scholarly journals Degenerative cervical myelopathy presenting as subjective lower limb weakness could be a trap towards misdiagnosis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Chi-An Luo ◽  
Meng-Ling Lu ◽  
Arun-Kumar Kaliya-Perumal ◽  
Lih-Huei Chen ◽  
Wen-Jer Chen ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Functional Recovery ◽  
Lower Limb ◽  
Cervical Myelopathy ◽  
Cord Compression ◽  
Surgical Decompression ◽  
Limb Weakness ◽  
Lower Limb Weakness ◽  
Tandem Spinal Stenosis ◽  
Degenerative Cervical Myelopathy

AbstractWhen patients presenting with subjective lower limb weakness (SLLW) are encountered, it is natural to suspect a lumbar pathology and proceed with related clinical examination, investigations and management. However, SLLW could be a sign of degenerative cervical myelopathy (DCM) due to an evolving cord compression. In such circumstances, if symptoms are not correlated to myelopathy at the earliest, there could be potential complications over time. In this study, we intend to analyse the outcomes after surgical management of the cervical or thoracic cord compression in patients with SLLW. Retrospectively, patients who presented to our center during the years 2010–2016 with sole complaint of bilateral SLLW but radiologically diagnosed to have a solitary cervical or thoracic stenosis, or tandem spinal stenosis and underwent surgical decompression procedures were selected. Their clinical presentation was categorised into three types, myelopathy was graded using Nurick’s grading and JOA scoring; in addition, their lower limb functional status was assessed using the lower extremity functional scale (LEFS). Functional recovery following surgery was assessed at 6 weeks, 3 months, 6 months, one year, and two years. Selected patients (n = 24; Age, 56.4 ± 10.1 years; range 32–78 years) had SLLW for a period of 6.4 ± 3.2 months (range 2–13 months). Their preoperative JOA score was 11.3 ± 1.8 (range 7–15), and LEFS was 34.4 ± 7.7 (range 20–46). Radiological evidence of a solitary cervical lesion and tandem spinal stenosis was found in 6 and 18 patients respectively. Patients gradually recovered after surgical decompression with LEFS 59.8 ± 2.7 (range 56–65) at 1 year and JOA score 13.6 ± 2.7 (range − 17 to 100) at 2 years. The recovery rate at final follow up was 47.5%. Our results indicate the importance of clinically suspecting SLLW as an early non-specific sign of DCM to avoid misdiagnosis, especially in patients without conventional upper motor neuron signs. In such cases, surgical management of the cord compression resulted in significant functional recovery and halted the progression towards permanent disability.

scholarly journals Study protocol for an observational study of cerebrospinal fluid pressure in patients with degenerative cervical myelopathy undergoing surgical deCOMPression of the spinal CORD: the COMP-CORD study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e037332
Author(s):  
Carl Moritz Zipser ◽  
Nikolai Pfender ◽  
Jose Miguel Spirig ◽  
Michael Betz ◽  
Jose Aguirre ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Spinal Cord ◽  
Cerebrospinal Fluid ◽  
Spinal Cord Compression ◽  
Study Protocol ◽  
Cervical Myelopathy ◽  
Fluid Pressure ◽  
Cord Compression ◽  
Surgical Decompression ◽  
Degenerative Cervical Myelopathy

IntroductionDegenerative cervical myelopathy (DCM) is a disabling spinal disorder characterised by sensorimotor deficits of upper and lower limbs, neurogenic bladder dysfunction and neuropathic pain. When suspected, cervical MRI helps to reveal spinal cord compression and rules out alternative diagnoses. However, the correlation between radiological findings and symptoms is weak. Cerebrospinal fluid pressure (CSFP) analysis may complement the appreciation of cord compression and be used for intraoperative and postoperative monitorings in patients undergoing surgical decompression.Methods and analysisTwenty patients diagnosed with DCM undergoing surgical decompression will receive standardised lumbar CSFP monitoring immediately before, during and 24 hours after operation. Rest (ie, opening pressure, CSF pulsation) and stimulated (ie, Valsalva, Queckenstedt’s) CSFP—findings in DCM will be compared with 20 controls and results from CSFP monitoring will be related to clinical and neurophysiological findings. Arterial blood pressure will be recorded perioperatively and postoperatively to calculate spinal cord perfusion pressure and spinal vascular reactivity index. Furthermore, measures of CSFP will be compared with markers of spinal cord compression by means of MR imaging.Ethics and disseminationThe study protocol conformed to the latest revision of the Declaration of Helsinki and was approved by the local Ethics Committee of the University Hospital of Zurich (KEK-ZH number PB-2016-00623). The main publications from this study will cover the CSFP fluid dynamics and pressure analysis preoperative, perioperative and postoperative correlated with imaging, clinical scores and neurophysiology. Other publications will deal with preoperative and postoperative spinal perfusion. Furthermore, we will disseminate an analysis on waveform morphology and the correlation with blood pressure and ECG. Parts of the data will be used for computational modelling of cervical stenosis.Trial registration numberClinicalTrials.gov Registry (NCT02170155).

scholarly journals Fatty infiltration in cervical flexors and extensors in patients with degenerative cervical myelopathy using a multi-muscle segmentation model

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253863
Author(s):  
Monica Paliwal ◽  
Kenneth A. Weber ◽  
Andrew C. Smith ◽  
James M. Elliott ◽  
Fauziyya Muhammad ◽  
...  
Keyword(s):  
Functional Recovery ◽  
Cervical Myelopathy ◽  
Fatty Infiltration ◽  
Cord Compression ◽  
Cross Sectional ◽  
Fat Infiltration ◽  
Japanese Orthopedic Association ◽  
Sensorimotor Deficits ◽  
Cervical Muscles ◽  
Degenerative Cervical Myelopathy

