Clinical and radiological correlates of severity and surgery-related outcome in cervical spondylosis

2001 ◽  
Vol 94 (2) ◽  
pp. 189-198 ◽  
Author(s):  
Anoushka Singh ◽  
H. Alan Crockard ◽  
Andrew Platts ◽  
John Stevens
Keyword(s):  
Mr Imaging ◽  
Cord Compression ◽  
Clinical Severity ◽  
Functional Improvement ◽  
Cervical Cord ◽  
Content Type ◽  
Related Data ◽  
Radiological Data ◽  
Signal Change ◽  
Fine Print

Object. The aim of this study was to determine if radiological features could be used to predict outcome in patients with cervical spondylotic myelopathy (CSM). Methods. The authors studied 69 patients consecutively referred to The National Hospital, Queen Square, for decompressive surgery. Data obtained from preoperative cervical spine magnetic resonance (MR) imaging studies were each analyzed on two separate occasions by two blinded radiologists. The parameters determined were signal change and the presence and severity of compression. Clinical outcome was determined by pre- and postoperative timed walks, as well as by evaluation of myelopathy disability index scores, Ranawat classification, and Nurick grades. There was good inter- and intraobserver reliability for determination of radiological data. A significant relationship was found between MR imaging signal change and surgery-related outcome, as reflected by improvement in walking parameters; however, this was confounded by the fact that signal change also related to preoperative walking parameters, and those patients for whom preoperative walking function was worse experienced greater functional improvement in walking postoperatively. The relationships between ambulatory-related data and severity or extent of spinal cord compression were less marked. Conclusions. Cervical cord compression and intrinsic MR imaging signal change correlate with clinical severity, and, in this population, the presence of signal change was correlated with better surgery-related outcome. However, confounding factors and the lack of strong correlation indicate that these radiological measurements are insufficient to be used as a reliable tool for predicting surgery-related benefits in individual patients.

Intramedullary ependymoma of the spinal cord

1990 ◽  
Vol 72 (4) ◽  
pp. 523-532 ◽  
Author(s):  
Paul C. McCormick ◽  
Roland Torres ◽  
Kalmon D. Post ◽  
Bennett M. Stein
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Tumor Recurrence ◽  
Neurological Deficits ◽  
Functional Improvement ◽  
Consecutive Series ◽  
Intramedullary Spinal Cord ◽  
Content Type ◽  
Fine Print

✓ A consecutive series of 23 patients underwent operative removal of an intramedullary spinal cord ependymoma between January, 1976, and September, 1988. Thirteen women and 10 men between the age of 19 and 70 years experienced symptoms for a mean of 34 months preceding initial diagnosis. Eight patients had undergone treatment prior to tumor recurrence and referral. Mild neurological deficits were present in 22 patients on initial examination. The location of the tumors was predominantly cervical or cervicothoracic. Radiological evaluation revealed a wide spinal cord in all cases. Magnetic resonance (MR) imaging was the single most important radiological procedure. At operation, a complete removal was achieved in all patients. No patient received postoperative radiation therapy. Histological examination revealed a benign ependymoma in all cases. The follow-up period ranged from 6 to 159 months (mean 62 months) with seven patients followed for a minimum of 10 years after surgery. Fourteen patients underwent postoperative MR imaging at intervals ranging from 8 months to 10 years postoperatively. No patient has been lost to follow-up review and there were no deaths. No patient showed definite clinical or radiological evidence of tumor recurrence during the follow-up period. Recent neurological evaluation revealed functional improvement from initial preoperative clinical status in eight patients, no significant change in 12 patients, and deterioration in three patients. The data support the belief that long-term disease-free control of intramedullary spinal ependymomas with acceptable morbidity may be achieved utilizing microsurgical removal alone.

