scholarly journals Assessment of spinal cord motion as a new diagnostic MRI-parameter in cervical spinal canal stenosis: study protocol on a prospective longitudinal trial

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Katharina Wolf ◽  
Axel J. Krafft ◽  
Karl Egger ◽  
Jan-Helge Klingler ◽  
Ulrich Hubbe ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Canal ◽  
Diagnostic Marker ◽  
Clinical Course ◽  
Spinal Canal Stenosis ◽  
Diagnostic Process ◽  
Control Group ◽  
Canal Stenosis ◽  
Cervical Spinal Canal ◽  
Prospective Longitudinal

Abstract Background Increased spinal cord motion has been proven to be a relevant finding within spinal canal stenosis disclosed by phase-contrast MRI (PC-MRI). Adapted PC-MRI is a suitable and reliable method within the well deliberated setting. As the decision between conservative and operative treatment can be challenging in some cases, further diagnostic marker would facilitate the diagnostic process. We hypothesize that increased spinal cord motion will correlate to clinical course and functional impairment and will contribute as a new diagnostic marker. Methods A monocentric, prospective longitudinal observational trial on cervical spinal canal stenosis will be conducted at the University Medical Center Freiburg. Patients (n = 130) with relevant cervical spinal canal stenosis, being defined by at least contact to the spinal cord, will be included. Also, we will examine a control group of healthy volunteers (n = 20) as proof-of-principle. We will observe two openly assigned branches of participants undergoing conservative and surgical decompressive treatment (based on current German Guidelines) over a time course of 12 month, including a total of 4 visits. We will conduct a broad assessment of clinical parameters, standard scores and gradings, electrophysiological measurements, standard MRI, and adapted functional PC-MRI of spinal cord motion. Primary endpoint is the evaluation of an expected negative correlation of absolute spinal cord displacement to clinical impairment. Secondary endpoints are the evaluation of positive correlation of increased absolute spinal cord displacement to prolonged evoked potentials, prediction of clinical course by absolute spinal cord displacement, and demonstration of normalized spinal cord motion after decompressive surgery. Discussion With the use of adapted, non-invasive PC-MRI as a quantitative method for assessment of spinal cord motion, further objective diagnostic information can be gained, that might improve the therapeutic decision-making process. This study will offer the needed data in order to establish PC-MRI on spinal cord motion within the diagnostic work-up of patients suffering from spinal canal stenosis. Trial registration German Clinical Trials Register, ID: DRKS00012962, Register date 2018/01/17

Cervical myelopathy in patients with ossification of the posterior longitudinal ligament

2009 ◽  
Vol 10 (2) ◽  
pp. 122-128 ◽  
Author(s):  
Macondo Mochizuki ◽  
Atsuomi Aiba ◽  
Mitsuhiro Hashimoto ◽  
Takayuki Fujiyoshi ◽  
Masashi Yamazaki
Keyword(s):  
Spinal Cord ◽  
Conservative Treatment ◽  
Spinal Canal ◽  
Clinical Course ◽  
Posterior Longitudinal Ligament ◽  
Treated Group ◽  
Spinal Canal Stenosis ◽  
Canal Stenosis ◽  
Residual Space ◽  
Surgical Group

Object The authors assessed the clinical course in patients with a narrowed cervical spinal canal caused by ossification of the posterior longitudinal ligament (OPLL), but who have no or only mild myelopathy. Additionally, the authors analyzed the factors contributing to the development and aggravation of myelopathy in patients with OPLLinduced spinal canal stenosis. Methods Between 1997 and 2004, the authors selected treatments for patients with cervical OPLL in whom the residual space available for the spinal cord was ≤ 12 mm. Treatment decisions were based on the severity of myelopathy at presentation. Twenty-one patients with no or mild myelopathy (defined as a Japanese Orthopaedic Association [JOA] scale score ≥ 14 points) received conservative treatment, with a mean follow-up period of 4.5 years. In 20 patients with moderate or severe myelopathy (JOA scale score < 14 points), the authors performed surgery via an anterior approach. The clinical course in these patients was assessed with the JOA scale and the OPLL types were classified. The authors evaluated the range of motion between C-1 and C-7, the developmental segmental sagittal diameter, the percentage of spinal canal diameter occupied by the OPLL (% ratio), and the residual space available for the spinal cord on cervical radiographs; T2-weighted MR images were examined for high signal changes (HSCs). Results In the conservative treatment group, 8 patients showed improvement, 12 remained unchanged, and 1 patient's condition became slightly worse during the observation period. Fifteen patients in this group had mixedtype, 3 had continuous-type, 2 had localized-type, and 1 had a segmental-type OPLL. In the surgically treated group, there were 12 patients with segmental-type, 10 patients with mixed-type, and 1 with localized-type OPLL. The mean range of motion at C1–7 was 36.4° in the conservatively treated group and 46.5° in the surgical group (p < 0.05). No significant difference was seen between the groups in terms of developmental segmental sagittal diameter, % ratio, or residual space available for the cord. No HSCs were noted in the conservative group, while 17 patients in the surgical group had HSCs (p < 0.05). Conclusions In the present study, the authors demonstrate that the mobility of the cervical spine and the type of OPLL are important factors contributing to the development and aggravation of myelopathy in patients with OPLLinduced spinal canal stenosis. The authors advocate conservative treatment in most patients with OPLLs who have no or only mild myelopathy, even in the presence of spinal canal narrowing.

scholarly journals Efficacy of Posterior Cervical Laminectomy and Decompression plus Lateral Mass Screw-Rod Internal Fixation in the Treatment of Multisegment Cervical Spinal Canal Stenosis and Effects on Cervical Curvature and Range of Motion Parameters

