation and/or neurotization during brachial plexus surgery.
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Takahashi, Shinobu, Shigehiro Morikawa, Masaaki Egawa, Yasuo Saruhashi, and Yoshitaka Matsusue. "Magnetic resonance imaging—guided percutaneous fenestration of a cervical intradural cyst." Journal of Neurosurgery: Spine 99, no. 3 (October 2003): 313–15. http://dx.doi.org/10.3171/spi.2003.99.3.0313.
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✓ The authors describe the case of a high cervical, intradural extramedullary cyst located anterior to the spinal cord in a 13-year-old boy. The lesion was fenestrated percutaneously by using real-time magnetic resonance (MR) imaging guidance and a local anesthetic agent. The patient's symptom, severe exercise-induced headache, immediately resolved after treatment. Nine months later, complete disappearance of the cyst was confirmed on MR imaging and computerized tomography myelography. Magnetic resonance imageing—guided fenestration can be considered a minimally invasive option for intradural cystic lesions.
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Wilson, Donald W., Roger T. Pezzuti, and James N. Place. "Magnetic Resonance Imaging in the Preoperative Evaluation of Cervical Radiculopathy." Neurosurgery 28, no. 2 (February 1, 1991): 175–79. http://dx.doi.org/10.1227/00006123-199102000-00001.
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Abstract Forty patients with cervical radiculopathy were examined preoperatively with magnetic resonance imaging (MRI). MRI was used alone in 27 (68%) of the 40 patients; the remainder also had computed tomography in conjunction with myelography. The primary criterion on MRI for a clinically significant lesion was asymmetrical narrowing of the subarachnoid space in the region of the nerve root. Surgical confirmation of the abnormality was obtained in all 40 cases. The operative findings were a herniated nucleus pulposus (32 of 40 patients), spondylosis (2 of 40 patients), or a combination of the two (6 of 40 patients). MRI identified a surgical lesion (herniated nucleus pulposus, spondylosis, or both) in 37 of the 40 (92%) patients. We think MRI is the only preoperative imaging examination necessary in most cases of cervical radiculopathy.
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Harrington, Frederick J., Matt J. Likavec, and Alison S. Smith. "Disc Herniation in Cervical Fracture Subluxation." Neurosurgery 29, no. 3 (September 1, 1991): 374–79. http://dx.doi.org/10.1227/00006123-199109000-00006.
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Abstract Previous reports of computed tomographic scan with contrast myelography in cervical spinal cord injury have shown a rate of disc herniation of less than 5%. We hypothesized that injuries associated with forces adequate to cause bone or ligamentous injury in the region of the disc space could be associated with higher and more significant rates of disc herniation. Thirty-seven consecutive traumatic midcervical fracture subluxations were reviewed. Fracture subluxation was defined by fracture of the facet joints, pedicles, or vertebral bodies or more than 3.5 mm subluxation from C2-C3 to C7-T1. Reduction was achieved in 97% and was not associated with neurological deterioration. On the basis of plain films, tomograms, and plain computed tomographic scans, the injuries were classified as flexion dislocation, flexion compression, compression burst, or extension injuries. Twenty-five computed tomographic scans with contrast myelograms and one magnetic resonance imaging scan were obtained. All patients with partial neurological deficits were studied. A herniated disc was defined as that which deformed the thecal sac and/or nerve roots. Retrospectively, a neuroradiologist reviewed the studies for the presence of herniated disc. Disc herniation was seen at the level of injury in 9 (35%) patients and not seen in other patients. Forty-seven percent of the patients with partial deficits had herniated discs. Herniated discwas seen most frequently in flexion dislocation and flexion compression injuries. Three patients (20%) with partial deficits underwent discectomy. Patients with partial spinal cord injury and discectomy, on average, improved more than other patients with partial spinal cord injury. The authors conclude that: 1) herniated discs occur frequently in cervical fracture subluxation and are clinically significant; 2) disc herniation is associated with flexion dislocation and flexion compression injuries; 3) neuroimaging studies should be obtained in all patients with cervical fracture subluxation and neurological deficit to rule out compressive discs.
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MOUZAKITIS (Η.Ν. ΜΟΥΖΑΚΙΤΗΣ), E. N., G. M. KAZAKOS (Γ.Μ. ΚΑΖΑΚΟΣ), M. N. PATSIKAS (Μ.Ν. ΠΑΤΣΙΚΑΣ), and Z. S. POLIZOPOULOU (Ζ.Σ. ΠΟΛΥΖΟΠΟΥΛΟΥ). "Cervical spondylomyelopathy in dogs." Journal of the Hellenic Veterinary Medical Society 64, no. 4 (December 20, 2017): 255. http://dx.doi.org/10.12681/jhvms.15505.
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Cervical spondylomyelopathy (CSM) is the most common disease of the cervical spine in large and giant breed dogs. Its exact aetiology is not known and the relevant pathophysiology is not clear; two clinical entities are currently recognised: disc-associated and osseous-associated spinal cord compression. History and clinical signs are indicative of cervical spondylomyelopathy, although its neurologic manifestation can vary from cervical pain only to tetraparesis and respiratory compromise. Imaging of the spine is fundamental for definitive diagnosis and includes radiography, myelography, computed tomography and magnetic resonance imaging. It is also the cornerstone of surgical planning. This is usually based on the subjective concept of dynamic or static compressive lesions. Among the advanced imaging techniques, magnetic resonance imaging is superior to myelography for diagnosis of cervical spondylomyelopathy, although, at present, these techniques can be considered complementary.Furthermore, attention is drawn to the false positive interpretations of magnetic resonance findings, which are related to clinically irrelevant spinal cord compression. Hence, the degree of agreement between neuroanatomic localization and neuroimaging is of the outmost importance. Conservative treatment consists of strict restriction of the animal and the use of steroid or non-steroid anti-inflammatory drugs. Objective of surgical treatment is to decompress the spinal cord. However, the decision-making process of surgical treatment is more complicated, because a large number of different surgical techniques have been proposed. Adjacent segment disease is a controversial complication of the surgical treatment of disk-associated cervical spondylomyelopathy and recently introduced motion-preserving techniques are targeted on reducing its occurrence. Significant prognostic information for focal parenchymal damage may derive from magnetic resonance imaging studies, but this remains to be further clarified.
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Sarto, Cibely G., Maria Cristina F. N. S. Hage, Luciana D. Guimarães, Robson F. Giglio, Andréa P. B. Borges, and Luiz C. Vulcano. "The role of B-mode ultrasonography in the musculoskeletal anatomical evaluation of the cervical region of the dog spine." Pesquisa Veterinária Brasileira 34, no. 1 (January 2014): 91–97. http://dx.doi.org/10.1590/s0100-736x2014000100015.
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This study characterized the normal musculoskeletal anatomy of the cervical segment of the spine of dogs by means of B-mode ultrasonography. The objective was to establish the role of B-mode ultrasonography for the anatomical evaluation of the cervical spine segment in dogs, by comparing the ultrasonographic findings with images by computed tomography and magnetic resonance imaging. The ultrasound examination, in transverse and median sagittal sections, allowed to identify a part of the epaxial cervical musculature, the bone surface of the cervical vertebrae and parts of the spinal cord through restricted areas with natural acoustic windows, such as between the atlanto-occipital joint, axis and atlas, and axis and the third cervical vertebra. The images, on transverse and sagittal planes, by low-field magnetic resonance imaging, were superior for the anatomical identification of the structures, due to higher contrast between the different tissues in this modality. Computed tomography showed superiority for bone detailing when compared with ultrasonography. As for magnetic resonance imaging, in addition to the muscles and cervical vertebrae, it is possible to identify the cerebrospinal fluid and differentiate between the nucleus pulposus and annulus fibrosus of the intervertebral discs. Although not the scope of this study, with knowledge of the ultrasonographic anatomy of this region, it is believed that some lesions can be identified, yet in a limited manner, when compared with the information obtained mainly with magnetic resonance imaging. The ultrasound examination presented lower morphology diagnostic value compared with the other modalities.
