RESUMEN
PURPOSE: The corpus callosum is crucial for interhemispheric interactions in the motor control of limb functions. Human and animal studies suggested spinal cord pathologies may induce cortical reorganization in sensorimotor areas. We investigate participation of the corpus callosum in executions of a simple motor task in patients with cervical spondylotic myelopathy (CSM) using transcranial magnetic stimulation. METHODS: Twenty patients with CSM with various MRI grades of severity of cord compression were compared with 19 normal controls. Ipsilateral silent period, contralateral silent period, central motor conduction time, and transcallosal conduction time (TCT) were determined. RESULTS: In both upper and lower limbs, TCTs were significantly increased for patients with CSM than normal controls ( p < 0.001 for all), without side-to-side differences. Ipsilateral silent period and contralateral silent period durations were significantly increased bilaterally for upper limbs in comparison to controls ( p < 0.01 for all), without side-to-side differences. There were no significant correlations of TCT with central motor conduction time nor severity of CSM for both upper and lower limbs ( p > 0.05 for all) bilaterally. CONCLUSIONS: Previous transcranial magnetic stimulation studies show increased motor cortex excitability in CSM; hence, increased TCTs observed bilaterally may be a compensatory mechanism for effective unidirectional and uniplanar execution of muscle activation in the distal limb muscles. Lack of correlation of TCTs with severity of CSM or central motor conduction time may be in keeping with a preexistent role of the corpus callosum as a predominantly inhibitory pathway for counteracting redundant movements resulting from increased motor cortex excitability occurring after spinal cord lesions.
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Cuerpo Calloso , Potenciales Evocados Motores , Espondilosis , Estimulación Magnética Transcraneal , Humanos , Cuerpo Calloso/fisiopatología , Cuerpo Calloso/diagnóstico por imagen , Masculino , Femenino , Persona de Mediana Edad , Espondilosis/fisiopatología , Potenciales Evocados Motores/fisiología , Adulto , Anciano , Vértebras Cervicales/fisiopatología , Conducción Nerviosa/fisiología , Enfermedades de la Médula Espinal/fisiopatología , Enfermedades de la Médula Espinal/diagnóstico por imagen , Compresión de la Médula Espinal/fisiopatologíaRESUMEN
INTRODUCTION: Degenerative cervical myelopathy is a condition of symptomatic cervical spinal cord compression secondary to a range of degenerative spinal pathology. Respiratory symptoms such as shortness of breath are not uncommonly reported by people with DCM and respiratory dysfunction has been described in several DCM studies. The objective of this review was therefore to systematically synthesise the current evidence on the relationship between DCM and respiratory function. METHODS: The review was registered on PROSPERO and adhered to PRISMA guidelines. Ovid MEDLINE and Embase were searched from inception to 14th March 2023. DCM studies reporting on any measure or outcome relating to respiratory function or disease were eligible. Reference lists of included studies and relevant reviews articles were hand searched. Title, abstract and full text screening, risk of bias and GRADE assessments were completed in duplicate. A quantitative synthesis is presented. RESULTS: Of 1991 studies identified by literature searching, 13 met inclusion criteria: 3 cohort studies, 5 case-control studies, 1 case series and 4 case studies. Forced vital capacity (FVC), peak expiratory flow rate (PEFR) and maximal voluntary ventilation (MVV) were reported to be lower in DCM patients than controls; there was inconsistency in comparisons of forced expiratory volume in 1 s (FEV1). There was conflicting evidence on whether surgical decompression was associated with improvements in respiratory parameters and on the relationship between level of spinal cord compression and respiratory dysfunction. CONCLUSION: DCM may be associated with respiratory dysfunction. However, consistency and quality of evidence is currently low. Further work should characterise respiratory dysfunction in DCM patients more rigorously and investigate putative mechanisms such as disruption to cervical nerve roots responsible for diaphragmatic innervation and damage to descending spinal projections from brainstem respiratory centres.
