Upper cervical myelopathy due to arachnoiditis and spinal cord tethering from adjacent C-2 osteomyelitis

2007 ◽  
Vol 6 (1) ◽  
pp. 64-67 ◽  
Author(s):  
Sharad Rajpal ◽  
Krisada Chanbusarakum ◽  
Praveen R. Deshmukh
Keyword(s):  
Spinal Cord ◽  
Cervical Myelopathy ◽  
Complete Resolution ◽  
Magnetic Resonance Image ◽  
Epidural Abscess ◽  
Odontoid Process ◽  
Surgical Decompression ◽  
Upper Cervical ◽  
High Cervical ◽  
Spinal Cord Tethering

✓Myelopathy caused by a spinal cord infection is typically related to an adjacent compressive lesion such as an epidural abscess. The authors report a case of progressive high cervical myelopathy from spinal cord tethering caused by arachnoiditis related to an adjacent C-2 osteomyelitis. This 70-year-old woman initially presented with a methicillin-sensitive Staphylococcus aureus osteomyelitis involving the C-2 odontoid process. She was treated with appropriate antibiotic therapy but, over the course of 4 weeks, she developed progressive quadriparesis. A magnetic resonance image revealed near-complete resolution of the C-2 osteomyelitis, but new ventral tethering of the cord was observed at the level of the odontoid tip. She subsequently underwent open surgical decompression and cord detethering. Postoperatively she experienced improvement in her symptoms and deficits, which continued to improve 1 year after her surgery. To the authors’ knowledge, this is the first reported case of progressive upper cervical myelopathy due to arachnoiditis and cord tethering from an adjacent methicillin-sensitive S. aureus C-2 osteomyelitis.

ANTERIOR CERVICAL APPROACH FOR THE TREATMENT OF CERVICAL MYELOPATHY

Neurosurgery ◽  
2007 ◽  
Vol 60 (suppl_1) ◽  
pp. S1-64-S1-70 ◽  
Author(s):  
Paul G. Matz ◽  
Patrick R. Pritchard ◽  
Mark N. Hadley
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Surgical Technique ◽  
Cervical Myelopathy ◽  
Cervical Spondylotic Myelopathy ◽  
Clinical Symptoms ◽  
Recovery Of Function ◽  
Surgical Decompression ◽  
Cervical Approach ◽  
Anterior Cervical Approach

Abstract COMPRESSION OF THE spinal cord by the degenerating cervical spine tends to lead to progressive clinical symptoms over a variable period of time. Surgical decompression can stop this process and lead to recovery of function. The choice of surgical technique depends on what is causing the compression of the spinal cord. This article reviews the symptoms and assessment for cervical spondylotic myelopathy (clinically evident compression of the spinal cord) and discusses the indications for decompression of the spinal cord anteriorly.

Microscopic Decompression of the Anterior Upper Cervical Spine: A Case of Odontoid Malunion to the Atlas

Neurosurgery ◽  
1984 ◽  
Vol 14 (5) ◽  
pp. 583-587 ◽  
Author(s):  
Jimmy Miller ◽  
Andrew D. Parent
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Odontoid Process ◽  
Transoral Approach ◽  
Upper Cervical Spine ◽  
Basilar Impression ◽  
Odontoid Fractures ◽  
Surgical Microscope ◽  
The Past ◽  
Upper Cervical

Abstract For the past 20 years, the transoral approach to the upper cervical spine has been utilized for odontoid fractures, the removal of an abnormal odontoid process, decompression of basilar impression, and biopsy or resection of nasopharyngeal or metastatic tumors. The effectiveness and safety of this procedure is well documented. Use of the surgical microscope adds to the efficiency and safety of the procedure. We are reporting a case of fusion of the odontoid base to the anterior arch of the atlas. To our knowledge, this entity has not been described previously. The spinal cord was protected by an initial posterior fusion of C-1, C-2, followed in 10 days by a tracheostomy and the transoral removal of the anterior C-1 arch and the abnormal dens. Because the medical history did not reveal a source of trauma, it is supposed that the patient had malunion of the odontoid process to C-2, with subsequent migration and fusion of the dens to the C-1 arch.

scholarly journals Surgical Treatment of C2 Odontoid Process Intussusception in Combination with Type I Chiari Malformation

2017 ◽  
pp. 66-72 ◽  
Author(s):  
A. N. Shkarubo ◽  
A. A. Kuleshov ◽  
I. V. Chernov ◽  
V. A. Shakhnovich ◽  
E. V. Mitrofanova ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Chiari Malformation ◽  
Odontoid Process ◽  
Type I ◽  
Basilar Impression ◽  
Posterior Decompression ◽  
Developmental Abnormalities ◽  
Brainstem Compression ◽  
Upper Cervical ◽  
One Step

