Clinical Correlations of Cervical Myelopathy and the Hoffmann Sign

2008 ◽  
Vol 9 (3) ◽  
pp. 237-242 ◽  
Author(s):  
John K. Houten ◽  
Louis A. Noce
Keyword(s):  
Cervical Spine ◽  
Cervical Myelopathy ◽  
Imaging Study ◽  
Posterior Longitudinal Ligament ◽  
Cord Compression ◽  
Neurological Deficits ◽  
Positive Sign ◽  
Cervical Cord ◽  
Babinski Sign ◽  
Tertiary Center

Object The Hoffmann sign is commonly used in clinical practice to assess cervical spine disease. It is whether the sign correlates with the severity of myelopathy, and no consensus exists regarding the significance a positive sign in asymptomatic individuals. Methods In a retrospective review of cervical spine surgeries for myelopathy due to cervical spondylosis, fication of the posterior longitudinal ligament, or disc herniation performed at a tertiary center, the authors data on the presence of hyperreflexia, the Hoffmann and Babinski signs, and modified Japanese Orthopaedic ciation (mJOA) scale scores. Then, in a prospective evaluation, new patients with lumbar spine complaints examined for the presence of a Hoffmann sign, and, if present, a cervical MR imaging study was assessed for compression. Results Of the 225 surgically treated patients, a Hoffmann sign occurred in 68%, hyperreflexia in 60%, and Babinski sign in 33%. In patients with milder disability (mJOA Scores 14–16), the Hoffmann sign was present 46%, whereas a Babinski sign occurred in 10%; in those with severe myelopathy and mJOA scores of ≤ 10, Hoffmann sign was present in 81% and the Babinski sign in 83%. Of 290 patients presenting exclusively with bar spine–related complaints, 36 (12%) had a positive Hoffmann sign. Magnetic resonance imaging demonstrated spinal cord compression in 91% when the sign was present bilaterally and 50% when positive unilaterally. Conclusions In patients surgically treated for cervical myelopathy, the Hoffmann sign is more prevalent more likely to be seen in individuals with less severe neurological deficits than the Babinski sign. In patients lumbar symptoms, a bilateral Hoffmann sign was a highly sensitive marker for occult cervical cord compression, whereas a unilateral Hoffmann sign correlated with similar disease in about one-half of patients.

scholarly journals Functional outcome of posterior laminectomy in case of cervical myelopathy with multilevel cervical cord compression

2018 ◽  
Vol 4 (4) ◽  
pp. 510-514
Author(s):  
Dr. Siddharth D Parekh ◽  
Dr. Arvind B Goregaonkar ◽  
Dr. Anoop Dhamangaokar ◽  
Dr. Apratim R Deekshit ◽  
Dr. Umesh P Kanade
Keyword(s):  
Functional Outcome ◽  
Cervical Myelopathy ◽  
Cord Compression ◽  
Cervical Cord ◽  
Cervical Cord Compression ◽  
Posterior Laminectomy

Atlantoaxial Instability

2018 ◽  
pp. 41-48
Author(s):  
Jonathan M. Parish ◽  
Domagoj Coric
Keyword(s):  
Cervical Spine ◽  
Ct Scan ◽  
Plain Film ◽  
Cord Compression ◽  
Atlantoaxial Instability ◽  
Cervical Cord ◽  
Screw Length ◽  
Cord Injury ◽  
Bony Anatomy ◽  
Atlantodental Interval

There are a number of different imaging modalities that can be used to confirm atlantoaxial instability. Plain film radiographs of the cervical spine can be used to assess the atlantodental interval (ADI). Cervical CT is necessary to assess the atlantoaxial bony anatomy as well as to assess the foramen transversarium at C1 and C2. In particular, CT scan should be used to estimate screw length, medial/lateral and cranial/caudal screw trajectory. MRI can also evaluate the extent of cervical cord compression or cord injury that has occurred due to atlantoaxial instability.