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Vértebras Cervicales , Humanos , Trastornos Respiratorios/etiología , Trastornos Respiratorios/fisiopatología , Compresión de la Médula Espinal/fisiopatología , Compresión de la Médula Espinal/etiología , Enfermedades de la Médula Espinal/complicaciones , Enfermedades de la Médula Espinal/fisiopatologíaAsunto(s)
Absceso Epidural/cirugía , Perforación del Esófago/cirugía , Esófago , Cuerpos Extraños/cirugía , Complicaciones Posoperatorias/cirugía , Cuadriplejía/cirugía , Compresión de la Médula Espinal/cirugía , Infecciones Estreptocócicas/cirugía , Animales , Huesos , Vértebras Cervicales/cirugía , Pollos , Descompresión Quirúrgica/métodos , Discectomía/métodos , Ingestión de Alimentos , Absceso Epidural/etiología , Absceso Epidural/fisiopatología , Perforación del Esófago/etiología , Esofagoscopía , Femenino , Cuerpos Extraños/complicaciones , Humanos , Laminectomía/métodos , Persona de Mediana Edad , Faringe , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatología , Cuadriplejía/etiología , Cuadriplejía/fisiopatología , Recuperación de la Función , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/fisiopatología , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/fisiopatología , Streptococcus anginosusRESUMEN
BACKGROUND: Degenerative compressive myelopathy (DCM) is caused by cervical cord compression. The relationship between the magnitude and clinical findings of cervical cord compression has been described in the literature, but the details remain unclear. This study aimed to clarify the relationship between the magnitude and clinical symptoms of cervical cord compression in community-dwelling residents. METHODS: The present study included 532 subjects. The subjective symptoms and the objective findings of one board-certified spine surgeon were assessed. The subjective symptoms were upper extremity pain and numbness, clumsy hand, fall in the past 1 year, and subjective gait disturbance. The objective findings were: Hoffmann, Trömner, and Wartenberg signs; Babinski's and Chaddock's signs; hyperreflexia of the patellar tendon and Achilles tendon reflexes; ankle clonus; Romberg and modified Romberg tests; grip and release test; finger escape sign; and grip strength. Using midsagittal T2-weighted magnetic resonance imaging, the anterior-posterior (AP) diameters (mm) of the spinal cord at the C2 midvertebral body level (DC2) and at each intervertebral disc level from C2/3 to C7/T1 (DC2/3-C7/T1) were measured. The spinal cord compression ratio (R) for each intervertebral disc level was defined and calculated as DC2/3-C7/T1 divided by DC2. The lowest R (LR) along C2/3 to C7/T1 of each individual was divided into 3 grades by the tertile method. The relationship between LR and clinical symptoms was investigated by trend analysis. RESULTS: The prevalence of subjective gait disturbance increased significantly with the severity of spinal cord compression (p = 0.002812), whereas the other clinical symptoms were not significantly related with the severity of spinal cord compression. CONCLUSIONS: The magnitude of cervical cord compression had no relationship with any of the neurologic findings. However, subjective gait disturbance might be a better indicator of the possibility of early stage cervical cord compression.
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Vértebras Cervicales/diagnóstico por imagen , Degeneración del Disco Intervertebral/epidemiología , Compresión de la Médula Espinal/epidemiología , Enfermedades de la Médula Espinal/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Médula Cervical/diagnóstico por imagen , Médula Cervical/patología , Vértebras Cervicales/fisiopatología , Femenino , Humanos , Vida Independiente , Degeneración del Disco Intervertebral/diagnóstico por imagen , Degeneración del Disco Intervertebral/fisiopatología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Médula Espinal/diagnóstico por imagen , Médula Espinal/fisiopatología , Compresión de la Médula Espinal/diagnóstico por imagen , Compresión de la Médula Espinal/fisiopatología , Enfermedades de la Médula Espinal/diagnóstico por imagen , Enfermedades de la Médula Espinal/fisiopatologíaRESUMEN
Neuropathic pain is one of the important challenges in the clinic. Although a lot of research has been done on neuropathic pain (NP), the molecular mechanism is still elusive. We aimed to investigate whether the Wnt/ß-catenin pathway was involved in NP caused by sustaining dorsal root ganglion (DRG) compression with the chronic compression of dorsal root ganglion model (CCD). Our RNA sequencing results showed that several genes related to the Wnt pathway have changed in DRG and spinal cord dorsal horn (SCDH) after CCD surgery. Therefore, we detected the activation of the Wnt/ß-catenin pathway in DRG and SCDH and found active ß-catenin significantly upregulated in DRG and SCDH 1 day after CCD surgery and peaked on days 7-14. Immunofluorescence results also confirmed nuclear translocalization of active ß-catenin in DRG and SCDH. Additionally, rats had obvious mechanical induced pain after CCD surgery and the pain was significantly alleviated after the application of the Wnt/ß-catenin pathway inhibitor XAV939. Furthermore, we found that the levels of proinflammatory factors tumor necrosis factor-α (TNF-α) and interleukin-18 (IL-18) were significantly elevated in CCD rat serum, while the levels of them were correspondingly decreased after the Wnt/ß-catenin pathway being inhibited. The results of Spearman correlation coefficient analysis showed that the levels of TNF-α and IL-18 were negatively correlated with the mechanical withdrawal thresholds (MWT) after CCD surgery. Collectively, our findings suggest that the Wnt/ß-catenin pathway plays a critical role in the pathogenesis of NP and may be an effective target for the treatment of NP.
