Surgical treatment for patients with cervical flexion myelopathy

1999 ◽  
Vol 91 (1) ◽  
pp. 33-42 ◽  
Author(s):  
Michihiro Kohno ◽  
Hiroshi Takahashi ◽  
Katsuhisa Ide ◽  
Kenta Yamakawa ◽  
Tatsuya Saitoh ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Muscular Atrophy ◽  
Rare Condition ◽  
Long Bone ◽  
Content Type ◽  
Neurological Improvement ◽  
Surgical Fusion ◽  
Number Of Patients ◽  
Cervical Flexion Myelopathy ◽  
Fine Print

Object. Cervical flexion myelopathy is a rare condition that mainly affects adolescent boys. In recent years, avoidance of neck flexion has been advocated as the treatment for cervical flexion myelopathy, and treatment with a cervical collar and surgery in which fusion of the cervical spine is performed have been found to be effective. However, previously reported series contained only a limited number of patients. The authors report their experience with treating 10 male patients in whom surgery was performed to correct cervical flexion myelopathy, and they evaluate the patients' surgical outcome. Methods. The authors performed anterior decompressive surgery and fusion in the cervical spine by using a long bone graft after resection of one or two vertebrae in seven patients. The other three patients underwent posterior fusion of four or five laminae. After surgery, symptom progression was stopped in all patients, muscle strength improved in seven, and sensory disturbance was alleviated in another two. However, the muscular atrophy in the upper extremities, which was evident in nine patients preoperatively, improved in only two. Conclusions. Because some neurological improvement was seen in nine of 10 patients, it is believed that surgical fusion of the cervical spine is an effective treatment for patients with cervical flexion myelopathy.

Cervicomedullary junction decompression in a case of Marshall-Smith syndrome

1991 ◽  
Vol 75 (2) ◽  
pp. 317-319 ◽  
Author(s):  
Conrad T. E. Pappas ◽  
Harold L. Rekate
Keyword(s):  
Cervical Spine ◽  
Brain Stem ◽  
Rare Condition ◽  
Craniovertebral Junction ◽  
Content Type ◽  
Cervicomedullary Junction ◽  
First Child ◽  
Bone Abnormalities ◽  
Fine Print

✓ The case is reported of a 2-year-old boy born with Marshall-Smith syndrome who had difficulty in swallowing and who exhibited spasticity and quadriparesis due to compression of the medulla and cervical spine. This is the first child with this rare condition reported to have brain-stem compression from bone abnormalities at the craniovertebral junction and who has required surgery.

Forestier disease associated with a retroodontoid mass causing cervicomedullary compression

2002 ◽  
Vol 96 (2) ◽  
pp. 190-196 ◽  
Author(s):  
Naresh P. Patel ◽  
Neill M. Wright ◽  
William W. Choi ◽  
Duncan Q. McBride ◽  
J. Patrick Johnson
Keyword(s):  
Cervical Spine ◽  
Neurological Symptoms ◽  
Posterior Fusion ◽  
Occipitocervical Fusion ◽  
Content Type ◽  
Neurological Improvement ◽  
Forestier Disease ◽  
Subaxial Cervical Spine ◽  
Fine Print

