MedWorm: Cervical Laminectomy

Comparison between anterior and posterior decompression for cervical spondylotic myelopathy: subjective evaluation and cost analysis

Orthopaedic Surgery — Wed, 01 Feb 2012 05:00:00 +0100

Conclusions: Both anterior and posterior decompressions (with instrumentation) are effective procedures for improving the neurological outcomes of patients with CSM. However, although the two approaches have similar health care costs, anterior cervical corpectomy (with instrumentation) seems to be subjectively assessed by patients as better. (Source: Orthopaedic Surgery)

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Anatomical study of the cervical nerve roots for posterior foraminotomy: cadaveric study

European Spine Journal — Tue, 24 Jan 2012 07:32:42 +0100

Conclusion Anatomic and morphologic study of the cervical nerve roots and their relationships to the lateral mass and the intervertebral disc are useful landmarks to reduce the operative complications of the posterior foraminotomy. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00586-012-2158-6Authors Mohamed Barakat, Neurosurgery Department, Faculty of Medicine, Zagazig University, Zagazig, EgyptYoussef Hussein, Anatomy Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt Journal European Spine JournalOnline ISSN 1432-0932Print ISSN 0940-6719 (Source: European Spine Journal)

Drug overdose resulting in quadriplegia

European Spine Journal — Wed, 11 Jan 2012 06:57:09 +0100

Conclusion Our patient suffered a spinal cord injury likely due to existing cervical stenosis, and in addition to an overdose of sedating medications, he likely sat in flexed neck position for prolonged period of time with the inability to modify his position. This likely resulted in cervical spine vascular and/or neurological compromise producing an irreversible spinal cord injury. Spinal cord injury is a rare finding in patients presenting with drug overdose. The lack of physical exam findings suggestive of trauma may delay prompt diagnosis and treatment, and thus clinicians must have a high index of suspicion when evaluating patients in this setting. Content Type Journal ArticleCategory Case ReportPages 1-4DOI 10.1007/s00586-011-2143-5Authors Teresa S. Wang, D...

Cervical ossification of the posterior longitudinal ligament: Anterior versus posterior approach

Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1) — Tue, 10 Jan 2012 05:00:00 +0100

Conclusions: The posterior indirect decompression and fixation has now been adopted as the primary treatment for cervical OPLL involving multiple levels with the canal occupancy by OPLL <50% at our institution because this approach leads to significantly less implant failures. Those patients with the occupancy ≥50% managed with anterior approach surgeries had better outcomes, but approach was more difficult and associated with higher risk and complications. (Source: Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1))

C2 lamina reconstruction using locking miniplate for the intradural tumor of the craniocervical junction (two case reports)

European Spine Journal — Sat, 07 Jan 2012 16:55:50 +0100

Conclusions This procedure results in rigid fixation of the reimplanted C2 lamina and helps to restore the paraspinous muscles. For these reasons, it appears to be a useful surgical procedure for spinal tumors requiring C2 laminectomy and does not cause postoperative kyphosis of the cervical spine. Content Type Journal ArticleCategory Case ReportPages 1-4DOI 10.1007/s00586-011-2138-2Authors Hisanori Ikuma, Department of Orthopaedic Surgery, Kagawa Rosai Hospital, 3-3-1 Joto-cho, Marugame, Kagawa 763-8502, JapanKensuke Shinohara, Department of Orthopaedic Surgery, Kagawa Rosai Hospital, 3-3-1 Joto-cho, Marugame, Kagawa 763-8502, JapanTakashi Maehara, Department of Orthopaedic Surgery, Kagawa Rosai Hospital, 3-3-1 Joto-cho, Marugame, Kagawa 763-8502, JapanYoshiki Yoko...

A rare case of life-threatening giant plexiform schwannoma

The Spine Journal — Tue, 03 Jan 2012 05:00:00 +0100

A 28-year-old woman with idiopathic scoliosis presented with a cervical mass and progressive gait disturbance over the course of 2 years. Examination demonstrated mild spastic paraplegia, hypoesthesia with upper level at T5 and severe respiratory failure requiring assisted ventilation. Magnetic resonance imaging showed multiple thoracic masses compressing left lung, trachea, and spinal cord (). Surgical resection was performed. Through C5–T1 laminectomy, the intradural part of the neoplasia was completely removed, and the extradural part was enucleated as much as possible. After surgery, the respiratory function improved. Histologic pattern and S100 protein diffuse reactivity were consistent with plexiform schwannoma, a rare benign cutaneous variation of schwannoma . Although deep-seated...

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Laparoscopic Sleeve Gastrectomy: a First Step for Rapid Weight Loss in Morbidly Obese Patients Requiring a Second Non-Bariatric Procedure

Obesity Surgery — Fri, 30 Dec 2011 06:48:23 +0100

Conclusions In this small group, laparoscopic sleeve gastrectomy appears to be an effective and safe first surgical approach for rapid weight loss in high-risk patients that require a second non-bariatric procedure. Content Type Journal ArticleCategory Clinical ResearchPages 1-5DOI 10.1007/s11695-011-0574-zAuthors Jesus E. Hidalgo, Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL, USAMayank Roy, Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL, USAAlexander Ramirez, Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL, USASamuel Szomstein, Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL, USARaul J. Rosenthal, Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL...

Neurosurgery at Queen Square

Journal of Pakistan Medical Students — Thu, 29 Dec 2011 05:00:00 +0100

This article has been peer reviewed. Article Submitted on: 9th October 2011 Article Accepted on: 28th November 2011 Funding sources: None declared Correspondence to:Hamza Tariq Medical student Address:King Edward Medical University, Lahore, Pakistan. Email: hamxatariq@yahoo.com Download PDF Elective Report The day I finished studying the anatomy of brain, I knew that I wanted to pursue neurosurgery as a career speciality. A medical student getting fascinated by the mysterious workings of the human brain is not something unusual. Here, in a mere 3 pounds of living tissue, lies the complexity sufficient to incarnate and store the record of a lifetime of the richest human experience. Our brains contain the secrets of ourselves. Its mystery lies in the fact that it con...

Less invasive approaches for the treatment of cervical schwannomas: our experience

European Spine Journal — Fri, 16 Dec 2011 16:52:47 +0100

Conclusions Minimal access procedures are increasingly gaining popularity but their use is poorly described in the treatment of cervical tumors. Less invasive approaches may effectively be used instead of traditional laminectomy in the treatment of cervical tumors, especially schwannomas, providing less iatrogenic traumatism and preventing postsurgical spinal instability. Modern neuroimaging allows adequate preoperative planning and microsurgical techniques provide adequate execution of the surgical act. The procedure has to be tailored case by case considering the specific lesional features and the individual anatomical situation. Content Type Journal ArticleCategory Review ArticlePages 1-10DOI 10.1007/s00586-011-2118-6Authors S. Raysi Dehcordi, Department of Sur...

Unusual spine anatomy contributing to wrong level spine surgery: a case report and recommendations for decreasing the risk of preventable 'never events'

Patient Safety in Surgery — Wed, 14 Dec 2011 05:00:00 +0100

CONCLUSION: This case highlights the importance of strict adherence to a preoperative method of vertebral labeling that focuses on the landmarks used to label a pathologic disc space, rather than simply relying on the reference to a particular level. That is, by designating the pathological level as the disc space associated with the fourth rib up from the last rib-bearing vertebrae, rather than calling it "T7-8," then the correct level can be found intraoperatively even in the case of abnormal segmentation. We recommend working closely with radiology during preoperative planning to identify unusual anatomy that may have been overlooked. We also recommend that radiology colleagues use the same system of identifying pathological levels when dictating their reports. Together, these strategie...

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Spinal posterior movement after posterior cervical decompression surgery: clinical findings and factors affecting postoperative functional recovery.

Orthopedics — Thu, 08 Dec 2011 22:48:02 +0100

This study investigated the posterior movement of the spinal cord after posterior decompression surgery and evaluated factors affecting postoperative functional recovery in patients with cervical spondylotic myelopathy (CSM). Thirty-two patients with CSM underwent posterior decompression from C3 to C7 through laminectomy (n=12) and single, open-door laminoplasty (n=20). There were no significant differences between laminectomy and laminoplasty in degree of spinal posterior movement, recovery rate, and curvature index. Japanese Orthopedic Association (JOA) scores improved from preoperative (10.63±1.77; range, 7-14) to 3-months postoperative (13.57±1.50; range, 11-16) (n=32, P<.05) and from preoperative (10.24±1.87; range, 7-14) to 6-months postoperative (14.16±1.54; range, 12-16) (n=...

Spinal cord bypass surgery with intercostal and spinal accessory nerves: an anatomical feasibility study in human cadavers.

Journal of Neurosurgery.Spine — Fri, 02 Dec 2011 05:00:00 +0100

Conclusions Both spinal accessory and intercostal nerves, accessible from a posterior approach in the prone position, can be successfully harvested and transferred to their respective targets in the cervical spinal cord and conus medullaris. As expected, the number of axons available to grow into the spinal cord diminishes distally along each nerve. To maximize axon "bandwidth" in nerve bypass procedures, the most proximal section of the nerve that can be transferred in a tension-free manner to a spinal level caudal to the level of injury should be implanted. This study supports the feasibility of SAN and intercostal nerve transfer as a means of treating SCI and may assist in the preoperative selection of candidates for future human clinical trials of cervical and thoracolumbar SCI bypass...

Isolated extradural tuberculous granuloma of the cervical spine: a case report

European Spine Journal — Thu, 01 Dec 2011 06:57:16 +0100

Conclusions The isolated IETG, although a rare entity, should be considered in the differential diagnosis of the intraspinal mass, especially in patients with spinal cord compression and a history of tuberculosis. If there is a progressing neurological deficit, a combination of surgical and anti-tuberculous treatment should be the optimal choice. Content Type Journal ArticleCategory Chinese sectionPages 1-4DOI 10.1007/s00586-011-2095-9Authors Qi Ding, Department of Spine Surgery, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Zhongshan Road No.321, Nanjing, 210008 ChinaZhen Liu, Department of Spine Surgery, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Zhongshan Road No.321, Nanjing, 210008 ChinaXu Sun, Department of ...

Cervical transpedicular fixation aided by biplanar flouroscopy.

Journal of Orthopaedic Surgery — Thu, 01 Dec 2011 05:00:00 +0100

CONCLUSION. Cervical transpedicular fixation provides strong stabilisation. With the aid of biplanar fluoroscopy, the risk of pedicle perforation was about 8%, but no neurovascular injury was ensued. PMID: 22184164 [PubMed - in process] (Source: Journal of Orthopaedic Surgery)

Extensive laminectomy for the treatment of ossification of the posterior longitudinal ligament in the cervical spine

Archives of Orthopaedic and Trauma Surgery — Fri, 25 Nov 2011 17:58:12 +0100

Conclusion Extensive laminectomy is effective in treating cervical OPLL, with mild cervical/shoulder pain, low rate of C5 nerve root palsy, and no recurrence of spinal cord compression symptoms. Content Type Journal ArticleCategory Orthopaedic SurgeryPages 1-7DOI 10.1007/s00402-011-1420-4Authors Xiaotao Zhao, Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, 300052 ChinaYuan Xue, Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, 300052 ChinaFeilong Pan, Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, 300052 ChinaHuajian Zhao, Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, 300052 ChinaPeng Li, Department of Orthop...

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Posterior surgery for cervical myelopathy: indications, techniques, and outcomes.

The Orthopedic Clinics of North America — Tue, 22 Nov 2011 10:37:47 +0100

This article details the controversies associated with the different treatment strategies in patients with cervical spondylotic myelopathy. The natural history, incidence, pathophysiology, physical examination, and imaging findings are discussed followed by the indications, techniques, and outcomes of patients treated with posterior cervical decompression via decompressive laminectomy, laminectomy and instrumented fusion, and laminoplasty. PMID: 22082627 [PubMed - in process] (Source: The Orthopedic Clinics of North America)

Posterior Surgery for Cervical Myelopathy: Indications, Techniques, and Outcomes

Orthopedic Clinics of North America — Thu, 17 Nov 2011 07:42:16 +0100

Laminectomy, durotomy, and piotomy effects on spinal cord intramedullary pressure in severe cervical and thoracic kyphotic deformity: a cadaveric study.

Journal of Neurosurgery.Spine — Fri, 11 Nov 2011 05:00:00 +0100

Conclusions In this cadaveric study, laminar decompression reduced ?IMP by approximately 15%?25%, while correction of the kyphotic deformity returned ?IMP to zero. This study helps explain the pathophysiology of myelopathy in kyphotic deformity and the failure of laminectomy alone for cervical and thoracic kyphotic deformities with myelopathy. In addition, the study emphasizes the need for correction of deformity during operative treatment of kyphotic deformity, the need for maintaining adequate intraoperative blood pressure during operative treatment, and the higher risk of spinal cord injury associated with operative treatment of kyphotic deformity. PMID: 22077470 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery.Spine)

Cervical chondroid chordoma in a standard dachshund: a case report

Acta Veterinaria Scandinavica — Fri, 21 Oct 2011 04:00:00 +0100

A ten-year-old male standard dachshund was presented with a history of neck pain and progressive gait disturbances. Following a neurological examination and diagnostic imaging, including CT, a neoplastic lesion involving the third and fourth cervical vertebrae was suspected. The lesion included an extradural mass on the right side of the spinal canal causing a local compression of the cervical cord. Surgery, using a modified dorsal laminectomy procedure, was performed in order to decompress the cervical spinal cord. Histopathological examination of the extradural mass indicated that the tumour was a chondroid chordoma. Following discharge, the quality of life for the dog was very good for a sustained period, but clinical signs recurred at 22 months. The dog was euthanased 25 months post-su...

