Assessing hand dysfunction in cervical spondylotic myelopathy.

METHODS: Twenty patients with CSM and 17 controls were recruited. Clinical scores of modified Japanese Orthopedic Association (mJOA) and Nurick were collected. MRI based compression grades such as cord distortion were assessed. Hand dysfunction was tested using a custom motorized apparatus. Subject's forearm was placed in a cast and positioned such that their metacarpophalangeal (MCP) joint was vertically aligned with the motor shaft. Surface electromyographic sensors were placed on flexor digitorum superficialis (FDS) and extensor digitorum communis muscles. Hyperreflexia was measured as the FDS muscle activation during reflex when the MCP joint was moved from flexion to extension at 300°/sec. Proprioception was quantified as the angle of detection in absence of visual or auditory cues (subjects were blindfolded and given noise-cancelling headphones). Strength was measured as the maximum isometric force at the MCP joint. 2-sample t-test (p<0.05) were performed to assess significant differences in reflexes, proprioception and strength among patients and controls (SPSS software version 24). RESULTS: Patients reported higher Nurick (1.90±1.0 vs 0±0, p<0.001) and lower mJOA scores (14.3±1.9 vs 18.0±0, p<0.001) as compared to controls. Similarly, patients with CSM had increased reflexes (peak FDS EMG) (0.073±0.096 vs. 0.014±0.010, p = 0.019). Patient proprioception was significantly worse; mean angle of detection was greater than twice as high in patients (9.6± 9.43°) compared to controls (4.0± 2.3°), p = 0.022. MRI based compression ratio (CR) was a significant predictor of hyperreflexia, CR<0.44 resulted in steep increase in reflex activity. Fifteen of the 20 patients who completed follow up testing at 6 months after surgery show substantial clinical improvement in reflexes and proprioceptive angle, while repeated testing in controls were unchanged. CONCLUSION: In conclusion, hyperreflexia and decline in proprioception are the main drivers of hand disability in patients with CSM. Of multiple scales, only a select few MRI scales (such as compression ratio) were predictive of increased reflexes. The study describes a pre-clinical testing apparatus to quantitatively and objectively assess primary presenting symptoms in CSM. This pilot apparatus has the potential to evaluate treatment efficacy through repeated testing. Objective testing of hand dysfunction can help inform the design of clinically feasible devices, guide MRI biomarker analysis, and improve our understanding of the progression of neurological injury in this patient population.

Can Modified Kurokawa's Double-Door Laminoplasty Reduce the Incidence of Axial Symptoms at Long-term Follow-up?: A Prospective Study of 152 Patients With Cervical Spondylotic Myelopathy.

STUDY DESIGN: A prospective cohort study. OBJECTIVE: The purpose of this study was to determine whether the modified procedure reduces long-term axial symptoms (AS) and to understand better why the AS occur. SUMMARY OF BACKGROUND DATA: Following Kurokawa's double-door laminoplasty, postoperative AS reduce the quality of life of patients with cervical spondylotic myelopathy. The etiology of AS remains unclear. Some studies report that preservation of the C7 spinous process can reduce the frequency of AS. The modified Kurokawa procedure prevents AS by preserving the semispinalis cervicis insertion in the spinous process of C2. However, it remains unclear whether the modified procedure lowers the incidence of AS in the long term (ie, >3 y). MATERIALS AND METHODS: This prospective cohort study investigated preoperative and postoperative v, cervical intervertebral range of motion, postoperative neurological recovery, neck disability index, visual analog scale, surgical cost, and time and blood loss. RESULTS: Both groups had satisfied improvement of neurological functions (P>0.05). At 3 months and 1 year after surgery, the difference in frequency between no symptoms and mild/severe symptoms was significant (traditional group, 39.06%; modified group, 20.45%) (P<0.05). Interestingly, 3 years after surgery, there were no significant between-group differences (P>0.05). CONCLUSIONS: This modified approach reduced the incidence of postoperative ASs at 3 months and 1 year after the operation; however, the between-group difference was not significantly different at the 3-year follow-up. The reason for this finding is unclear; it may indicate that the incidence of AS is caused by other factors, such as the preservation of the C7 spinous process rather than the C2 spinous process.

The posterior cervical foraminotomy in the treatment of cervical disc/osteophyte disease: a single-surgeon experience with a minimum of 5 years' clinical and radiographic follow-up.