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Morenski, John David, Anthony M. Avellino, J. Paul Elliott, and H. Richard Winn. "Bilateral Multiple Cervical Root Avulsions without Skeletal or Ligamentous Damage Resulting from Blast Injury: Case Report." Neurosurgery 50, no. 6 (June 1, 2002): 1368–71. http://dx.doi.org/10.1097/00006123-200206000-00032.
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Abstract OBJECTIVE AND IMPORTANCE We describe a unique case of multiple bilateral cervical root injuries without ligamentous or bony injury secondary to a sandblast accident. CLINICAL PRESENTATION A 19-year-old man sustained a sandblast injury to his face, neck, chest, and upper extremities, with immediate loss of motor and sensory function occurring in both of his upper extremities. Cervical spine x-rays, computed tomography, and magnetic resonance imaging demonstrated no fracture, soft tissue abnormality, or malalignment. The restriction of deficits to the patient's upper extremities suggested a central cervical spinal cord injury, bilateral brachial injuries, or a conversion disorder. INTERVENTION Cervical computed tomographic myelography revealed multiple bilateral nerve root injuries. CONCLUSION This case report is unique in the literature in that it describes a patient with multiple cervical nerve root injuries secondary to sandblast injury without ligamentous or bony injury. Although magnetic resonance imaging remains the diagnostic modality of choice in patients with acute spinal cord injury, it is deficient in demonstrating cervical root injury in the acute setting. In this setting, computed tomographic myelography is superior.
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Mummaneni, Praveen V., Michael G. Kaiser, Paul G. Matz, Paul A. Anderson, Michael Groff, Robert Heary, Langston Holly, et al. "Preoperative patient selection with magnetic resonance imaging, computed tomography, and electroencephalography: does the test predict outcome after cervical surgery?" Journal of Neurosurgery: Spine 11, no. 2 (August 2009): 119–29. http://dx.doi.org/10.3171/2009.3.spine08717.
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Object The objective of this systematic review was to use evidence-based medicine to assess whether preoperative imaging or electromyography (EMG) predicts surgical outcomes in patients undergoing cervical surgery. Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to the preoperative imaging and EMG. Abstracts were reviewed after which studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results Preoperative MR imaging and CT myelography are successful in confirming clinical radiculopathy (Class II). Multilevel T2 hyperintensity, T1 focal hypointensity combined with T2 focal hyperintensity, and spinal cord atrophy each convey a poor prognosis (Class III). There is conflicting data concerning whether focal T2 hyperintensity or cervical stenosis are associated with a worse outcome. Electromyography has mixed utility in predicting outcome (Class III). Conclusions Magnetic resonance imaging or CT myelography are important for preoperative assessment. Magnetic resonance imaging may be helpful in assessing prognosis, whereas EMG has mixed utility in assessing outcome.
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Shafaie, Farid F., Franz J. Wippold, Mokhtar Gado, Thomas K. Pilgram, and K. Daniel Riew. "Comparison of Computed Tomography Myelography and Magnetic Resonance Imaging in the Evaluation of Cervical Spondylotic Myelopathy and Radiculopathy." Spine 24, no. 17 (September 1999): 1781. http://dx.doi.org/10.1097/00007632-199909010-00006.
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Steinmetz, Michael P., Todd J. Stewart, Christopher D. Kager, Edward C. Benzel, and Alexander R. Vaccaro. "CERVICAL DEFORMITY CORRECTION." Neurosurgery 60, suppl_1 (January 1, 2007): S1–90—S1–97. http://dx.doi.org/10.1227/01.neu.0000215553.49728.b0.
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Abstract SUBAXIAL CERVICAL DEFORMITIES most often occur in the sagittal plane, primarily as kyphosis. Kyphosis may develop secondary to advanced degenerative disease, trauma, neoplastic disease, or after surgery. Whatever the cause, the development of cervical deformity should be avoided and corrected when appropriate because the greater the deformity, the greater the probability of an associated neurological deficit or chronic pain. Patients usually present with mechanical type cervical pain, with or without neurological deficit (i.e., myelopathy). They may also be relatively asymptomatic. Work-up includes appropriate imaging studies, such as radiographs, including dynamic images, and magnetic resonance imaging or computed tomography myelography. The deformity may be accurately assessed and an appropriate surgical strategy undertaken. Depending on flexibility of the deformity and the presence or absence of facet ankylosis, a dorsal, ventral, or combined approach may be used. All approaches are unique in their ability to correct a deformity and in their associated complications. A comprehensive discussion of each is undertaken.
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Korneev, I. A., T. A. Akhadov, I. A. Mel'nikov, O. S. Iskhakov, N. A. Semenova, D. M. Dmitrenko, A. V. Manzhurtsev, M. I. Akhlebinina, P. E. Menshchikov, and M. V. Ublinskiy. "The role of magnetic resonance imaging in acute trauma of the cervical spine in children." Medical Visualization 22, no. 6 (March 1, 2019): 105–15. http://dx.doi.org/10.24835/1607-0763-2018-6-105-115.
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Aim.To evaluate the role of magnetic resonance imaging (MRI) as a diagnostic method in children with acute trauma of the cervical spine and spinal cord, to compare the correspondence of MRI results with neurologic symptoms in accordance with the ASIA scale.Materials and methods.156 children with acute trauma of spine and spinal cord at the age from 6 months up to 18 years were studied. MRI was performed on a Phillips Achieva 3T scanner. The standard protocol included MYUR (myelography) in coronal and sagittal projections, STIR and T2VI FS SE in sagittal projection, T2VI SE or T2 * VI FSGE (axial projection), 3D T1VI FSGE before and after contrast enhancement. Contrast substance was injected intravenously in the form of a bolus at the rate of 0.1 mmol/kg (equivalent to 0.1 ml/kg) at a rate of 3 to 4 ml.Results.The causes of cervical spine blunt trauma were: road accidents (55), catatrauma (60), “diver” trauma (21), blunt trauma (20). Intramedullary lesions of the spinal cord were detected: concussion (49), bruising / crushing (27), hematomia (34), disruption with divergence of segments (21), accompanied by edema (141); extramedullary lesions: epi- and subdural, intralesive and sub-connective and soft tissues hematomas (68), ruptures of bundles (48), fractures (108), dislocation and subluxation of the vertebrae (35), traumatic disc herniation (37), spinal cord compression and/or rootlets (63), statics violation (134), instability (156).Conclusion.MRI is the optimal method for spinal cord injury diagnostics. In the acute period of injury this technique has limited application, but it can however serve as a primary diagnostic method in these patients. MRI should be performed no later than the first 72 hours after injury. The most optimal for visualization of cervical spine trauma and spinal cord are T2VI SE and STIR in sagittal projection with suppression of signal from fat. MRI results correlate with neurologic symptoms at the time of performance according to the ASIA scale, and therefore MRI should be performed in all patients with acute cervical spine trauma, whenever possible.
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Saba, N., A. Rani, G. Sehgal, Rk Verma, Ak Srivastava, and M. Faheem. "Fusion of axis with third cervical vertebra: a case report." Romanian Neurosurgery 30, no. 2 (June 1, 2016): 284–88. http://dx.doi.org/10.1515/romneu-2016-0044.
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Abstract Introduction: Fusion of one or more contiguous vertebral segments is usually the result of embryological failure of normal spinal segmentation. It may be associated with syndromes such as Klippel-Feil. Fused cervical vertebrae (FCV) may also be acquired or pathologic. FCV is generally associated with disease like tuberculosis, other infections, juvenile rheumatoid arthritis and trauma. The commonest site of involvement is C2-C3. In condition of fusion the two vertebrae appear not only structurally as one but also function as one. This anomaly may be asymptomatic; however, it may also manifest in the form of serious clinical features such as myelopathy, limitation of the neck movement, muscular weakness, atrophy or neurological sensory loss. Case report: We observed the fusion of axis with 3rd cervical vertebra. Body, laminae and spines of C2 and C3 were completely fused on both anterior and posterior aspects, whereas the pedicles and transverse processes were not fused. Foramen transversarium was present on both the vertebrae bilaterally. Conclusion: This variation is noteworthy to neurosurgeons and radiologists in studying computed tomography (CT) and magnetic resonance imaging (MRI) scans.