Cervical Laminoplasty for Multilevel Cervical Myelopathy

Clinical and Developmental Immunology — Sun, 02 Oct 2011 22:55:48 +0100

Cervical spondylotic myelopathy can result from degenerative cervical spondylosis, herniated disk material, osteophytes, redundant ligamentum flavum, or ossification of the posterior longitudinal ligament. Surgical intervention for multi-level myelopathy aims to decompress the spinal cord and maintain stability of the cervical spine. Laminoplasty was major surgical advancement as laminectomy resulted in kyphosis and unsatisfactory outcomes. Hirabayashi popularised the expansive open door laminoplasty which was later modified several surgeons. Laminoplasty has changed the way surgeons approach multilevel cervical spondylotic myelopathy. (Source: Clinical and Developmental Immunology)

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Lumbosacral sensory neuronal activity is enhanced by activation of urothelial purinergic receptors.

Brain Research Bulletin — Thu, 08 Sep 2011 04:00:00 +0100

Authors: Munoz A, Somogyi GT, Boone TB, Smith CP Abstract Urothelial purinergic receptors are important for the regulation of afferent sensory pathways in bladder pain and overactivity. Using in vivo electrophysiological recordings we evaluated the activity of spinal dorsal horn neurons in female rats at the L6/S1 level when urinary bladder pressure was abruptly increased. Intravesical infusion of ATP and systemic application of suramin allowed us to evaluate the contribution of urothelial purinergic receptors. Rats were anesthetized with isofluorane. Suprapubic, venous and tracheal catheters were implanted. Laminectomy was performed at the L6-S1 spinal levels. The cervical spinal cord was transected, and rats were mechanically pithed. Anesthesia was stopped, rats were ventilated, ...

Systematic Review of Cohort Studies Comparing Surgical Treatment for Multilevel Ossification of Posterior Longitudinal Ligament: Anterior vs Posterior Approach.

Orthopedics — Sat, 13 Aug 2011 16:16:12 +0100

Authors: Xu J, Zhang K, Xiangyang M, Yin Q, Wu Z, Xia H, Wang Z There have been no standards or guidelines for the treatment of ossification of posterior longitudinal ligament, especially multilevel ossification of posterior longitudinal ligament. The purpose of this study was to compare results of major surgical treatment for multilevel ossification of posterior longitudinal ligament. Databases including MEDLINE, EMBASE, the Cochrane library, and bibliographies of identified and review articles were searched to find randomized, controlled trials or retrospective cohort studies comparing anterior and posterior approach from 1980 to December 2010. Approximately 1375 articles were found initially, 92 abstracts were screened, 23 articles were retrieved in full; 3 studies were included in ...

Remarkable epidural scar formation compressing the cervical cord after osteoplastic laminoplasty with hydroxyapatite spacer.

Journal of Neurosurgery.Spine — Thu, 11 Aug 2011 23:00:00 +0100

Authors: Kuraishi K, Hanakita J, Takahashi T, Minami M, Mori M, Watanabe M Abstract The authors report on an 81-year-old woman whose condition deteriorated 2 months after undergoing osteoplastic laminoplasty with placement of hydroxyapatite spacers. Magnetic resonance imaging showed postlaminectomy scar formation compressing the cervical spinal cord. The patient underwent laminectomy and removal of remarkably thick epidural scar tissue, which resulted in resolution of her symptoms. Histological diagnosis of the scar was fibrous granulation tissue with foreign body granuloma, characterized by multinucleated giant cells and marked increases of capillary vessels, fibroblasts, and collagen fibers. This case of symptomatic postlaminectomy scar formation after osteoplastic laminoplasty s...

Cranial epidural spread of contrast medium and new methylene blue dye in sternally recumbent anaesthetized dogs

Veterinary Anaesthesia and Analgesia — Thu, 11 Aug 2011 18:37:23 +0100

Conclusions No significant inhibitory effect of upward slope on cranial epidural spread of the solution was observed. Other factors may have greater effect on epidural spread in sternally recumbent dogs. (Source: Veterinary Anaesthesia and Analgesia)

Hemiparesis Caused by Cervical Spontaneous Spinal Epidural Hematoma: A Report of 3 Cases

International Journal of Telemedicine and Applications — Thu, 28 Jul 2011 14:10:13 +0100

We report three cases of spontaneous spinal epidural hematoma (SSEH) with hemiparesis. The first patient was a 73-year-old woman who presented with left hemiparesis, neck pain, and left shoulder pain. A cervical MRI scan revealed a left posterolateral epidural hematoma at the C3–C6 level. The condition of the patient improved after laminectomy and evacuation of the epidural hematoma. The second patient was a 62-year-old man who presented with right hemiparesis and neck pain. A cervical MRI scan revealed a right posterolateral dominant epidural hematoma at the C6-T1 level. The condition of the patient improved after laminectomy and evacuation of the epidural hematoma. The third patient was a 60-year-old woman who presented with left hemiparesis and neck pain. A cervical MRI scan revea...

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Weakness of the neck extensors, possible causes and relation to adolescent idiopathic cervical kyphosis

Medical Hypotheses — Sun, 17 Jul 2011 23:00:00 +0100

Abstract: Cervical kyphosis may be congenital, or occur as a result of laminectomy, post-traumatic deformity, infection, neuromuscular disorders such as muscular dystrophies, motor neuron disorders such as amyotrophic lateral sclerosis, tumor, and inflammation such as ankylosing spondylitis. Furthermore, adolescent idiopathic cervical kyphosis was defined as cervical kyphotic deformity of adolescent patient without any cause such as those previously described. As no standard values for “cervical kyphosis” could be found in the literature, many reported studies only report a subjective classification, “kyphotic, straight or lordotic”. But this method had proven to be unreliable. Grob et al. defined “straight” for the global curvature as +4° to −4°, and lordotic and kyphotic ...

Preserving the C7 spinous process in laminectomy combined with lateral mass screw to prevent axial symptom

Journal of Orthopaedic Science — Tue, 12 Jul 2011 06:06:34 +0100

Conclusion The C7 spinous process might play an important role in preventing axial symptom, but there is a need for randomized, control studies with long-term follow-up to clarify the results. Content Type Journal ArticlePages 1-6DOI 10.1007/s00776-011-0115-6Authors Peng Zhang, Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, 050051 Shijiazhuang, ChinaYong Shen, Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, 050051 Shijiazhuang, ChinaYing-Ze Zhang, Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, 050051 Shijiazhuang, ChinaWen-Yuan Ding, Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road,...

Acidic fibroblast growth factor for repair of human spinal cord injury: a clinical trial.

Journal of Neurosurgery.Spine — Thu, 09 Jun 2011 23:00:00 +0100

Conclusions The use of aFGF for spinal cord injury was safe and feasible in the present trial. There were significant improvements in ASIA motor and sensory scale scores, ASIA impairment scales, neurological levels, and functional independence measure at 24 months after treatment. Further large-scale, randomized, and controlled investigations are warranted to evaluate the efficacy and long-term results. PMID: 21663406 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery.Spine)

Decompressive cervical Laminectomy and Lateral Mass Screw-rod arthrodesis: Surgical Analysis and outcome

Scoliosis — Wed, 18 May 2011 23:00:00 +0100

Conclusion: decompressive cervical spine laminectomy and Lateral mass screw stabilization is a technique that can be used for a variety of cervical spine pathologies with safety and efficiency .Key words: lateral mass, arthrodesis, cervical myelopathy, spinal fixation, decompressive laminectomy (Source: Scoliosis)

Novel biodegradable α-TCP/poly(amino acid) composite artificial lamina following spinal surgery for prevention of intraspinal scar adhesion

European Spine Journal — Thu, 05 May 2011 05:45:25 +0100

In conclusion, α-TCP/poly(amino acid) composite artificial lamina can significantly prevent scar tissue from infiltrating the spinal canal. Content Type Journal ArticlePages 1-7DOI 10.1007/s00586-011-1795-5Authors Bo Ran, Department of Orthopaedic Surgery, The Huaxi Hospital, Si-Chuan University, 37 Waiguoxuexiang, Sichuan, 610041 ChinaYue-Ming Song, Department of Orthopaedic Surgery, The Huaxi Hospital, Si-Chuan University, 37 Waiguoxuexiang, Sichuan, 610041 ChinaHao Liu, Department of Orthopaedic Surgery, The Huaxi Hospital, Si-Chuan University, 37 Waiguoxuexiang, Sichuan, 610041 ChinaLi-Min Liu, Department of Orthopaedic Surgery, The Huaxi Hospital, Si-Chuan University, 37 Waiguoxuexiang, Sichuan, 610041 ChinaQuan Gong, Department of Orthopaedic Surgery, The Huaxi Hospital, Si-...

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[Cervical cord compression by hereditary multiple exostosis: Case report and review of literature.]

Neuro-Chirurgie — Thu, 28 Apr 2011 23:00:00 +0100

CONCLUSION: The cervical exostosis associated with HME is a rare disease. The clinical symptomatology is dominated by spinal cord compression and surgical treatment allows excellent clinical results. PMID: 21531431 [PubMed - as supplied by publisher] (Source: Neuro-Chirurgie)

Incidence of postoperative symptomatic epidural hematoma in spinal decompression surgery.

Journal of Neurosurgery.Spine — Thu, 28 Apr 2011 23:00:00 +0100

Conclusions Postoperative SEH was most frequent after thoracic laminectomy. In cervical and thoracic surgeries, symptoms of SEH were noted within 24 hours, mostly severe paralysis, and almost half of the lumbar surgery patients had symptoms after suction drain removal. PMID: 21529204 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery.Spine)

Do intramedullary spinal cord changes in signal intensity on MRI affect surgical opportunity and approach for cervical myelopathy due to ossification of the posterior longitudinal ligament?

European Spine Journal — Wed, 27 Apr 2011 16:31:30 +0100

In conclusion, regardless of hyperintensity on T2-weighted imaging or hypointensity on T1-weighted imaging in patients with OPLL, severe damage to the spinal cord is indicated. Surgical treatment should be provided before the advent of intramedullary spinal cord changes in signal intensity on MRI. The anterior approach is more effective than posterior approach for treating cervical myelopathy due to OPLL characterized by intramedullary spinal cord changes in signal intensity on MRI. Content Type Journal ArticlePages 1-8DOI 10.1007/s00586-011-1813-7Authors Qizhi Sun, Department of Orthopedics, Changzheng Hospital, Secondary Millitary Medical University of China, 415 Fengyang Road, Shanghai, 200003 People’s Republic of ChinaHongwei Hu, Department of Orthopedics, No. 88 Hospital o...

Epithelioid hemangioendotheliomas of the spine: clinical characters with middle and long-term follow-up under surgical treatments

European Spine Journal — Fri, 22 Apr 2011 05:45:21 +0100

Abstract Epithelioid hemangioendothelioma, an aggressive vascular tumor has the rarity of morbidity that arises in the spine. There were few cases reported in literatures in recent years, and little was known about this disease. A review study of the patient files in our constitutions between 1996 and 2006 showed that five patients were treated for spinal epithelioid hemangioendothelioma. Although only five patients, this study attempts to bring more informations about this rare lesion. This patient group included two males and three females. The lesions located in the cervical (case 1) or thoracic (case 2–4) or lumbar spine (case 5). Treatments included: laminectomy and cytoreductive surgery followed by external beam irradiation (one patient), expanded resection in piec...

Spinal epidural hematoma following removal of incorrectly placed jugular central venous catheter.

Journal of Neurosurgery.Spine — Thu, 21 Apr 2011 23:00:00 +0100

Authors: Yokoyama K, Kawanishi M, Yamada M, Tanaka H, Ito Y, Kuroiwa T The authors report a rare case of iatrogenic spinal epidural hematoma associated with central venous catheter cannulation via the right internal jugular vein. This 59-year-old man was operated on for stomach cancer while under general anesthesia. A central venous line was inserted via the right internal jugular vein. The operation was completed uneventfully and postoperative fluid replacement was continued without interruption. On postoperative Day 2, marked swelling around the right side of his neck gradually worsened. Cervical CT demonstrated that the catheter tip of the central venous line had penetrated the jugular vein and entered the intervertebral foramen (C5-6), thereby reaching the spinal epidural space. Th...

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Surgical management of ventral intradural spinal lesions.

Journal of Neurosurgery.Spine — Thu, 14 Apr 2011 23:00:00 +0100

Conclusions Most intradural spinal lesions can be treated with contemporary microsurgical techniques with long-term control or cure of the lesion and preservation of neurological function. Standard posterior approaches provide adequate exposure to safely remove the vast majority of these lesions without the need for a potentially destabilizing resection of the facet or pedicle. Posterior exposures with varying degrees of lateral bone resection, dentate ligament division, and gentle cord rotation may also provide adequate exposure for safe removal of nonmidline ventrolateral superficial pial presenting spinal cord lesions. Nevertheless, in certain cases of ventral intradural lesions, anterior approaches are necessary and should be considered under appropriate circumstances. PMID: 214958...