OBJECT: This study details long-term clinical and radiographic outcomes following single-level posterior cervical foraminotomy for degenerative disc or osteophyte disease. METHODS: The authors conducted a retrospective review of 162 cases involving patients treated by a single surgeon using a posterior cervical foraminotomy. Inclusion criteria were a minimum of 5 years' clinical and radiographic follow-up and unilateral single-level posterior cervical foraminotomy for degenerative disease between C-3 and C-7. Patients who had undergone previous operations, those who underwent bilateral procedures, and those who underwent foraminotomy as part of a larger laminectomy were excluded. The Neck Disability Index (NDI) was used for clinical follow-up, and radiographic follow-up was performed using static and dynamic lateral radiographs to compare focal and segmental alignment and changes in disc-space height. RESULTS: The mean presenting NDI score was 18 (range 2-39). The most common presenting symptoms were radiculopathy (110 patients [68%]), neck pain (85 patients [52%]), and subjective weakness (91 patients [56%]). The mean preoperative focal angulation at the surgically treated level was 4.2 degrees (median 4.1 degrees , range 7.3-15.3 degrees ), and the mean preoperative segmental curvature between C-2 and C-7 was 18.0 degrees (median 19.3 degrees , range -22.1 to 39.3 degrees ). The mean postoperative NDI score was 8 (range 0-39). Improvement in NDI scores was seen in 150 patients (93%). Resolution of radiculopathy was experienced by 104 patients (95% of patients with radiculopathy). The mean radiographic follow-up was 77.3 months (range 60-177 months). No statistically significant changes in focal or segmental kyphosis or disc-space height were seen among the overall cohort with time (Cox proportional hazards analysis and Student t-test, p > 0.05). The mean postoperative focal angulation was 4.1 degrees (median 3.9 degrees , range -9.9 degrees to 15.1 degrees ) and mean postoperative segmental angulation was 17.6 degrees (median 15.4 degrees , range -40.2 to 35.3 degrees ). Postoperative instability on dynamic imaging was present in 8 patients (4.9%); 7 of these patients were clinically asymptomatic and were treated conservatively, and 1 required cervical fusion. Postoperative loss of lordosis (defined as segmental Cobb angle < 10 degrees ) was seen in 30 patients (20%), 9 of whom had clinical symptoms and 4 of whom required further surgical correction. Factors associated with worsening sagittal alignment (Cox proportional hazards analysis, p < 0.05) included age > 60 at initial surgery, the presence of preoperative cervical lordosis of < 10 degrees , and the need for posterior surgery after the initial foraminotomy. CONCLUSIONS: The posterior cervical foraminotomy is highly effective in treating patients with cervical radiculopathy and results in long-lasting pain relief and improved quality-of-life outcomes in most patients. Long-term radiographic follow-up shows no significant trend toward kyphosis, although select patient subsets (patients older than 60 years, patients who had previous posterior surgery, and patients with < 10 degrees of lordosis preoperatively) appear to be at higher risk and require closer follow-up.

The prevalence and characteristics of thoracic magnetic resonance imaging findings in men.

STUDY DESIGN: A cross-sectional study of thoracic magnetic resonance image (MRI) findings. OBJECTIVE: To examine the prevalence of different thoracic MRI findings for T6-T12 and their associations with age and one another by level. SUMMARY OF BACKGROUND DATA: There is a dearth of descriptive epidemiology of thoracic MRI findings in the general population. METHODS: Thoracic MRIs of 524 men were assessed qualitatively and quantitatively for a variety of findings, including disc bulging, height and signal, vertebral deformities, endplate irregularities, osteophytes, and hemangiomas. Descriptive statistics, correlation coefficients and STATA's survey analysis were used. RESULTS: In the lower thoracic spine, 5.4% to 9.5% of the discs, depending on level, were qualitatively assessed as moderately to severely narrowed. Anterior bulging was more common than posterior, which was relatively rare and mild when present. Signal was lower in the midthoracic than lower discs. At least 1 moderate or severe vertebral deformity was found in 6.1% of the subjects, suggesting fracture, and hemangiomas were identified in 2.3% of subjects. Disc signal correlated most highly with age (r = 0.31-0.42). Qualitatively assessed disc height narrowing (r = 0.29-0.46) and quantitative disc height (r = 0.11-0.29) were associated with disc signal. Upper and lower endplate irregularities were associated with one another (r = 0.17-0.32), as were bulging and osteophytes, anteriorly (r = 0.35-0.61) and posteriorly (r = 0.26-0.45). CONCLUSION: Degenerative MRI findings beyond a mild grade were not commonly observed in the thoracic spine among 35-70-year-old men. Posterior bulges, in particular, were rare. The highest correlation with age existed for disc signal. Different MRI findings were associated with one another, but the magnitude of association varied by level. The effects of individual judgments and disc level on prevalence rates were apparent.