Symptomatic hydrocephalus and reversible spinal cord compression in Listeria monocytogenes meningitis

1989 ◽  
Vol 71 (4) ◽  
pp. 620-622 ◽  
Author(s):  
Eric C. Raps ◽  
David H. Gutmann ◽  
James R. Brorson ◽  
Michael O'Connor ◽  
Howard I. Hurtig
Keyword(s):  
Spinal Cord ◽  
Listeria Monocytogenes ◽  
Cord Compression ◽  
Cervical Cord ◽  
Communicating Hydrocephalus ◽  
Ventricular Drainage ◽  
Central Nervous System Infections ◽  
Content Type ◽  
Clinical Syndromes ◽  
Fine Print

✓ Central nervous system infections with Listeria monocytogenes result in varied clinical syndromes ranging from meningitis to rhomboencephalitis. A case of Listeria meningitis complicated by symptomatic communicating hydrocephalus and hydrostatic cervical cord compression is presented which clinically and radiographically improved with aggressive ventricular drainage.

Cervical cord neurapraxia: classification, pathomechanics, morbidity, and management guidelines

1997 ◽  
Vol 87 (6) ◽  
pp. 843-850 ◽  
Author(s):  
Joseph S. Torg ◽  
Thomas A. Corcoran ◽  
Lawrence E. Thibault ◽  
Helene Pavlov ◽  
Brian J. Sennett ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Causative Factor ◽  
Neurological Injury ◽  
Cervical Cord ◽  
Cervical Canal ◽  
Content Type ◽  
Risk Of Recurrence ◽  
X Ray ◽  
Canal Diameter ◽  
Fine Print

✓ One hundred ten cases of the transient neurological phenomenon, cervical cord neurapraxia (CCN), are presented. The authors established a classification system for CCN, developed a new computerized measurement technique for magnetic resonance (MR) imaging, investigated the relationship of the cervical cord to the canal, and analyzed clinical, x-ray, and MR data. One hundred nine males and one female were included in the study; the average age of the participants was 21 years (range 13–33 years). All episodes occurred during sports participation; 87% occurred while the patient was playing football. Follow-up review lasting an average of 3.3 years was available for 105 patients (95%). Narrowing of the sagittal diameter of the cervical canal in the adult spine was confirmed to be a causative factor. Cervical cord neurapraxia was not associated with permanent neurological injury and no permanent morbidity occurred in patients who returned to contact activities. Of the patients returning to contact activities, 35 (56%) experienced a recurrent episode. The risk of recurrence was increased with smaller spinal canal/vertebral body ratio (p < 0.05), smaller disc-level canal diameter (p < 0.05), and less space available for the cord (p < 0.05). There was no correlation between either the classification of the CCN episode or the disease noted on MR imaging and x-ray films and the risk of recurrence. The authors conclude that: 1) CCN is a transient neurological phenomenon and individuals with uncomplicated CCN may be permitted to return to their previous activity without an increased risk of permanent neurological injury; 2) congenital or degenerative narrowing of the sagittal diameter of the cervical canal is a causative factor; 3) the overall recurrence rate after return to play is 56%; and 4) the risk of recurrence is strongly and inversely correlated with sagittal canal diameter and it is useful in the prediction of future episodes of CCN (p < 0.001). These data will enable the physician to counsel individuals regarding a predicted risk of recurrence based on canal measurements.

Cervical flexion myelopathy: a “tight dural canal mechanism”

1987 ◽  
Vol 66 (6) ◽  
pp. 935-937 ◽  
Author(s):  
Yoshinobu Iwasaki ◽  
Kunio Tashiro ◽  
Seiji Kikuchi ◽  
Mayumi Kitagawa ◽  
Toyohiko Isu ◽  
...  
Keyword(s):  
Morphological Changes ◽  
Cord Compression ◽  
Cervical Cord ◽  
Posterior Border ◽  
Disc Disease ◽  
Content Type ◽  
Neuroradiological Examination ◽  
Cervical Flexion Myelopathy ◽  
Progressive Weakness ◽  
Fine Print

✓ The authors describe a case of flexion myelopathy due to specific morphological changes of the cervical cord, termed a “tight dural canal mechanism.” The patient was an 18-year-old man with progressive weakness and muscle atrophy of the left arm. Neuroradiological examination revealed that the lower cervical cord was compressed during flexion of the cervical spine, but that there was no disc disease or cervical vertebral instability. The cord compression was attributed to a pinching mechanism by the posterior border of the vertebral body and the posterior component of the dura on flexion.

