Cervical spinal disease

2019 ◽  
pp. 697-710
Author(s):  
Navin Furtado ◽  
Georgios Tsermoulas ◽  
Adikarige Haritha Dulanka Silva
Keyword(s):  
Cervical Spine ◽  
Natural History ◽  
Neck Pain ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Posterior Longitudinal Ligament ◽  
Surgical Approaches ◽  
Systemic Diseases ◽  
Spinal Disease ◽  
Disc Disease ◽  
Degenerative Cervical Myelopathy

Degenerative cervical spinal disease refers to neck pain, myelopathy, and/or radiculopathy. It is a common problem with increased prevalence above the age of 55 years. Understanding the natural history and pathophysiology is crucial in selecting patients for surgery. The degenerative pathological processes that can occur in the cervical spine include degenerative disc disease, degenerative cervical myelopathy, ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF). There are also systemic diseases affecting the cervical spine and these include rheumatoid disease, sero-negative spondyloarthropathies and diffuse idiopathic skeletal hyperostosis (DISH). This section describes the pathology of cervical spinal disease, the clinical management, surgical approaches, and controversies in the field.

Cervical pneumatocyst

2011 ◽  
Vol 15 (3) ◽  
pp. 332-335 ◽  
Author(s):  
Jason M. Hoover ◽  
Doris E. Wenger ◽  
Laurence J. Eckel ◽  
William E. Krauss
Keyword(s):  
Cervical Spine ◽  
Carpal Tunnel Syndrome ◽  
Neck Pain ◽  
Carpal Tunnel ◽  
Chronic Neck Pain ◽  
Cervical Radiculopathy ◽  
Disc Disease ◽  
Left Hand ◽  
Tunnel Syndrome ◽  
Multilevel Fusion

The authors present the case of a 56-year-old right hand–dominant woman who was referred for chronic neck pain and a second opinion regarding a cervical lesion. The patient's pain was localized to the subaxial spine in the midline. She reported a subjective sense of intermittent left arm weakness manifesting as difficulty manipulating small objects with her hands and fingers. She also reported paresthesias and numbness in the left hand. Physical and neurological examinations demonstrated no abnormal findings except for a positive Tinel sign over the left median nerve at the wrist. Electromyography demonstrated bilateral carpal tunnel syndrome with no cervical radiculopathy. Cervical spine imaging demonstrated multilevel degenerative disc disease and a pneumatocyst of the C-5 vertebral body. The alignment of the cervical spine was normal. A review of the patient's cervical imaging studies obtained in 1995, 2007, 2008, and 2010 demonstrated that the pneumatocyst was not present in 1995 but was present in 2007. The lesion had not changed in appearance since 2007. At an outside institution, multilevel fusion of the cervical spine was recommended to treat the pneumatocyst prior to evaluation at the authors' institution. The authors, however, did not think that the pneumatocyst was the cause of the patient's neck pain, and cervical pneumatocysts typically have a benign course. As such, the authors recommended conservative management and repeated MR imaging in 6 months. Splinting was used to treat the patient's carpal tunnel syndrome.

scholarly journals Analysis of Cervical Spine Alignment and its Relationship with Other Spinopelvic Parameters after Laminoplasty in Patients with Degenerative Cervical Myelopathy

2020 ◽  
Vol 9 (3) ◽  
pp. 713 ◽  
Author(s):  
Seok Woo Kim ◽  
Seung Bo Jang ◽  
Hyung Min Lee ◽  
Jeong Hwan Lee ◽  
Min Uk Lee ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Posterior Longitudinal Ligament ◽  
Intervertebral Disc Herniation ◽  
Spinopelvic Parameters ◽  
Cervical Alignment ◽  
Before And After ◽  
Reducible Group ◽  
Cervical Spine Alignment ◽  
Degenerative Cervical Myelopathy ◽  
Cervical Motion

For patients with kyphosis of the cervical spine, laminoplasty is usually incapable of improving neurological symptoms as it worsens kyphotic alignment. Thus, laminoplasty is not recommended in the presence of kyphotic alignment. Nevertheless, laminoplasty may be selected for myelopathy due to multiple-segment intervertebral disc herniation or ossification of posterior longitudinal ligament despite kyphotic alignment. This study examined whether cervical alignment influences surgical outcomes. Cervical alignment before the surgery was classified into lordosis and non-lordosis, and the non-lordosis group was subclassified into reducible and non-reducible groups to determine the change in cervical alignment before and after the surgery and to analyze its relationship with spinopelvic parameters. The lordosis group showed an increase in upper cervical motion (C0-2 Range of Motion (ROM), C0-2ROM/C0-7ROM) after surgery, while the non-lordosis group exhibited a decrease in C2-7ROM and C0-7ROM. The C0-2ROM was maintained without any reduction in the reducible group, while there was no significant change in cervical alignment and ROM of the non-reducible group. None of these changes showed significant association with the spinopelvic parameters of other sites. However, having a non-reducible type non-lordosis is not a proper indication for laminoplasty, as it does not change the alignment after surgery. Therefore, cervical alignment and reducibility should be identified before surgery.