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Fraga-Manteiga, E., K. Eatwell, S. Smith, E. Mancinelli, and T. Schwarz. "Traumatic atlanto-occipital subluxation and cranial cervical block vertebrae in a Golden Eagle (Aquila chrysaetos)." Vlaams Diergeneeskundig Tijdschrift 82, no. 4 (August 29, 2013): 211–15. http://dx.doi.org/10.21825/vdt.v82i4.16698.
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A Golden Eagle (Aquila chrysaetos) was evaluated for a balance/equilibrium disorder after suffering trauma due to a hard landing during fi tness training. Magnetic resonance imaging and computed tomography demonstrated a chronic atlanto-occipital subluxation with craniodorsal displacement of the atlas (atlanto-occipital overlapping) causing dynamic brainstem and spinal cord compression and an old malunion fracture with fusion of C1 and C2. The bird was euthanized because of clinical deterioration and poor prognosis.
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Zheng, Shan, Aikeremujiang Muheremu, Yuqing Sun, Wei Tian, and Cheng-ai Wu. "Preoperative imaging differences of patients with cervical spondylosis with cervical vertigo indicate the prognosis after cervical total disc replacement." Journal of International Medical Research 48, no. 2 (October 23, 2019): 030006051987703. http://dx.doi.org/10.1177/0300060519877033.
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Objective To evaluate the relationship between the preoperative imaging differences and prognosis in patients with cervical spondylosis with cervical vertigo who underwent total disc replacement (TDR). Methods This was a retrospective study of patients with cervical spondylosis with cervical vertigo treated with single-segment TDR. The severity of pre- and postoperative cervical vertigo was evaluated separately. Paired samples t-tests were used to compare the severity of the symptoms before and after surgery. Characteristics of plain films, computed tomography myelography and magnetic resonance imaging were compared between patients with different outcomes by analysis of variance and Fisher’s exact tests. Results The severity of cervical vertigo was significantly different after single-segment TDR. Three groups with different treatment outcomes were not significantly different with regard to gender, age, type of the cervical spondylosis, follow-up time, segment of surgery, cervical curve, range of motion, T2WI high signal in the spinal cord, and location of compression. The type of compression was significantly different between the three groups. Conclusions Cervical vertigo was improved in patients with cervical spondylosis through the TDR procedure. Those in whom a herniated disc was the main source of compression may have a better prognosis following TDR.
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Yasuda, Hiromi, Tadanobu Shimura, Masato Okigami, Shigeyuki Yoshiyama, Masaki Ohi, Koji Tanaka, Yasuhiko Mohri, and Masato Kusunoki. "Esophageal Cancer with Bone Marrow Hyperplasia Mimicking Bone Metastasis: Report of a Case." Case Reports in Oncology 9, no. 3 (November 7, 2016): 679–84. http://dx.doi.org/10.1159/000449525.
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A 63-year-old man visited the clinic with numbness in the right hand. Magnetic resonance imaging demonstrated multiple low-intensity lesions in the cervical vertebrae and sacrum, which was suspicious of cervical bone metastasis. Fluorodeoxyglucose positron emission tomography/computed tomography revealed areas of increased fluorodeoxyglucose uptake in the thoracic esophagus, sternum and sacrum. A flat, elevated esophageal cancer was identified by upper gastrointestinal endoscopy, and the macroscopic appearance indicated early-stage disease. From the cervical, thoracic and abdominal computed tomography images, there were no metastatic lesions except for the bone lesions. To confirm whether the bone lesions were metastatic, we performed bone biopsy. The histopathological diagnosis was bone marrow hyperplasia. It was crucial for treatment planning to establish whether the lesions were distant metastases. Here, we report a case of esophageal cancer with bone marrow hyperplasia mimicking bone metastasis.
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Inenaga, Chikanori, Tokutaro Tanaka, Naoki Sakai, and Shigeru Nishizawa. "Diagnostic and surgical strategies for intractable spontaneous intracranial hypotension." Journal of Neurosurgery 94, no. 4 (April 2001): 642–45. http://dx.doi.org/10.3171/jns.2001.94.4.0642.
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✓ The authors present the case of a 55-year-old man suffering from intractable spontaneous intracranial hypotension, in whom conservative treatment with 19 weeks of bed rest was not effective. In this period the patient twice underwent surgery for bilateral chronic subdural hematoma, a complication of spontaneous intracranial hypotension. Conventional radionuclide cisternography, magnetic resonance imaging, and computerized tomography myelography did not demonstrate cerebrospinal fluid (CSF) leakage. Repeated radionuclide cisternography with the patient in an upright position revealed leakage of the tracer at upper cervical levels. Computerized tomography myelography with breath holding also showed CSF leakage of the contrast medium bilaterally at upper cervical levels. The patient underwent surgery, and bilateral C-2 and C-3 spinal nerve root pouches were sealed off from the subarachnoid space with oxidized cellulose cotton and fibrin glue. Epiarachnoid spaces around the root sleeves were also sealed to ensure complete resolution of the CSF leakage. After the surgery, the patient was completely free of the disease. In the case of intractable persistent spontaneous intracranial hypotension, surgical treatment is preferable to long-term conservative management. To identify CSF leakage, radionuclide cisternography with the patient in the upright position is useful. When obvious leakage is encountered, surgical sealing of the lesion should be performed via a subarachnoid approach.
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Scott, Eric W., Craig R. Cazenave, and Chat Virapongse. "Spinal Subarachnoid Hematoma Complicating Lumbar Puncture: Diagnosis and Management." Neurosurgery 25, no. 2 (August 1, 1989): 287–93. http://dx.doi.org/10.1227/00006123-198908000-00022.
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Abstract Two patients with altered hemostatic mechanisms developed spinal subarachnoid hemorrhage after difficult lumbar punctures. One patient had received anticoagulation therapy soon after lumbar puncture and the other had a low platelet count (63,000/mm3) at the time of lumbar puncture. In both patients a hematoma evolved, producing blockage of cerebrospinal fluid flow. Clinical manifestations consisted of severe back and radicular pain with sphincteric disturbances followed by rapidly developing severe paraparesis. Of the methods of radiographic evaluation that were used, including computed tomography (CT) without contrast enhancement, myelography, CT with intrathecally administered contrast medium, and magnetic resonance imaging, we found the best study to be myelography via lateral cervical puncture followed by CT. Unfortunately, diagnosis was delayed, and surgical evacuation of the hematomas did not substantially improve the patients' conditions. The salient clinical and radiographic features of this disorder and its pathophysiology are reviewed. Prompt recognition of these lesions is necessary so that surgical intervention may maximize chances of recovery.
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Davarski, Atanas N., Borislav D. Kitov, Christo B. Zhelyazkov, Stefan D. Raykov, Ivo I. Kehayov, Ilyan G. Koev, and Borislav M. Kalnev. "Surgical management of metastatic tumors of the cervical spine." Folia Medica 55, no. 3-4 (September 1, 2013): 39–45. http://dx.doi.org/10.2478/folmed-2013-0026.