[Tinnitus diagnosis and treatment on the basis of our experiences]. / Diagnostyka i leczenie szumów usznych na podstawie wlasnych doswiadczen.

INTRODUCTION: The aim of the study was to analise tinnitus diagnosis and treatment on the basis of our experiences. MATERIAL AND METHODS: 137 patients hospitalizated in Otolaryngology and Laryngological Oncology Clinic because of tinnitus (88 women - 64% and 49 men - 35,8%) were included to the study. The diagnostic procedures were unified that enabled put forward correct diagnosis. After history and otoscopy, detailed audiologic diagnostic procedures (pure tone audiometry, suprathreshold audiometry, speech audiometry, acoustic immittance measures, auditory brainstem responses) were taken. Electronystagmography and videonystagmography, tinnitus loudness match, head and neck radiologic examinations supplemented diagnostic procedures. Alternative tinnitus treatment options were applied. RESULTS: Study confirmed that tinnitus is the most frequent in patients above 50 years old (67,8% of participants). Tinnitus frequently coexist with bilateral sensorineural hearing impairment (69,1% of participants). 40,1% from asalysed group of patients complained of tinnitus of medium frequencies and 30,6% of patients complained of high frequency tinnitus. 42,3% of participants suffered from vertigo. CONCLUSIONS: The risk of tinnitus increases in patients above 55 years old that suffer from metabolic conditions and cervical spondylosis. Tinnitus frequently coexist with bilateral sensorineural hearing impairment and are bilateral or they are noticeable in better hearing ear. The most beneficial to tinnitus is causal and symptomatic treatment with several methods application.

C5 nerve root palsy after cervical laminoplasty and posterior fusion with instrumentation.

STUDY DESIGN: Consecutive case series. OBJECTIVE: To compare the incidence and clinical characteristics of postoperative fifth cervical nerve root palsy (C5 palsy) in patients with cervical myelopathy treated by laminoplasty alone and laminoplasty with posterior instrumentation. SUMMARY OF BACKGROUND DATA: In patients who have multilevel cervical myelopathy with reducible kyphosis or instability, the authors have performed laminoplasty together with instrumented fusion to restore lordosis and stability. There seems to be a high incidence of postoperative C5 palsy in these patients. METHODS: Seventy-three patients with a mean age of 60.5 years and multilevel cervical myelopathy treated by laminoplasty from 1995 to 2005 were reviewed. Incidence, side, and severity of muscle weakness from patients with C5 palsy after posterior instrumented fusion (instrumented group) was compared with those without instrumentation (noninstrumented group). Radiologic parameters were assessed to identify predisposing factors. RESULTS: Overall 10 of 73 (14%) patients developed the C5 palsy, of which 5 (50%) of 10 patients were in instrumented group, and 5 of 63 (8%) patients were in noninstrumented. Three of 5 (60%) had the palsy on the same side of the opened lamina in the instrumented group, in the same proportion as the noninstrumented. Three (60%) patients in instrumented group developed deltoid weakness grade 1, but none in the noninstrumented had weaker than grade 3. All of the palsied in the instrumented group recovered within 2 years after surgery without removal of implant. Of the 5 patients with the palsy in the instrumented group, 3 had anterolisthesis before surgery and posterior translation of C4 on C5 by the surgery, and no patient without the palsy had the anterolisthesis. CONCLUSIONS: Posterior cervical fusion using instrumentation for restoration of lordotic alignment combined with laminoplasty is highly associated with severe postoperative C5 palsy in patients with multilevel cervical myelopathy and C4 anterolisthesis.

Surgical outcomes of elderly patients with cervical spondylotic myelopathy.