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Citocinas/metabolismo , Ganglios Espinales/metabolismo , Neuralgia/metabolismo , Compresión de la Médula Espinal/metabolismo , Vía de Señalización Wnt , beta Catenina , Animales , Enfermedad Crónica , Ganglios Espinales/fisiopatología , Compuestos Heterocíclicos con 3 Anillos/farmacología , Compuestos Heterocíclicos con 3 Anillos/uso terapéutico , Interleucina-18/metabolismo , Masculino , Neuralgia/tratamiento farmacológico , Dimensión del Dolor , Umbral del Dolor , Células del Asta Posterior , Ratas , Ratas Sprague-Dawley , Compresión de la Médula Espinal/fisiopatología , Factor de Necrosis Tumoral alfa/metabolismo , Vía de Señalización Wnt/efectos de los fármacos , beta Catenina/efectos de los fármacosRESUMEN
The application of electric field stimulation (EFS) can reduce the cation influx after spinal cord injury. However, regenerated cation influx and reestablished injury potential are observed after EFS. Polyethylene glycol (PEG) is popular as an effective cell membrane fusion agent. This study aims to determine the effects of the combination therapy of EFS and PEG in the ex vivo spinal cord after compression. The ex vivo spinal cords of female rats with compression injury were incubated in a double sucrose gap recording chamber (DSGRC) and randomly divided into the following four groups: (1) compression group: compression only, (2) EFS group: EFS for 15 min, (3) PEG group: PEG treatment for 4 min, and (4) EFS + PEG group: EFS for 15 min and PEG treatment for 4 min. The hematoxylin-eosin staining was performed to measure the necrotic area of the spinal cords. The gap potential was detected, and the area under the curve of the gap potential was calculated. The intracellular cation concentration, membrane permeability, and compound action potential were measured and quantified. Results revealed no significant difference in the necrotic areas among different groups, and the compression model of the ex vivo spinal cord in the DSGRC had high consistency and stability. The combination therapy could attenuate cation inflow, promote cell membrane restoration, and promote the functional recovery of the spinal cord conduction after compression in ex vivo spinal cords.
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Estimulación Eléctrica/métodos , Polietilenglicoles/farmacología , Compresión de la Médula Espinal/fisiopatología , Médula Espinal/fisiopatología , Potenciales de Acción/efectos de los fármacos , Animales , Terapia Combinada/métodos , Femenino , Conducción Nerviosa/efectos de los fármacos , Técnicas de Cultivo de Órganos , Ratas , Ratas Sprague-Dawley , Médula Espinal/efectos de los fármacosRESUMEN
Degenerative Cervical Myelopathy (DCM) is a spinal cord disorder that causes significant physical disabilities in older patients. While most DCM research focuses on the spinal cord, widespread reorganization of the brain may occur to compensate for functional impairment. This observational study used diffusion spectrum imaging (DSI) to examine reorganization of cerebral white matter associated with neurological impairment as measured by the modified Japanese Orthopedic Association (mJOA), and severity of neck disability as measured by the Neck Disability Index (NDI) score. A total of 47 patients were included in the cervical spondylosis (CS) cohort: 38 patients with DCM (mean mJOA = 14.6, and mean NDI = 12.0), and 9 neurologically asymptomatic patients with spinal cord compression (mJOA = 18, and mean NDI = 7.0). 28 healthy volunteers (HCs) served as the control group. Lower generalized fractional anisotropy (GFA) was observed throughout much of the brain in patients compared to HCs (p < 0.05). Fiber pathways associated with somatosensory functions, such as the corpus callosum and corona radiata, showed increased quantitative anisotropy (QA) in patients compared to HCs. Correlation analyses further suggested that structural connectivity was enhanced to compensate for neurological dysfunction within sensorimotor regions, where fibers such as the posterior corona radiata had NQA values that were negatively associated with mJOA (p = 0.0020, R2 = 0.2935) and positively associated with NDI score (p = 0.0164, R2 = 0.1889). Altogether, these results suggest that DCM and neurologically asymptomatic spinal cord compression patients tend to have long-term reorganization within the brain, particularly in those regions responsible for the perception and integration of sensory information, motor regulation, and pain modulation.