Pancreatic cancer metastasis presenting as an arachnoid cyst of the cervical spine: a case report

European Journal of Orthopaedic Surgery and Traumatology — Fri, 11 Mar 2011 18:06:35 +0100

This report describes a rare case of metastasis of pancreatic cancer presenting as an arachnoid cyst of the cervical spine. The significance of this study is that metastatic cystic lesions from pancreatic cancer should be considered in the differential diagnosis of arachnoid cysts of the spinal canal. Content Type Journal ArticlePages 1-4DOI 10.1007/s00590-011-0788-8Authors Jun-Yeong Seo, Department of Orthopedic Surgery, Jeju National University Hospital, Jeju Self Governing Province, Jeju, South KoreaIn-Soo Oh, Department of Orthopedic Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, KoreaIl-Nam Son, Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo...

Transverse connectors providing increased stability to the cervical spine rod-screw construct: an in vitro human cadaveric study.

Journal of Neurosurgery.Spine — Fri, 11 Mar 2011 00:00:00 +0100

Conclusions Regardless of the degree of cervical destabilization, 1 or 2 TCs decreased motion compared with rods and screws alone. Axial rotation was most affected. Transverse connectors effectively increase the rigidity of rod-screw constructs in the cervical spine. Severe cervical instability can be overcome with the use of 2 TCs, but in cases in which 2 cannot be used, 1 should be adequate and superior to none. PMID: 21395395 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery.Spine)

Analysis of demographics, risk factors, clinical presentation, and surgical treatment modalities for the ossified posterior longitudinal ligament.

Neurosurgical Focus — Tue, 01 Mar 2011 00:00:00 +0100

Conclusions Ossification of the posterior longitudinal ligament can no longer be viewed as a disease of the Asian population exclusively. Since OPLL among white populations is being diagnosed more frequently, surgeons must be aware of the most appropriate surgical option. The outcomes of the various surgical treatments among the different populations with OPLL appear similar. Compared with other procedures, however, anterior decompression led to the best neurological outcomes. PMID: 21361749 [PubMed - in process] (Source: Neurosurgical Focus)

Ossification of the posterior longitudinal ligament: pathogenesis, management, and current surgical approaches.

Neurosurgical Focus — Tue, 01 Mar 2011 00:00:00 +0100

Authors: Smith ZA, Buchanan CC, Raphael D, Khoo LT Ossification of the posterior longitudinal ligament (OPLL) is an important cause of cervical myelopathy that results from bony ossification of the cervical or thoracic posterior longitudinal ligament (PLL). It has been estimated that nearly 25% of patients with cervical myelopathy will have features of OPLL. Patients commonly present in their mid-40s or 50s with clinical evidence of myelopathy. On MR and CT imaging, this can be seen as areas of ossification that commonly coalesce behind the cervical vertebral bodies, leading to direct ventral compression of the cord. While MR imaging will commonly demonstrate associated changes in the soft tissue, CT scanning will better define areas of ossification. This can also provide the clinician...

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Dorsal versus ventral surgery for cervical ossification of the posterior longitudinal ligament: considerations for approach selection and review of surgical outcomes.

Neurosurgical Focus — Tue, 01 Mar 2011 00:00:00 +0100

Authors: Shin JH, Steinmetz MP, Benzel EC, Krishnaney AA Ossification of the posterior longitudinal ligament is a common cause of radiculopathy and myelopathy that often requires surgery to achieve decompression of the neural elements. With the evolution of surgical technique and a greater understanding of the biomechanics of cervical deformity, the criteria for selecting one approach over the other has been the subject of increased study and remains controversial. Ventral approaches typically consist of variations of the cervical corpectomy, whereas dorsal approaches include a wide range of techniques including laminoplasty, laminectomy, and laminectomy with instrumented fusion. Herein, the features and limitations of these approaches are reviewed with an emphasis on complications and...

Surgical management of cervical ossification of the posterior longitudinal ligament: natural history and the role of surgical decompression and stabilization.

Neurosurgical Focus — Tue, 01 Mar 2011 00:00:00 +0100

Conclusions Anterior cervical decompression and reconstruction is a safe and appropriate treatment for cervical spondylitic myelopathy in the setting of OPLL. For patients with maintained cervical lordosis, posterior cervical decompression and stabilization is advocated. The use of laminectomy or laminoplasty is indicated in patients with preserved cervical lordosis and less than 60% of the spinal canal occupied by calcified ligament in a "hill-shaped" contour. PMID: 21434819 [PubMed - in process] (Source: Neurosurgical Focus)

Acquired progressive hypotonia in infancy: consider compressive cervical myelopathy.

Acta Paediatrica — Fri, 25 Feb 2011 00:00:00 +0100

Conclusion: Most anomalies of the vertebras are asymptomatic. Only symptomatic anomalies with compression and neurological symptoms need surgery. (Source: Acta Paediatrica)

Acquired progressive hypotonia in infancy: consider compressive cervical myelopathy

Acta Paediatrica — Fri, 25 Feb 2011 00:00:00 +0100

Conclusion: Most anomalies of the vertebras are asymptomatic. Only symptomatic anomalies with compression and neurological symptoms need surgery. (Source: Acta Paediatrica)

Treatment of cervical stenotic myelopathy: a cost and outcome comparison of laminoplasty versus laminectomy and lateral mass fusion.

Journal of Neurosurgery.Spine — Fri, 25 Feb 2011 00:00:00 +0100

Conclusions Patients treated with laminoplasty and patients treated with laminectomy and fusion had similar improvements in Nurick scores, mJOA scores, and Odom outcomes. Patients who underwent fusion typically had higher preoperative neck pain scores, but their neck pain improved significantly after surgery. There was no significant change in the neck pain scores of patients treated with laminoplasty. Our series suggests cervical fusion significantly reduces neck pain in patients with stenotic myelopathy, but that the cost of the implant and rate of reoperation are greater than in laminoplasty. PMID: 21388285 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery.Spine)

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Spatiotemporal CCR1, CCL3(MIP-1α), CXCR4, CXCL12(SDF-1α) expression patterns in a rat spinal cord injury model of posttraumatic neuropathic pain.

Journal of Neurosurgery.Spine — Fri, 18 Feb 2011 00:00:00 +0100

Conclusions The authors report lesion grade-dependent upregulation of different chemokines/chemokine receptors after spinal cord contusion lesions in pain-processing spinal cord regions in a clinically relevant model of traumatic SCI in rats. Prolonged chemokine induction further correlated with below-level pain development in the delayed time course after severe SCI and was coexpressed with pain-associated peptides and receptors, suggesting that chemokines play a crucial role in chronic central pain mechanisms after SCI. PMID: 21332278 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery.Spine)

Posterior cervical fixation following laminectomy: a stress analysis of three techniques

European Spine Journal — Fri, 11 Feb 2011 11:50:44 +0100

Abstract The aim of this study was to compare the following three main fixation techniques: pedicle screw (PS) technique, lateral mass screw (LS) technique, and transarticular screw (TS) technique. A detailed, geometrically accurate, nonlinear C3–C7 FE model had been successfully developed and validated. Then three finite element (FE) models were reconstructed by different fixation techniques following C4–C6 level laminectomy. A compressive preload of 74 N combined with a pure moment of 1.8 Nm in flexion, extension, left–right lateral bending, and left–right axial rotation was applied to the models. The results showed that maximum von Mises stress on the fixation devices was much higher in the FE models of TS technique, compared with the models of PS and LS te...

Cystic deterioration of the C1-2 articulation: clinical implications and treatment outcomes.

Journal of Neurosurgery.Spine — Fri, 11 Feb 2011 00:00:00 +0100

Conclusions Synovial cysts of the atlantoaxial joint are rare. They occur in older patients in whom clinical deterioration is likely to occur. In most cases, these cysts can be diagnosed preoperatively. Transoral decompression with posterior fusion is an effective treatment for C1-2 degenerative cysts and can be accomplished with few complications. However, the ideal treatment for these lesions remains unknown. PMID: 21314283 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery.Spine)

Long-term stability after multilevel cervical laminectomy for spinal cord tumor resection in von Hippel-Lindau disease.

Journal of Neurosurgery.Spine — Fri, 28 Jan 2011 00:00:00 +0100

Conclusions Whereas patients with VHL disease will often require multiple laminectomies for cervical spinal cord hemangioblastoma resection, a limited number of patients (12%) will develop clinical instability. Because prophylactic cervical instrumentation confers limited benefit at the time of spinal cord tumor resection for most patients, and because these patients need life-long MR imaging of the spinal cord, the quality of which may be affected by instrumentation, longitudinal clinical and radiological evaluation may be used to determine which patients will require stabilization. PMID: 21275550 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery.Spine)

Cervical Microendoscopic Discectomy and Decompression

Seminars in Spine Surgery — Tue, 18 Jan 2011 00:00:00 +0100

Posterior cervical foraminotomy and discectomy has been used to treat disk pathology and foraminal stenosis since the 1940s. In properly selected patients, the outcomes were quite successful in relieving radicular symptoms. The associated postoperative pain and potential instability led many surgeons to abandon the technique in favor of the anterior approach to the cervical spine. In the late 1990s, the refinement of minimally invasive techniques revived the posterior approach because patients could be offered a procedure that resulted in less postoperative pain and less disruption of the posterior elements. The advent of the minimally invasive technologies allowed surgeons to have direct access to the pathology with minimal destruction of surrounding tissues. Today, the microendoscopic fo...

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Glioneuronal tumor with neuropil-like islands of the spinal cord with diffuse leptomeningeal neuraxis dissemination

Journal of Neuro-Oncology — Tue, 28 Dec 2010 15:32:05 +0100

Abstract A 54-year-old Caucasian female presented with a 1 year history of intermittent numbness of the left leg progressing to bilateral, lower extremity sensory loss that advanced to include impaired vibration and proprioception. The subsequent thoracic spine magnetic resonance imaging (MRI) scan revealed a heterogeneous, avidly enhancing, centrally situated spinal cord mass involving T7 through T10 in association with thick linear enhancement of the anterior and posterior cord surfaces extending both superiorly and inferiorly. Both the cervical and lumbar spine MRI demonstrated diffuse leptomeningeal disease as well. A brain MRI revealed focal leptomeningeal enhancement in the left and right sylvian fissures, the suprasellar cistern, and the posterior fossa; a patt...

Hemilaminectomy for removal of extramedullary or extradural spinal cord tumors: medium to long-term clinical outcomes.

Yonsei Medical Journal — Sat, 18 Dec 2010 14:41:24 +0100

Conclusion: Hemilaminectomy is useful for extramedullary or extradural spinal cord tumors in providing fair neurological status and restoration of spinal sagittal alignment in medium to long-term follow-up. PMID: 21155044 [PubMed - in process] (Source: Yonsei Medical Journal)

Return to golf after spine surgery.

Journal of Neurosurgery.Spine — Wed, 08 Dec 2010 00:00:00 +0100

Conclusions The return to golf after spine surgery depends on many variables, including the general well-being of patients in terms of pain control and comfort when golfing. This survey serves as a guide that can assist medical practitioners in telling patients the average times recommended by surgeons across North America regarding return to golf after spine surgery. PMID: 21142457 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery.Spine)

Laminoplasty versus Laminectomy and Fusion for Multilevel Cervical Spondylotic Myelopathy.

Clinical Orthopaedics and Related Research — Fri, 19 Nov 2010 00:00:00 +0100

CONCLUSIONS: Patients in both the laminectomy with fusion and laminoplasty cohorts reported similar functional improvements after treatment for cervical spondylotic myelopathy. Prospective randomized control trials are needed to determine whether one procedure is truly superior. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. PMID: 21089002 [PubMed - as supplied by publisher] (Source: Clinical Orthopaedics and Related Research)

Radiculopathy of the Eighth Cervical Nerve

The Journal of Orthopaedic and Sports Physical Therapy — Fri, 22 Oct 2010 05:00:00 +0100

DISCUSSION: The report illustrates the utility of a combination of physical examination, EMG and NCSs, and imaging in the diagnosis of a C8 radiculopathy in a patient presenting with forearm and hand symptoms but without cervical or upper quarter symptoms. LEVEL OF EVIDENCE: Diagnosis, level 4.J Orthop Sports Phys Ther 2010;40(12):811-817, Epub 22 October 2010. doi:10.2519/jospt.2010.3187KEY WORDS: electromyography, magnetic resonance imaging, neck nerve conduction studies, ulnar nerve (Source: The Journal of Orthopaedic and Sports Physical Therapy)

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Radiculopathy of the Eighth Cervical Nerve.

Physical Therapy — Thu, 21 Oct 2010 23:00:00 +0100

DISCUSSION: The significance of this report illustrates the utility of a combination of physical examination, EMG and NCS studies, and imaging in the diagnosis of a C8 radiculopathy in a patient presenting with forearm and hand symptoms but without cervical or upper quarter symptoms. LEVEL OF EVIDENCE: Diagnosis, level 4. J Orthop Sports Phys Ther, Epub 22 October 2010. doi:10.2519/jospt.2010.3187. PMID: 20972345 [PubMed - as supplied by publisher] (Source: Physical Therapy)

Axial pain after posterior cervical spine surgery: a systematic review

European Spine Journal — Tue, 12 Oct 2010 16:49:40 +0100

The objective of this study was to provide a systematic review of the current understanding of axial pain after cervical laminoplasty and laminectomy, and summarize clinical features, influence factors and preventive measures of axial pain after posterior decompressive surgery based on a review of literature published in the English language. Axial pain distributes over nuchal, periscapular and shoulder regions. Posterior surgery is not the major cause of axial pain, but axial pain can be worsened by the procedure. There are many clinical factors that influence postoperative axial pain such as age, preoperative axial pain, different surgical technique and postoperative management, but most of them are still controversial. Several surgical modifications have been innovated to reduce ...