Type I Chiari malformation is often accompanied by congenital developmental abnormalities such as platybasia, basilar impression and C2 odontoid process retroflexion that may cause anterior compression of brainstem structures and upper cervical segments of spinal cord. Formerly the conventional method was posterior decompression even in presence of anterior brainstem compression. This article presents on a kinetic example the tactics of one-step treatment of patients with type I Chiari malformation accompanied by basilar impression and C2 odontoid process retroflexion via transoral approach only that was used for both decompression and C1-C2 segment anterior stabilization. Surgical intervention enabled to achieve the decompression of brainstem structures and upper cervical segments of spinal cord, normalization liquor dynamics and subsequent redislocation of cerebellar tonsils to normal position (above the Chamberlain line).

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 High cervical myelopathy due to bony craniovertebral junction anomalies (atlantoaxial dislocation) in pediatric population- clinical scoring system

2016 ◽  
Vol 52 (02) ◽  
pp. 131-138
Author(s):  
Raj Kumar
Keyword(s):  
Cervical Myelopathy ◽  
Scoring System ◽  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Atlantoaxial Dislocation ◽  
Surgical Approaches ◽  
Lower Cranial Nerve ◽  
Complex Anatomy ◽  
Clinical Scoring ◽  
High Cervical

SUMMARYBony craniovertebral junction anomalies are rare anomalies to cause high cervical myelopathy. Atlantoaxial dislocation (congenital) is one of the commonest bony anomaly in children presenting with high cervical compression. It is relatively common in India with an incidence of 5-8 / 1000. When the distance of atlas (anterior arch) is more than 3mm ( 4 mm children) from odontoid process, it is called as Atlantoaxial dislocation (AAD) resulting into bony compression of high cervical cord. The patients may present with quadriparesis, sensory impairment in all limbs along with lower cranial nerve involvement. Because of lower medullary involvement the respiratory compromises are also frequent, posing a threat to life. Complex anatomy of foramen magnum, plethora of clinical conditions and atypical surgical approaches are responsible for poor outcome in these children. A new clinical scoring system for myelopathy was evolved in order to have an objective and precise grading of these cases preoperatively and postoperatively. The need of precise scoring system was felt to have reproducibility and easy applicability in children of craniovertebral junction anomalies in order to fetch even minimal improvement or deterioration following complex surgery. Motor functions, gait, sensory, sphincteric, respiratory function & spasticity were the parameters included in study of scoring system. This study was done in 177 operated cases of AAD (67 patients, below 14 years of age included for statistical analysis). Their detailed clinical & radiological evaluation was done preoperatively & postoperatively. The Kumar & Kalra high cervical myelopathy grading system was thus, introduced in literature. System was easy to use, interpret and was more sensitive to the changes in neurological status. It helped neurosurgeons and neurologists globally to evaluate and prognosticate the cases of Atlantoaxial dislocation.

Atlas hypoplasia as a cause of high cervical myelopathy

1993 ◽  
Vol 79 (6) ◽  
pp. 917-919 ◽  
Author(s):  
Yoji Komatsu ◽  
Tomoyuki Shibata ◽  
Susumu Yasuda ◽  
Yukio Ono ◽  
Tadao Nose
Keyword(s):  
Spinal Cord ◽  
Cervical Myelopathy ◽  
Neurological Recovery ◽  
Decompressive Laminectomy ◽  
Content Type ◽  
High Cervical ◽  
Fine Print

✓ A high cervical myelopathy due to atlas hypoplasia is described in a 56-year-old man; the condition caused marked segmental compression of the spinal cord. A remarkable neurological recovery followed decompressive laminectomy of the atlas and adjacent regions. The authors discuss the embryology and etiology of this anomaly.

scholarly journals Functional outcome assessment for surgical decompression of cervical spondylotic myelopathy

2021 ◽  
Vol 9 (1) ◽  
pp. 70
Author(s):  
Tinu Ravi Abraham ◽  
Ajax John ◽  
P. K. Balakrishnan ◽  
Tom Jose
Keyword(s):  
Spinal Cord ◽  
Functional Outcome ◽  
Cervical Myelopathy ◽  
Cervical Spondylotic Myelopathy ◽  
Functional Results ◽  
Surgical Decompression ◽  
Herniated Disc ◽  
Average Hospital ◽  
Japanese Orthopedic Association ◽  
Cost Effective Treatment