Object. Forestier Disease (FD) is a progressive skeletal disorder affecting predominantly older men. It is also known as diffuse idiopathic skeletal hyperostosis (DISH) and is characterized by massive anterior longitudinal ligament calcification that forms a bridge on the anterior border of the thoracic and subaxial cervical spine. To the authors' knowledge, retroodontoid masses associated with FD have not been described. Methods. Five patients with FD and multilevel subaxial cervical fusion were treated for retroodontoid masses and cervicomedullary junction (CMJ) compression. There were four men and one woman (mean age 73 years, range 54–86 years). All patients suffered progressive neurological symptoms resulting from anterior compression of the CMJ. Four patients underwent combined transoral resection of the ligamentous mass followed by an occipitocervical fusion procedure. One patient with circumferential CMJ compression underwent a posterior decompression and occipitocervical fusion. Histopathological examination of the mass showed hypertrophic degenerative fibrocartilage. Early postoperative neurological improvement was noted in all patients. The follow-up period ranged from 4 to 19 months. At the end of the follow-up period, four patients experienced neurological improvement. One patient died 3 weeks postsurgery of pulmonary complications. Conclusions. The osseous elements of the occipitoatlantoaxial complex are not directly affected by FD. The ligamentous structures of the odontoid process, however, are exposed to significantly altered biomechanics resulting from fusion of the subaxial cervical spine associated with FD. Stress-induced compensatory ligamentous hypertrophic changes at the craniovertebral junction cause CMJ compression and subsequent neurological deterioration. This previously undescribed entity should be considered in patients with FD or DISH who present with progressive quadriparesis. Transoral decompression and posterior fusion are often needed in patients with large masses and severe progressive neurological deficits. Selected patients with smaller masses and milder neurological symptoms may be treated with posterior fusion alone.

A new technique for exposure of the cervical spine laminae

2002 ◽  
Vol 96 (1) ◽  
pp. 122-126 ◽  
Author(s):  
Tateru Shiraishi
Keyword(s):  
Cervical Spine ◽  
New Technique ◽  
Diverse Range ◽  
Content Type ◽  
Spinous Processes ◽  
Technical Details ◽  
A New Technique ◽  
Fine Print

✓ The author describes a new technique for exposure of the cervical spine laminae in which the attachments of the semispinalis cervicis and multifidus muscles to the spinous processes are left untouched. It provides a conservative exposure through which a diverse range of posterior cervical surgeries can be performed. In contrast to conventional cervical approaches, none of the muscular attachments to the spinous processes is compromised. In this paper the author describes the technical details and discusses the applications of the procedure.

Intradural extramedullary tuberculoma of the cervical spine

1984 ◽  
Vol 60 (1) ◽  
pp. 200-203 ◽  
Author(s):  
Jeff S. Compton ◽  
Nicholas W. C. Dorsch
Keyword(s):  
Cervical Spine ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Ct Scanning ◽  
Nerve Roots ◽  
Content Type ◽  
Vehicle Accident ◽  
Calcified Lesion ◽  
Intradural Extramedullary ◽  
Fine Print

✓ A case is reported of a 45-year-old man who developed quadriplegia following a trivial motor-vehicle accident. Investigation including computerized tomography (CT) of the cervical spine revealed a large calcified lesion displacing the spinal cord and nerve roots, which proved to be a tuberculoma. The case is unusual in regard to the age of the patient, the size, location, and nature of the lesion, the mode of presentation, and the delineation of the lesion by CT scanning.

Paralysis of both arms from injury of the upper portion of the pyramidal decussation: “cruciate paralysis”

1970 ◽  
Vol 33 (4) ◽  
pp. 376-380 ◽  
Author(s):  
Herbert S. Bell
Keyword(s):  
Rare Condition ◽  
Clinical Entity ◽  
Content Type ◽  
Fine Print

✓ A new clinical entity, “cruciate paralysis,” manifested by paralysis in both arms without weakness in the legs, is described. The mechanism that produces this rare condition is discussed and the possibility of differential injury to the pyramidal decussation emphasized.

Dose—response tolerance of the visual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery

1998 ◽  
Vol 88 (1) ◽  
pp. 43-50 ◽  
Author(s):  
Klaus A. Leber ◽  
Jutta Berglöff ◽  
Gerhard Pendl
Keyword(s):  
Stereotactic Radiosurgery ◽  
Cavernous Sinus ◽  
Dose Response ◽  
Cranial Nerves ◽  
Visual Pathways ◽  
Content Type ◽  
Number Of Patients ◽  
Response Tolerance ◽  
Fine Print