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ABSTRACT OBJECTIVE: To present the results from the clinical presentation, the imaging diagnostics, surgery and postoperative status of 17 patients with cervical spine metastases, to analyse all data and make the respective conclusions and compare them with the available data in the literature. PATIENTS AND METHODS: The study analysed data obtained by patients with metastatic cervical tumours treated in St George University Hospital over a period of seven years. All patients underwent diagnostic imaging tests which included, separately or in combination, cervical x-rays, computed tomography scan and magnetic-resonance imaging. Severity of neurological damage and its pre- and postoperative state was graded according to the Frankel Scale. For staging and operating performance we used the Tomita scale and Harrington classification. RESULTS: Seven patients had only one affected vertebra, 4 patients - two vertebrae, one patient - three vertebrae, 2 patients - four vertebrae, and in the other 3 patients more than one segment was affected. Surgery was performed in 12 patients. One level anterior corpectomy was performed in 6 patients, three patients had two-level surgery, and one patient - three-level corpectomy; in the remaining 2 cases we used posterior approach in surgery. Complete corpectomy was performed in 4 patients, subtotal corpectomy was used in 6 patients and partial - in 2 patients. Anterior stabilization system ADD plus® (Ulrich GmbH & Co. KG, Ulm, Germany) was implanted in 2 patients; in 8 patients anterior titanium plate and bone graft were used, and in 1 patient - posterior cervical stabilization system. CONCLUSIONS: Because of the pronounced pain syndrome and frequent neurological lesions as a result of the cervical spine metastases use of surgery is justified. The main purpose is to maximize tumor resection, achieve optimal spinal cord and nerve root decompression and stabilize the affected segment.
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Hirasawa, Rui, Takashi Itabashi, Tsuneji Kita, and Chikato Mannoji. "Ventral Longitudinal Intraspinal Fluid Collection in Patients with Cervical Disc Herniation: A Report of Two Cases." Case Reports in Orthopedics 2020 (March 23, 2020): 1–7. http://dx.doi.org/10.1155/2020/3439403.
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We encountered two cases of cervical disc herniation, wherein cerebrospinal fluid collection in the ventral epidural space between the cervical spine and the thoracic spine was noted. The patients, two women aged 71 and 43 years, were diagnosed with cervical disc herniation and underwent anterior cervical discectomy and fusion. Unexpected cerebrospinal fluid leakage was observed prior to exposure of the dura mater. Notably, the dura mater was intact following the removal of the herniated disc in both cases. No cerebrospinal fluid leakage symptoms were observed, and relief from the neurological symptoms related to the cervical disc herniation was observed in both cases following the surgery. Findings of preoperative magnetic resonance imaging and computed tomography myelography were carefully reviewed, retrospectively. Both patients presented with similar features including expansion of cerebrospinal fluid collection in the ventral epidural space between the cervical spine and the thoracic spine. These observed features were similar to those of superficial siderosis, which is a form of duropathy—a disease caused by dural defects. Therefore, the patients in this case study might have a subclinical duropathy with associated cervical disc herniation.
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Klatzkow, Sarah, Matthew D. Johnson, Michele James, and Sheila Carrera-Justiz. "Ventral Stabilization of a T2-T3 Vertebral Luxation via Median Sternotomy in a Dog." Case Reports in Veterinary Medicine 2018 (September 10, 2018): 1–6. http://dx.doi.org/10.1155/2018/9152394.
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An 8-year-old neutered male miniature Poodle presented for evaluation of a suspected T3-L3 lesion with cervical component following vehicular trauma. Magnetic resonance imaging and computed tomography revealed a T2-T3 luxation with right displacement of T3. A T2 caudal endplate fracture was present as well as multifocal noncompressive bulges of cervical intervertebral discs. Conservative management failed and ventral stabilization of C7-T4 was performed via a median sternotomy. Paired String-of-Pearls plates were placed on the ventral aspect of vertebrae. Eight weeks postoperatively, the dog was ambulatory with moderate pelvic limb paraparesis. A luxation of T2-T3 is uncommon in small animals and surgical stabilization is poorly described in literature. This case report demonstrates the use of a ventral approach to cranial thoracic vertebral stabilization with a successful outcome.
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Harsh, Griffith R., George W. Sypert, Philip R. Weinstein, Donald A. Ross, and Charles B. Wilson. "Cervical spine stenosis secondary to ossification of the posterior longitudinal ligament." Journal of Neurosurgery 67, no. 3 (September 1987): 349–57. http://dx.doi.org/10.3171/jns.1987.67.3.0349.
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✓ Ossification of the posterior longitudinal ligament (OPLL) is a well-documented cause of cervical spine stenosis and myelopathy among Japanese patients. Reports of OPLL in North Americans are rare. Choices of diagnostic method and treatment for this entity remain controversial. The authors report the results of management of 20 patients in the United States with symptomatic OPLL of the cervical spine. These represented 10% to 20% of patients operated on over the last 3 years for myelopathy secondary to structural spinal compression. Most of these OPLL patients were Caucasian (60%), male (male:female 4:1), and middle-aged (median age 47.5 years). Six had previously undergone laminectomy or discectomy. Cervical roentgenograms and standard myelography occasionally suggested the diagnosis. Axial computerized tomography (CT) metrizamide myelography with small interslice intervals proved invaluable for diagnosis and operative planning. Magnetic resonance imaging was not necessary for diagnosis. Retrovertebral calcification extended over one to five bodies (mean 2.75). The mass ranged in size from 5 to 16 mm in anteroposterior diameter and reduced the residual canal diameter to a mean (± standard deviation) caliber of 9.42 ± 2.41 mm (mean narrowing ratio 0.44 ± 0.12). Anterior cervical decompression by medial corpectomy and discectomy with fusion uniformly reduced preoperative myelopathy. Complications were limited to transient neurological deterioration in two patients, recurrent laryngeal nerve palsy in one, and halo device pin site infections in two. At a mean postoperative interval of 15 months, improvement was seen in each category of deficit: extremity weakness, hypesthesia, hypertonia, and urinary dysfunction. All fusions produced solid unions. It is concluded that OPLL of the cervical spine is an unexpectedly prevalent cause of myelopathy among patients treated in the United States. Thin-section axial CT metrizamide myelography with small interslice intervals is essential for the investigation of patients who may have OPLL. Anterior decompression and stabilization by medial corpectomy, discectomy, removal of the calcified mass, and fusion is a safe and effective method of treatment.
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Miyakoshi, Naohisa, Yoichi Shimada, Yuji Kasukawa, and Shigeru Ando. "Progressive myelopathy due to idiopathic intraspinal tumoral calcinosis of the cervical spine." Journal of Neurosurgery: Spine 7, no. 3 (September 2007): 362–65. http://dx.doi.org/10.3171/spi-07/09/362.
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✓Tumoral calcinosis is a rare disorder that most often occurs in periarticular regions of the extremities. Here, the authors report on an extremely rare case of idiopathic intraspinal tumoral calcinosis of the cervical spine. This 54-year-old man presented with a 2-week history of progressive cervical myelopathy. Results of magnetic resonance imaging and computed tomography myelography of the cervical spine revealed an intraspinal calcified mass lesion posterior to the spinal cord at the C3–4 level, resulting in marked spinal cord compression. Spinal cord decompression and en bloc resection of the mass lesion were performed via a C-2 laminoplasty and C3–4 laminectomy. The mass was localized in the dura mater. Histologically, the lesion consisted of numerous nodules with amorphous calcified materials and a florid proliferation of multinucleated giant cells; that is, its histological characteristics were identical to those of tumoral calcinosis. The symptoms disappeared completely after surgery. In all previously reported cases of cervical tumoral calcinosis, the lesion was located in the paraspinal soft tissue, with bone and facet joint involvement. The present case is the first reported instance of cervical tumoral calcinosis localized only in the spinal canal.
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Barnett, Gene H., Russell W. Hardy, John R. Little, Janet W. Bay, and George W. Sypert. "Thoracic spinal canal stenosis." Journal of Neurosurgery 66, no. 3 (March 1987): 338–44. http://dx.doi.org/10.3171/jns.1987.66.3.0338.