The effect of spinal instrumentation on kinematics at the cervicothoracic junction: emphasis on soft-tissue response in an in vitro human cadaveric model.

Journal of Neurosurgery.Spine — Thu, 30 Sep 2010 23:00:00 +0100

CONCLUSIONS: When stopping thoracic constructs at T-1, care should be taken to preserve the SSL/ISL complex to avoid destabilization of the supra-adjacent CTJ, which may manifest clinically as proximal-junction kyphosis. In an analogous fashion, if a T-1 laminectomy is required for neural decompression or surgical access, consideration should be given to extending instrumentation into the cervical spine. Facet capsule disruption, as might be encountered during T-1 pedicle screw placement, may not be an acutely destabilizing event, due to the interaction of the C7–T1 facet joints with T-1 instrumentation. PMID: 20887140 [PubMed - in process] (Source: Journal of Neurosurgery.Spine)

Gait Analysis for Evaluating the Relationship Between Increased Signal Intensity on T2-Weighted Magnetic Resonance Imaging and Gait Function in Cervical Spondylotic Myelopathy

Archives of Physical Medicine and Rehabilitation — Wed, 29 Sep 2010 17:45:23 +0100

Abstract: Kim CR, Yoo JY, Lee SH, Lee DH, Rhim SC. Gait analysis for evaluating the relationship between increased signal intensity on T2-weighted magnetic resonance imaging and gait function in cervical spondylotic myelopathy.Objective: To determine relationships between increased signal intensity (ISI) on T2-weighted cervical spine magnetic resonance imaging (MRI) and parameters of gait analysis in patients with cervical spondylotic myelopathy (CSM).Design: Retrospective comparative study.Setting: Gait analysis laboratory.Participants: Patients (N=36) who undertook cervical laminectomy or laminoplasty because of CSM.Interventions: Not applicable.Main Outcome Measures: Subjects were evaluated by using the modified Japanese Orthopaedic Association (JOA) scale, the Nurick scale, cervical sp...

Angiographically proven cervical venous engorgement: a possible concurrent cause in the pathophysiology of Hirayama’s myelopathy

Neurological Sciences — Mon, 20 Sep 2010 19:55:47 +0100

The objective of this study is to discuss the possible role of cervical posterior epidural plexus engorgement during cervical flexion in the pathogenesis of Hirayama myelopathy. In Hirayama disease, MRI during neck flexion often shows that the posterior dura detaches from the posterior arches compressing the spinal cord. Autopsies demonstrated asymmetric changes in the anterior horns consistent with chronic ischemic damage, attributed to arterial insufficiency during flexion or to microcirculatory changes due to compression by the tight dura. In a 15-year-old patient with 5-year history of distal upper limbs weakness, MRI demonstrated marked venous engorgement of the posterior epidural plexus in cervical flexion, confirmed by angiography. Laminectomy from C3 to C6 with duraplasty was...

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Correlative study of nerve root palsy and cervical posterior decompression laminectomy and internal fixation.

Orthopedics — Mon, 16 Aug 2010 01:12:04 +0100

This study investigates the probable causes of nerve root palsy through the retrospective study of pre- and postoperative cervical curvature change for patients with cervical spondylosis and incidences of nerve root palsy. A consecutive series of 91 patients with cervical compressive myelopathy treated by laminectomy and internal fixation were reviewed. Nerve root palsy developed in 21 of 91 patients (23%) (group A). The other 70 patients, 41 men and 29 women, were chosen as controls (group B). A neutral lateral cervical spine radiograph was taken of all patients. The overall curvature of the cervical spine, the cervical curvature index, and the change rate were measured and compared.The pre- and postoperative change rate of cervical curvatures in groups A and B was 19.17+/-7.62 and 18.03+...

Concurrent occipital hypoplasia, occipital dysplasia, syringohydromyelia, and hydrocephalus in a Yorkshire terrier.

The Canadian Veterinary Journal — Sun, 01 Aug 2010 00:00:00 +0100

Authors: Cagle L Magnetic resonance imaging of a 7.5-year-old neutered male Yorkshire terrier with mild generalized ataxia and intermittent neck scratching led to a diagnosis of caudal occipital malformation and syringohydromyelia. Surgical exploration led to a diagnosis of occipital dysplasia with concurrent occipital hypoplasia. Following a dorsal laminectomy of the first cervical vertebra there was no progression or improvement a month later. PMID: 21037897 [PubMed - in process] (Source: The Canadian Veterinary Journal)

Traumatic Cervical Cord Transection without Facet Dislocations-A Proposal of Combined Hyperflexion-Hyperextension Mechanism: A Case Report.

J Korean Med Sci — Sat, 31 Jul 2010 23:00:00 +0100

Authors: Cha YH, Cho TH, Suh JK A patient is presented with a cervical spinal cord transection which occurred after a motor vehicle accident in which the air bag deployed and the seat belt was not in use. The patient had complete quadriplegia below the C5 level and his imaging study showed cervical cord transection at the level of the C5/6 disc space with C5, C6 vertebral bodies and laminar fractures. He underwent a C5 laminectomy and a C4-7 posterior fusion with lateral mass screw fixation. Previous reports have described central cord syndromes occurring in hyperextension injuries, but in adults, acute spinal cord transections have only developed after fracture-dislocations of the spine. A case involving a post-traumatic spinal cord transection without any evidence of radiologic facet...

Syringomyelia associated with Chiari I malformation treated with foramen magnum decompression and duraplasty using a polyglycolic acid patch and fibrin glue: a case report.

Journal of Nippon Medical School — Sat, 31 Jul 2010 23:00:00 +0100

Authors: Sugawara A, Isu T, Kim K, Matsumoto R, Isobe M, Ogasawara K A 31-year-old woman presented with worsening numbness and pain in the arms and chest. Neurological findings at admission were decreased pain sensation and temperature sensation in the arms and chest. Magnetic resonance demonstrated a large cervical syrinx from the level of C4 to Th4 associated with Chiari I malformation. Occipital craniectomy and C1 laminectomy were performed for foramen magnum decompression. Intraoperative ultrasonography, performed after removal of the outer membrane of the dura mater at the level of the foramen magnum, revealed insufficient decompression. Therefore, the dura mater was completely opened and duraplasty was performed with a polyglycolic acid patch and fibrin glue. Sufficient decompres...

Clinical analysis of thoracic ossified ligamentum flavum without ventral compressive lesion

European Spine Journal — Wed, 14 Jul 2010 22:59:02 +0100

Abstract The aim of this study was to analyze the clinical characteristics of thoracic ossified ligamentum flavum (OLF) and to elucidate prognostic factors as well as effective surgical treatment modality. The authors analyzed 106 thoracic OLF cases retrospectively from January 1999 to December 2008. The operative (n = 40) and the non-operative group (n = 66) were diagnosed by magnetic resonance imaging (MRI) and/or computed tomography (CT) imaging. We excluded cases exhibiting ventral compressive lesions causing subarachnoid space effacement in thoracic vertebrae as well as those with a coexisting cervical compressive myelopathy. Those in the operative group were treated with decompressive laminectomy as well as resection of OLF. The preoperative neurol...

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Utility of neurophysiological monitoring using dorsal column mapping in intramedullary spinal cord surgery.

Journal of Neurosurgery.Spine — Mon, 31 May 2010 23:00:00 +0100

Conclusions Dorsal column mapping is a useful technique for guiding the surgeon in locating the midline for myelotomy in intramedullary spinal cord surgery. In conjunction with somatosensory evoked potential, motor evoked potential, and D-wave recordings, we have been able to reduce the surgical morbidity related to dorsal column dysfunction in this small group of patients. PMID: 20515347 [PubMed - in process] (Source: Journal of Neurosurgery.Spine)

Necrotising sarcoid granulomatosis of the spinal cord: case report.

Collegium Antropologicum — Mon, 31 May 2010 23:00:00 +0100

We report a patient who presented with leg weakness and cervical lymphadenopathy. Thoracical magnetic resonance imaging showed an inhomogenously increased signal in the thickened portion of the cord. Multilevel laminectomy and spinal cord biopsy revealed granulomatous infiltrations with necrosis. Review of the histopathological finding established the diagnosis of necrotising sarcoid granulomatosis (NSG) of the spinal medulla, cytological FNA diagnosis of the neck lymph node was granulomatous inflammation with necrosis, but histopathological analysis of the same neck lymph node disclosed granulomatous inflammation without necrosis. On further radiographic chest evaluation mediastinal lymphadenopathy was found. Immunophenotyping of lymphocytes in bronchoalveolar lavage fluid (BALF) was indi...

Localization of cervical and cervicomedullary stimulation leads for pain treatment using median nerve somatosensory evoked potential collision testing.

Journal of Neurosurgery — Thu, 27 May 2010 23:00:00 +0100

Conclusions Somatosensory evoked potentials can be used safely and successfully for predicting the lateralization of cervical spinal cord stimulator placement. Moreover, they can also intraoperatively alert the surgical team to inadvertent displacement of a lead during anchoring. Further studies are needed to determine whether apart from assisting with proper lateralization, SSEP collision testing may help to optimize electrode positioning and improve pain control outcomes. PMID: 20509731 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery)

Torkildsen shunt: re-evaluation of the historical procedure

Child's Nervous System — Wed, 26 May 2010 14:48:04 +0100

Conclusion The Torkildsen shunt can be effective in selected patients with hydrocephalus even in the era of computed tomography, magnetic resonance imaging, and neuroendoscopy. Although the surgical procedure is technically more demanding, the procedure enables one to avoid a standard ventriculoperitoneal shunt. Content Type Journal ArticleCategory Original PaperDOI 10.1007/s00381-010-1182-2Authors Nobuhito Morota, National Center for Child Health and Development Department of Neurosurgery, National Children’s Medical Center 2-10-1 Okura, Setagaya-ku Tokyo 157-8535 JapanSatoshi Ihara, National Center for Child Health and Development Department of Neurosurgery, National Children’s Medical Center 2-10-1 Okura, Setagaya-ku Tokyo 157-8535 JapanTakashi Araki, Nationa...

Comparison of prognostic value of different MRI classifications of signal intensity change in cervical spondylotic myelopathy

The Spine Journal — Wed, 26 May 2010 13:55:44 +0100

Abstract: Background Context: Signal intensity (SI) changes of the spinal cord on magnetic resonance imaging (MRI) in cervical spondylotic myelopathy (CSM) are thought to be a predictor of surgical outcome. However, the clinical significance of SI change remains controversial. Although several classifications exist for SI change, there are no previous studies comparing their prognostic significance.Purpose: To determine the MRI classification of SI changes in patients with CSM that is useful for prognostication of surgical outcome.Study Design: Retrospective case study.Patient Sample: Patients who underwent cervical laminectomy for CSM between the time period of January 2000 and December 2005.Outcome Measure: Clinical outcome was measured by the recovery rate (RR) and the postoperative Nur...

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Highlights of Anesthetic Considerations for Intraoperative Neuromonitoring

Seminars in Cardiothoracic and Vascular Anesthesia — Fri, 14 May 2010 09:51:21 +0100

Though relatively new, intraoperative neurophysiological monitoring (IONM) has become standard of care for many neurosurgical procedures. The use of IONM has substantially decreased the rate of paralysis after deformity surgery, and has been validated in cervical spine surgery, and thoracic and lumbar laminectomy ((1) (2), (3). The main modalities are: somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), and electromyography (EMGs). Each test examines a functionally separate area of the spinal cord, which test is chosen depends on the location of the surgery and the patient’s preexisting injuries and deficits (6). Inhaled anesthetics decrease the waveform amplitude and increase latency, intravenous anesthetics have the same effect but to a lesser degree. Best anes...

Diagnostic and therapeutic strategy for confounding radiation myelitis

Clinical Neurology and Neurosurgery — Fri, 02 Apr 2010 15:38:27 +0100

We report a case of confounding radiation myelitis to demonstrate the usefulness of surgical biopsy in ensuring the correct diagnosis and to avoid unnecessary treatment. The patient was a 40-year-old man with a history of epiglottis carcinoma and sarcoidosis. Six months after radiation therapy and chemotherapy for epiglottis carcinoma, he noticed paresthesia and dysesthesia in the left arm and leg. Two months after that, he complained of severe neck pain and rapidly progressing weakness in all extremities. MRI showed an enhanced intramedullary lesion with extensive edema in the cervical spinal cord. Radiation myelitis, intramedullary spinal tumor, and neurosarcoidosis were considered as differential diagnoses. Spinal cord biopsy with laminectomy was performed and radiation myelitis was dia...