As the number of patients treated with stereotactic radiosurgery increases, it becomes particularly important to define with precision adverse effects on distinct structures of the nervous system. Object. This study was designed to assess the dose—response tolerance of the visual pathways and cranial nerves after exposure of the cavernous sinus to radiation. Methods. A total of 66 sites in the visual system and 210 cranial nerves of the middle cranial fossa were investigated in 50 patients who had undergone gamma knife treatment for benign skull base tumors. The mean follow-up period was 40 months (range 24–60 months). Follow-up examinations consisted of neurological, neuroradiological, and neuroophthalmological evaluations. The actuarial incidence of optic neuropathy was zero for patients who received a radiation dose of less than 10 Gy, 26.7% for patients receiving a dose in the range of 10 to less than 15 Gy, and 77.8% for those who received doses of 15 Gy or more (p < 0.0001). Previously impaired vision improved in 25.8% and was unchanged in 51.5% of patients. No sign of neuropathy was seen in patients whose cranial nerves of the cavernous sinus received radiation doses of between 5 and 30 Gy. Because tumor control appeared to have been achieved in 98% of the patients, the deterioration in visual function cannot be attributed to tumor progression. Conclusions. The structures of the visual pathways (the optic nerve, chiasm, and tract) exhibit a much higher sensitivity to single-fraction radiation than other cranial nerves, and their particular dose—response characteristics can be defined. In contrast, the oculomotor and trigeminal nerves have a much higher dose tolerance.

Tethered cord syndrome in children with anorectal malformations

2000 ◽  
Vol 92 (4) ◽  
pp. 626-630 ◽  
Author(s):  
Natarajan Muthukumar ◽  
Bhuvaneswari Subramaniam ◽  
Thangaraj Gnanaseelan ◽  
Ramesh Rathinam ◽  
Appaswamy Thiruthavadoss
Keyword(s):  
Tethered Cord ◽  
Anorectal Malformations ◽  
Neurological Deficits ◽  
Radiographic Evidence ◽  
Content Type ◽  
X Ray ◽  
Neurological Improvement ◽  
Intraspinal Anomalies ◽  
Bone Abnormalities ◽  
Fine Print

Object. Anorectal malformations are known to be associated with neurological deficits, which may contribute to the disability suffered by patients with these malformations. This study was undertaken to determine the incidence and pattern of sacral abnormalities in children with anorectal malformations, the incidence and nature of the neurological deficits, and the incidence and nature of operable intraspinal abnormalities in patients with this condition.Methods. Neurological evaluation was performed in 81 children with anorectal malformations. Plain x-ray films were obtained to identify the presence of sacral abnormalities. The patients with neurological deficits were evaluated for the presence of operable intraspinal anomalies, and when such anomalies were identified, correction of the same was undertaken. In 21% of these children radiographic evidence of sacral abnormalities was shown. Fifteen percent of patients harbored neurological deficits, and 10% harbored operable intraspinal anomalies. In addition, one patient had split notochord syndrome. Patients with operable intraspinal anomalies underwent surgical correction, with resultant neurological improvement.Conclusions. Bone abnormalities of the sacrum, neurological deficits, and operable intraspinal lesions are not uncommon in children with anorectal malformations. Because the neurological deficits can contribute to the disability suffered by these individuals, we recommend routine screening of patients with anorectal malformations and neurological deficits and/or sacral abnormalities for the early identification and treatment of potentially correctable intraspinal lesions.

Vertical atlantoaxial distraction injuries: radiological criteria and clinical implications

2004 ◽  
Vol 1 (3) ◽  
pp. 273-280 ◽  
Author(s):  
L. Fernando Gonzalez ◽  
David Fiorella ◽  
Neil R. Crawford ◽  
Robert C. Wallace ◽  
Iman Feiz-Erfan ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Control Group ◽  
Lateral Mass ◽  
Healthy Individuals ◽  
Mr Images ◽  
Content Type ◽  
Radiological Criteria ◽  
Surgical Fusion ◽  
Imaging Results ◽  
Fine Print