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Encéfalo/diagnóstico por imagen , Vértebras Cervicales/diagnóstico por imagen , Imagen de Difusión Tensora/métodos , Compresión de la Médula Espinal/diagnóstico por imagen , Espondilosis/diagnóstico por imagen , Sustancia Blanca/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Anisotropía , Encéfalo/fisiopatología , Vértebras Cervicales/fisiopatología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/fisiopatología , Enfermedades de la Médula Espinal/complicaciones , Enfermedades de la Médula Espinal/diagnóstico por imagen , Enfermedades de la Médula Espinal/fisiopatología , Espondilosis/complicaciones , Espondilosis/fisiopatología , Sustancia Blanca/fisiopatologíaRESUMEN
Spinal osteochondromas are very rare, and they present with nonspecific localized pain owing to bone involvement. Diagnosis is made based on direct X-ray and computed tomography (CT) imaging of the exophytic bone lesion with pedunculated or sessile structure. Although asymptomatic patients can be observed, surgical excision is the main treatment modality. We present the case of a 34-year-old man with solitary thoracic osteochondroma. The patient presented with complaints of pain in the legs, numbness, and inability to walk. The diagnosis was confirmed with CT imaging showing calcified heterogeneous bone lesion originating from the left side of T1-2 facet joint. After total excision, histopathological examination revealed the diagnosis of osteochondroma. No new clinical or radiological findings were detected in the 10-month follow-up.
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Procedimientos Ortopédicos/métodos , Osteocondroma , Compresión de la Médula Espinal , Neoplasias de la Columna Vertebral , Vértebras Torácicas , Adulto , Disección/métodos , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Osteocondroma/complicaciones , Osteocondroma/patología , Compresión de la Médula Espinal/diagnóstico , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/fisiopatología , Neoplasias de la Columna Vertebral/complicaciones , Neoplasias de la Columna Vertebral/patología , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/patología , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
OBJECTIVE: Recovery of hand motor function after surgical treatment in myelopathy patients is commonly observed. Accurate evaluation of postoperative hand function contributes to assessing the efficacy of surgical treatment. However, no objective and effective evaluation method has been widely accepted in clinical practice. Therefore, the study aimed to explore the value of Myelopathy-hand Functional Evaluation System (MFES) in assessing the postoperative hand function for myelopathy patients. MATERIAL AND METHOD: MFES mainly consist of a pair of wise-gloves and a computer with software. One hundred and thirty myelopathy patients were included and all of them received optimal surgery treatment. The Japanese Orthopaedic Association (JOA) scores were marked at preoperative and at 6 months after surgery. All patients were asked to perform the 10-s grip and release test, and the hand movements were simulated and converted into waveforms by MFES. The waveform parameters were measured and analyzed. RESULTS: The JOA scores and the number of grip-and-release (G-R) cycles significantly increased after surgery. Correspondingly, the waveforms of ulnar three fingers were significantly higher and narrower, along with the significantly declined average time per cycle in postoperative. The a/b ratio (Wave height/wave width) of five fingers were significantly higher in postoperative than that in preoperative. Based on the improvement rate of a/b, the excellent and good rate of surgical outcomes was 62.30 %, which was significantly higher than that (47.69 %) based on the improvement rate of JOA scores (P = 0.019). CONCLUSION: MFES is an effective assessment tool in evaluating the postoperative hand function for myelopathy patients.
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Fuerza de la Mano/fisiología , Mano/fisiopatología , Rendimiento Físico Funcional , Compresión de la Médula Espinal/cirugía , Fusión Vertebral , Espondilosis/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Vértebras Cervicales/cirugía , Discectomía , Femenino , Humanos , Laminectomía , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Compresión de la Médula Espinal/fisiopatología , Espondilosis/fisiopatología , Resultado del TratamientoAsunto(s)
Alcaptonuria/diagnóstico , Enfermedades Óseas Metabólicas/diagnóstico por imagen , Vértebras Cervicales/diagnóstico por imagen , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Ocronosis/diagnóstico , Compresión de la Médula Espinal/diagnóstico por imagen , Espondilosis/diagnóstico por imagen , Adulto , Alcaptonuria/complicaciones , Alcaptonuria/orina , Trastornos Neurológicos de la Marcha/etiología , Trastornos Neurológicos de la Marcha/fisiopatología , Ácido Homogentísico/orina , Humanos , Desplazamiento del Disco Intervertebral/etiología , Desplazamiento del Disco Intervertebral/fisiopatología , Masculino , Ocronosis/complicaciones , Ocronosis/orina , Enfermedades de la Esclerótica/etiología , Enfermedades de la Esclerótica/patología , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/fisiopatología , Espondilosis/etiología , Espondilosis/fisiopatología , Incontinencia Urinaria/etiología , Incontinencia Urinaria/fisiopatologíaRESUMEN
OBJECTIVE: Metastatic spinal cord compression (MSCC) is a frequent phenomenon in cancer disease, often leading to severe neurological deficits. Especially in patients with complete motor paralysis, regaining the ability to walk is an important treatment goal. Our study, therefore, aimed to assess the neurological outcome of patients with MSCC and complete motor paralysis after decompressive surgery. METHODS: Patients with MSCC and complete motor paralysis, surgically treated by decompressive surgery between 2004-2014 at a single institution were retrospectively analyzed. Clinical patient data were collected from medical records. To assess the neurological outcome, Frankel grade (FG) at admission and discharge were compared. Statistical analysis was performed to identify factors associated with an ambulatory status after surgery. RESULTS: Twenty-eight patients were included in this study. The majority of metastases (57 %) were located in the thoracic spine and 75 % showed extraspinal tumor spread. The median interval between loss of ambulation and surgery was 35 h (IQR: 29-70). Posterior circumferential decompression without stabilization was performed in all cases within 24 h of admission. Neurological function improved in 17 patients (63 %) and seven (26 %) even regained the ability to walk following surgery. The rate of complications was low (7%). In statistical analysis, only the Karnofsky Performance Index (KPI) displayed a significant predictive value for an ambulatory status at discharge. CONCLUSIONS: Our findings indicate that severely affected MSCC patients with complete motor paralysis might benefit from decompressive surgery even when the loss of ambulation occurred more than 24 h ago.