Cervical Spondylotic Myelopathy: A Review of the Evidence

Orthopedic Clinics of North America — Wed, 31 Mar 2010 23:00:00 +0100

This article explores some of the controversies about CSM and reviews pertinent articles, specifically prospective and randomized clinical trials when possible, to obtain the cleanest and least biased data. The 4 current controversial topics that surround CSM are: (1) natural history of mild CSM; (2) surgical approach: anterior versus posterior; (3) laminoplasty or laminectomy; and (4) cervical arthroplasty for CSM. (Source: Orthopedic Clinics of North America)

Single-Stage Posterolateral Corpectomy and Circumferential Stabilization without Laminectomy in the Upper Thoracic Spine: Cadaveric Study and Report of Three Cases.

Turkish Neurosurgery — Wed, 31 Mar 2010 23:00:00 +0100

CONCLUSION: The corpectomy procedure could be clearly performed under bilateral visualization of healthy bony margins with this technique. Although preserved laminae and spinous process lose the connection to the involved segment and hanged to adjacent levels only with posterior ligamentous complex, we propose that a chance of interlaminar fusion could further contribute to spinal stabilization rather than posterior instrumentation only. PMID: 20401851 [PubMed - in process] (Source: Turkish Neurosurgery)

Cervical spondylotic myelopathy: a review of the evidence.

The Orthopedic Clinics of North America — Wed, 31 Mar 2010 23:00:00 +0100

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Spontaneous stabilisation of postlaminectomy cervical kyphosis by anterior longitudinal ligament ossification.

Singapore Medical Journal — Wed, 31 Mar 2010 23:00:00 +0100

We report a case of spontaneous stabilisation of postlaminectomy cervical kyphosis by anterior longitudinal ossification in the absence of an ossified posterior longitudinal ligament, thus circumventing the need for surgical intervention. PMID: 20505898 [PubMed - in process] (Source: Singapore Medical Journal)

Comparison between anterior and posterior decompression with instrumentation for cervical spondylotic myelopathy: sagittal alignment and clinical outcome.

Neurosurgical Focus — Mon, 01 Mar 2010 00:00:00 +0100

Conclusions . These results demonstrate that both anterior and posterior decompression (with instrumentation) are effective procedures to improve the neurological outcome of patients with CSM. However, sagittal alignment may be better restored using the anterior approach, but harbors a higher rate of loss of correction. In cases involving a preexisting cervical kyphosis, an anterior or combined approach might be necessary to restore the lordotic cervical alignment. PMID: 20192660 [PubMed - in process] (Source: Neurosurgical Focus)

Coincidence of cervical spondylotic myelopathy and intramedullary ependymoma: a potential diagnostic pitfall.

Journal of Neurosurgery.Spine — Mon, 01 Mar 2010 00:00:00 +0100

Authors: Kurzbuch AR, Rilliet B, Vargas MI, Boex C, Tessitore E The authors report the case of a 58-year-old man presenting with a 3-year history of clinical signs of progressive cervical spondylotic myelopathy (CSM). Magnetic resonance imaging showed a severe stenosis of the cervical spinal canal at C3-4 and C5-6 levels due to multiple discopathies. High signal intensities on T2-weighted MR images of the spinal cord and low signal intensities on T1-weighted images at the C2-6 levels were noted, as was contrast enhancement at the C3-4 level. The patient underwent a bilateral decompressive laminectomy at C3-6. The patient did not show any clinical improvement. Thus, further cervical MR imaging was performed and the differential diagnosis of an intramedullary tumor was considered in view...

Duplication of the inferior vena cava in a patient presenting for IVC filter placement.

The Journal of Vascular Access — Tue, 16 Feb 2010 00:00:00 +0100

We present the case of a 45- year-old male with factor V leiden and protein C deficiency, who required cessation of warfarin anticoagulation in preparation for cervical laminectomy. The patient had a duplicated IVC and required placement of a caval filter in each IVC. PMID: 20175061 [PubMed - as supplied by publisher] (Source: The Journal of Vascular Access)

Cervical myelopathy in athetoid and dystonic cerebral palsy: retrospective study and literature review

European Spine Journal — Tue, 12 Jan 2010 06:44:40 +0100

Abstract The early onset of degenerative cervical lesions has been well described in patients suffering from athetoid or dystonic cerebral palsy. Myelopathy can occur and aggravate of their unstable neurological status. Diagnosis and treatment are delayed and disrupted by the abnormal movements. This retrospective study was implemented to evaluate the symptoms, the anatomical findings, and the surgical management of seven patients from 20 to 56 years old suffering from cervical myelopathy and athetoid or dystonic cerebral palsy. The mean delay in diagnosis was 15 months and the mean follow-up was 33 months. The initial symptoms were spasticity, limbs weakness, paresthesias and vesico-sphinteric dysfunction. In addition to abnormal movements, imaging demonstra...

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Giant craniocervical junction schwannoma involving the hypoglossal nerve: case report.

Turkish Neurosurgery — Fri, 01 Jan 2010 00:00:00 +0100

Authors: Kabatas S, Cansever T, Yilmaz C, Demiralay E, Celebi S, Caner H OBJECTIVE: The authors present the case of a dumbbell-shaped schwannoma of the upper cervical spine involving the ventral rami of C-2 sensory root and rising through the foramen magnum up to the pontobulbar junction. The 27-year-old male patient complaining of hoarseness, imbalance and experiencing cervical pain and cervical muscle contractions for 2 months was admitted to the hospital. The cervical T1 and T2- weighted magnetic resonance (MR) images revealed the presence of a slightly hyperintense left C1-2 intra-extradural lesion which had eroded the clivus and odontoid process and enlarged the intervertebral foramen and was rising up to ponto-bulbar junction. A posterior approach was used to perform a suboccipit...

An unusual occurrence of chondromyxoid fibroma with secondary aneurysmal bone cyst in the cervical spine

The Spine Journal — Mon, 28 Dec 2009 00:00:00 +0100

Conclusions: Treatment of CMF and ABC is challenging in the spine because of the proximity to neural structures. Aggressive surgical treatment makes recurrence less likely but creates the risk of spinal instability. Adequate surgical treatment needs to provide spinal stability. (Source: The Spine Journal)

Choice of surgical approach for ossification of the posterior longitudinal ligament in combination with cervical disc hernia

European Spine Journal — Fri, 11 Dec 2009 06:52:38 +0100

In conclusion, surgeons should consider the potential for CDH when performing spinal cord decompression and deciding the surgical approach in patients presenting with OPLL. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00586-009-1239-7Authors Hai-song Yang, Changzheng Hospital Department of Orthopaedic Surgery No. 415 Feng Yang Road 200003 Shanghai ChinaDe-yu Chen, Changzheng Hospital Department of Orthopaedic Surgery No. 415 Feng Yang Road 200003 Shanghai ChinaXu-hua Lu, Changzheng Hospital Department of Orthopaedic Surgery No. 415 Feng Yang Road 200003 Shanghai ChinaLi–li Yang, Changzheng Hospital Department of Orthopaedic Surgery No. 415 Feng Yang Road 200003 Shanghai ChinaWang-jun Yan, Changzheng Hospital Department of Orthopaedic Surgery No. 415 Feng Yang R...

Pentax-AWS videolaryngoscope for awake nasal intubation in patients with unstable necks

British Journal of Anaesthesia — Thu, 10 Dec 2009 16:21:41 +0100

In patients with unstable necks and at risk of pulmonary aspiration, awake fibreoptic intubation is often appropriate. However, stabilization of the neck can make fibreoptic intubation more difficult. I report the use of awake nasal intubation using the Pentax-Aiway Scope (AWS) in three patients with restricted neck movement, in whom awake fibreoptic intubation had failed. Case 1: a 59-yr-old man, at risk of aspiration, required an emergency cervical laminectomy. Awake fibreoptic intubation was attempted while a Halo vest was being applied, but it was impossible to see the glottis, mainly due to pharyngeal and laryngeal oedema. The Pentax-AWS was easily inserted orally, and nasotracheal intubation was achieved within 20 s. Case 2: an 85-yr-old woman with neck injury required emergency surg...

Incarcerated herniation of the cervical spinal cord after laminectomy for an ossification of the yellow ligament

European Spine Journal — Wed, 25 Nov 2009 16:50:28 +0100

Abstract A 74-year-old man showed a spastic gait and myelopathy in both the hands. Computed tomography revealed an OPLL on C3 and C4, bony spurs on the dorsal side of C4–C6, and an OYL on C3 and C4. We scheduled a two-stage decompression for both the OPLL and OYL. First, we performed laminectomy on the C3–C6 segments and resected the OYL. We did not observe any dural tear or CSF leakage in the dura. The patient’s neurological symptoms improved. After the laminectomy, his myelopathy recurred. Postoperative MRI showed a spinal cord herniation. We had the C3/4 anterior cervical disectomy and fusion as we planned. In addition, we performed a surgery to repair the damaged dura mater at the site of spinal cord herniation at the same second surgery. The integrity of the ara...

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Bone morphogenetic protein-2 used in spinal fusion with spinal cord injury penetrates intrathecally and elicits a functional signaling cascade

The Spine Journal — Mon, 16 Nov 2009 00:00:00 +0100

Abstract: Background context: The use of recombinant human bone morphogenetic protein-2 (rhBMP-2) and its indications for spinal fusion continue to be expanded with recent reports citing spinal trauma application. However, there are no data establishing the effects of rhBMP-2 on the injured spinal cord.Purpose: The purpose of this study was to evaluate the extent of bone morphogenetic protein (BMP)–specific intrathecal signaling after application to the spine at various time points after a spinal cord injury (SCI).Study design: This is an in vivo rat study using a combination of the dorsal hemisection SCI and the posterolateral arthrodesis animal models.Methods: Sixty-five female Sprague-Dawley rats underwent either a T9–T10 dorsal hemisection SCI (n=52) or laminectomy only (n=13). Spi...

Case report Epidural tuberculosis involving the entire spine

Fri, 30 Oct 2009 14:29:46 +0100

We discuss an elderly male who developed severe back pain, rapidly progressing paraparesis and urinary retention consequent to L5-S1 spinal tuberculosis with dissemination of epidural tubercular abscess and granulation tissue to the cervical, thoracic, lumbar and sacral region. The initial diagnosis of lumbo-sacral pathology with high thoracic extension was tackled by an L5 laminectomy and decompression along with saline flushing and evacuation of the thoraco-lumbar and sacral epidural abscess with the aid of a catheter passed superiorly and inferiorly. He developed neck pain and upper limb weakness subsequently and was found to have extensive extradural cervical compression by granulation tissue. He underwent C4-7 laminectomy and decompression of the cord. He was started on four-drug anti...

Intradural cervical root adjacent interconnections in the normal, prefixed, and postfixed brachial plexus.

Journal of Neurosurgery.Spine — Thu, 01 Oct 2009 00:00:00 +0100

Conclusions Such variations as intradural interconnections may lead to misinterpretation of spinal levels harboring pathological entities of the spinal axis and should be considered during surgical procedures of this region such as rhizotomy. However, the present study did not find a correlation between the level of these interconnections and whether the brachial plexus was pre- or postfixed (that is, there were no observable shifts intradurally that corresponded to the extradural segmental contributions to the brachial plexus). PMID: 19929336 [PubMed - in process] (Source: Journal of Neurosurgery.Spine)

Article 3: Fear-Avoidance Beliefs on Pain Intensity and Patient-Reported Disability After Spine Surgery

Archives of Physical Medicine and Rehabilitation — Wed, 30 Sep 2009 23:00:00 +0100

Objective: To determine the effects of fear of movement/(re)injury on pain intensity, pain interference and disability among patients undergoing spine surgery for degenerative disc disease (DDD), after controlling for depressive symptoms. Design: Prospective cohort design. Setting: University-based clinic setting. Participants: Seventy patients, 18 to 88 years of age, treated by laminectomy and/or fusion procedure for cervical (N=27) or lumbar (N=43) DDD. Interventions: Not applicable. Main Outcome Measures: Pain intensity and pain interference measured by the Brief Pain Inventory. A secondary outcome variable was pain-related disability (Oswestry or Neck Disability Index). Results: Mean fear-avoidance beliefs at baseline were 41.4 (SD:4.4) and 40.6 (SD:6.3) for cervical and lumbar patient...

Original paper Serum cortisol levels following acute experimental spinal cord injury

Fri, 04 Sep 2009 06:57:14 +0100

Conclusions: Activation of endogen cortisol secretion of the organism starts immediately after the SCI injury and throughout the experiment the serum cortisol levels in neurotrauma groups remained high compared with the control and sham-operated groups. At the beginning, the level of neurological lesion (cervical or thoracic) affected differently the level of serum cortisol at a statistically significant level but this difference disappeared at the 6th hour. (Source: Articles of Polish Journal of Neurology and Neurosurgery - TERMEDIA publishing house)

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Anterior neurodecompression of kyphotic spondylogenic myelopathy Ranawat grade III and posterior decompression of lordotic spine improve walking ability.

Collegium Antropologicum — Tue, 01 Sep 2009 00:00:00 +0100

Authors: Margetić P, Elabjer E, Milosević M, Skoro I, Milanov B, Stancić M Cervical spondylosis is common condition rarely associated with radiculomyelopathy which surgical treatment, according to meta-analysis, is not better than nonsurgical. Our hypothesis was that neurodecompression which type is chosen according to spinal alignment should result in better functional improvement comparing with nonsurgical treatment. Between January 1, 1998 and December 31, 2007 a total of 77 patients with spondylogenic myelopathy were selected for the study. The inclusion criteria were symptoms and signs of myelopathy Ranawat grade III. Exclusion criteria were amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS). The curvature of the cervical spine was determined by Ishi...