Object. The authors sought to establish radiological criteria for the diagnosis of C1–2 vertical distraction injuries. Methods. Conventional radiography, computerized tomography (CT), and magnetic resonance (MR) imaging findings in five patients with a C1–2 vertical distraction injury were correlated with their clinical history, operative findings, and autopsy findings. The basion—dens interval (BDI) and the C-1 and C-2 lateral mass interval (LMI) were measured in 93 control patients who underwent CT angiography; these measurements were used to define the normal BDI and LMI. The MR imaging results obtained in 30 healthy individuals were used to characterize the normal signal intensity of the C1–2 joint. The MR imaging results were compared with MR images obtained in five patients with distraction injuries. In the 93 patients, the BDI averaged 4.7 mm (standard deviation [SD] 1.7 mm, range 0.6–9 mm) and the LMI averaged 1.7 mm (SD 0.48 mm, range 0.7–3.3 mm). Based on CT scanning in the five patients with distraction injuries, the BDIs (mean 11.9 mm, SD 3.2 mm; p < 0.001) and LMIs (mean 5.5 mm, SD 2 mm; p < 0.0001) were significantly greater than in the control group. Fast—spin echo inversion-recovery MR images obtained in these five patients revealed markedly increased signal distributed throughout the C1–2 lateral mass articulations bilaterally. Conclusions. In 95% of healthy individuals, the LMI ranged between 0.7 and 2.6 mm. An LMI greater than 2.6 mm indicates the possibility of a distraction injury, which can be confirmed using MR imaging. Patients with a suspected C1–2 distraction injury may be candidates for surgical fusion of C1–2.

Delayed intracranial migration of cervical sublaminar and interspinous wires and subsequent cerebellar abscess

2002 ◽  
Vol 97 (1) ◽  
pp. 113-117 ◽  
Author(s):  
Kevin L. Stevenson ◽  
Matthew Wetzel ◽  
Ian F. Pollack
Keyword(s):  
Cervical Spine ◽  
Neurological Injury ◽  
Cervical Fusion ◽  
Content Type ◽  
Cerebellar Abscess ◽  
Delayed Complication ◽  
History Of ◽  
Delayed Complications ◽  
The Wire ◽  
Fine Print

✓ Delayed complications associated with sublaminar and interspinous wiring in the pediatric cervical spine are rare. The authors present a case of delayed complication in which a cervical fusion wire migrated into the cerebellum, causing subsequent cerebellar abscess 2 years after posterior cervical arthrodesis. A craniotomy was required to remove the wire and drain the abscess. Despite their history of safety and successful fusion, procedures involving sublaminar and interspinous wiring carry a risk of neurological injury secondary to wire migration. A thorough neuroimaging evaluation is required in patients who have undergone fusion and who have neurological complaints to detect late instrumentation-related sequelae.

Intraoperative anatomical studies in patients with aneurysms of the anterior communicating artery complex

1992 ◽  
Vol 76 (4) ◽  
pp. 629-634 ◽  
Author(s):  
Edgar Nathal ◽  
Nobuyuki Yasui ◽  
Takeshi Sampei ◽  
Akifumi Suzuki
Keyword(s):  
Surgical Approach ◽  
Radical Surgery ◽  
Anatomical Variations ◽  
Surgical Approaches ◽  
Anterior Communicating Artery ◽  
Anatomical Studies ◽  
Content Type ◽  
Number Of Patients ◽  
Vascular Elements ◽  
Fine Print

✓ The intraoperative anatomical findings of the anterior communicating artery (ACoA) complex in 46 patients with anatomical variations were compared to those in an equal number of patients without variations in order to determine the visualization of the elements of the vascular complex. All patients underwent radical surgery for an ACoA aneurysm by one of three different surgical approaches: transsylvian, anterior interhemispheric, or basal interhemispheric. Visualization of the vascular elements was similar in patients with or without anatomical variations. The differences observed were dependent on the surgical approach selected and on the projection of the aneurysm. It was found that, even when the intraoperative anatomical field and the number of vascular elements visualized are different from those obtained in autopsy studies, the vascular microanatomical characteristics can be confirmed with each surgical approach to the extent necessary to ensure safe clipping of aneurysms in patients both with and without anatomical variations.

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