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Bo Liu ◽  
Yufei Wang ◽  
Yaning Zhang
Keyword(s):  
Internal Fixation ◽  
Range Of Motion ◽  
Spinal Canal ◽  
Spinal Canal Stenosis ◽  
Control Group ◽  
Observation Group ◽  
Lateral Mass ◽  
Lateral Mass Screw ◽  
Canal Stenosis ◽  
Cervical Spinal Canal

Objective. To investigate the clinical effects of posterior laminectomy and decompression plus lateral mass screw-rod internal fixation for the treatment of multisegment cervical spinal canal stenosis and the improvement of cervical curvature and range of motion in patients. Methods. A total of 68 patients with multisegment cervical spinal stenosis who were treated in our hospital from January 2019 to June 2020 were selected and randomly divided into the control group and the observation group according to the random number table, with 34 patients in each group. The patients in the control group were treated with traditional posterior cervical open-door laminoplasty with silk suture fixation, while those in the observation group were treated with posterior cervical laminectomy and decompression plus lateral mass screw-rod internal fixation. The perioperative index of patients in the two groups was recorded, and the clinical efficacy of patients was evaluated. The patient’s JOA score, cervical physiological curvature, and cervical range of motion were evaluated. The occurrence of complications was recorded during follow-up. Results. The amount of intraoperative bleeding and postoperative rehabilitation training time in the observation group was less than that in the control group ( P < 0.05 ). There was no significant difference in operation time between the two groups ( P > 0.05 ). The total effective rate of the observation group was significantly higher than that of the control group ( P < 0.05 ). The JOA scores at 1 week, 6 months, and 12 months after operation in the observation group were higher than those in the control group ( P < 0.05 ). The physiological curvature of cervical spine in the observation group at 1 week, 6 months, and 12 months after operation was higher than that in the control group ( P < 0.05 ). The cervical range of motion at 12 months after operation in the observation group was significantly higher than that in the control group ( P < 0.05 ). The incidence of postoperative complications in patients of the observation group was significantly lower than that of the control group ( P < 0.05 ). Conclusion. Posterior laminectomy and decompression plus lateral mass screw-rod internal fixation can help patients to improve various clinical symptoms caused by nerve compression and obtain better improvement of cervical curvature and range of motion. It is an ideal surgical method for the treatment of multisegment cervical spinal canal stenosis, and it is conducive to improving the clinical efficacy of patients.

scholarly journals T1 Mapping Quantifies Spinal Cord Compression in Patients With Various Degrees of Cervical Spinal Canal Stenosis

2020 ◽  
Vol 11 ◽  
Author(s):  
Ilko L. Maier ◽  
Sabine Hofer ◽  
Eva Eggert ◽  
Katharina Schregel ◽  
Marios-Nikos Psychogios ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Spinal Canal ◽  
T1 Mapping ◽  
Cord Compression ◽  
Spinal Canal Stenosis ◽  
Canal Stenosis ◽  
Cervical Spinal Canal

scholarly journals Quantification of spinal cord compression using T1 mapping in patients with cervical spinal canal stenosis – Preliminary experience

2019 ◽  
Vol 21 ◽  
pp. 101639 ◽  
Author(s):  
Ilko L. Maier ◽  
Sabine Hofer ◽  
Arun A. Joseph ◽  
K. Dietmar Merboldt ◽  
Eva Eggert ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Spinal Canal ◽  
T1 Mapping ◽  
Cord Compression ◽  
Spinal Canal Stenosis ◽  
Canal Stenosis ◽  
Cervical Spinal Canal

scholarly journals Non-traumatic Causes of Brown-sequard Syndrome: A Case Series and Clinical Update With Systematic Review

2021 ◽  
Vol 7 (2) ◽  
pp. 92-106
Author(s):  
Vaner Köksal ◽  
◽  
Mahmoud Osama ◽  
Mohammed Ali Alvi ◽  
◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Canal ◽  
Epidural Hematoma ◽  
Complete Recovery ◽  
Spinal Canal Stenosis ◽  
Spinal Epidural Hematoma ◽  
Traumatic Injuries ◽  
Canal Stenosis ◽  
Cervical Spinal Canal ◽  
Brown Sequard Syndrome

Background and Importance: Brown-Sequard Syndrome (BSS) is a rare neurological condition resulting from a hemisection injury to or unilateral compression on the spinal cord. The common causes of BSS that are amenable to be treated surgically can be divided into traumatic and non-traumatic injuries. Traumatic injuries are often reported as the main cause of BSS. However, non-traumatic injuries of the spinal cord are more seen in recent years. This study aims to classify and update surgically treatable causes of BSS. Case Presentation: Retrospective data of 17 patients operated for BSS between 2008 and 2020 were included. The long-term outcomes of these patients were evaluated. In addition, a comprehensive search in PubMed, Scopus, and CINAHL was conducted for the retrieval of all relevant studies. Results: Magnetic Resonance Image (MRI) of our patients revealed Cervical Disc Herniation (CDH), spinal canal stenosis with cervical spondylosis, epidural hematoma, and ossification of the posterior longitudinal ligament. The postoperative outcomes of our cases ranged from partial to complete recovery. While the patients with acute epidural hemorrhage achieved complete recovery after surgery, neurological deficits in the other patients, especially those with severe cervical spinal canal stenosis, persisted despite adequate surgical decompression. The systematic literature review revealed that CDH is the most common non-traumatic surgically treatable cause of BSS, followed by spinal cord herniation and spinal epidural hematoma. Conclusion: Non-traumatic injuries of the spinal cord accompanied by narrowed cervical spinal canal pathologies are prominent surgically treatable causes of BSS. Contrary to the definition made 100 years ago, BSS can occur spontaneously due to underlying pathologies rather than major traumatic injuries.

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