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✓ Hypertrophy of the posterior spinal elements leading to compromise of the spinal canal and its neural elements is a well-recognized pathological entity affecting the lumbar or cervical spine. Such stenosis of the thoracic spine in the absence of a generalized rheumatological, metabolic, or orthopedic disorder, or a history of trauma is generally considered to be rare. Over a 2-year period the authors have treated six cases of thoracic myelopathy associated with thoracic canal stenosis. In four patients the deficits developed gradually and painlessly. The three older patients had a clinical profile characterized by complaints of pseudoclaudication, spastic lower limbs, and evidence of posterior column dysfunction. Two patients were younger adults with low thoracic myelopathy associated with local back pain after minor trauma. Both patients also had congenital narrowing of the thoracic spinal canal. Oil and metrizamide contrast myelography in the prone position were of limited value in diagnosing this condition; in fact, myelography may be misleading and result in erroneous diagnosis of thoracic disc protrusion, when the principal problem is dorsal and lateral compression from hypertrophied facets. Magnetic resonance imaging and computerized tomography sector scanning were more useful in the diagnosis of this disorder than was myelography. Thoracic canal stenosis may be more common than is currently recognized and account for a portion of the failures in anterior and lateral decompression of thoracic disc herniations.
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Kubota, Motoo, Naokatsu Saeki, Akira Yamaura, Yoshiaki Yamamoto, Yuko Nemoto, and Toshio Fukutake. "Congenital spondylolysis of the axis with associated myelopathy." Journal of Neurosurgery: Spine 98, no. 1 (January 2003): 84–86. http://dx.doi.org/10.3171/spi.2003.98.1.0084.
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✓ Cervical spondylolysis is a rare clinical entity and occurs predominantly at the C-6 level. The authors describe a patient with congenital spondylolysis of the axis that caused myelopathy. The patient was a 57-year-old woman with long-standing gait disturbance. Plain cervical radiography revealed a radiolucent defect across the pedicle of the axis. Magnetic resonance imaging of the cervical spine in the neutral, flexion, and extension neck positions as well as a computerized tomography myelography in the neutral neck position failed to demonstrate any spinal cord compression. When she rotated her neck, however, the spinal cord was caught between the hypertrophic anterior arch of the atlas and posterior part of the slipped pedicle of the axis on the contralateral side. The spinal cord was transformed into a pear shape. Mechanical injury to the spinal cord seemed to explain her neurological presentation. This is, to the authors' knowledge, the 15th case of axial spondylolysis and the sixth case of spinal cord involvement of the cervical spondylolysis. No cases involving myelopathy secondary to such a unique mechanism have been reported previously in the literature.
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Wang, Bingjin, Weifang Liu, and Xianlin Zeng. "Idiopathic cervical spinal subdural haematoma: a case report and literature review." Journal of International Medical Research 47, no. 3 (February 14, 2019): 1365–72. http://dx.doi.org/10.1177/0300060519829666.
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This report describes a case of idiopathic cervical spinal subdural haematoma (SSDH) in which the haematoma was spontaneously absorbed without any treatment. A 68-year-old male patient presented with persistent neck pain and no obvious cause. Magnetic resonance imaging (MRI) revealed a space-occupying lesion at the C4–T1 levels. The lesion was initially misdiagnosed as a tumour. An operation was arranged to remove the tumour, but a preoperative computed tomography scan showed no obvious abnormal soft tissue density in the cervical spinal canal. Repeat enhanced MRI showed degeneration of the cervical vertebrae, but no obvious abnormal soft tissue density and no obvious enhanced signals in the cervical spinal canal. Spontaneous resolution of an idiopathic cervical SSDH was considered. Idiopathic cervical SSDH without obvious neurological symptoms are difficult to diagnose, so suspected cases should be carefully monitored. If the neurological symptoms grow progressively more debilitating with time, emergency surgery might need to be considered. To avoid unnecessary surgery, conservative management should be an option for patients with minimal neurological deficits and re-examination with MRI could be the best way to observe the dynamic changes taking place in the idiopathic cervical SSDH.
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Schöller, Karsten, Sebastian Siller, Christian Brem, Jürgen Lutz, and Stefan Zausinger. "Diffusion Tensor Imaging for Surgical Planning in Patients with Cervical Spondylotic Myelopathy." Journal of Neurological Surgery Part A: Central European Neurosurgery 81, no. 01 (June 10, 2019): 001–9. http://dx.doi.org/10.1055/s-0039-1691822.
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Abstract Background and Study Aims/Objective Despite its invasiveness, computed tomography myelography (CTM) is still considered an important supplement to conventional magnetic resonance imaging (MRI) for preoperative evaluation of multilevel cervical spondylotic myelopathy (CSM). We analyzed if diffusion tensor imaging (DTI) could be a less invasive alternative for this purpose. Material and Methods In 20 patients with CSM and an indication for decompression of at least one level, CTM was performed preoperatively to determine the extent of spinal canal/cerebrospinal fluid (CSF) space and cord compression (Naganawa score) for a decision on the number of levels to be decompressed. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were correlated with these parameters and with MRI-based increased signal intensity (ISI). Receiver operating characteristic analysis was performed to determine the sensitivity to discriminate levels requiring decompression surgery. European Myelopathy Score (EMS) and neck/radicular visual analog scale (VAS-N/R) were used for clinical evaluation. Results According to preoperative CTM, 20 levels of maximum and 16 levels of relevant additional stenosis were defined and decompressed. Preoperative FA and particularly ADC showed a significant correlation with the CTM Naganawa score but also with the ISI grade. Furthermore, both FA and ADC facilitated a good discrimination between stenotic and nonstenotic levels with cutoff values < 0.49 for FA and > 1.15 × 10−9 m2/s for ADC. FA and especially ADC revealed a considerably higher sensitivity (79% and 82%, respectively) in discriminating levels requiring decompression surgery compared with ISI (55%). EMS and VAS-N/R were significantly improved at 14 months compared with preoperative values. Conclusion DTI parameters are highly sensitive at distinguishing surgical from nonsurgical levels in CSM patients and might therefore represent a less invasive alternative to CTM for surgical planning.
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Ono, Atsushi, Toru Yokoyama, Takuya Numasawa, Kanichiro Wada, and Satoshi Toh. "Dural damage due to a loosened hydroxyapatite intraspinous spacer after spinous process–splitting laminoplasty." Journal of Neurosurgery: Spine 7, no. 2 (August 2007): 230–35. http://dx.doi.org/10.3171/spi-07/08/230.
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✓Excellent results from laminoplasty for cervical spinal myelopathy have been reported in many studies. Nevertheless, C-5 nerve root palsy or axial pain such as neck and shoulder pain after laminoplasty are known postoperative complications. To the authors' knowledge, dural damage from dislocation of the hydroxyapatite intraspinous spacer due to absorption of the tip of the spinous process has not been reported. Two cases of dural damage from dislocation of the hydroxyapatite intraspinous spacer after laminoplasty are described. Radiographs, computed tomography myelography, and magnetic resonance (MR) imaging revealed the dislocation of the hydroxyapatite intraspinous spacer, the absorption of the tip of the spinous process, and dural sac compression due to the hydroxyapatite intraspinous spacer. In one patient, the MR imaging studies revealed liquorrhea around the hydroxyapatite intraspinous spacers. Both patients underwent removal of the hydroxyapatite intraspinous spacer and attained good neurological recovery. In patients with dislocation of the hydroxyapatite intraspinous spacer associated with absorption of the tip of the spinous process after spinous process–splitting laminoplasty, each case should be evaluated for aggravating symptoms of myelopathy, dural damage, and liquorrhea around the spacer.
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Sahlu, Abat, Brook Mesfin, Abenezer Tirsit, and Knut Wester. "Spinal cord compression secondary to vertebral echinococcosis." Journal of Neurosciences in Rural Practice 7, no. 01 (January 2016): 143–46. http://dx.doi.org/10.4103/0976-3147.165357.
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ABSTRACTWe describe a patient with progressive lower limb weakness and paresthesia 3 days after falling from a considerable height. Magnetic resonance imaging and computed tomography revealed collapsed Th2 and Th3 vertebrae. A tuberculous (TB) spondylitis was suspected, and anti-TB medication was started however with no clinical improvement. She was referred to our center and operated. A 3 level discectomy and 2 level corpectomy were performed with iliac bone grafting and anterior plating via an anterior cervical approach. The patient developed an esophagocutaneous fistula that was repaired and cured. The biopsy specimen showed a hydatid cyst of the vertebra as the cause of the lesion. After the result, she was started on oral albendazole. At follow-up nearly 4 months after surgery, the patient had regained significant power in her lower limbs with a muscular strength of 5/5 in both legs, thus making it possible to walk without support.