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Carcinoma/secundario , Descompresión Quirúrgica/métodos , Paraplejía/cirugía , Recuperación de la Función , Terapia Recuperativa , Compresión de la Médula Espinal/cirugía , Neoplasias de la Columna Vertebral/secundario , Anciano , Neoplasias de la Mama/patología , Carcinoma/complicaciones , Estudios de Factibilidad , Femenino , Humanos , Estado de Ejecución de Karnofsky , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos , Paraplejía/etiología , Paraplejía/fisiopatología , Pronóstico , Neoplasias de la Próstata/patología , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/fisiopatología , Neoplasias de la Columna Vertebral/complicaciones , Tiempo de Tratamiento , Resultado del TratamientoRESUMEN
OBJECTIVE: Whether and when cervical disc arthroplasty (CDA) could be indicated for preoperative cervical spine kyphosis is unclear. The purpose of the study was to compare the clinical and radiological outcomes of single-level CDA and single-level anterior cervical discectomy and fusion (ACDF) in the patient with preoperative reversible kyphosis. PATIENTS AND METHODS: From 2014-2018, patients who underwent single-level CDA and single-level ACDF were consecutively reviewed. The Japanese Orthopedic Association score, Neck Disability Index and VAS were used to evaluate clinical outcomes. Range of motion (ROM), C2-7 Cobb angle, functional spinal unit (FSU) angle, and heterotopic ossification (HO) were assessed. RESULTS: Thirty-eight CDA patients (a mean follow-up of 39.8 months) and 42 ACDF patients (37.6 months) with preoperative reversible kyphosis were included. Both groups had significant improvements in clinical outcomes, without statistically significant differences. Before surgery, there was no significant difference in cervical alignment and ROM between groups. After surgery, both groups had a significant increase in C2-7 angle and FSU without significant inter-group differences. At the last follow-up, CDA group consisted of 5 cases of lordosis, 11 cases of kyphosis and 22 cases of straight spine, while the corresponding case number in ACDF group was 4, 12 and 26 (P = 0.866). The C2-7 ROM was preserved in both groups. The segmental ROM of CDA group decreased mildly from 8.3° preoperatively to 5.1° finally, whereas the segmental ROM of ACDF group decreased significantly to nearly zero. 60.5 % (23/38) patients in CDA group developed HO with 9 levels of grade â ¢ and 3 levels of grade â £. CONCLUSION: For the patients with single-level disc degenerative disease and preoperative reversible kyphosis, both CDA and ACDF achieved satisfactory and comparable clinical results. CDA was non-inferior to ACDF regarding the radiological outcomes of cervical alignment. Patients in CDA group had a relatively high incidence of HO formation.