A novel dynamic model for experimental spinal cord compression

2005 ◽  
Vol 2 (4) ◽  
pp. 466-471 ◽  
Author(s):  
Gerhard Marquardt ◽  
Matthias Setzer ◽  
Alf Theisen ◽  
Edgar Dettmann ◽  
Volker Seifert
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Dynamic Model ◽  
Dura Mater ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Neurological Deficits ◽  
Content Type ◽  
Interlaminar Approach ◽  
Fine Print

Object. The goal of this study was to develop a novel dynamic model for experimental spinal cord compression that closely approximates neoplastic epidural compression of the spinal cord in humans. Methods. In 30 New Zealand white rabbits, the thoracic spine was exposed via a posterior approach. On each side of one vertebral lamina a small hole was drilled caudal to the articular process. A silicone band was passed through these holes, forming a loop. The spinal dura mater was exposed via an interlaminar approach. The loop was brought into contact with the dura mater and fixed in its position encircling 270° of the circumference of the spinal cord. Thereafter, the loop was gradually tightened at set times by pulling at the ends of the band and fixing them again in their new position. The spinal cord was thus increasingly compressed in a circular and dynamic manner. Neurological deficits of various degrees were created in all animals in the compression group, and the compressive effect of the loop was reliably demonstrated on MR imaging. After decompression of the spinal cord, the neurological deficits were reversible in the majority of animals, and MR imaging revealed either no signal changes or only circumscribed ones within the cord. In contrast, MR images obtained in animals that did not recover revealed the occurrence of extensive chronic myelopathy. Conclusions. This novel model features reproducibility of paresis and neurological recovery. It is a dynamic model simulating circular tumor growth and is characterized by its easy, straightforward, and cost-saving applicability.

Familial os odontoideum

1989 ◽  
Vol 70 (4) ◽  
pp. 636-639 ◽  
Author(s):  
Michael K. Morgan ◽  
Burton M. Onofrio ◽  
Claire E. Bender
Keyword(s):  
Mr Imaging ◽  
Index Case ◽  
Cord Compression ◽  
Os Odontoideum ◽  
Type Ii ◽  
Content Type ◽  
X Ray ◽  
Autosomal Dominance ◽  
Flexion And Extension ◽  
Fine Print

✓ A familial asymptomatic os odontoideum with a Klippel-Feil type II fusion of C-2 and C-3 is reported. The pattern of inheritance within this family is consistent with that of autosomal dominance. The index case, a 16-year-old boy, was studied with plain cervical spine x-ray films, lateral cervical tomography in flexion and extension, fluoroscopic evaluation of the subluxation, and magnetic resonance (MR) imaging of the spine in flexion and extension. In spite of the subluxation noted on flexion and extension, there was no evidence of cord compression on MR imaging. The etiology and management of this condition are discussed.

Cervical cord compression due to a hypoplastic atlas

2001 ◽  
Vol 94 (1) ◽  
pp. 133-136 ◽  
Author(s):  
Daniel May ◽  
Benoît Jenny ◽  
Antonio Faundez
Keyword(s):  
Cord Compression ◽  
Cervical Cord ◽  
Posterior Decompression ◽  
Late Adulthood ◽  
Content Type ◽  
Cervical Cord Compression ◽  
Sagittal Diameter ◽  
Fine Print

✓ The authors report the case of a 66-year-old man with progressive, nontraumatic, C-1 cord compression who presented with a complete but hypoplastic atlas. They review six cases found in the literature. Symptoms usually develop in the late adulthood; the sagittal diameter of the canal measures 10 mm or less. The treatment requires a posterior decompression. Opening of the dura is sometimes necessary. There is no pressing need for a primary stabilization device.

Acute cervical cord injury without fracture or dislocation of the spinal column

2000 ◽  
Vol 93 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Izumi Koyanagi ◽  
Yoshinobu Iwasaki ◽  
Kazutoshi Hida ◽  
Minoru Akino ◽  
Hiroyuki Imamura ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Spinal Canal ◽  
Spinal Column ◽  
Cord Compression ◽  
Cervical Cord ◽  
Content Type ◽  
Cord Injury ◽  
Cervical Cord Injury ◽  
Fine Print