BACKGROUND: Cervical spondylotic myelopathy is a potentially serious neurologic disorder that commonly presents with gait difficulty and hand dysfunction. Because the development of CSM is in large part related to advanced spondylosis and degenerative disk disease, elderly patients appear to be at an increased risk to develop this condition. The surgical outcomes of this patient population have been understudied; the authors seek to report their clinical results in a series of patients with CSM older than 75 years who underwent surgical treatment. METHODS: This report is composed of a cohort of 36 elderly patients (older than 75 years) and 34 younger patients (younger than 65 years) who underwent decompressive surgery for CSM at one institution between 2001 and 2005. The patients' functional status was evaluated preoperatively and postoperatively using the mJOA disability scale. RESULTS: The mean follow-up time in the elderly group was 24 months, with a range from 12 to 48 months. There was a statistically significant improvement between mean preoperative (11.3) and postoperative (14.4) mJOA scores (P< .0001). The younger group had a higher neurologic recovery rate (71%) than the elderly group (59%); however, this was not statistically significant (P= .29). The postoperative complication rate in the elderly population (38%) was higher than in the younger group (6%; P= .002). CONCLUSION: Elderly patients with CSM are likely to obtain neurologic improvement after decompressive surgery. Their postoperative complication rate is higher than that of younger patients, yet most complications appear to be self limiting and do not adversely affect neurologic outcome.

Self-reported hard physical work combined with heavy smoking or overweight may result in so-called Modic changes.

BACKGROUND: Recently, the MRI finding of "Modic changes" has been identified as pathologic spinal condition that probably reflects a vertebral inflammatory process (VIP), which coincides with spinal pain in most. We hypothesized that heavy smoking in combination with macro- or repeated microtrauma could lead to VIP. The objectives were to investigate if combinations of self-reported heavy smoking, hard physical work, and overweight would be more strongly linked with VIP than with other spinal conditions, such as degenerated discs and non-specific low back pain (LBP). METHODS: Secondary analysis was made of a data base pertaining to a population-based cross-sectional study. A population-generated cohort of 412 40-yr old Danes provided questionnaire information on smoking, weight, height, type of work, and LBP. MRI was used to determine the presence/absence of disc degeneration and of VIP. Associations were tested between three explanatory variables (type of work, smoking, and body mass index) and four outcome variables (LBP in the past year, more persistent LBP in the past year, disc degeneration, and VIP). Associations with these four outcome variables were studied for each single explanatory variable and for combinations of two at a time, and, finally, in a multivariable analysis including all three explanatory variables. RESULTS: There were no significant associations between the single explanatory variables and the two pain variables or with disc degeneration. However, VIP was found in 15% of non-smokers vs. 26% of heavy smokers. Similarly, VIP was noted in 11% of those in sedentary jobs vs. 31% of those with hard physical work. Further, the prevalence of VIP in those, who neither smoked heavily nor had a hard physical job was 13%, 25% in those who either smoked heavily or had a hard physical job, and 41% in those who both smoked heavily and worked hard. The odds ratio was 4.9 (1.6-13.0) for those who were both heavy smokers and had a hard physical job as compared to those who were classified as "neither". Similar but weaker findings were noted for the combination of overweight and hard physical work but not for the combination of smoking and overweight. CONCLUSION: Hard physical work in combination with either heavy smoking or overweight is strongly associated with VIP. If this finding can be reproduced in other studies, it may have consequences in relation to both primary and secondary prevention of LBP, because blue collar workers, who are most likely to experience the consequences of LBP, also are those who are most likely to smoke.

Incidência de osteófitos na coluna vertebral / Osteophyte incidence on vertebral column

Ao longo do processo de evolução o homem adquiriu a postura ereta. Devido à ação da gravidade surgiram algumas complicações decorrentes dessa postura; entre elas o aparecimento de osteófitos. O objetivo do presente estudo foi verificar a incidência de osteófitos em exames laudados da coluna vertebral e qual a região da coluna mais acometida. Para isso foram utilizados 1089 laudos de 636 indivíduos, sendo 55,5% mulheres e 44,5% homens, atendidos em um intervalo de 6 meses, de janeiro a junho de 2006 em uma Clínica de Radiologia particular do Alto Tietê. Os resultados encontrados foram que dos laudos,26,9% foram considerados anormais. Das três regiões da coluna vertebral, foram encontrados osteófitos respectivamente para mulheres e homens: 15,4% e 5,7% região cervical; 13,6% e 12,4% região torácica e 17,9% e 13,7% região lombar. O grau de osteófito mais encontrado foiosteófito marginal para as regiões cervical e lombar e labiação marginal predominou na região torácica. Concluiu-se que a incidência de osteófitos do total de laudos analisados foi 26,9% ea região da coluna mais acometida foi a lombar. Além disso, as mulheres apresentaram mais casos de osteófitos que homens.