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Vértebras Cervicales/cirugía , Discectomía/métodos , Degeneración del Disco Intervertebral/cirugía , Cifosis/fisiopatología , Fusión Vertebral/métodos , Reeemplazo Total de Disco/métodos , Adulto , Femenino , Humanos , Degeneración del Disco Intervertebral/complicaciones , Degeneración del Disco Intervertebral/fisiopatología , Cifosis/etiología , Masculino , Persona de Mediana Edad , Radiculopatía/fisiopatología , Compresión de la Médula Espinal/fisiopatologíaRESUMEN
BACKGROUND: Spinal epidural lipomatosis (SEL) is the excessive accumulation of extradural adipose tissue. Severe cases could result in myelopathy, and very rarely, in syringomyelia formation. Surgery has been associated with high morbidity and mortality, and no proven long-term benefits. The objective was to provide a technical description of an efficient and cost-effective procedure for multilevel thoracic decompression without requiring spinal instrumentation. METHODS: A technique of multilevel hemilaminotomy windows is described in a patient with severe thoracic SEL causing syringomyelia. A 3-dimensional spine model was created to illustrate the technique and working angles. We performed a literature review by searching PubMed, Ovid Embase, and Scopus electronic databases with the predetermined inclusion criteria of cases with spinal lipomatosis and a fluid cavity within the spinal cord. RESULTS: The patient's deficit and syringomyelia resolved postoperatively. A review of the literature revealed only 3 cases of syringomyelia secondary to SEL. Syringomyelia expansion occurred in all cases leading to progressive neurologic decline, and surgery with removal of the excessive adipose tissue resolved the syringomyelia and improved the neurologic functioning in all cases. CONCLUSIONS: This technique of multilevel alternating hemilaminotomy "windows" allows for safe and effective decompression and resection of the excessive adipose tissue with reduced operative time and without requiring spine instrumentation. The technique maintains the integrity of the posterior column, thus reducing the risk of postdecompression deformity. Careful bipolar electrocoagulation of internal vertebral veins and meticulous hemostasis is key for minimizing the intraoperative blood loss and avoiding postoperative hematoma formation.
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Descompresión Quirúrgica/métodos , Laminectomía/métodos , Compresión de la Médula Espinal/cirugía , Siringomielia/cirugía , Vértebras Torácicas/cirugía , Tejido Adiposo , Adulto , Espacio Epidural , Femenino , Humanos , Imagenología Tridimensional , Lipomatosis/complicaciones , Imagen por Resonancia Magnética , Compresión de la Médula Espinal/diagnóstico por imagen , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/fisiopatología , Siringomielia/diagnóstico por imagen , Siringomielia/etiología , Siringomielia/fisiopatologíaRESUMEN
STUDY DESIGN: A retrospective study of prospectively collected data. OBJECTIVE: This study aimed to examine how radiological parameters affect dynamic changes in the cross-sectional area of the spinal cord (CSA) in cervical spondylotic myelopathy (CSM) patients and how they correlate with the severity of myelopathy, by evaluating multi-modal spinal cord evoked potentials (SCEPs). SUMMARY OF BACKGROUND DATA: Appropriate assessments of dynamic factors should reveal hidden spinal cord compression and provide useful information for choosing surgical procedures. METHODS: Seventy-nine CSM patients were enrolled. They were examined with kinematic CT myelography (CTM), and the spinal levels responsible for their CSM were determined via SCEP examinations. The C2-7 angle, C2-7 range of motion, and percentage of slip were measured on the midsagittal view during flexion and extension, and the CSA was measured on the axial view in each neck position using kinematic CTM. The patients who exhibited the smallest CSA values during extension and flexion were classified into Groups E and F, respectively. RESULTS: Fifty-two (65.8%) and 27 (34.2%) cases were included in Groups E and F, respectively. The preoperative JOA score did not differ significantly between the groups; however, the preoperative lower-limb JOA score of Group F was significantly lower than that of Group E (2.24â±â0.82 vs. 2.83â±â1.09, Pâ=â0.016). In the multiple logistic regression analysis, a small C2-7 angle during extension (ß = 5°, odds ratio: 0.69, 95% confidence interval [CI]: 0.54-0.90) and the slip percentage during flexion (ß = 5%, odds ratio: 1.42, 95% CI: 1.09-1.85) were identified as significant predictors of belonging to Group F. CONCLUSION: Exhibiting more severe spinal cord compression during neck flexion was associated with a small C2-7 angle and anterior spondylolisthesis. The neurological status of the patients in Group F was characterized by severe lower limb dysfunction because of a disturbed blood supply to the anterior column.Level of Evidence: 4.
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Potenciales Evocados , Cifosis/complicaciones , Mielografía/efectos adversos , Compresión de la Médula Espinal/diagnóstico por imagen , Compresión de la Médula Espinal/etiología , Espondilolistesis/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Vértebras Cervicales/cirugía , Femenino , Humanos , Cifosis/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Radiografía , Rango del Movimiento Articular/fisiología , Estudios Retrospectivos , Compresión de la Médula Espinal/fisiopatología , Compresión de la Médula Espinal/cirugía , Enfermedades de la Médula Espinal/cirugía , Osteofitosis Vertebral/complicaciones , Espondilolistesis/diagnóstico por imagen , Espondilosis/cirugía , Tomografía Computarizada por Rayos XRESUMEN
More information is available concerning risks of craniocervical junction issues in infancy than at later ages. Therefore, we elected to quantify the risks at greater than 1 year of age through a retrospective analysis of 477 individuals with achondroplasia using a REDCap database. Evaluation of these 477 individuals revealed 77 (16.1%) who had pathologic neurologic manifestations after 1 year of age related to the craniocervical junction. Within this subpopulation of 77 individuals, 43 (55.8%) underwent craniocervical decompression surgery, or 9.0% of the total population. Whether decompressed or not, most individuals with craniocervical junction issues after infancy had a normal outcome, without long-term neurological sequelae (57/77, 74.0%). The remaining 20 had various long-term neurological issues. This is the first cohort based estimate of risks related to the upper cervical spine in individuals with achondroplasia specifically beyond infancy.