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Kazan, Saim, Özgür Özdemir, Mahmut Akyüz, and Recai Tuncer. "Spinal intradural arachnoid cysts located anterior to the cervical spinal cord." Journal of Neurosurgery: Spine 91, no. 2 (October 1999): 211–15. http://dx.doi.org/10.3171/spi.1999.91.2.0211.
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✓ The authors describe two rare occurrences of radiographically, surgically, and pathologically confirmed spinal intradural arachnoid cysts (not associated with additional pathological entities) that were located anterior to the cervical spinal cord. These lesions have been reported previously in only eight patients. The patients described in this report were young adults who presented with progressive spastic tetraparesis shortly after sustaining mild cervical trauma and in whom no neurological deficit or bone fracture was demonstrated. The presence of an intradural arachnoid cyst was detected on postcontrast computerized tomography (CT) myelography and on magnetic resonance imaging; both diagnostic tools correctly characterized the cystic nature of the lesion. Plain radiography, plain tomography, and contrast-enhanced CT scans were not diagnostic. In both cases a laminectomy was performed, and the wall of the cyst was excised and fenestrated with subarachnoid space. Postoperatively, the patients made complete neurological recoveries. Based on a review of the literature, arachnoid cysts of the spinal canal may be classified as either extra- or intradural. Intradural arachnoid cysts usually arise posterior to the spinal cord in the thoracic spine region; however, these cysts very rarely develop in the cervical region. The pathogenesis of arachnoid cysts is unclear, although congenital, traumatic and inflammatory causes have been postulated. The authors believe that the formation of an arachnoid cyst cannot be explained by simply one mechanism because, in some reported cases, there has been accidental or iatrogenic trauma in association with congenital lesions. They also note that an intradural arachnoid cyst located anterior to the cervical spinal cord is an extremely rare disorder that may cause progressive myelopathy; however, the postoperative prognosis is good.
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Burina, Adnan, Dzevdet Smajlovic, Osman Sinanovic, Mirjana Vidovic, and Omer C. Ibrahimagic. "ARNOLD – CHIARI MALFORMATION AND SYRINGOMYELIA." Acta Medica Saliniana 38, no. 1 (June 9, 2009): 44–46. http://dx.doi.org/10.5457/ams.v38i1.31.
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Generally, Arnold – Chiari malformation associated with syringomyelia is not rare. In this case report we present a 52 years old female patient with a history of neck-pain, low-back pain, pain in both arms as well as frequent numbness in the lateral regions of both arms. She also experienced walk disturbance and in her previous history she reports a car accident, twenty-eight years ago. She broke windshield with her forehead, but remained conscious at the time. At the time of admittance at the Department of Neurology, her neurological status was remarkable for cerebellar symptomatology (ataxia, positive Romberg-sign, «finger–nose» test which she did with tremor and was not able to perform «tandem-walk»), hypoestesia of the right side of the body, hyper-reflection of both arms and legs, bilaterally, more pronounced at the right side; right foot subclonus and spastic-ataxic walk. Neurological status could not be explained by previously performed tests: x-ray of cervical spine, lumbal myelography, computerized tomography (CT) of the brain. However, magnetic resonance imaging (MRI) of the brain and cervical spine verified Arnold-Chiari malformation (type I) associated with syringomyelia from C3 to C7. Patient was referred to surgery and subsequent physical rehabilitation.
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Diener, HC, M. Kaminski, G. Stappert, D. Stolke, and B. Schoch. "Lower Cervical Disc Prolapse May Cause Cervicogenic Headache: Prospective Study in Patients Undergoing Surgery." Cephalalgia 27, no. 9 (September 2007): 1050–54. http://dx.doi.org/10.1111/j.1468-2982.2007.01385.x.
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In 1983 Sjaastad published for the first time diagnostic criteria for cervicogenic headache. Until now there have been no prospective studies investigating whether cervical disc prolapse can cause cervicogenic headache. Between July 2002 and July 2003 50 patients with cervical disc prolapse proven by computed tomography, myelography or magnetic resonance imaging were recruited and prospectively followed for 3 months. Patients were asked at different time points about headache and neck pain by questionnaires and structured interviews. These data were collected prior to and 7 and 90 days after surgery for the disc prolapse. Fifty patients with lumbar disc prolapse, matched for age and sex, undergoing surgery were recruited as controls. Headache and neck pain was diagnosed according to International Headache Society (IHS) criteria. Twelve of 50 patients with cervical disc prolapse reported new headache and neck pain. Seven patients (58%) fulfilled the 2004 IHS criteria for cervicogenic headache. Two of 50 patients with lumbar disc prolapse had new headaches. Their headaches did not fulfil the criteria for cervicogenic headache. One week after surgery, 8/12 patients with cervical disc prolapse and headache reported to be pain free. One patient was improved and three were unchanged. Three months after cervical prolapse surgery, seven patients were pain free, three improved and two unchanged. This prospective study shows an association of low cervical prolapse with cervicogenic headache: headache and neck pain improves or disappears in 80% of patients after surgery for the cervical disc prolapse. These results indicate that pain afferents from the lower cervical roots can converge on the cervical trigeminal nucleus and the nucleus caudalis.
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Del Curling, O., David J. Gower, and Joe M. McWhorter. "Changing Concepts in Spinal Epidural Abscess: A Report of 29 Cases." Neurosurgery 27, no. 2 (August 1, 1990): 185–92. http://dx.doi.org/10.1227/00006123-199008000-00002.
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Abstract A review of our recent experience with spinal epidural abscess (SEA) reveals several important changing concepts in diagnosis, etiology, management, and outcome. All cases of SEA seen by our service from August 1975 to July 1989 were reviewed retrospectively, and 29 patients were identified (19 men and 10 women, aged 13-78 years). Abscesses were located in the lumbar (n = 21), thoracic (n = 7), and cervical (n = 1) epidural spaces. Gram-positive organisms were the infectious agent in 72% of the cases, and Staphyloccus aureus was the sole agent in 45% other agents were Gram-negative aerobes (n = 5), a Gram-negative anaerobe (n = 1), Mycobacterium tuberculosis(n = 1), and Sporotrichum schenckii(n = 1), the last occurring in a young woman with acquired immune deficiency syndrome. Seventeen patients had concomitant extraspinal infections. Diagnosis was confirmed by myelography, computed tomography, or magnetic resonance imaging. All patients underwent operative decompression and debridement; 2 required a second procedure for persistent infection. The most common operative findings were pus and granulation tissue in the epidural space (52%); the preoperative course correlated poorly with operative findings. The wound was closed primarily in 84% of cases. Postoperative intravenous antibiotic courses for the bacterial abscesses ranged from 1.5 to 6 weeks (median, 2 weeks), followed by antibiotics given orally for 0 to 6 weeks. Two patients died perioperatively. Neurological outcome was good in 21 patients and fair in 6 (mean follow-up, 1.4 years). Over the last 50 years the spectrum of organisms causing SEA has broadened, and the distinction between acute and chronic SEAs has minimal clinical significance. In addition, magnetic resonance imaging has come to have an adjunctive diagnostic role. Treatment by operative debridement, primary wound closure, and short courses of antibiotics given intravenously and orally has a consistently good result, and prognosis has markedly improved.
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Herrmann, Hans-Dietrich, Michael Neuss, and Dietrich Winkler. "Intramedullary Spinal Cord Tumors Resected with CO2 Laser Microsurgical Technique: Recent Experience in Fifteen Patients." Neurosurgery 22, no. 3 (March 1, 1988): 518–22. http://dx.doi.org/10.1227/00006123-198803000-00011.