With the evolution of mankind appeared the erect posture. Due to gravity actioncomplications appeared because of this posture, like the osteophytes. The aim of this study was to investigate osteophyte incidence on vertebral column and the most affected column region. For this were used 1089 reports of 636 patients: 55.5% women and 44.5% men, attended between january and june of 2006 in a privet Clinic on Alto do Tietê, region of São Paulo. Resultsrevealed that 26.9% of reports had alterations. Region’s analysis revealed osteophytes in men and women, respectively: 15.4% and 5.7% on cervical region; 13.6% and 12.4% on thoracic region and 17.9% and 13.7% on lumbar region. The most common kind of osteophyte was marginal osteophyte on cervical and lumbar regions and marginal labium was predominant on thoracic region. The incidence of osteophytes on vertebral column was 26.9% and lumbar region was the most affected. Besides, women have more osteophytes cases than men.

Major vascular injury during anterior lumbar spinal surgery: incidence, risk factors, and management.

STUDY DESIGN: Retrospective chart review. OBJECTIVE: To examine the incidence of major vascular injury during anterior lumbar spinal surgery, attempt to identify predisposing risk factors, and to discuss management techniques. SUMMARY OF BACKGROUND DATA: Major vascular injury can be a catastrophic complication of anterior lumbar spinal surgery. METHODS: Current procedural terminology codes were used to identify the occurrence of major vascular injury, defined as injury to the iliac vessels, vena cava, and aorta. Once identified, the office record, hospital chart, operative note, and diagnostic test results were reviewed in detail. RESULTS: Three hundred forty-five operations were performed on 338 patients. Incidence of major vascular complication was 2.9% (10 of 345). There were 9 injuries of the common iliac vein and a single aortic injury. Risk factors identified in patients with major vascular injury were current or previous osteomyelitis or discogenic infection (n = 3), previous anterior spinal surgery (n = 2), spondylolisthesis (n = 2; 1 isthmic Grade II, 1 iatrogenic Grade II), large anterior osteophyte (n = 2), transitional lumbosacral vertebra (n = 1), and anterior migration of interbody device (n = 1). Lateral venorrhaphy by suture (n = 6) and hemoclip application (n = 2) was augmented by topical agents, which constituted the sole method of repair on 1 occasion. Magnetic resonance venography demonstrated iliac vein thrombosis in 1 patient. CONCLUSION: Current or previous osteomyelitis or discogenic infection, previous anterior spinal surgery, spondylolisthesis, osteophyte formation, transitional lumbosacral vertebra and anterior migration of interbody device point to an increased risk of vascular injury during anterior lumbar spinal surgery. Careful handling of the vascular structures and liberal use of topical hemostatic agents can lead to control of hemorrhage and preservation of vascular patency. Routine postoperative surveillance for proximal deep vein thrombosis, by magnetic resonance venography of the pelvic veins and inferior vena cava, should be performed after venorrhaphy.

Quality of life assessment using the Short Form-12 (SF-12) questionnaire in patients with cervical spondylotic myelopathy: comparison with SF-36.

STUDY DESIGN: Clinical outcome study comparing the Short Form-36 (SF-36) and Short Form-12 (SF-12) assessment scales in patients with cervical spondylotic myelopathy (CSM). OBJECTIVES: To compare the validity, reliability, and sensitivity to change of the SF-12 and SF-36 scales in CSM patients undergoing decompressive surgery. SUMMARY OF BACKGROUND DATA: The SF-36 is a generic Health Related Quality of Life (HRQoL) questionnaire, consisting of 36 questions that can be reported as a Physical (PCS) and Mental Component Summary (MCS). Recently, an abbreviated version of SF-36, the SF-12, which uses only 12 questions drawn from the SF-36, has been described. METHODS: In this prospective study, patients with CSM undergoing decompressive surgery, self-completed the SF-36 questionnaire before surgery and at 6 months after surgery. SF-12 item responses were abstracted from the responses given to the SF-36 questionnaire. The validity, reliability, and sensitivity to change of the PCS and MCS components of SF-12 and SF-36 scales were compared. RESULTS: Overall, 105 patients underwent anterior (N = 58) or posterior (N = 47) decompressive surgery. After surgery, there were improvements in the PCS components of both the SF-36 (40 +/- 2 to 54 +/- 2) and SF-12 (34 +/- 2 to 48 +/- 3), as well as in the MCS component of the SF-36 (48 +/- 2 to 63 +/- 2) and SF-12 (43 +/- 2 to 59 +/- 2) (P < 0.001). The sensitivity to change and absolute sensitivity for both SF-12 and SF-36 were comparable, but the reliability of SF-36 was marginally greater. There were close and linear correlations between the SF-36 and SF-12 scores for both the PCS and MCS components, before and after surgery (R = 0.86 to 0.93; P < 0.0001). CONCLUSIONS: Both the SF-12 and SF-36 scales are valid and sensitive to changes in physical and mental health status in CSM patients, undergoing decompressive surgery. Despite its abbreviated nature, the SF-12 appears to be an adequate substitute for SF-36, and its brevity should increase its attractiveness to both clinicians and patients.