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Acondroplasia/diagnóstico , Compresión de la Médula Espinal/diagnóstico , Enfermedades de la Médula Espinal/diagnóstico , Acondroplasia/complicaciones , Acondroplasia/epidemiología , Acondroplasia/fisiopatología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/patología , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Compresión de la Médula Espinal/complicaciones , Compresión de la Médula Espinal/fisiopatología , Enfermedades de la Médula Espinal/complicaciones , Enfermedades de la Médula Espinal/epidemiología , Enfermedades de la Médula Espinal/fisiopatología , Adulto JovenRESUMEN
BACKGROUND: Degenerative Cervical Myelopathy results from spine degenerations narrowing the spinal canal and inducing cord compressions. Prognosis is challenging. This study aimed at simulating typical spinal cord compressions observed in patients with a realistic model to better understand pathogenesis for later prediction of patients' evolution. METHODS: A 30% reduction in cord cross-sectional area at C5-C6 was defined as myelopathy threshold based on Degenerative Cervical Myelopathy features from literature and MRI measurements in 20 patients. Four main compression types were extracted from MRIs and simulated with a comprehensive three-dimensional finite element spine model. Median diffuse, median focal and lateral types were modelled as disk herniation while circumferential type additionally involved ligamentum flavum hypertrophy. All stresses were quantified along inferior-superior axis, compression development and across atlas-defined spinal cord regions. FINDINGS: Anterior gray and white matter globally received the highest stress while lateral pathways were the least affected. Median diffuse compression induced the highest stresses. Circumferential type focused stresses in posterior gray matter. Along inferior-superior axis, those two types showed a peak of constraints at compression site while median focal and lateral types showed lower values but extending further. INTERPRETATION: Median diffuse type would be the most detrimental based on stress amplitude. Anterior regions would be the most at risk, except for circumferential type where posterior regions would be equally affected. In addition to applying constraints, ischemia could be a significant component explaining the early demyelination reported in lateral pathways. Moving towards patient-specific simulations, biomechanical models could become strong predictors for degenerative changes.
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Vértebras Cervicales/patología , Fenómenos Mecánicos , Compresión de la Médula Espinal/etiología , Enfermedades de la Médula Espinal/complicaciones , Fenómenos Biomecánicos , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Compresión de la Médula Espinal/diagnóstico por imagen , Compresión de la Médula Espinal/patología , Compresión de la Médula Espinal/fisiopatologíaRESUMEN
OBJECTIVE: Atlantoaxial instability, although rarely reported in the literature, can be associated with cervical dystonia (CD) and may lead to compression of the cord at the craniovertebral junction. We present a case series of 4 patients of longstanding CD with neurologic complications. Treatment strategies and challenges are discussed. METHODS: Retrospective analysis of 4 cases of longstanding CD with complications of myelopathy or radiculopathy. RESULTS: The average age at onset of complications was 28 years (range, 17-37). The average duration of CD was 23.75 years. Narrowing of the craniovertebral junction was seen in 3 patients, of which 2 had os odontoideum, and 1 had rotational malalignment at the atlantoaxial joint. One patient had disc desiccation with bulge and intramedullary signal changes in the cord at C3-4 level. Medical treatment was not satisfactory, but botulinum toxin was partly useful in all. One patient had sequelae of myelopathy and did recover partially after deep brain stimulation. Of the 2 patients who underwent surgical fixation with a fusion of the spine, one improved, and the other had no improvement due to irreversible cord damage. The overall outcome was satisfactory only in 2 patients. CONCLUSIONS: Early-onset CD can lead to cord complications at a young age and at higher levels of the cervical spine and at the cervicovertebral junction. Comprehensive management by a multidisciplinary team is crucial to prevent complications early.