Background In patients with degenerative cervical myelopathy (DCM) that have spinal cord compression and sensorimotor deficits, surgical decompression is often performed. However, there is heterogeneity in clinical presentation and post-surgical functional recovery. Objectives Primary: a) to assess differences in muscle fat infiltration (MFI) in patients with DCM versus controls, b) to assess association between MFI and clinical disability. Secondary: to assess association between MFI pre-surgery and post-surgical functional recovery. Study design Cross-sectional case control study. Methods Eighteen patients with DCM (58.6 ± 14.2 years, 10 M/8F) and 25 controls (52.6 ± 11.8 years, 13M/12 F) underwent 3D Dixon fat-water imaging. A convolutional neural network (CNN) was used to segment cervical muscles (MFSS- multifidus and semispinalis cervicis, LC- longus capitis/colli) and quantify MFI. Modified Japanese Orthopedic Association (mJOA) and Nurick were collected. Results Patients with DCM had significantly higher MFI in MFSS (20.63 ± 5.43 vs 17.04 ± 5.24, p = 0.043) and LC (18.74 ± 6.7 vs 13.66 ± 4.91, p = 0.021) than controls. Patients with increased MFI in LC and MFSS had higher disability (LC: Nurick (Spearman’s ρ = 0.436, p = 0.003) and mJOA (ρ = -0.399, p = 0.008)). Increased MFI in LC pre-surgery was associated with post-surgical improvement in Nurick (ρ = -0.664, p = 0.026) and mJOA (ρ = -0.603, p = 0.049). Conclusion In DCM, increased muscle adiposity is significantly associated with sensorimotor deficits, clinical disability, and functional recovery after surgery. Accurate and time efficient evaluation of fat infiltration in cervical muscles may be conducted through implementation of CNN models.

scholarly journals Lower limb weakness: an unusual cause

2018 ◽  
Vol 5 (5) ◽  
pp. 2011
Author(s):  
Antony Leo Jerry ◽  
Sundari S. ◽  
Krithika A. P.
Keyword(s):  
Lower Limb ◽  
Cord Compression ◽  
Acute Onset ◽  
Long Bones ◽  
Age Group ◽  
Rare Presentation ◽  
Limb Weakness ◽  
Solitary Lesion ◽  
Pediatric Age Group ◽  
Lower Limb Weakness

Osteochondromas are usually tumours of the long bones and occurs rarely in other bones. Osteochondroma of rib causing spinal cord compression is a rare presentation with only 8 cases reported in literature involving similar presentation in pediatric age group. Our case is a boy who presented with paraparesis of acute onset. All the usual suspects were ruled out. The cause was found to be a solitary lesion arising from the head of the 3rd rib causing cord compression. Laminectomy and decompression with excision of the lesion was done. On HPE it showed features of osteochondroma. Post operatively the child recovered well, the weakness and sensations improved.

scholarly journals Postpartum femoral neuropathy: managing the next pregnancy

2019 ◽  
Vol 12 (12) ◽  
pp. e232967 ◽  
Author(s):  
Cathy Rowland ◽  
Daniel Kane ◽  
Maeve Eogan
Keyword(s):  
Caesarean Section ◽  
Motor Function ◽  
Lower Limb ◽  
Elective Caesarean Section ◽  
Mode Of Delivery ◽  
Primiparous Woman ◽  
Limb Weakness ◽  
Femoral Neuropathy ◽  
Lower Limb Weakness ◽  
Spontaneous Labour

A 34-year-old primiparous woman presented in spontaneous labour and had an unassisted vaginal birth of a 3.5 kg infant. Postnatally, the patient experienced lower limb weakness and was unable to mobilise unassisted. A diagnosis of postpartum femoral neuropathy was made. Full recovery of normal motor function was not achieved until 5 months postpartum. She returned in her next pregnancy, seeking advice on how to avoid this complication from reoccurring. It was decided that an elective caesarean section was an appropriate mode of delivery, which she underwent at 39 weeks without complication and without recurrence of the femoral neuropathy.

Improving sit-to-stand transition by the saddle-assistive device in the spinal cord injury: A case study

2021 ◽  
pp. 095441192110033
Author(s):  
Akbar Hojjati Najafabadi ◽  
Saeid Amini ◽  
Farzam Farahmand
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Lower Limb ◽  
Reaction Force ◽  
Assistive Device ◽  
Limb Weakness ◽  
Sit To Stand ◽  
Lower Limb Weakness ◽  
Wide Range ◽  
Cord Injury

Physical problems caused by fractures, aging, stroke, and accidents can reduce foot power; these, in the long term, can dwindle the muscles of the waist, thighs, and legs. These conditions provide the basis for the invalidism of the harmed people. In this study, a saddle-walker was designed and evaluated to help people suffering from spinal cord injury and patients with lower limb weakness. This S-AD works based on body weight support against the previously report designs. This saddle-walker consisted of a non-powered four-wheel walker helping to walk and a powered mechanism for the sit-to-stand (STS) transfer. A set of experiments were done on the STS in the use of the standard walker and the saddle-assistive device(S-AD). A comparison of the results showed that this device could reduce the vertical ground reaction force (GRF) of the legs up to 70%. Using this device could help a wide range of patients with lower limb weakness and SCI patients in changing from sitting to standing.

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