Object. It is known that the spinal cord can sustain traumatic injury without associated injury of the spinal column in some conditions, such as a flexible spinal column or preexisting narrowed spinal canal. The purpose of this study was to characterize the clinical features and to understand the mechanisms in cases of acute cervical cord injury in which fracture or dislocation of the cervical spine has not occurred. Methods. Eighty-nine patients who sustained an acute cervical cord injury were treated in our hospitals between 1990 and 1998. In 42 patients (47%) no bone injuries of the cervical spine were demonstrated, and this group was retrospectively analyzed. There were 35 men and seven women, aged 19 to 81 years (mean 58.9 years). The initial neurological examination indicated complete injury in five patients, whereas incomplete injury was demonstrated in 37. In the majority of the patients (90%) the authors found degenerative changes of the cervical spine such as spondylosis (22 cases) or ossification of the posterior longitudinal ligament (16 cases). The mean sagittal diameter of the cervical spinal canal, as measured on computerized tomography scans, was significantly narrower than that obtained in the control patients. Magnetic resonance (MR) imaging revealed spinal cord compression in 93% and paravertebral soft-tissue injuries in 58% of the patients. Conclusions. Degenerative changes of the cervical spine and developmental narrowing of the spinal canal are important preexisting factors. In the acute stage MR imaging is useful to understand the level and mechanisms of spinal cord injury. The fact that a significant number of the patients were found to have spinal cord compression despite the absence of bone injuries of the spinal column indicates that future investigations into surgical treatment of this type of injury are necessary.

Magnetic resonance imaging documentation of coexistent traumatic locked facets of the cervical spine and disc herniation

1993 ◽  
Vol 79 (3) ◽  
pp. 341-345 ◽  
Author(s):  
Stephen E. Doran ◽  
Stephen M. Papadopoulos ◽  
Thomas B. Ducker ◽  
Kevin O. Lillehei
Keyword(s):  
Cervical Spine ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Disc Herniation ◽  
Closed Reduction ◽  
Clinical Status ◽  
Cord Compression ◽  
Herniated Disc ◽  
Content Type ◽  
Fine Print

✓ The coexistence of traumatic locked facets of the cervical spine and a herniated disc is not well described. The authors present a series of patients with traumatic locked facets who demonstrated a high incidence of associated disc herniation documented on magnetic resonance (MR) imaging. Thirteen patients with either unilateral (four cases) or bilateral (nine cases) locked facets of the cervical spine were analyzed retrospectively. Immediate closed reduction using traction and/or manipulation was attempted in the first nine cases treated and was successful in only three; however, the procedure was abandoned in three cases due to deterioration in the patient's clinical status. In the subsequent four patients, an MR image was obtained prior to attempts at closed reduction. All patients underwent MR imaging of the cervical spine. Of eight consecutive cases treated at the University of Michigan, frank disc herniation with fragmented disc in the canal was found in five while pathological disc bulging was found in the other three. All five cases contributed by other institutions had concurrent disc herniation. This series illustrates the importance of using MR imaging to document the presence of a herniated disc during the initial evaluation of a patient with traumatic locked facets of the cervical spine and prior to attempted reduction of the locked facets. Experience indicates that closed reduction of facet dislocation associated with disc rupture may result in increased spinal cord compression and neurological deficit. If a herniated disc is discovered. anterior discectomy and fusion would be favored as the initial therapy over attempts at closed reduction or operative posterior reduction.

Anomalous vertebral artery—induced cervical cord compression causing severe nape pain

2001 ◽  
Vol 95 (1) ◽  
pp. 146-149 ◽  
Author(s):  
Kei Watanabe ◽  
Kazuhiro Hasegawa ◽  
Kou Takano
Keyword(s):  
Spinal Cord ◽  
Rare Case ◽  
Cord Compression ◽  
Cervical Cord ◽  
Resonance Imaging ◽  
Content Type ◽  
Cervical Cord Compression ◽  
Vertebral Arteries ◽  
Signal Void ◽  
Fine Print

✓ The authors describe a very rare case of cervical cord compression caused by anomalous bilateral vertebral arteries (VAs). A 65-year-old woman had been suffering from intractable nape pain and torticollis. Magnetic resonance imaging revealed a signal void region in which spinal cord compression was present. Angiography demonstrated anomalous bilateral VAs compressing the spinal cord. Microvascular decompressive surgery was successfully performed. Neuroradiological and intraoperative findings are presented.

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