scholarly journals Cervical total disc replacement with the Mobi-C cervical artificial disc compared with anterior discectomy and fusion for treatment of 2-level symptomatic degenerative disc disease: a prospective, randomized, controlled multicenter clinical trial

2013 ◽  
Vol 19 (5) ◽  
pp. 532-545 ◽  
Author(s):  
Reginald J. Davis ◽  
Kee D. Kim ◽  
Michael S. Hisey ◽  
Gregory A. Hoffman ◽  
Hyun W. Bae ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cervical Spine ◽  
Neck Pain ◽  
Pain Score ◽  
Total Disc Replacement ◽  
Artificial Disc ◽  
Study Success ◽  
Disc Disease ◽  
Cervical Arthroplasty ◽  
Cervical Total Disc Replacement

Object Cervical total disc replacement (TDR) is intended to treat neurological symptoms and neck pain associated with degeneration of intervertebral discs in the cervical spine. Anterior cervical discectomy and fusion (ACDF) has been the standard treatment for these indications since the procedure was first developed in the 1950s. While TDR has been shown to be a safe and effective alternative to ACDF for treatment of patients with degenerative disc disease (DDD) at a single level of the cervical spine, few studies have focused on the safety and efficacy of TDR for treatment of 2 levels of the cervical spine. The primary objective of this study was to rigorously compare the Mobi-C cervical artificial disc to ACDF for treatment of cervical DDD at 2 contiguous levels of the cervical spine. Methods This study was a prospective, randomized, US FDA investigational device exemption pivotal trial of the Mobi-C cervical artificial disc conducted at 24 centers in the US. The primary clinical outcome was a composite measure of study success at 24 months. The comparative control treatment was ACDF using allograft bone and an anterior plate. A total of 330 patients were enrolled, randomized, and received study surgery. All patients were diagnosed with intractable symptomatic cervical DDD at 2 contiguous levels of the cervical spine between C-3 and C-7. Patients were randomized in a 2:1 ratio (TDR patients to ACDF patients). Results A total of 225 patients received the Mobi-C TDR device and 105 patients received ACDF. At 24 months only 3.0% of patients were lost to follow-up. On average, patients in both groups showed significant improvements in Neck Disability Index (NDI) score, visual analog scale (VAS) neck pain score, and VAS arm pain score from preoperative baseline to each time point. However, the TDR patients experienced significantly greater improvement than ACDF patients in NDI score at all time points and significantly greater improvement in VAS neck pain score at 6 weeks, and at 3, 6, and 12 months postoperatively. On average, patients in the TDR group also maintained preoperative segmental range of motion at both treated segments immediately postoperatively and throughout the study period of 24 months. The reoperation rate was significantly higher in the ACDF group at 11.4% compared with 3.1% for the TDR group. Furthermore, at 24 months TDR demonstrated statistical superiority over ACDF based on overall study success rates. Conclusions The results of this study represent the first available Level I clinical evidence in support of cervical arthroplasty at 2 contiguous levels of the cervical spine using the Mobi-C cervical artificial disc. These results continue to support the use of cervical arthroplasty in general, but specifically demonstrate the advantages of 2-level arthroplasty over 2-level ACDF. Clinical trial registration no.: NCT00389597 (ClinicalTrials.gov).

scholarly journals A Review on Diagnosis and Management of Cervical Spondylosis

2021 ◽  
pp. 668-674
Author(s):  
Ahmed Abdulaziz G. Ibrahim ◽  
Ali Mohammed A. Alahmari ◽  
Abdullah Hassan F. Alsuayri ◽  
Abdullah Misfer M. Algomshah ◽  
Saeed Ghanem S. Almlfi ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Neck Pain ◽  
Cervical Spondylosis ◽  
Natural Aging ◽  
Posterior Longitudinal Ligament ◽  
Cervical Radiculopathy ◽  
Intervertebral Discs ◽  
Degenerative Changes ◽  
Facet Joints ◽  
Wide Range