scholarly journals Cervical myelopathy due to neurovascular compression syndrome caused by persistent first intersegmental artery: a case report

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Takuro Endo ◽  
Taku Sugawara ◽  
Naoki Higashiyama
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cervical Myelopathy ◽  
Anatomical Variation ◽  
Cord Compression ◽  
Burning Sensation ◽  
Motor Dysfunction ◽  
Neurological Deficits ◽  
Left Shoulder ◽  
Neurovascular Compression

Abstract Background Persistent first intersegmental artery (PFIA) is a rare anatomical variation of vertebral arteries and is an asymptomatic finding in most cases. Here we report a rare case of cervical myelopathy caused by spinal cord compression by the PFIA. Case presentation The patient was a 52-year-old man who complained of numbness and burning sensation around the neck and left shoulder area, partial weakness in the left deltoid muscle, right side thermal hypoalgesia, and disturbance of deep sensation since the past 1 year, and the symptoms had gradually worsened. Magnetic resonance imaging (MRI) and computed tomography (CT) showed spinal cord compression by the left PFIA at the C1/C2 level. Because conservative treatment was ineffective, microvascular decompression (MVD) of the PFIA was performed. The left PFIA was laterally transposed using polytetrafluoroethylene (PTFE) bands and anchored to the dura mater using three PTFE bands. To achieve adequate transposition, the small blood vessels bridging the spinal cord and PFIA and the dorsal root nerve had to be sacrificed. Postoperative T2-weighted MRI showed a small hyperintense region in the lateral funiculus of the spinal cord, but no new neurological deficits were identified. In the early postoperative stage, the patient’s deep sensory impairment and motor dysfunction were improved. His numbness and burning sensation almost disappeared, but slight thermal hypoalgesia remained in the lower limb. Conclusion MVD is an effective treatment for spinal cord compression caused by the PFIA, but further studies are necessary to help address technical difficulties and avoid complications.

scholarly journals A Clinical Practice Guideline for the Management of Patients With Degenerative Cervical Myelopathy: Recommendations for Patients With Mild, Moderate, and Severe Disease and Nonmyelopathic Patients With Evidence of Cord Compression

2017 ◽  
Vol 7 (3_suppl) ◽  
pp. 70S-83S ◽  
Author(s):  
Michael G. Fehlings ◽  
Lindsay A. Tetreault ◽  
K. Daniel Riew ◽  
James W. Middleton ◽  
Bizhan Aarabi ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Surgical Intervention ◽  
Guideline Development ◽  
Cord Compression ◽  
Operative Intervention ◽  
Prophylactic Surgery ◽  
Cervical Cord ◽  
Duration Of Symptoms ◽  
Degenerative Cervical Myelopathy ◽  
The Impact

Study Design: Guideline development. Objectives: The objective of this study is to develop guidelines that outline how to best manage (1) patients with mild, moderate, and severe myelopathy and (2) nonmyelopathic patients with evidence of cord compression with or without clinical symptoms of radiculopathy. Methods: Five systematic reviews of the literature were conducted to synthesize evidence on disease natural history; risk factors of disease progression; the efficacy, effectiveness, and safety of nonoperative and surgical management; the impact of preoperative duration of symptoms and myelopathy severity on treatment outcomes; and the frequency, timing, and predictors of symptom development. A multidisciplinary guideline development group used this information, and their clinical expertise, to develop recommendations for the management of degenerative cervical myelopathy (DCM). Results: Our recommendations were as follows: (1) “We recommend surgical intervention for patients with moderate and severe DCM.” (2) “We suggest offering surgical intervention or a supervised trial of structured rehabilitation for patients with mild DCM. If initial nonoperative management is pursued, we recommend operative intervention if there is neurological deterioration and suggest operative intervention if the patient fails to improve.” (3) “We suggest not offering prophylactic surgery for non-myelopathic patients with evidence of cervical cord compression without signs or symptoms of radiculopathy. We suggest that these patients be counseled as to potential risks of progression, educated about relevant signs and symptoms of myelopathy, and be followed clinically.” (4) “Non-myelopathic patients with cord compression and clinical evidence of radiculopathy with or without electrophysiological confirmation are at a higher risk of developing myelopathy and should be counselled about this risk. We suggest offering either surgical intervention or nonoperative treatment consisting of close serial follow-up or a supervised trial of structured rehabilitation. In the event of myelopathic development, the patient should be managed according to the recommendations above.” Conclusions: These guidelines will promote standardization of care for patients with DCM, decrease the heterogeneity of management strategies and encourage clinicians to make evidence-informed decisions.