Epidural tuberculosis involving the entire spine.

Neurologia i Neurochirurgia Polska — Tue, 01 Sep 2009 00:00:00 +0100

Authors: Mathew J, Tripathy P, Grewal S We discuss an elderly male who developed severe back pain, rapidly progressing paraparesis and urinary retention consequent to L5-S1 spinal tuberculosis with dissemination of epidural tubercular abscess and granulation tissue to the cervical, thoracic, lumbar and sacral region. The initial diagnosis of lumbo-sacral pathology with high thoracic extension was tackled by an L5 laminectomy and decompression along with saline flushing and evacuation of the thoraco-lumbar and sacral epidural abscess with the aid of a catheter passed superiorly and inferiorly. He developed neck pain and upper limb weakness subsequently and was found to have extensive extradural cervical compression by granulation tissue. He underwent C4-7 laminectomy and decompression o...

Comparison of ventral corpectomy and plate-screw-instrumented fusion with dorsal laminectomy and rod-screw-instrumented fusion for treatment of at least two vertebral-level spondylotic cervical myelopathy

European Spine Journal — Fri, 07 Aug 2009 11:18:25 +0100

The objective of the article is to verify the hypothesis that the dorsal multilevel laminectomy and rod-screw-instrumented fusion (DLF) for multilevel spondylotic cervical myelopathy (MSCM) is less strenuous for patients, and less prone to perioperative complications, than ventral multilevel corpectomy and plate-screw-instrumented fusion (VCF), while clinical outcome is comparable. One hundred and three successive patients were treated for at least two vertebral-level MSCM, 42 of them by VCF and 61 by DLF. The two patients groups were retrospectively compared. VCF patients were slightly younger than DLF patients (62.5 ± 10.61 years versus 66 ± 12.4 years, P = 0.012). In VCF patients, a median of 2 (2–3) corpectomies and in DLF patients a med...

Extensive posterolateral exposure and total removal of the giant extraforaminal dumbbell tumors of cervical spine: surgical technique in a series of 16 patients

The Spine Journal — Thu, 06 Aug 2009 23:00:00 +0100

Conclusions: Extensive posterolateral exposure enables surgeons to reach the lateralmost portion of CSDTs and also facilitates septation of the VA and resection of vertebral body encroachment of the tumor. (Source: The Spine Journal)

Enlargement of an osseous loose body in the cervical spine with cord compression

The Spine Journal — Thu, 06 Aug 2009 23:00:00 +0100

Conclusion: We report herein an extremely rare case of an osseous loose body in the spinal canal with cord compression. This report represents the first documented case of growth of a loose body in the spinal canal. (Source: The Spine Journal)

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Endoscopic Suboccipital Decompression on Pediatric Chiari Type I

min - Minimally Invasive Neurosurgery — Sat, 01 Aug 2009 12:20:45 +0100

Minim Invasive Neurosurg 2009; 52: 119-125DOI: 10.1055/s-0029-1224170Abstract To minimize the invasiveness and maximize the adequacy of Chiari decompression on pediatric patients, 0° and 30° endoscopes were adapted to perform the procedure of suboccipital craniectomy and upper cervical laminectomies.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Abstract | Full text (Source: min - Minimally Invasive Neurosurgery)

Laminectomy and fusion for the treatment of cervical degenerative myelopathy.

Journal of Neurosurgery.Spine — Fri, 31 Jul 2009 23:00:00 +0100

Conclusions Laminectomy with fusion (arthrodesis) is an effective strategy to improve functional outcome in CSM and OPLL. PMID: 19769494 [PubMed - in process] (Source: Journal of Neurosurgery.Spine)

Cervical laminectomy for the treatment of cervical degenerative myelopathy.

Journal of Neurosurgery.Spine — Fri, 31 Jul 2009 23:00:00 +0100

Conclusions Laminectomy is an acceptable therapy for near-term functional improvement of CSM (Class III). It is associated with development of kyphosis, however. PMID: 19769493 [PubMed - in process] (Source: Journal of Neurosurgery.Spine)

Cervical surgical techniques for the treatment of cervical spondylotic myelopathy.

Journal of Neurosurgery.Spine — Fri, 31 Jul 2009 23:00:00 +0100

Conclusions Multiple approaches exist with similar near-term improvements; however, laminectomy appears to have a late deterioration rate that may need to be considered when appropriate. PMID: 19769492 [PubMed - in process] (Source: Journal of Neurosurgery.Spine)

Surgical management of cervical degenerative disease: the evidence related to indications, impact, and outcome.

Journal of Neurosurgery.Spine — Fri, 31 Jul 2009 23:00:00 +0100

Authors: Fehlings MG, Arvin B In this special edition of Journal of Neurosurgery: Spine, a series of systematic reviews sponsored by the Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons/Congress of Neurological Surgeons is presented. This collection of comprehensive reviews summarizes the medical evidence related to the surgical management of cervical degenerative disc disease. Several of the key conclusions are discussed in this introduction to the issue: There is Class II evidence to suggest that the clinical condition remains stable when observed over a 3-year period in patients with mild-to-moderate cervical spondylotic myelopathy (CSM) and age younger than 75 years. There is consistent Class III evidence that the duration...

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Unilateral ossified ligamentum flavum in the high cervical spine causing myelopathy

Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1) — Thu, 30 Jul 2009 11:29:52 +0100

Udit Singhal, Manoj Jain, Awadhesh K Jaiswal, Sanjay BehariIndian Journal of Orthopaedics 2009 43(3):305-308High cervical ossified ligamentum flavum (OLF) is rare and may cause progressive quadriparesis and respiratory failure . Our two patients had unilateral OLF between C1 and C4 levels. MR showed a unilateral, triangular bony excrescence with low signal and a central, intermediate or high signal on all pulse sequences due to bone marrow within. There was Type I thecal compression (partial deficit of contrast media ring). The first patient had a linear and nodular OLF with calcification within tectorial membrane, C2-3 fusion and unilateral C2-facetal hypertrophy; and the second patient, a lateral, linear OLF with loss of lordosis and C3-6 s...

Cervical synovial cyst: case report and review of literature

European Spine Journal — Thu, 23 Jul 2009 09:09:14 +0100

Abstract Synovial cysts, typically observed in the lumbar spine eventually associated with degenerative changes of the facet joints, only rarely present in the cervical spine. Up to now, only 28 symptomatic cases are described in literature. Typically, the treatment of these cases is a decompressive laminectomy followed by complete surgical removal of the lesion. The authors present the case of an 84-year-old man with a symptomatic synovial cyst involving the space between C7 and T1. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00586-009-1094-6Authors Francesco Costa, Istituto IRCCS Galeazzi Department of Neurosurgery Via R. Galeazzi 4 20100 Milan ItalyClaudia Menghetti, Istituto IRCCS Galeazzi Department of Neurosurgery Via R. Galeazzi 4 20100 Milan Ital...

The relationship between preoperative cervical alignment and postoperative spinal cord drift after decompressive laminectomy and arthrodesis for cervical spondylotic myelopathy

Surgical Neurology — Thu, 16 Jul 2009 12:18:25 +0100

Conclusions: Preoperative cervical alignment does not statistically correlate with postoperative spinal cord drift in patients undergoing multisegmental decompressive laminectomy and fusion for CSM. The observation of significant posterior shifting of the spinal cord in the context of straight or kyphotic preoperative alignment suggests that posterior decompression and arthrodesis represent a viable option in the surgical management of patients with CSM with nonlordotic preoperative alignment. (Source: Surgical Neurology)

Unilateral ossified ligamentum flavum in the high cervical spine causing myelopathy

Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1) — Wed, 15 Jul 2009 11:20:15 +0100

Singhal Udit, Jain Manoj, Jaiswal Awadhesh K, Behari SanjayIndian Journal of Orthopaedics 2009 43(3):305-308High cervical ossified ligamentum flavum (OLF) is rare and may cause progressive quadriparesis and respiratory failure . Our two patients had unilateral OLF between C1 and C4 levels. MR showed a unilateral, triangular bony excrescence with low signal and a central, intermediate or high signal on all pulse sequences due to bone marrow within. There was Type I thecal compression (partial deficit of contrast media ring). The first patient had a linear and nodular OLF with calcification within tectorial membrane, C2-3 fusion and unilateral C2-facetal hypertrophy; and the second patient, a lateral, linear OLF with loss of lordosis and C3-6 s...

Acute swan-neck deformity and spinal cord compression after cervical laminectomy.

The Canadian Journal of Neurological Sciences — Tue, 30 Jun 2009 23:00:00 +0100

Authors: Rahme R, Boubez G, Bouthillier A, Moumdjian R PMID: 19650366 [PubMed - in process] (Source: The Canadian Journal of Neurological Sciences)

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Serum cortisol levels following acute experimental spinat cord injury.

Neurologia i Neurochirurgia Polska — Tue, 30 Jun 2009 23:00:00 +0100

Conclusions: Activation of endogen cortisol secretion of the organism starts immediately after the SCI injury and throughout the experiment the serum cortisol levels in neurotrauma groups remained high compared with the control and sham-operated groups. At the beginning, the level of neurological lesion (cervical or thoracic) affected differently the level of serum cortisol at a statistically significant level but this difference disappeared at the 6th hour. PMID: 19742394 [PubMed - as supplied by publisher] (Source: Neurologia i Neurochirurgia Polska)

Task-Dependent Modulation of Primary Afferent Depolarization in Cervical Spinal Cord of Monkeys Performing an Instructed Delay Task

Journal of Neurophysiology — Sun, 28 Jun 2009 23:00:00 +0100

Task-dependent modulation of primary afferent depolarization (PAD) was studied in the cervical spinal cord of two monkeys performing a wrist flexion and extension task with an instructed delay period. We implanted two nerve cuff electrodes on proximal and distal parts of the superficial radial nerve (SR) and a recording chamber over a hemi-laminectomy in the lower cervical vertebrae. Antidromic volleys (ADVs) in the SR were evoked by intraspinal microstimuli (ISMS, 3–10 Hz, 3–30 µA) applied through a tungsten microelectrode, and the area of each ADV was measured. In total, 434 ADVs were evoked by ISMS in two monkeys, with onset latency consistently shorter in the proximal than distal cuffs. Estimated conduction velocity suggest that most ADVs were caused by action potenti...

Direct cord implantation in brachial plexus avulsions: revised technique using a single stage combined anterior (first) posterior (second) approach and end-to-side side-to-side grafting neurorrhaphy

Journal of Brachial Plexus and Peripheral Nerve Injury — Thu, 18 Jun 2009 23:00:00 +0100

Conclusion: Through providing proper exposure to the brachial plexus and to the cervical cord, the single stage combined anterior (first) posterior (second) approach approach might stimulate brachial plexus surgeons to go more for direct cord implantation. In this study, it allowed for placing side grafts along an extensive donor recipient area by end-to-side side-to-side grafting neurorrhaphy and thus improved results.Level of evidence: Level IV, prospective case series. (Source: Journal of Brachial Plexus and Peripheral Nerve Injury)

Spontaneous Cervical Epidural Hematoma Masquerading as an Abscess on Magnetic Resonance Imaging Scan

Journal of Manipulative and Physiological Therapeutics — Sun, 31 May 2009 23:00:00 +0100

Conclusions: The MRI features of SSEH may be misleading and mimic other spinal lesions such as abscess. Presence of tapering superior and inferior margins, spotty Gadolinium enhancement in the mass, along with abrupt clinical onset of pain and neurologic deficit, should raise the suspicion toward epidural hematoma. Enhancement in the hyperacute stage of the hematoma itself might indicate continued bleeding and, in the case of deteriorating neurologic status, will necessitate decompression. (Source: Journal of Manipulative and Physiological Therapeutics)

Functional outcome of corpectomy in cervical spondylotic myelopathy

Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1) — Thu, 07 May 2009 18:01:02 +0100

Conclusions: Cervical corpectomy is a reliable and rewarding procedure for CSM, with functional improvement in most patients. (Source: Table of Contents : Indian Journal of Orthopaedics : 2007 - 41(1))

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Upper cervical spinal cord tumors: review of 13 cases

Journal of Orthopaedic Science — Wed, 01 Apr 2009 06:05:13 +0100

Conclusions Spinal cord tumors in the upper cervical region tend to progress as dumbbell tumors. As all the neurinomas had this shape (Eden type 2 or 3) at C1/2, this anatomy might favor progression to the extradural and extraforaminal spaces. However, it also allows total removal of the tumor via a posterior approach. To maintain postoperative cervical alignment, the surgeon should select the least invasive approach to the paraspinal muscles attached to the spinous process of C2 Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-008-1309-4Authors Masahiko Watanabe, Tokai University School of Medicine Department of Orthopaedic Surgery, Surgical Science 143 Shimokasuya, Isehara Kanagawa 259-1193 JapanDaisuke Sakai, Tokai University School of Medici...

Distal-type cervical spondylotic amyotrophy: incidence and outcome after central corpectomy.