Degenerative disorders of the lumbar and cervical spine.

Degenerative disorders in the spine are normal, age-related phenomena and largely asymptomatic in most cases. Conservative management of lumbar and cervical spondylosis is the mainstay of treatment, and most patients with symptomatic degenerative changes respond appropriately with nonsurgical management. Surgical intervention can be considered an appropriate and viable option when conservative measures have failed. Treatment options should always be directed toward the specific nature and location of the patient's individual pathology. Although current standards in the surgical management of lumbar and cervical degenerative disorders include discectomy, neural decompression, and instrumented spinal arthrodesis, new approaches that address this often-challenging clinical entity are on the horizon.

Spondylolysis and spondylolisthesis in the child and adolescent: a new classification.

Spondylolysis and spondylolisthesis commonly are diagnosed in children and adolescents. The diagnostic workup and treatment plan vary widely among physicians. Although the orthopaedic literature is extensive on the topic, it is our opinion that a lack of clarity exists with regards to etiology, terminology, subtypes of spondylolysis and spondylolisthesis, and treatment. Important basic principles regarding spondylolysis and spondylolisthesis, with emphasis on clinical evaluation and nonsurgical treatment, serve as the basis for a new classification. We propose a new classification for pediatric spondylolysis and spondylolisthesis that is comprehensive, simple, and easily applied. This scheme is based on clinical presentation and spinal morphology and is more appropriate for the child and adolescent than the existing classification schemes of Wiltse-Newman and Marchetti-Bartolozzi. Algorithms for evaluation and treatment of spondylolysis and spondylolisthesis in children and adolescents, based on this new classification, are presented.

Intervertebral disk calcification of the spine in an elderly population: radiographic prevalence, location, and distribution and correlation with spinal degeneration.

PURPOSE: To determine the prevalence, distribution, and location of intervertebral disk calcification (IDC) in the thoracic and lumbar spine and the association of IDC with radiographically evident spinal degenerative changes in cadavers. MATERIALS AND METHODS: Anterior vertebral columns comprising T1 through L5 were removed from 223 cadavers (183 men, 40 women; mean age at death, 67 years; range, 37-94 years). Approximately 5-mm-thick parasagittal sections were investigated with high-contrast radiography. The presence of IDC, osteophytes, vertebral endplate abnormalities, and vacuum phenomena was recorded, and the height of disk space was measured at 3,568 intervertebral levels. Logistic regression analysis was performed. RESULTS: IDC was identified in 178 (80%) of the 223 cadavers. Of 3,568 disks, 459 (13%) had IDC, and 289 cases (63%) were located in the annulus fibrosus. IDC was most common in the lower thoracic spine, occurring in 275 (60%) of 459 disks. IDC occurred in 159 (87%) of 183 men and 19 (48%) of 40 women. Logistic regression analysis was adjusted for age, and results showed that the frequency of IDC was significantly higher in men in upper, middle, and lower segments of the thoracic spine (P <.05) but not in the lumbar spine (P =.09). IDC correlated with increasing age (P <.001) and disk space loss (P <.001) at all spinal levels. There was no association of IDC with vacuum phenomena or vertebral endplate abnormalities at any spinal level. CONCLUSION: IDC is common in elderly persons, especially in the annulus fibrosus and lower thoracic spine. The prevalence of IDC increases with age and extent of disk space loss.

Late complications of adult idiopathic scoliosis primary fusions to L4 and above: the effect of age and distal fusion level.