Background: Cervical spondylotic myelopathy (CSM) is one of the most common dysfunctions of spinal cord occurs due to degenerative changes in cervical spine disc and facet joints. It is a form of progressive spine disease including herniated disc and spinal cord stenosis which manifests as changes in gait, skilled hand movements, muscle strength, bladder dysfunction etc. Recent studies and trials have established that surgical decompression of cervical spinal is a cost-effective treatment modality which provide satisfactory functional recovery. This study aimed at the functional outcome of surgical decompression of CSM.Methods: The prospective study of 100 cases of cervical myelopathy for which decompressive surgery was done from August 2020 to August 2021. Results were analysed according to Nuricks and modified Japanese orthopedic association scoring system (MJOA).Results: Seventy one males and 29 females were included in this study with average age was 53 and average hospital stay was 3.55 days. Average pre-op Nurick score was 1.93, while score after 6 months and 1year were 1.44 and 1.15respectively. Average pre-op MJOA score was 13.63, while score after 6 months and 1 year were 14.58 and 15.74 respectively.Conclusions: The functional results of decompressive surgeries for cervical myelopathy are satisfactory. Both anterior and posterior approaches are recommended for multiple cervical myelopathy with comparable outcomes. DM and age was observed as the independent predictor for functional outcome, while, gender and level of disease got less significant predictive value.

Pyogenic Osteomyelitis of an Invaginated Odontoid Process with Rapid Deterioration of High Cervical Myelopathy: A Case Report

1998 ◽  
Vol 140 (10) ◽  
pp. 1093-1094 ◽  
Author(s):  
M. Kurimoto ◽  
S. Endo ◽  
M. Ohi ◽  
Y. Hirashima ◽  
N. Matsumura ◽  
...  
Keyword(s):  
Case Report ◽  
Cervical Myelopathy ◽  
Odontoid Process ◽  
Rapid Deterioration ◽  
Pyogenic Osteomyelitis ◽  
High Cervical

Synovial cyst and degeneration of the transverse ligament: an unusual cause of high cervical myelopathy

1997 ◽  
Vol 86 (6) ◽  
pp. 1027-1030 ◽  
Author(s):  
Patrick Fransen ◽  
Gian Paolo Pizzolato ◽  
Philippe Otten ◽  
Alain Reverdin ◽  
René Lagier ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Spinal Cord ◽  
Synovial Cyst ◽  
Cystic Degeneration ◽  
Transverse Ligament ◽  
Radiological Findings ◽  
Content Type ◽  
Upper Cervical ◽  
High Cervical ◽  
Fine Print

✓ A case of cystic degeneration of the transverse ligament located posteriorly to the dens and causing compression to the lower medulla and upper cervical spinal cord is reported. The clinical, pathological, and radiological findings are described and compared to the literature to characterize this syndrome more fully. The advantages of a posterolateral surgical approach are stressed.

scholarly journals Apparently benign craniocervical signs in achondroplasia: “neurologic leftovers” identified through a retrospective dataset

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Cory J. Smid ◽  
Janet M. Legare ◽  
Peggy Modaff ◽  
Richard M. Pauli
Keyword(s):  
Spinal Cord ◽  
Cervical Myelopathy ◽  
Craniocervical Junction ◽  
Neurologic Complications ◽  
Clinically Significant ◽  
High Cervical ◽  
Neurologically Intact ◽  
Apparent Evidence ◽  
Neurosurgical Intervention

Abstract Background Achondroplasia is the most common dwarfing disorder. It can result in a variety of sequelae, including neurologic complications, among which high cervical myelopathy is one of particular concern. However, some individuals with achondroplasia appear to have persistent signs by physical examination that, while they might suggest the presence of high cervical myelopathy, remain isolated, non-progressive and apparently benign. To document and quantify these apparently benign craniocervical signs (ABCS) a cohort of 477 individuals with achondroplasia was retrospectively analyzed and information regarding persistent neurologic features suggestive of high cervical myelopathy was recorded in a REDCap database. Results Within this cohort, 151 individuals (31.7%) had neurologic examinations that were in some manner concerning. Of these, 46 (30.5% of the subpopulation) required cervicomedullary decompressive surgery. The remaining 105 had concerning signs by examination but no apparent evidence for clinically significant cervical myelopathy. Of those 105 individuals, 88 (83.8%; 18.4% of the entire population) remained neurologically intact throughout their follow-up, and without clinical sequelae. Conclusions It appears that many individuals with achondroplasia, if carefully examined, may demonstrate isolated, initially concerning signs suggestive of cervical myelopathy, but in the vast majority these are benign and do not indicate need for aggressive neurosurgical intervention. Further investigations may help to identify ways to differentiate these benign features from the less common but more problematic true myelopathic ones. We postulate that the “neurologic leftovers” may arise from temporally remote, subtle damage to the spinal cord at the craniocervical junction, which damage otherwise does not reach clinical relevance.

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