Journal of Neurosurgery.Spine — Tue, 31 Mar 2009 23:00:00 +0100

CONCLUSIONS: Distal-type CSA is a rare form of CSM that should be differentiated from motor neuron disease on the basis of subtle sensory symptoms or signs in the upper limbs, and the presence of significant cord compression on the MR imaging. Patient outcome after central corpectomy is good and long lasting. PMID: 19441997 [PubMed - indexed for MEDLINE] (Source: Journal of Neurosurgery.Spine)

The posterior cervical foraminotomy in the treatment of cervical disc/osteophyte disease: a single-surgeon experience with a minimum of 5 years' clinical and radiographic follow-up.

Journal of Neurosurgery.Spine — Tue, 31 Mar 2009 23:00:00 +0100

CONCLUSIONS: The posterior cervical foraminotomy is highly effective in treating patients with cervical radiculopathy and results in long-lasting pain relief and improved quality-of-life outcomes in most patients. Long-term radiographic follow-up shows no significant trend toward kyphosis, although select patient subsets (patients older than 60 years, patients who had previous posterior surgery, and patients with < 10 degrees of lordosis preoperatively) appear to be at higher risk and require closer follow-up. PMID: 19441994 [PubMed - indexed for MEDLINE] (Source: Journal of Neurosurgery.Spine)

Cervical Hemangioblastoma with holocord syrinx

Surgical Neurology — Mon, 30 Mar 2009 23:00:00 +0100

A 38-year-old woman patient presented to us with complaints of progressive quadriparesis along with bladder bowel involvement for 6 months. On examination, she had spastic quadriparesis with power 4/5 (Medical Research Council grade) and hesitancy with urge incontinence. Plain magnetic resonance imaging (MRI) of spine suggested possibility of an intramedullary extending from the cervicomedullary to the cervicothoracic junction (). However, complete spinal contrast imaging revealed a well-defined avid and homogenously enhancing intramedullary tumor at C7-T1 vertebral level with accompanying holocord syrinx extending from cervicomedullary junction up to the conus suggestive of a spinal hemagioblastoma with holocord syringomyelia () A focal C7-D1 laminectomy with gross total excision of the t...

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Spontaneous Cervical Epidural Hematoma Causing Brown-Sequard Syndrome: Case Report.

Turkish Neurosurgery — Sat, 07 Mar 2009 15:02:38 +0100

CONCLUSION: This report highlights the various presentations, evaluation, and management options for this rare diagnosis. It emphasizes the necessity of prompt diagnosis for possible emergent intervention. PMID: 19263364 [PubMed - as supplied by publisher] (Source: Turkish Neurosurgery)

Comparative study of anterior versus posterior decompression in elderly patients of cervical myelopathy with co-morbid conditions

European Journal of Orthopaedic Surgery & Traumatology — Sat, 07 Mar 2009 11:00:43 +0100

Conclusion Anterior decompression is the gold standard. However, in medically unfit patients with multi-level circumferential compression laminectomy is an equally rewarding option. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00590-009-0444-8Authors Sudeep Jain, All India Institute of Medical Sciences New Delhi 79 First Floor, Raja Garden New Delhi 110015 IndiaSaurabh Singh, All India Institute of Medical Sciences New Delhi 79 First Floor, Raja Garden New Delhi 110015 IndiaAnil Kumar Joshi, All India Institute of Medical Sciences New Delhi 79 First Floor, Raja Garden New Delhi 110015 IndiaChirayu Pamecha, Nathiba Hargovindas Lallubhai Municipal Medical College Ahmedabad Ahmedabad IndiaBharat Dave, Nathiba Hargovindas Lallubhai Municipal Medical Co...

Modified Minimally Invasive Surgical Approach to Cervical Neuromas with Intraforaminal Components: Hemi-semi-laminectomy and Supraforaminal Burr Hole (Modified Foraminotomy) Technique

min - Minimally Invasive Neurosurgery — Sun, 01 Mar 2009 07:43:37 +0100

Minim Invasive Neurosurg 2009; 52: 56-58DOI: 10.1055/s-0028-1104564Abstract The aim of this study was to develop a minimal invasive approach suitable for exploring neuromas with an intraforaminal component in the cervical spine with the aim of preservation of as much of the mechanically relevant bone structures and facet joints as possible.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Abstract | Full text (Source: min - Minimally Invasive Neurosurgery)

Surgical resection without dural reconstruction of a lumbar meningioma in an elderly woman

European Spine Journal — Sat, 14 Feb 2009 10:20:14 +0100

Abstract Meningiomas of the spine occur in the thoracic spine in approximately 80%, followed in frequency by the cervical and lumbar regions. The treatment of spinal meningiomas is complete surgical resection. As intraspinal meningiomas are almost always adherent to the dura, extensive dural resection or diathermic treatment of the dural attachment is usually performed to prevent tumor recurrence. The authors present the case of lumbar spinal meningioma in 82-year-old woman. Successful resection with preservation of the dura mater using the technique of Saito et al. (Spine 26:1805-1808, 2001) is described: After lumbar laminectomy a small incision was made in the surface of the spinal dura. The dura mater was separated into its inner and outer layers, and the tumor was rese...

Biomechanical rigidity of cadaveric cervical spine with posterior versus combined posterior and anterior instrumentation.

Journal of Neurosurgery.Spine — Sun, 01 Feb 2009 05:00:00 +0100

CONCLUSIONS: Rigidity imparted to the cervical spine by a 5-level posterior lateral mass fixation is not augmented by anterior instrumentation. PMID: 19278327 [PubMed - in process] (Source: Journal of Neurosurgery.Spine)

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Pneumatic Kerrison rongeur: technical note.

Surgical Neurology — Tue, 13 Jan 2009 05:00:00 +0100

CONCLUSION: The new pneumatically powered Kerrison rongeur not only is safe and easy to use but also virtually eliminates the manual fatigue and, at times, pain associated with prolonged bone removal from the use of standard Kerrison rongeurs. PMID: 19147188 [PubMed - as supplied by publisher] (Source: Surgical Neurology)

A novel strategy for repairing preganglionic cervical root avulsion in brachial plexus injury by sural nerve grafting.

Journal of Neurosurgery — Fri, 02 Jan 2009 05:00:00 +0100

Conclusions The authors' new surgical strategy yielded clinical improvement in muscle strength after preganglionic brachial plexus injury, such that nerve regeneration may have taken place. Reconnection of the brachial plexus to the cervical spinal cord is possible. Functional motor recovery, observed through increases in Medical Research Council-rated muscle strength in the affected arm, is likewise possible. PMID: 19119881 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery)

Congenital irreducible atlantoaxial dislocation associated with cervical intramedullary astrocytoma causing progressive spastic quadriparesis

Neurology India — Fri, 02 Jan 2009 04:23:43 +0100

Chatley Anooj, Jaiswal Awadesh K, Jain Manoj, Behari SanjayNeurology India 2008 56(4):477-479Simultaneous presence of congenital irreducible atlantoaxial dislocation (AAD) and cervical intramedullary astrocytoma has not been previously described and may cause disabling myelopathy. This 55-year-old lady presented with suboccipital pain, spastic quadriparesis, Lhermitte's phenomenon and sphincteric disturbances. Lateral radiographs and magnetic resonance imaging showed irreducible AAD, occipitalized atlas, C2-3 fusion, and,an intramedullary tumor from C2-5 level iso-to-hypointense, non-enhancing, except in a small segment in the dorsal C2 level. A suboccipital craniectomy with C2-5 laminectomy revealed a greyish-white tenacious tumor. The tumor was decompressed using a C2-5 midline m...

Cervical and thoracic spine tumor management: surgical indications, techniques, and outcomes.

The Orthopedic Clinics of North America — Thu, 11 Dec 2008 03:31:12 +0100

Authors: Mazel C, Balabaud L, Bennis S, Hansen S Since the first pioneering work in the area of tumors of the spine, medical professionals have sought to determine the proper role of spine surgery in the management of spinal tumors. Experience has proven that spine surgery is effective in the treatment of spinal cord compression for decreasing pain and improving quality of life with low rates of surgical complications. We use several staging systems to assess the patient's prognosis, to determine the best type of tumoral resection in preoperative surgical planning, and to provide guidance as to the best therapeutic option for the patient. In the surgical treatment of spine tumors, one of two opposing strategies must be chosen: (1) palliative surgery with cord decompression and spine st...

[Febrile cellulitis surrounding a scar revealing a large immunoblastic B-cell lymphoma.]

Annales de Dermatologie et de Cenereologie — Mon, 01 Dec 2008 05:00:00 +0100

We report the first case of a pericicatricial skin infiltration, mimicking febrile dermohypodermitis, revealing diffuse immunoblastic large B-cell non-Hodgkin's lymphoma. PATIENTS AND METHODS: Four months after decompressive cervical laminectomy, a 56-year-old man presented an inflammatory pericicatricial patch evoking cellulitis in a setting of hyperthermia and lymphadenopathy. Blood cultures and bacteriological analysis of skin biopsy samples were negative. The images showed infiltration of the soft subcutaneous areas and polyadenopathy. Two weeks later, several subcutaneous nodules appeared on the trunk. Histological analysis and immunolabelling pointed to immunoblastic large B-cell non-Hodgkin's lymphoma. A clone of B lymphocytes CD45+, CD20+, CD79a+, Bcl2+, CD5+, MUM1+, CD3-, CD10-, C...

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Apnea and macrocephaly-cutis marmorata telangiectatica congenita

Brain & Development — Fri, 28 Nov 2008 00:00:00 +0100

Abstract: The authors report a case of an infant girl with macrocephaly-cutis marmorata telangiectatica congenita (Macrocephaly-CMTC). This patient presented with developmental delay, mild subcostal retractions, and occasional apneic spells. An MRI demonstrated mild to moderate lateral ventricle hydrocephalus, left hemi-megalencephaly, and left cerebellar tonsillar herniation with full occlusion of the cisterna magna. Her foramen magnum was narrowed, measuring 17.5mm in transverse diameter. This value was significantly below the 50th percentile for age, which is 23.5mm. Together, these findings were suggestive of cervicomedullary cord compression, concerning for sudden death. The patient underwent posterior fossa decompression by suboccipital craniectomy and cervical laminectomy. Initially...

Apnea and macrocephaly-cutis marmorata telangiectatica congenita.

Brain & Development — Wed, 26 Nov 2008 05:00:00 +0100

Authors: Franklin B, Gasco J, Rangel-Castilla L, Nauta HJ The authors report a case of an infant girl with macrocephaly-cutis marmorata telangiectatica congenita (Macrocephaly-CMTC). This patient presented with developmental delay, mild subcostal retractions, and occasional apneic spells. An MRI demonstrated mild to moderate lateral ventricle hydrocephalus, left hemi-megalencephaly, and left cerebellar tonsillar herniation with full occlusion of the cisterna magna. Her foramen magnum was narrowed, measuring 17.5mm in transverse diameter. This value was significantly below the 50th percentile for age, which is 23.5mm. Together, these findings were suggestive of cervicomedullary cord compression, concerning for sudden death. The patient underwent posterior fossa decompression by suboccip...

Acute symptomatic cerebellar tonsillar herniation following intraoperative lumbar drainage.

Journal of Neurosurgery — Fri, 10 Oct 2008 04:00:00 +0100

Authors: Sugrue PA, Hsieh PC, Getch CC, Batjer HH Complications of tonsillar herniation associated with lumbar drainage have been reported in the literature. However, acutely symptomatic tonsillar herniation after intraoperative lumbar drainage is rare. The following case illustrates the risk associated with cerebrospinal fluid (CSF) drainage in the setting of tonsillar herniation. The use of lumbar drainage during cranial surgery is a common practice for reducing intracranial pressure and enhancing exposure, but is not without complications. In addition to the complications of the insertion procedure itself, the change in pressure gradient between the intracranial and the suboccipital compartments is of key importance. The authors present the case of a patient who underwent a subtempo...

Chiari malformation in a patient presenting with knee pain.

Physical Therapy — Wed, 01 Oct 2008 04:00:00 +0100

Authors: Walk M The patient was a 20-year-old male collegiate athlete who was referred to physical therapy for left knee pain. The patient reported an insidious onset of symptoms 1 year prior to evaluation and the symptoms were intermittent in nature, though exacerbation of his knee pain was attributed to being tackled during a backyard football game 3 months prior to evaluation. He described his left knee pain as "burning" that worsened with walking more than 10 minutes and reported that his left foot would "go to sleep" after sitting for approximately 30 minutes. He also complained of decreased standing balance. Additionally, the patient reported that he had episodic headaches. Because of a strong suspicion of spinal cord involvement, the patient was immediately taken to the emergenc...

Cervical Intradural Ventral Arachnoid Cyst Resected Via Anterior Corpectomy With Reconstruction: A Case Report.

Turkish Neurosurgery — Fri, 26 Sep 2008 17:06:20 +0100

CONCLUSION: For purely ventral cervical intradural arachnoid cysts, which compress the spinal cord dorsally, an anterior approach can allow access to the lesion without any need for intraoperative manipulation of the spinal cord. For such cases, the anterior approach prevents the consequent risk of neurological injury due to posterior approaches. PMID: 18814111 [PubMed - as supplied by publisher] (Source: Turkish Neurosurgery)

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Cervical juxtafacet cyst combined with spinal dysraphism.

Clinical Imaging — Mon, 01 Sep 2008 04:00:00 +0100

We present a case of a patient with radicular pain and early onset myelopathy. A juxtafacet cyst at the cervico-thoracic junction combined with discal herniation and spina bifida occulta was diagnosed with computed tomography (CT) and magnetic resonance imaging (MRI). Laminectomy with removal of the cyst was the treatment and the patient recovered rapidly. PMID: 18760727 [PubMed - in process] (Source: Clinical Imaging)

Upper airway obstruction after cervical spine fusion surgery: role of cervical fixation angle.