Cilostazol, a selective Type III phosphodiesterase inhibitor: prevention of cervical myelopathy in a rat chronic compression model

2014 ◽  
Vol 20 (1) ◽  
pp. 93-101 ◽  
Author(s):  
Shinji Yamamoto ◽  
Ryu Kurokawa ◽  
Phyo Kim
Keyword(s):  
Spinal Cord ◽  
Grip Strength ◽  
Motor Neurons ◽  
Cervical Myelopathy ◽  
Cervical Spondylotic Myelopathy ◽  
Phosphodiesterase Inhibitor ◽  
Cord Compression ◽  
Anterior Horn ◽  
Cervical Cord ◽  
Forced Running

Object Regional blood flow is decreased in experimental models of chronic spinal cord compression, and the alteration presumably contributes to the development of myelopathy. Cilostazol (Otsuka Pharmaceuticals Co.), a selective Type III phosphodiesterase inhibitor, has been shown to be neuroprotective in cerebral hypoperfusion animal models and clinically effective in preventing the recurrence of cerebral infarction. To investigate the neuroprotective effect of cilostazol on cervical spondylotic myelopathy, the preventive effect against progressive motor dysfunction and the loss of anterior horn motor neurons were assessed using a chronic cord compression model in rats. Methods To produce chronic cervical cord compression in male Wistar rats, thin polyurethane sheets (3 × 5 × 0.7 mm) that gradually expand over 48–72 hours by absorbing water were implanted under the C5–6 laminae. In sham operations, the sheets were momentarily placed and then immediately removed. This model has been shown to reproduce characteristic features of clinical cervical myelopathy, with progressive motor disturbances after a latency period and insidious neuronal loss preceding the onset of symptoms. In the treatment group, cilostazol (30 mg/kg/day) was orally administered to the rats once a day, starting the day after surgery and continuing through the entire observation period of 25 weeks. In the control group, vehicle solution was administered under the same protocol. Changes in motor function were monitored by measuring bilateral forepaw grip strength and the duration of forced running on a treadmill. Twenty-five weeks after surgery, cervical spinal cords were examined histopathologically. Results Cilostazol preserved both forepaw grip strength and forced running capability. The drug also preserved anterior horn motor neurons in the C5–6 spinal cord segment, which diminished in number in the untreated chronic compression group. The drug decreased the number of TUNEL-positive apoptotic cells. Conclusions These results indicate that cilostazol is neuroprotective in the chronically compressed cervical cord and is potentially useful in the treatment of cervical spondylotic myelopathy.

Cervical Spine Injury From Unrecognized Craniocervical Instability in Severe Pierre Robin Sequence Associated With Skeletal Dysplasia

2018 ◽  
Vol 55 (5) ◽  
pp. 773-777 ◽  
Author(s):  
Xiao Zhu ◽  
Kelly N. Evans ◽  
Areeg El-gharbawy ◽  
Jonathan Y. Lee ◽  
Jack E. Brooker ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Skeletal Dysplasia ◽  
Spinal Injury ◽  
Cord Compression ◽  
Spine Injury ◽  
Cervical Cord ◽  
Pierre Robin Sequence ◽  
Robin Sequence ◽  
Craniocervical Instability ◽  
Pierre Robin