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Abstract We have operated upon 15 intramedullary spinal cord tumors with the aid of a CO2 laser attached to the microscope. The operative technique is described. Most of the tumors were localized within the cervical spinal cord. Nine tumors were benign gliomas: 4 ependymomas, 1 subependymoma, 3 astrocytomas, and 1 ganglioglioma. Six were removed totally, and 3 were removed subtotally. The remaining 6 tumors consisted of 3 hemangioblastomas, 1 intramedullary neurofibroma, 1 lipoma, and 1 primary intramedullary melanoma. Neurological function postoperatively compared to the preoperative function of the upper extremities was unchanged in 13 patients (86.5%), improved in 1, and worse in 1 patient. In the lower extremities, the preoperative neurological status was unchanged in 11 patients (73.3%), improved in 1 patient, and worse in 3 patients (20%). Magnetic resonance imaging was superior to myelography and computed tomography in localizing these lesions. Enhancement with paramagnetic substances (e.g., gadolinium-DTPA) helps to localize solid tumor within cysts. Histological evaluation of small tissue biopsies or frozen section histology is unreliable. The entire lesion should be exposed in all cases, and an attempt should be made to remove the tumor totally or, if this is not possible, to resect as much of the center of the tumor as is possible until the cord is decompressed. The decision to administer further treatment is based on the histological features of the tumor. (Neurosurgery 22:518-522, 1988)
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Barnes, Bryan, Regis W. Haid, Gerald Rodts, Brian Subach, and Michael Kaiser. "Early results using the Atlantis anterior cervical plate system." Neurosurgical Focus 12, no. 1 (January 2002): 1–7. http://dx.doi.org/10.3171/foc.2002.12.1.14.
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Object The authors present a retrospective review of 77 patients in whom they performed anterior cervical discectomy and fusion (ACDF) in the treatment of radiculopathy and/or myelopathy. In all cases anterior interbody fusion was performed using the Atlantis locking plate system to treat the degenerative disease. Methods There were 41 men and 36 women (mean age 53.8 years), and 24 active cigarette smokers (31%) in the group. All patients presented with signs and symptoms of cervical radiculopathy and/or myelopathy, and magnetic resonance imaging or computerized tomography myelography demonstrated evidence of radicular and/or spinal cord compression at one or more cervical levels. Thirty-one patients underwent single-level ACDF, 20 patients underwent multilevel ACDF without posterior instrumentation, in eight patients one- to four-level corpectomies were supplemented with posterior fixation, 12 patients underwent single-level corpectomy, and six patients underwent multilevel corpectomy with no posterior instrumentation. The mean follow-up period was 15.33 months; overall good-to-excellent outcome was seen in 75% of patients; osseous fusion was demonstrated in 93.5%. In all patients except three, fibular allograft was used as graft material. The degree of overall cervical lordosis was measured at the last follow up and was compared with normal values obtained in age-matched individuals. In addition, the degree of cervical lordosis at fusion levels was compared with overall cervical lordosis. In patients in all five of the aforementioned categories significantly less lordosis was demonstrated than in age-matched controls. In patients who underwent single-level ACDF, single-level corpectomy, and multilevel ACDF significantly less lordosis was observed at the fusion segment than that in the overall cervical spine. Complications included one episode of chronic anterior wound drainage treated with intravenous antibiotic medication and one postoperative posterior wound infection, which required reoperation and intravenous antibiotic medication. Two cases (2.6%) of anterior screw backout and/or breakage were identified. One patient died of unrelated causes within 3 months of operation. Conclusions These initial results indicate that use of the Atlantis plate system for anterior cervical arthrodesis produces fusion rates and clinical outcomes that are comparable with those obtained using other locking plating systems. It has the unique advantage, however, of providing the surgeon with the choice of fixed, variable, or hybrid screw constructs as a way of tailoring screw angles to individual anatomical/biomechanical needs.
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Kumar, Rakesh, Jamal Taha, and Alson Lee Greiner. "Herniation of the spinal cord." Journal of Neurosurgery 82, no. 1 (January 1995): 131–36. http://dx.doi.org/10.3171/jns.1995.82.1.0131.
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✓ Herniation of the spinal cord, or displacement of the cord outside the dura, is so rare that only 13 cases have been reported in the literature. The authors report a new case of spontaneous herniation of the spinal cord in a 38-year-old man who presented with lower left limb paresis and Brown-Séquard syndrome, with a T-8 sensory level. Displacement of the spinal cord was noted on computerized tomography following myelography and on magnetic resonance imaging. The herniated cord was confirmed at operation and reduced intradurally. Postoperatively, the patient showed complete neurological recovery. Based on a review of the literature, herniation of the spinal cord may be classified as spontaneous, iatrogenic, or traumatic. At cervical levels, the spinal cord has herniated into an iatrogenic pseudomeningocele located dorsally. At thoracic levels, spinal cord herniations were reported to be in a preexisting extradural arachnoid cyst located ventrally. The authors propose a pathogenesis for spinal cord herniation based on abnormal positioning of the spinal cord in the dural sleeve and the known anteroposterior movements of the cord that occur with cardiac and respiratory pulsations. The presence of a dural defect situated on the concavity of the spinal curvature is a prerequisite for this rare condition. As adhesions develop between the cord and the edges of the dural defect, cerebrospinal fluid pulsations push the cord into a preexisting cyst. The authors suggest modifying the classification by Nabors, et al., of spinal meningeal cysts to include this mechanism of spinal cord herniation. This diagnosis should also be considered in the differential diagnosis of myelopathy in the absence of a mass lesion.
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Pang, Dachling, John Zovickian, Angelica Oviedo, and Greg S. Moes. "Limited Dorsal Myeloschisis: A Distinctive Clinicopathological Entity." Neurosurgery 67, no. 6 (December 1, 2010): 1555–80. http://dx.doi.org/10.1227/neu.0b013e3181f93e5a.
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Abstract BACKGROUND: Limited dorsal myeloschisis (LDM) is a distinctive form of spinal dysraphism characterized by 2 constant features: a focal “closed” midline defect and a fibroneural stalk that links the skin lesion to the underlying cord. The embryogenesis is hypothesized to be incomplete disjunction between cutaneous and neural ectoderms, thus preventing complete midline skin closure and allowing persistence of a physical link (fibroneural stalk) between the disjunction site and the dorsal neural tube. OBJECTIVE: To illustrate these features in 51 LDM patients. METHODS: All patients were studied with magnetic resonance imaging or computed tomography myelography, operated on, and followed for a mean of 7.4 years. RESULTS: There were 10 cervical, 13 thoracic, 6 thoracolumbar and 22 lumbar lesions. Two main types of skin lesion were saccular (21 patients), consisting of a skin-base cerebrospinal fluid sac topped with a squamous epithelial dome, and nonsaccular (30 patients), with a flat or sunken squamous epithelial crater or pit. The internal structure of a saccular LDM could be a basal neural nodule, a stalk that inserts on the dome, or a segmental myelocystocele. In nonsaccular LDMs, the fibroneural stalk has variable thickness and complexity. In all LDMs, the fibroneural stalk was tethering the cord. Twenty-nine patients had neurological deficits. There was a positive correlation between neurological grade and age, suggesting progression with chronicity. Treatment consisted of detaching the stalk from the cord. Most patients improved or remained stable. CONCLUSION: LDM is a distinctive clinicopathological entity and a tethering lesion with characteristic external and internal features. We propose a new classification incorporating both saccular and flat lesions.
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Ozawa, Hiroshi, Takashi Kusakabe, Toshimi Aizawa, Takeshi Nakamura, Yushin Ishii, and Eiji Itoi. "Tumors at the lateral portion of the C1–2 interlaminar space compressing the spinal cord by rotation of the atlantoaxial joint: new aspects of spinal cord compression." Journal of Neurosurgery: Spine 17, no. 6 (December 2012): 552–55. http://dx.doi.org/10.3171/2012.9.spine12562.
