A Possible Correlation between Facet Orientation and Development of Degenerative Cervical Spinal Stenosis

Background Previous studies have demonstrated the relationship between sagittal facet orientation and cervical degenerative spondylolisthesis. However, the associations between facet orientation and cervical spinal stenosis (CSS) have rarely been studied. Methods One hundred and twenty patients with CSS (CSS group) and 120 healthy participants (control group) were consecutively enrolled. The cervical facet angles and anteroposterior diameter (A-P diameter) of spinal canal at each subaxial cervical levels were measured using axial magnetic resonance imaging. The intersection angle of the midsagittal line of the vertebra to the facet line represents the orientation of the facet joint. Results The facet angles on the right side at C2- C3 and C3-C4 in CSS group and at C2- C3 in control group had significantly higher values than those of the other sides. Besides, the facet angles and A-P diameter of spinal canal in CSS group were significantly smaller than those in control group at all levels (p < 0.05). Conclusions Our study demonstrated that patients with CSS have smaller axial cervical facet joint angles compared to the healthy individuals. Further studies are needed to elicit the specific underlying mechanism between sagittalization of the cervical facet joints and the pathology of CSS.

Severe altered mentation due to cervicothoracic intrathecal pump after correction of cervical stenosis: a case report

BackgroundCerebral spinal fluid (CSF) dynamics are complex and changes in spinal anatomy may influence the rostrocaudal movement of intrathecal medications. We present the first reported case demonstrating that acute cervical spinal stenosis may impede the distribution of adjacent intrathecal medications, and that correction of such stenosis and the resulting changes in CSF flow may necessitate significant adjustments in the intrathecal infusates.Case presentationWe present a case of a 60-year-old male patient with a cervicothoracic intrathecal pump (ITP) infusing morphine, bupivacaine, and baclofen for chronic neck pain. The alert and oriented patient had a recent fall resulting in an acute severe cervical stenosis and cord compression which required urgent surgical decompression. Postoperatively, after the cervical decompression, the patient had significant altered mental status requiring a naloxone infusion. Multiple attempts to reduce the naloxone infusion were initially not successful due to worsened somnolence. The previously tolerated ITP medications were continuously reduced over the next 14 days, allowing concomitant decrease and eventual cessation of the naloxone infusion while maintaining patient mental status. The only opioids the patient received during this period were from the ITP.ConclusionsThis case presents clinical evidence that severe spinal stenosis may impede the rostral CSF distribution of intrathecal medications. Intrathecal medications previously tolerated by patients prior to decompression may need to be significantly reduced in the postoperative period.

MRI-Based Classification Scheme for Degenerative Cervical Spinal Stenosis (DCSS Classification)

Background: The severity of Degenerative Cervical Spinal Stenosis (DCSS) is currently assessed by determining the sagittal diameter of the spinal canal, the degree of narrowing, and the level of stenosis using magnetic resonance imaging (MRI). The aim of our study was to develop and evaluate an optimized, MRI-based classification of DCSS to support treatment decision-making. Methods: We analyzed preoperative MRI scans of 75 patients to determine key morphological features of DCSS. Based on the features found, a classification was proposed and tested on ten representative image sets by 53 neurosurgeons to determine practicability and inter-observer reliability. Results: DCSS extended over one (13 and 17 % of pat.), two (23 and 31 % of pat.) or three (39 and 52 % of pat.). Thickening of the ligaments was observed in 71%, scoliosis in 3% and grade I spondylolisthesis in 11% of the patients. The DCSS classification has three main Types (A, B, C), which differ in the extent of the stenoses and thickening of the ligaments. Each main class has 2-3 subtypes depending on the position of the stenosis (lateral/medial) and the number of stenotic segments. An additional suffix indicates the presence of concomitant pathology (spondylolisthesis, scoliosis). 26 (49 %) neurosurgeons rated the classification as useful. For the main classes, interobserver reliability was fair (k=0.23). For subtype and concomitant pathology, interobserver reliability was low (k=0.14). Conclusions: In the study a new classification system for degenerative spinal stenoses was developed, which combines anatomical and clinical defect characteristics. Deviations in the classification result from a strict subdivision, so that adjustments are necessary.