Pierre Robin Sequence (PRS) can be associated with skeletal dysplasias, presenting with craniocervical instability and devastating spinal injury if unrecognized. The authors present the case of an infant with PRS and a type II collagenopathy who underwent multiple airway-securing procedures requiring spinal manipulation before craniocervical instability was identified. This resulted in severe cervical cord compression due to odontoid fracture and occipitoatlantoaxial instability. This case highlights the importance of early cervical spine imaging and cautious manipulation in infants with PRS and suspected skeletal dysplasia.

scholarly journals Magnetic resonance imaging assessment of degenerative cervical myelopathy: a review of structural changes and measurement techniques

2016 ◽  
Vol 40 (6) ◽  
pp. E5 ◽  
Author(s):  
Aria Nouri ◽  
Allan R. Martin ◽  
David Mikulis ◽  
Michael G. Fehlings
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Cervical Myelopathy ◽  
Structural Changes ◽  
Sagittal Alignment ◽  
Measurement Techniques ◽  
Cord Compression ◽  
Age Related ◽  
Magnetic Resonance Imaging Assessment ◽  
Degenerative Cervical Myelopathy

Degenerative cervical myelopathy encompasses a spectrum of age-related structural changes of the cervical spine that result in static and dynamic injury to the spinal cord and collectively represent the most common cause of myelopathy in adults. Although cervical myelopathy is determined clinically, the diagnosis requires confirmation via imaging, and MRI is the preferred modality. Because of the heterogeneity of the condition and evolution of MRI technology, multiple techniques have been developed over the years in an attempt to quantify the degree of baseline severity and potential for neurological recovery. In this review, these techniques are categorized anatomically into those that focus on bone, ligaments, discs, and the spinal cord. In addition, measurements for the cervical spine canal size and sagittal alignment are also described briefly. These tools have resulted collectively in the identification of numerous useful parameters. However, the development of multiple techniques for assessing the same feature, such as cord compression, has also resulted in a number of challenges, including introducing ambiguity in terms of which methods to use and hindering effective comparisons of analysis in the literature. In addition, newer techniques that use advanced MRI are emerging and providing exciting new tools for assessing the spinal cord in patients with degenerative cervical myelopathy.

Ossification of the posterior longitudinal ligament: a review

2011 ◽  
Vol 30 (3) ◽  
pp. E1 ◽  
Author(s):  
Kriangsak Saetia ◽  
Dosang Cho ◽  
Sangkook Lee ◽  
Daniel H. Kim ◽  
Sang Don Kim
Keyword(s):  
Clinical Presentation ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Posterior Longitudinal Ligament ◽  
The Elderly ◽  
Cord Compression ◽  
Neurological Deficits ◽  
Advantages And Disadvantages ◽  
Asian Patients ◽  
Dynamic Factors ◽  
Bladder Symptoms

Ossification of the posterior longitudinal ligament (OPLL) is most commonly found in men, the elderly, and Asian patients. There are many diseases associated with OPLL, such as diffuse idiopathic skeletal hyperostosis, ankylosing spondylitis, and other spondyloarthropathies. Several factors have been reported to be associated with OPLL formation and progression, including genetic, hormonal, environmental, and lifestyle factors. However, the pathogenesis of OPLL is still unclear. Most symptomatic patients with OPLL present with neurological deficits such as myelopathy, radiculopathy, and/or bowel and bladder symptoms. There are some reports of asymptomatic OPLL. Both static and dynamic factors are related to the development of myelopathy. Plain radiography, CT, and MR imaging are used to evaluate OPLL extension and the area of spinal cord compression. Management of OPLL continues to be controversial. Each surgical technique has some advantages and disadvantages, and the choice of operation should be made case by case, depending on the patient's condition, level of pathology, type of OPLL, and the surgeon's experience. In this paper, the authors attempt to review the incidence, pathology, pathogenesis, natural history, clinical presentation, classification, radiological evaluation, and management of OPLL.

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