Cervical spondylosis is a term that encompasses a wide range of progressive degenerative changes that affect all components of the cervical spine (i.e., intervertebral discs, facet joints, Luschka joints, flava ligaments, and laminae). It is a natural aging process and occurs in most people after the age of five. Most people with radiographic spondylotic changes in the cervical spine  remain asymptomatic, and 25% of those under  40, 50% of those over  40, and 85% of those over  60 show some evidence of degenerative changes , including changes in  the environment. Uncovertebral joints, facet joints, posterior longitudinal ligament (PLL) and yellow ligament lead to  narrowing of the spinal canal and intervertebral foramina. As a result, the spinal cord, spinal vasculature, and nerve roots can become compressed, leading to the three clinical syndromes that occur with cervical spondylosis: axial neck pain, cervical myelopathy, and cervical radiculopathy. Cervical spondylosis is usually diagnosed for clinical reasons only, but imaging is also required. Treatment for cervical spondylosis can be medical or surgical, depending on whether the patient has symptoms of myelopathy, radicular pain, or neck pain.

scholarly journals Medicolegal corner (spine): Contraindicated use of DuraSeal in anterior cervical spine led to quadriplegia

2021 ◽  
Vol 12 ◽  
pp. 532
Author(s):  
Nancy E Epstein ◽  
John Lancione Esq
Keyword(s):  
Cerebrospinal Fluid ◽  
Cervical Spine ◽  
Package Insert ◽  
Standard Of Care ◽  
Posterior Longitudinal Ligament ◽  
Cord Compression ◽  
Csf Leak ◽  
Confined Space ◽  
Disc Disease ◽  
Hydrogel Swelling

Background: The package insert for DuraSeal (Integra LifeSciences, Princeton NJ) states it is Contraindicated for use in the anterior cervical spine (confined space): “Do not apply DuraSeal® hydrogel to confined bony structures where nerves are present since neural compression may result due to hydrogel swelling (…up to 12% of its size in any direction).” Further, it should not be used to treat massive unrepaired cerebrospinal fluid (CSF) leaks in any location; “…(it) is indicated as an adjunct to sutured dural repair during spine surgery to provide watertight closure,” but it is not to be used “...for a gap greater than 2 mm….” Methods: A spinal surgeon interpreted a geriatric patient’s MR as showing severe C3-C4 to C5-C6 anterior cord compression due to disc disease/spondylosis. However, he never reviewed the CT report/images that documented marked ossification of the posterior longitudinal ligament (OPLL) with multiple signs of dural penetrance. Results: The anterior C4, C5 corpectomy, and C3-C6 strut fusion/plating resulted in a massive, irreparable cerebrospinal fluid (CSF) leak. Despite the contraindications, the surgeon mistakenly applied DuraSeal which caused the patient’s postoperative quadriplegia (i.e., as documented on the delayed postoperative MR scan). Following a secondary surgery consisting of a laminectomy/posterior fusion, the patient was still quadriplegic. Further, as he requested no postoperative MR scan and performed no subsequent corrective surgery (i.e., anterior removal of DuraSeal), the patient remained permanently quadriplegic. Conclusion: DuraSeal is directly contraindicated for use in the anterior cervical spine, with/without a CSF leak. Here, utilizing DuraSeal for anterior cervical OPLL surgery resulted in permanent quadriplegia, and was below the standard of care.

scholarly journals Associations between Clinical Findings and Severity of Diffuse Idiopathic Skeletal Hyperostosis in Patients with Ossification of the Posterior Longitudinal Ligament

2021 ◽  
Vol 10 (18) ◽  
pp. 4137
Author(s):  
Takashi Hirai ◽  
Soraya Nishimura ◽  
Toshitaka Yoshii ◽  
Narihito Nagoshi ◽  
Jun Hashimoto ◽  
...  
Keyword(s):  
Back Pain ◽  
Neck Pain ◽  
Clinical Symptoms ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Posterior Longitudinal Ligament ◽  
Clinical Findings ◽  
Cross Sectional ◽  
Computed Tomography Images ◽  
Significant Difference ◽  
Whole Spine