UNLABELLED: STUDY DESIGN A retrospective analysis of primary cases of adult idiopathic scoliosis treated with long instrumented fusions from the thoracic spine proximally to segments that range from T11 to L4 distally. OBJECTIVE: To analyze whether patients requiring revision surgery had lower postoperative SRS-24 scores; age >or=40 years correlated with higher rates of revision surgery; disc degeneration below the fusion occurred more commonly with a more distal lowest instrumented vertebra or older patient age (>or=40 years); and whether smokers had higher rates of major complications or revision surgery. SUMMARY OF BACKGROUND DATA: Few reports describe complications related to primary long fusions using modern 2+ rods, hook/pedicle screw instrumentation methods in the treatment of adult idiopathic scoliosis. METHODS: Sixty-seven patients were analyzed with an average age of 38.8 years (range 21-61 years). The average clinical follow-up was 7.8 years (range 2-16 years): 42 patients had >5 years follow-up, including 23 patients with >10 years follow-up. Patients were categorized by age (< or >or=40 years) and level of the lowest instrumented vertebra (T11-L2 vs. L3-L4). Upright radiographs and postoperative SRS-24 questionnaires from the latest follow-up date were analyzed. RESULTS: Patients requiring revision surgery had lower total score (average 72.0) than those that did not (total score = 94.2; P = 0.01). More specifically, patients with pseudarthrosis had lower total scores (average 74.7) than those without (average total score = 93.5; P = 0.02). When analyzing age, there were similar rates of pseudarthrosis, but higher rates of transition syndrome (2) and sagittal/coronal imbalance (1 each) in patients >or=40 years. Subsequent distal disc degeneration did not correlate significantly with more distal lowest instrumented vertebra or older patient age. Smokers did not have higher rates of major complications or revision surgery than nonsmokers. CONCLUSIONS: Patients with adult idiopathic scoliosis and long fusions had similar pseudarthrosis rates, but higher rates of transition syndrome when lowest instrumented vertebra was L3-L4 relative to levels T11-L2. When categorized by age, complication rates were similar in each group. Patients with pseudarthroses or other diagnoses requiring revision surgery had lower SRS-24 total scores than those without (P = 0.02 and P = 0.01, respectively).

Amyotrophic lateral sclerosis: frequent complications by cervical spondylosis.

Cervical spondylosis is associated with myelopathy and radiculopathy, which sometimes mimic clinical manifestations of amyotrophic lateral sclerosis (ALS), a fatal neurodegenerative disorder that affects upper and lower motor neurons. Cervical spondylosis may coexist with ALS because both diseases preferentially affect individuals of middle or old age. We investigated 63 patients with ALS to clarify the complications of cervical spondylosis and other spinal disorders and to explore the history of surgical treatment for them. We found cervical spondylosis in 30 patients (48%), lumbar spondylosis in 7 (13%), ossification of the posterior longitudinal ligament (OPLL) in 4 (6.3%), and ossification of the yellow ligament (OYL) in 4 (6.3%). Surgery was performed early in the course of the disease on the cervical spine in five patients (7.9%) and on the lumbar spine in one (1.6%); these patients consulted our clinic because their motor symptoms had progressed even after the spinal surgery. Our results indicate that nearly half of all ALS patients have their disease complicated by cervical spondylosis, and that a careful differential diagnosis for ALS is necessary before making decisions about spinal surgery.

[Occupational disease 2108. Degenerative changes of the cervical spine as a causality criterion in the assessment of discogenic diseases according to BeKV 2108]. / Berufserkrankung 2108. Degenerative Veränderungen der Halswirbelsäule als Kausalitätskriterium in der Begutachtung bandscheibenbedingter Erkrankungen gemäss BeKV 2108.

With the second amendment to the Ordinance on Occupational Diseases (BeKV) of 18 December 1992, discogenic diseases of the spine are included in the disease register of occupational diseases for the first time. If occupations that impose stress on the spine have been practised for many years, the possibility exists of recognizing degenerative diseases as an occupational disease. In assessment practice, the radiological data on the spine exposed to stress is compared with that of regions which are remote from the stress (cervical/thoracic spine). This pattern of the distribution of degenerative disease is then used as the basis for determining a causal relationship between the occupation causing the stress and disease of the axial skeleton. The pattern of degeneration of the cervical spine was investigated in two groups, one with ( n =153) and one without ( n =333) occupations that impose stress on the lumbar spine. A cumulative score of degenerative changes was elaborated and presented as a new classification. No differences were found between the groups with regard to either the frequency of occurrence, segmental distribution or severity of disease. In both groups, degenerative changes correlated with age. The prevailing assessment practice is discussed on the basis of these data.

[Is lumbar disk disease an occupational disease? Scientific background, radiological findings, and medical legal interpretations]. / Die Berufskrankheit 2110. Wissenschaftliche Grundlagen, radiologisches Erscheinungsbild und Begutachtungskriterien.