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The authors describe 2 patients with C-2 nerve root tumors in whom the lesions were located bilaterally in the lateral portions of the C1–2 interlaminar space and compressed the spinal cord when the atlantoaxial joint was rotated. The patients were adult men with neurofibromatosis. Each presented with clumsiness of both hands and motor weakness of the extremities accompanied by spastic gait. Magnetic resonance imaging of the cervical spine performed with the neck in the neutral position showed tumors at the bilateral lateral portion of the C1–2 interlaminar space without direct compression of the spinal cord. The spinal cord exhibited an I-shaped deformity at the same level as the tumors in one case and a trapezoidal deformity at the same level as the tumors in the other case. Computed tomography myelography and MRI on rotation of the cervical spine revealed bilateral intracanal protrusion of the tumors compressing the spinal cord from the lateral side. The tumors were successfully excised and occipitocervical fusion was performed. The tumors were pushed out into the spinal canal from the bilateral lateral portion of the interlaminar spaces due to rotation of the atlantoaxial joint. This was caused by a combination of posteromedial displacement of the lateral mass on the rotational side of the atlas and narrowing of the lateral portion of the interlaminar space on the contralateral side due to the coupling motion of the lateral bending and extension of the atlas. The spinal cord underwent compression from both lateral sides in a one-way rotation. Without sustained spinal cord compression, intermittent long-term dynamic spinal cord compression from both lateral sides should induce a pathognomonic spinal cord deformity and the onset of paralysis. To the authors' knowledge, there have been no reports of the present conditions—that is, the bilateral protrusion of tumors from the bilateral lateral portion of the C1–2 interlaminar spaces into the spinal canal due to atlantoaxial rotation.
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Tator, Charles H., Michael Fehlings, Kevin Thorpe, and Wayne Taylor. "Current use and timing of spinal surgery for management of acute spinal cord injury in North America: results of a retrospective multicenter study." Neurosurgical Focus 6, no. 1 (January 1999): E4. http://dx.doi.org/10.3171/foc.1999.6.1.5.
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A multicenter retrospective study was performed in 36 participating North American centers to examine the use and timing of surgery in the treatment of acute spinal cord injury (SCI). The study was conducted to obtain information required for the planning of a randomized controlled trial of early compared with late decompressive surgery. The records of all patients aged 16 to 75 years with acute SCI who were admitted to the 36 centers within 24 hours of injury over a 9-month period (August 1994 to April 1995) were examined to obtain data on admission variables, methods of diagnosis, use of traction, and surgical variables including type and timing of surgery. A total of 585 patients with acute SCI or cauda equina injury were admitted to these centers, although approximately half were ultimately excluded because they did not meet inclusion criteria. Common causes for exclusion were late admission, age, gunshot wound, and an absence of spinal cord compression demonstrated on imaging studies. Thus, only approximately 50% of acute SCI patients would be eligible for inclusion in a study of acute decompressive procedures. Although 100% of patient underwent computerized tomography (CT) scaning, only 54% underwent magnetic resonance imaging, and CT myelography was performed in only 6%. Complete neurological injuries (American Spinal Injury Association Grade A) were present in 57.8%. Traction was applied in only 47% of patients with cervical injuries, of which only 42% demonstrated successful decompression by traction. Neurological deterioration occurred in 8.1% of patients after traction. Surgery was performed in 65.4% of patients. The timing of surgery varied widely: less than 24 hours in 23.5% of patients; 25 to 48 hours in 15.8%; 48 to 96 hours in 19.0%; and 5 days or longer in 41.7% of patients. These data indicate that whereas surgery is commonly performed in patients with acute SCI, one-third of the cases are managed nonoperatively, and there is very little agreement on the optimum timing of surgical treatment. The results of this study confirm the need for a randomized controlled trial to determine the optimum timing of surgical decompressive procedures in patients with SCI.
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Tator, Charles H., Michael Fehlings, Kevin Thorpe, and Wayne Taylor. "Current use and timing of spinal surgery for management of acute spinal cord injury in North America: results of a retrospective multicenter study." Journal of Neurosurgery: Spine 91, no. 1 (July 1999): 12–18. http://dx.doi.org/10.3171/spi.1999.91.1.0012.
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Object. A multicenter retrospective study was performed in 36 North American centers to examine the use and timing of surgery in patients who have sustained acute spinal cord injury (SCI). The study was performed to obtain information required for the planning of a randomized controlled trial in which early and late decompressive surgery are compared. Methods. The records of all patients aged 16 to 75 years with acute SCI admitted to 36 centers within 24 hours of injury over a 9-month period in 1994 and 1995 were examined to obtain data on admission variables, methods of diagnosis, use of traction, and surgical variables including type and timing of surgery. A total of 585 patients with acute SCI or cauda equina injury were admitted to participating centers, although approximately half were ultimately excluded because they did not meet inclusion criteria. Common causes for exclusion were late admission, age, gunshot wound, and absence of signs of compression on imaging studies. Thus, only approximately 50% of patients with acute SCI would be eligible for inclusion in a study of acute decompressive surgery. Although all patients underwent computerized tomography (CT) scanning, only 54% underwent magnetic resonance imaging, and CT myelography was performed in only 6%. Complete neurological injuries (American Spinal Injury Association Grade A) were present in 57.8%. Traction was applied in only 47% of patients who sustained cervical injury, in whom decompressive traction was successful in only 42% of cases. Neurological deterioration occurred in 8.1% of cases after traction. Surgery was performed in 65.4% of patients. The timing of surgery varied widely: less than 24 hours postinjury in 23.5%, between 25 and 48 hours postinjury in 15.8%, between 48 and 96 hours in 19%, and more than 5 days postinjury in 41.7% of patients. Conclusions. These data indicate that although surgery is commonly performed in patients with acute SCI, one third of cases are managed nonoperatively, and there is very little agreement on the optimum timing of surgical treatment. The results of this study confirm the need for a randomized controlled trial to assess the optimum timing of decompressive surgery in SCI.
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Cohen-Gadol, Aaron A., J. Bradley White, James J. Lynch, Gary M. Miller, and William E. Krauss. "Synovial cysts of the thoracic spine." Journal of Neurosurgery: Spine 1, no. 1 (July 2004): 52–57. http://dx.doi.org/10.3171/spi.2004.1.1.0052.
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Object. Thoracic synovial cysts (TSCs) are rare and are usually the subject of case reports. The authors studied the clinical manifestations, radiological aspects, and surgical treatment in a series of patients at their institution who harbored TSCs. They also review the literature to discuss the potential factors involved in the pathogenesis of this lesion. Methods. A database search of 16,000 patients who underwent decompressive spine surgery at the Mayo Clinic (Rochester, MN) between 1976 and 2003 disclosed nine patients (0.06%) in whom a diagnosis of TSC had been made. All patients were men. The mean age at presentation was 73 ± 5 years and mean duration of symptoms was 5 ± 3 months. The mean duration of follow up was 4 ± 3 years. The patients had no history of trauma or spine surgery. All patients had spastic paraparesis; two had urinary difficulties. Detailed neurological examination revealed myelopathy and radiculopathy with a sensory level of T10—L4. Magnetic resonance imaging revealed bilateral cysts in four patients and unilateral lesions in five. Three of the cysts were at the T-10 interspace, seven at the T-11 interspace, and three at the T-12 interspace. Seven cysts were on the right and six were on the left. Computerized tomography myelography performed in five patients revealed a gas bubble in the TSC in two patients. All patients underwent laminectomy/partial facetectomy, excision of the cyst, and decompression of the thecal sac and nerve root without any complications. None of these patients underwent a fusion. Eight patients (89%) experienced moderate to excellent relief of their preoperative signs and symptoms and one patient (11%) remained stable. There was no evidence of cyst recurrence at the site of surgery or other spinal segments at follow-up examination in any patient. Conclusions. When compared with their lumbar and cervical spine counterparts, TSCs are exceedingly rare. Their rarity may be explained by the decreased mobility of the thoracic spinal segments. The origin of TSCs is more likely degenerative rather than traumatic. Based on their experience and the follow-up duration, surgery provided durable relief from symptoms.