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Articulación Atlantoaxoidea/cirugía , Inestabilidad de la Articulación/terapia , Radiculopatía/terapia , Compresión de la Médula Espinal/terapia , Fusión Vertebral , Tortícolis/terapia , Inhibidores de la Liberación de Acetilcolina/uso terapéutico , Adolescente , Adulto , Articulación Atlantoaxoidea/fisiopatología , Toxinas Botulínicas/uso terapéutico , Estimulación Encefálica Profunda , Femenino , Humanos , Degeneración del Disco Intervertebral/etiología , Degeneración del Disco Intervertebral/fisiopatología , Degeneración del Disco Intervertebral/cirugía , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/fisiopatología , Masculino , Bloqueo Nervioso , Radiculopatía/etiología , Radiculopatía/fisiopatología , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/fisiopatología , Tortícolis/complicaciones , Tortícolis/fisiopatología , Adulto JovenRESUMEN
OBJECTIVE: This report analyzes the significance of osteophytes in the overall pathologic scheme in patients with single-level or multilevel cervical spinal degeneration. METHODS: From January 2010 to December 2018, 249 patients with cervical spondylosis were surgically treated. The alterations in ventral compression caused by disc bulges, osteophytes, and ligament buckling (disc-osteophye-ligament [DOL] complex) at single or multiple levels were evaluated after surgical treatment that involved only spinal fixation and did not involve any kind of bone or soft tissue decompression. Delayed (≥1 year after surgery) postoperative imaging was available in 165 patients and these patients formed the study group. Forty-five patients underwent facet distraction arthrodesis (group A), 106 patients underwent only-fixation involving transarticular screw insertion (group B), and 14 patients underwent hybrid fixation that involved both intra-articular spacers and transarticular fixation techniques (group C) as the surgical treatment. RESULTS: The size of the DOL complex at the segments that underwent fixation was reduced in 136 patients. The size of the DOL complex or its related dural or neural compression did not increase in any of the cases evaluated. Reduction in the size of DOL was more pronounced in patients in group A in both immediate postoperative and delayed images and in patients in group C at spinal levels at which facet distraction was performed using facet distraction spacers. CONCLUSIONS: Spinal stabilization reduces the size of osteophytes. Facet distraction spacers are more effective in reduction of the size of DOL in both immediate and delayed postoperative periods.
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Artrodesis/métodos , Vértebras Cervicales/cirugía , Osteofito/diagnóstico por imagen , Compresión de la Médula Espinal/diagnóstico por imagen , Espondilosis/cirugía , Articulación Cigapofisaria/cirugía , Anciano , Tornillos Óseos , Vértebras Cervicales/diagnóstico por imagen , Femenino , Humanos , Hipertrofia/diagnóstico por imagen , Hipertrofia/fisiopatología , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Desplazamiento del Disco Intervertebral/fisiopatología , Ligamento Amarillo/patología , Masculino , Persona de Mediana Edad , Osteofito/fisiopatología , Radiculopatía/fisiopatología , Estudios Retrospectivos , Compresión de la Médula Espinal/fisiopatología , Espondilolistesis/diagnóstico por imagen , Espondilolistesis/fisiopatología , Espondilosis/diagnóstico por imagen , Espondilosis/fisiopatología , Resultado del Tratamiento , Articulación Cigapofisaria/diagnóstico por imagen , Articulación Cigapofisaria/fisiopatologíaRESUMEN
OBJECTIVE: The goal of the present study was to examine the effect of vertebral body fracture on the InterVertebral Foraminal IVF parameters with an input acceleration to the seat bottom in the inferior-to-superior direction. METHODS: A series of 43 isolated lumbar spines underwent vertical dynamic loading using the vertical accelerative device to determine the influence of inferior to superior loading through the lumbar spine on the intervertebral foramen (IVF) geometries. Existence of foraminal stenosis was quantified using pre- and post-test computed tomography (CT) images. Foraminal height (IVF_Ht) and posterior disk height (PD_Ht) were the key IVF parameters. RESULTS: There was a significant (p < 0.05) decrease in the post-test IVF measurements compared to the pretest measurements. Furthermore, 30% of the total 49 AIS 2 cases and 70% of the total 21 AIS 3 cases had IVF values below the literature reported thresholds for IVF_Ht of < 15 mm and PD_Ht of < 4 mm, indicating likely occurrence of foraminal stenosis. CONCLUSIONS: These results underscore the need to assess foraminal geometry in compression fractures of the lumbar spine from vertical dynamic loading.
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Accidentes de Tránsito/estadística & datos numéricos , Compresión de la Médula Espinal/fisiopatología , Fracturas de la Columna Vertebral/fisiopatología , Cuerpo Vertebral/lesiones , Soporte de Peso/fisiología , Aceleración , Anciano , Humanos , Compresión de la Médula Espinal/diagnóstico por imagen , Fracturas de la Columna Vertebral/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
We present a case in which a movement disorder neurologist developed two different hyperkinetic movements due to corticospinal tract hyperexcitability, which resolved completely with surgical removal of an epidural spinal canal tumor. The first-hand description of these movements creates a unique opportunity for enhanced insight into these complex movement phenomena.