Acta Anaesthesiologica Taiwanica — Mon, 01 Sep 2008 04:00:00 +0100

We present the case of a 56-year-old female with breast cancer and metastasis to the cervical spine. The surgical procedure involved C2-C3 laminectomy, posterior fixation (C0-C5), and C2 neurectomy. Tracheal extubation was carried out in the intensive care unit, and upper airway obstruction immediately followed. Emergency cricothyrotomy was performed under well-managed ventilation with a laryngeal mask after several failed intubation attempts. Over-flexion of the cervical spine fixation and severe prevertebral soft tissue swelling were the most probable causes of upper airway obstruction. With a well-adjusted angle for fixation of the cervical spine under fluoroscopic guidance before the procedure, such a surgical mishap could be avoided. Reintubation with a fiberscope might be considered ...

Cervical spine instability following cervical laminectomies for Chiari II malformation: a retrospective cohort study

Child's Nervous System — Fri, 15 Aug 2008 06:41:48 +0100

Conclusion Radiographic evidence of cervical spine instability following multilevel cervical laminectomies for Chiari II is common but may be of minimal clinical significance. The reason for the lack of clinical instability in what might be considered high-risk patients is not understood. Content Type Journal ArticleCategory Original PaperDOI 10.1007/s00381-008-0694-5Authors Fred C. Lam, University of Alberta Department of Neurosurgery Edmonton Alberta CanadaBeverly J. Irwin, BC Children’s Hospital Division of Pediatric Neurosurgery, Department of Pediatric Surgery 4480 Oak Street, #K3-159 Vancouver British Columbia V6H 3V4 CanadaKenneth J. Poskitt, BC Children’s and Women’s Center Department of Neuroradiology Vancouver British Columbia CanadaPaul Steinbok, BC C...

Long-term outcome of laminectomy and instrumented fusion for cervical ossification of the posterior longitudinal ligament

International Orthopaedics — Thu, 07 Aug 2008 09:59:28 +0100

Abstract Between January 2000 and December 2003, a total of 83 patients (64 men and 19 women, average age: 56.4 years, range: 42–78 years) who underwent posterior laminectomy and instrumented fusion for ossification of the posterior longitudinal ligament (OPLL) were included in this study to investigate the long-term outcome of this surgical option and clarify which factors affect the prognosis. After an average 4.8-year follow-up, the mean Japanese Orthopaedic Association (JOA) score significantly increased from 9.2 ± 1.3 points before operation to 14.2 ± 0.9 points at the latest follow-up (P < 0.01). The improvement rate (IR) of neurological function ranged from 11.1 to 87.5%, with a mean of 62.4 ± 13.2%. Among 83 patients, 59 (71.1%) pa...

Spinal myoclonus following a peripheral nerve injury: A case report

BioMed Central — Wed, 06 Aug 2008 04:00:00 +0100

Spinal myoclonus is a rare disorder characterized by myoclonic movements in muscles that originate from several segments of the spinal cord and usually associated with laminectomy, spinal cord injury, post-operative, lumbosacral radiculopathy, spinal extradural block, myelopathy due to demyelination, cervical spondylosis and many other diseases. On rare occasions, it can originate from the peripheral nerve lesions and be mistaken for peripheral myoclonus. Careful history taking and electrophysiological evaluation is important in differential diagnosis. The aim of this report is to evaluate the clinical and electrophysiological characteristics and treatment results of a case with spinal myoclonus following a peripheral nerve injury without any structural lesion. (Source: BioMed Central)

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Posterior stabilization strategies following resection of cervicothoracic junction tumors: review of 90 consecutive cases.

Journal of Neurosurgery.Spine — Fri, 01 Aug 2008 04:00:00 +0100

Conclusions Current posterior instrumentation strategies involving LMSRSs and PSSs provide excellent and safe stabilization of the cervicothoracic junction following resection of primary or metastatic tumors. PMID: 18764742 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery.Spine)

Treatment of Cervical Degenerative Disc Disease – Current Status and Trends

Zentralblatt fur Neurochirurgie - Central European Neurosurgery — Wed, 30 Jul 2008 13:50:51 +0100

This article reviews the evolution of the operative treatment of cervical disc disease in the last 80 years, outlines the advantages and disadvantages of each approach and technique and focuses on the rationale of the paradigm shifts. Current established and alternative treatment concepts are illuminated and discussed together with the currently relevant literature.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Abstract | Full text (Source: Zentralblatt fur Neurochirurgie - Central European Neurosurgery)

Treatment of Cervical Degenerative Disc Disease - Current Status and Trends.

Zentralblatt fur Neurochirurgie — Tue, 29 Jul 2008 04:00:00 +0100

This article reviews the evolution of the operative treatment of cervical disc disease in the last 80 years, outlines the advantages and disadvantages of each approach and technique and focuses on the rationale of the paradigm shifts. Current established and alternative treatment concepts are illuminated and discussed together with the currently relevant literature. PMID: 18666050 [PubMed - as supplied by publisher] (Source: Zentralblatt fur Neurochirurgie)

C1–C2 arthrodesis after transoral odontoidectomy and suboccipital craniectomy for ventral brain stem compression in Chiari I patients

European Spine Journal — Wed, 16 Jul 2008 05:59:57 +0100

We report two patients who underwent transoral odontoidectomy with preservation of the anterior arch of the atlas and suboccipital craniectomy with C1 laminectomy followed by C1–C2 arthrodesis. Preservation of the anterior arch of the atlas in conjunction with C1–C2 arthrodesis stabilizes the occipito–atlanto-axial segments while conserving more cervical mobility as compared to an occipitocervical fusion. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00586-008-0706-xAuthors Steven W. Hwang, Tufts-New England Medical Center Department of Neurosurgery #178 750 Washington Street Boston MA 02111 USACarl B. Heilman, Tufts-New England Medical Center Department of Neurosurgery #178 750 Washington Street Boston MA 02111 USARon I. Riesenburger, Tufts-New England Me...

Spinal meningiomas: Clinical and therapeutic tonsiderations

Central European Journal of Medicine — Fri, 11 Jul 2008 07:09:34 +0100

This study reports on the dominant features of spinal meningiomas before and after treatment. We treated 30 patients (23 female) with meningiomas of the spinal canal from 1992 to 2003. The mean age was 68 (range: 43–91). Upon admission, 26 patients presented with a marked neurological deficit (11 paraparesis, 9 motor weakness, 4 myelopathic ataxia, 1 quadriplegia, and 1 cauda equina syndrome). Two patients had sensory deficits, and two had pain only. The distribution of the tumors was as follows: 8 cases were cranio-cervical, 1 case was cervical, 6 cases were at the cervico-thoracic junction, 9 cases were of the thoracic spine, 5 cases were of the thoracolumbar spine, and 1 case was of the lumbar spine. Five cases also had intracranial manifestations. The mean interval between the ...

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Lateral Cord Stimulation Decreases Spastic Electromyographic Spreading: Responses in a Brain-Damaged Pig Preparation

Neuromodulation — Tue, 08 Jul 2008 04:00:00 +0100

Conclusions. This experiment demonstrated that LCS produces threshold increases to abolish abnormally propagated electromyographic evoked responses induced by the electrical stimulation of the fourth lumbar root in pigs with experimental cortical and subcortical brain lesions. (Source: Neuromodulation)

[Evaluation of the clinical and radiological results of cervical longitudinal median somatotomy without graft.]

Neuro-Chirurgie — Fri, 04 Jul 2008 04:00:00 +0100

CONCLUSIONS: The cervical longitudinal median somatotomy without graft is an easy and reliable technique that can be proposed as first-line treatment for cervical spondylotic myelopathy related to anterior compression. It decreases the cost and the duration of the surgical procedure, it protects the patient from the complications and sequelae related to graft harvesting and the use of implants. It should be limited to patients without preoperative kyphosis who are over 50 years old. PMID: 18603268 [PubMed - as supplied by publisher] (Source: Neuro-Chirurgie)

Spinal intradural arteriovenous fistula with unusual presentation: case report and literature review

Child's Nervous System — Thu, 03 Jul 2008 08:16:49 +0100

Conclusion The rarity of a pediatric spinal AVF presenting with spontaneous Intracranial SAH, makes this case very peculiar. This is the first reported pediatric case of cervical cord AVF with this clinical presentation found in the literature. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00381-008-0656-yAuthors Luis Alonso Fernández, Children’s Hospital of Eastern Ontario Division of Neurosurgery 401 Smyth Ottawa ON K1H 8L1 CanadaMunyao Nzau, Children’s Hospital of Eastern Ontario Division of Neurosurgery 401 Smyth Ottawa ON K1H 8L1 CanadaEnrique Ventureyra, Children’s Hospital of Eastern Ontario Division of Neurosurgery 401 Smyth Ottawa ON K1H 8L1 Canada Journal Child's Nervous SystemOnline ISSN 1433-0350Print ISSN 0256-7040 (Source: Chi...

[Primary cervical epidural low-grade non-hodgkin's lymphoma: A case report and review of the literature.]

Cancer radiotherapie — Tue, 17 Jun 2008 04:00:00 +0100

We report a 43-year-old woman admitted for a total functional disability of the four limbs. Magnetic resonance imaging revealed a cervical epidural mass C2-C3. A laminectomy was performed. The histological study revealed a small cells lymphoma. The patient underwent chemotherapy and radiotherapy. There was a favourable evolution. She is in complete remission with a follow-up of two years. We review literature to describe epidemiological, clinical and therapeutic features with evolutive aspects in primary epidural non-hodgkin's lymphomas. PMID: 18565781 [PubMed - as supplied by publisher] (Source: Cancer radiotherapie)

A novel anterior technique for simultaneous single-stage anterior and posterior cervical release for fixed kyphosis.

Journal of Neurosurgery.Spine — Sun, 01 Jun 2008 04:00:00 +0100

In this report the authors describe an anterior technique for simultaneous anterior and posterior lateral mass release. The vertebral artery is mobilized using this technique, allowing for its lateral retraction. The nerve roots are visualized and retracted superiorly and inferiorly. The lateral mass and facets can then be accessed anteriorly using an osteotome or drill for the release. The authors illustrate this technique in a patient who developed fixed scoliosis and kyphosis of the cervical spine after surgery for degenerative disc disease. To the authors' knowledge, this is the first report of this technique. PMID: 18518684 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery.Spine)

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Spinal osteochondroma: spectrum of a rare disease.

Journal of Neurosurgery.Spine — Sun, 01 Jun 2008 04:00:00 +0100

Authors: Srikantha U, Bhagavatula ID, Satyanarayana S, Somanna S, Chandramouli BA check markOsteochondromas are the most common benign bone tumor. Although the metaphysial region of long bones is the usual site of these tumors, the vertebrae may be infrequently affected. The presentation may vary from typical compressive myelopathy to radiculopathy or radiculomyelopathy, depending on the site of involvement. The authors present 3 consecutive cases of cervical spine osteochondromas encountered over 3 years at their institution, each different in its site of involvement, presentation, and chosen treatment. The patient in Case 1 had the typical presentation and lesion site, and was treated with a conventional laminectomy. The patient in Case 2 presented with an extensive disease that requ...

Contributions of the fourth spinal nerve to the brachial plexus without prefixation.

Journal of Neurosurgery.Spine — Sun, 01 Jun 2008 04:00:00 +0100

Conclusions In ~ 20% of normally composed brachial plexuses (those with extradural contributions from only C5-T1) we found intradural C4-5 neural connections. Such variations may lead to misinterpretation of spinal levels in pathological conditions of the spinal axis and should be considered in surgical procedures of this region, such as rhizotomy. PMID: 18518676 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery.Spine)

Factors associated with cervical instability requiring fusion after cervical laminectomy for intradural tumor resection.

Journal of Neurosurgery.Spine — Thu, 01 May 2008 04:00:00 +0100

Conclusions In the authors' experience with intradural cervical tumor resection, patients presenting with myelopathic motor symptoms or those undergoing a >/= 3-level cervical laminectomy had an increased likelihood of developing subsequent symptomatic instability requiring fusion. A >/= 3-level laminectomy with myelopathic motor symptoms may herald patients most likely to benefit from cervical fusion at the time of tumor resection. PMID: 18447686 [PubMed - in process] (Source: Journal of Neurosurgery.Spine)

Chiari malformation presenting as a focal motor deficit. Report of two cases.

Journal of neurosurgery. Pediatrics — Thu, 01 May 2008 04:00:00 +0100

Authors: Laufer I, Engel M, Feldstein N, Souweidane MM Chiari malformations may present with a wide range of symptoms and signs. Nevertheless, focal foot weakness as a presentation of a Chiari malformation has not been described in the pediatric neurosurgical literature. Two children with Chiari malformations and holocord syringomyelia presented with manifestations of a supposed isolated lumbar radiculopathy. Neurological deficits completely resolved after decompressive suboccipital craniectomy and cervical laminectomy. These cases emphasize the importance of imaging the entire craniospinal axis and avoidance of therapeutic intervention specifically aimed at a radiculopathic process when initial imaging fails to show a structural abnormality at the spinal level of deficit. The possible...