AIM: It should be cleared whether or not the interpretation of lumbar disk disease as an occupational disease is justifiable. Which disc changes follow whole-body vibration and can they be distinguished from those which occur constitutionally while aging? METHOD: Orthopedic meta-analysis of epidemiological and occupational studies concerning the influence of whole- body vibration. RESULTS: Reliable studies are rare. Severe methodological problems limit the interpretation of difficult relationships. The role of age when working influences begin as well as the stress and behaviour of exposed persons away from the work-place before and while working with whole-body vibration is not known. There is no study which could be called exact according orthopedic criteria. It is therefore not evident that whole-body vibration causes lumbar disc disease. CONCLUSIONS: After whole-body vibration similar to long term heavy lifting an earlier beginning of disk degeneration in X-ray-studies can be observed. This leads to prevalence differences, which diminish with increasing age. Deviation to the left of the prevalence curve lasts for five to ten years. Whole-body vibration leads to a topographic modification of disk degeneration of the lumbar spine. After long duration exposition an increased amount of spondylotic changes at the thoracolumbar junction and the middle half of lumbar spine can be observed (up to the upper plate of the fourth vertebral body). This can be explained by biomechanic means: whole-body vibration caused by tractor driving and similar long-term exposures leads to traction of the disks of the lower thoracic spine and the upper and middle parts of lumbar spine.

Association of transforming growth factor beta1 genotype with spinal osteophytosis in Japanese women.

OBJECTIVE: To examine the possible relationship between a T-->C polymorphism at nucleotide position 29 of the transforming growth factor beta1 (TGFbeta1) gene and genetic susceptibility to radiographic spinal osteophytosis. METHODS: A total of 540 postmenopausal Japanese women were subjected to radiography of the spine and determination of bone mineral density (BMD) for the lumbar spine and total body. Changes in lumbar intervertebral discs were examined in 67 individuals with either osteoporosis or spinal osteophytosis by magnetic resonance imaging (MRI). TGFbeta1 genotype was determined with an allele-specific polymerase chain reaction assay. The serum concentration of TGFbeta1 was measured in 29 control subjects and in 36 patients with spinal osteophytosis. RESULTS: Among all study subjects, the prevalence of radiographic spinal osteophytosis in individuals with the CC genotype was greater than that in those with the TC or TT genotype. Logistic regression analysis, adjusted for age, height, body weight, time since menopause, smoking status, body fat, lean mass, and either lumbar spine or total body BMD, demonstrated that the frequency of the C allele in subjects with spinal osteophytosis was significantly greater than that in those without this condition. Comparison among control, osteoporosis, and spinal osteophytosis groups also revealed that the C allele was more prevalent in subjects with osteophytosis than in controls, even after adjustment for BMD. In contrast, as previously shown, the frequency of the C allele was lower in osteoporosis patients than in controls. The intervertebral disc area and the ratio of disc area to vertebral body area, as determined by MRI, were also lowest in subjects with the CC genotype. The serum concentration of TGFbeta1 increased with the number of C alleles in both controls and patients with spinal osteophytosis. CONCLUSION: The T29-->C polymorphism of the TGFbeta1 gene exhibited inverse patterns of association with genetic susceptibility to spinal osteophytosis and with osteoporosis. Although radiographic evaluation of osteophytes might not reflect the actual disease severity, the C allele, which protects against osteoporosis, may be a risk factor for genetic susceptibility to spinal osteophytosis.

Ausencia de espondiloartropatías en los índigenas pimas en la época colonial / Absence of Spondyloarthropathies in Pima indians in the colonial times

Objetivo. Hochberg menciona la alta prevalencia de espondilitis anquilosante en los pimas. Se decidió buscar espondiloartropatías (Esp A) antes del mestizaje o en los inicios del mismo. Material y Métodos. Se revisaron todos los documentos y descripciones de los pimas al contacto español, en la colonia y después de la Independencia. Resultados. Las descripciones más importantes fueron seis, de 1708 a 1795, en contacto con los pimas de seis a treinta años y ninguno describe datos de EA ni incapacidades. Discusión. La veracidad de los documentos puede cuestionarse pero al único médico no describe ninguna cura local para problemas que sugieran Esp A y otras descripciones hablan de la gran salud de éstos indígenas. La ausencia al trabajo era severamente castigada por lo que las incapacidades hubieran sido evidentes. El presente trabajo sugiere la ausencia de Esp A en los indígenas pimas en la época colonial y abre el camino para estudios antropológicos e inmunogenéticos