Background: This study investigated how diffuse idiopathic skeletal hyperostosis (DISH) influences clinical characteristics in patients with cervical ossification of the posterior longitudinal ligament (OPLL). Although DISH is considered unlikely to promote neurologic dysfunction, this relationship remains unclear. Methods: Patient data were prospectively collected from 16 Japanese institutions. In total, 239 patients with cervical OPLL were enrolled who had whole-spine computed tomography images available. The primary outcomes were visual analog scale pain scores and the results of other self-reported clinical questionnaires. Correlations were sought between clinical symptoms and DISH using the following grading system: 1, DISH at T3-T10; 2, DISH at both T3–10 and C6–T2 and/or T11–L2; and 3, DISH beyond the C5 and/or L3 levels. Results: DISH was absent in 132 cases, grade 1 in 23, grade 2 in 65, and grade 3 in 19. There were no significant correlations between DISH grade and clinical scores. However, there was a significant difference in the prevalence of neck pain (but not in back pain or low back pain) among the three grades. Interestingly, DISH localized in the thoracic spine (grade 1) may create overload at the cervical spine and lead to neck pain in patients with cervical OPLL. Conclusion: This study is the first prospective multicenter cross-sectional comparison of subjective outcomes in patients with cervical OPLL according to the presence or absence of DISH. The severity of DISH was partially associated with the prevalence of neck pain.

Cervical Radiculopathy

2018 ◽  
pp. 101-108
Author(s):  
Michael Karsy ◽  
Ilyas Eli ◽  
Andrew Dailey
Keyword(s):  
Cervical Spine ◽  
Neck Pain ◽  
Cervical Spondylosis ◽  
Cervical Radiculopathy ◽  
Surgical Approaches ◽  
Anatomical Landmarks ◽  
Cervical Fusion ◽  
Spine Mobility ◽  
Posterior Cervical Fusion ◽  
Spine Disease

Degenerative cervical spondylosis resulting in cervical radiculopathy or myelopathy can be a significant source of morbidity for patients. Traditional surgical approaches have involved anterior or posterior cervical fusion with decompression; however, these techniques may result in higher cost compared with noninstrumented cases, reduction of spine mobility, and adjacent level disease. Anterior microforaminotomy, first described by Jho in 1996, involves a microdiscectomy and decompression of the cervical spine without arthrodesis. Posterior approaches to the foramina can also be an option. In this chapter, the authors describe the use of lateral disc foraminotomies in the treatment of cervical spine disease. These techniques are mainly for the treatment of cervical radiculopathy without instability or mechanical neck pain. Techniques for both anterior and posterior approaches, including pitfalls and key anatomical landmarks, are described.

scholarly journals Ossification of Posterior Longitudinal Ligament in Cervical Spine and Its Association With Ossified Lesions in the Whole Spine: A Cross-Sectional Study of 2500 CT Scans

2021 ◽  
pp. 219256822199344
Author(s):  
Neerav Anand Singh ◽  
Ajoy Prasad Shetty ◽  
Sridhar Jakkepally ◽  
Dinesh Kumarasamy ◽  
Rishi Mukesh Kanna ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Prevalence Rate ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Posterior Longitudinal Ligament ◽  
Cross Sectional Study ◽  
Ct Scans ◽  
Chi Square ◽  
Cross Sectional ◽  
Ossified Posterior Longitudinal Ligament ◽  
Whole Spine

Study Design: A retrospective study. Objective: To identify the prevalence and characteristics of ossified posterior longitudinal ligament (OPLL) in the cervical spine and its association with other spinal ligament ossifications. Method: This study is a retrospective review of whole spine CT scans of polytrauma patients from 2009 to 2018. Patients were screened for cervical OPLL (C-OPLL), thoracolumbar OPLL, thoracic ossified ligamentum flavum (OLF), cervical and thoracolumbar ossified anterior longitudinal ligament (C-OALL AND T-L OALL), ossified nuchal ligament (ONL) and, diffuse idiopathic skeletal hyperostosis (DISH) using CT scans. Their prevalence and distributions were assessed using statistical tools. Chi-square tests were used to determine statistical association between the categorical parameters. Results: Out of 2500 patients, 128 had C-OPLL with a prevalence rate of 5.12% with mean age of 55.89 year. The most commonly affected level was C5, followed by C6, and C4. The segmental OPLL was highest in number (77.7%), followed by localized type (14.8%). While the prevalence rate of thoracic OPLL was 0.56%, OLF was 9.9%. Ossifications that coexisted along with C-OPLL were thoracic OPLL (7.81%), thoracic OLF (36.71%), cervical OALL (29.68%), thoracolumbar OALL (37.5%), DISH (27.34%) and, ONL (7.03%). Conclusion: Our study indicated a prevalence rate of 5.12% for C-OPLL with a predominance of segmental OPLL (77.7%). Among these patients, approximately 36% had coexisting thoracic OLF. In patients with symptomatic OPLL induced cervical myelopathy, MRI analysis of whole spine with relevant CT correlation may help in detecting additional ossification sites of compression.

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