Cases reported "Spinal Stenosis"

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1/92. A single case report of healing through specific martial art therapy: comparison of MRI to clinical resolution in severe cervical stenosis: a case report.

    OBJECTIVES: A 76-year-old patient with chronic and severe spinal cord compression secondary to cervical stenosis, a cervical osteophyte, and a herniated intervertebral cervical disk had lasting resolution of symptoms after completing a specific, martial art-based, physical therapy program. We wanted to determine if there were structural changes in the cervical spine that could account for the prompt resolution of symptoms. DESIGN: A 76-year-old female completed 8 weeks of a specific, martial art-based, physical therapy. The pretherapy and posttherapy cervical magnetic resonance images (MRIs) were compared. A follow-up evaluation was done at 1 year. RESULTS: The patient was symptom-free within 8 weeks of the start of therapy. She remained symptom-free at 1 year follow-up evaluation. There were no obvious structural differences in the pretherapy and posttherapy MRI studies. CONCLUSIONS: Resolution of symptoms was directly related to the specific martial art therapy. However, there were no changes in the pretherapy and posttherapy MRI studies, suggesting a significant adaptation to the spinal compression had occurred. These data suggest a viable option to surgery in elderly patients with chronic and severe cervical spinal stenosis.
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2/92. A case of cervical myelopathy with developmental canal stenosis at the level of the atlas. A case report.

    The craniocervical junction is one of the most common sites of malformations. Only three cases of myelopathy due to hypoplasia of atlas have been reported previously. Among these malformations, the hypoplasia of atlas was first described by Wackenheim in 1974. Although developmental canal stenosis due to the hypoplasia of atlas seems to have a tendency of causing the cervical myelopathy, only three cases of cervical myelopathy due to this condition have been reported previously. A 77-year-old man with severe canal stenosis at the level of the atlas is reported. The clinical manifestations were 20-year history of progressive gait disturbance and paresis of both upper and lower extremities. The spinal cord was markedly compressed at the level of the atlas. The clinical manifestations improved after a resection of posterior arch of the atlas.
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3/92. Anomaly of the axis causing cervical myelopathy. Case report.

    Although the craniovertebral junction is one of the most common sites at which anomalies develop, spina bifida occulta of the axis (C-2) associated with cervical myelopathy is extremely rare. The authors present the case of a 46-year-old man who developed progressive tetraparesis caused by a cervical canal stenosis at the level of the axis. The spinal cord was compressed by an invaginated bifid lamina of the axis. The patient made a remarkable recovery after undergoing decompressive laminectomy of C-3 and removal of the bifid posterior arch of the axis.
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4/92. Circumferential cervical surgery for spondylostenosis with kyphosis in two patients with athetoid cerebral palsy.

    BACKGROUND: patients with athetoid cerebral palsy may develop severe degenerative changes in the cervical spine decades earlier than their normal counterparts due to abnormal cervical motion. methods: Two patients, 48 and 52 years of age, presented with moderate to severe myelopathy (Nurick Grades IV and V). MR and 3-dimensional CT studies demonstrated severe spondylostenosis with kyphosis in both patients. This necessitated multilevel anterior corpectomy with fusion (C2-C7, C3-C7) using fibula and iliac crest autograft and Orion plating, followed by posterior wiring, fusion using Songer cables, and halo placement. RESULTS: Postoperatively, both patients improved, demonstrating only mild or mild to moderate (Nurick Grades II and III) residual myelopathy. Although both fused posteriorly within 3.5 months, the patient with the fibula graft developed a fracture of the anterior C7 body with mild anterior graft migration, and inferior plate extrusion into the C7-T1 interspace. However, because he has remained asymptomatic for 9 months postoperatively, without dysphagia, removal of the plate has not yet been necessary. CONCLUSIONS: patients with athetoid cerebral palsy should undergo early prospective cervical evaluations looking for impending cord compromise. When surgery is indicated, circumferential surgery offers the maximal degree of cord decompression and stabilization with the highest rate of fusion.
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5/92. Unilateral thoracic canal stenosis.

    Two unusual cases of thoracic spinal canal stenosis are reported. The cord compression was a result of unilateral hypertrophy of the lamina and facet joint. Bony decompression resulted in rapid neurological recovery.
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6/92. Atlantal stenosis: a rare cause of quadriparesis in a child. Case report.

    The authors report the case of a 3-year-old boy who suffered from quadriparesis and respiratory distress after failing to execute a somersault properly. neuroimaging revealed spinal cord contusion with marked spinal canal stenosis at the level of the atlas. No subtle instability, occult fracture, or other congenital abnormalities were confirmed. Spinal cord contusion with marked canal stenosis is rare, and only several adult cases have been reported. Severe stenosis at the level of the atlas may predispose individuals to severe spinal cord contusion, as occurred in our patient after sustaining trivial trauma.
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7/92. Neuropraxia of the cervical spinal cord following cervical spinal cord trauma: a report of five patients.

    Neuropraxia of the cervical spinal cord is a rare condition which is almost exclusively reported in American football players following cervical hyperextension or hyperflexion trauma. In this entity-neurological symptoms of both arms and legs for a period of up to 15 minutes are observed with complete recovery. We report the characteristics of five patients not involved in contact sport activities with a neuropraxia of the spinal cord following cervical trauma. In four of the five patients, this syndrome was associated with a cervical canal stenosis. Surgical decompression was performed in two patients with progressive neurological symptoms after an initial period of recovery. The cases illustrates that although neuropraxia of the spinal cord is usually seen in athletes, also other persons may be at risk for developing this condition, especially when a preexisting spinal stenosis is present. patients who experienced neuropraxia of the spinal cord should thus be evaluated carefully for the presence of cervical spinal cord abnormalities.
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8/92. dialysis-related spinal canal stenosis: a clinicopathological study on amyloid deposition and its AGE modification.

    Three cases operated for spinal canal stenosis induced by dialysis-related amyloidosis (DRA) were investigated clinicopathologically. Cases were all-male, and had undergone hemodialysis around 20 years. In two cases, cervical plain x-rays showed only minor spondylotic changes. However, magnetic resonance imaging (MRI), myelography, and computed tomography (CT) showed extradural thickness with compression on the cervical spinal cord and cauda equina. In one case cervical x-rays showed typical destructive spondyloarthropathy (DSA), and MRI showed compression myelopathy. Surgical treatment on both cervical and lumbar spine in two cases and on cervical spine only in one case successfully reduced the symptoms. Extradural thickened tissue and ligament flavum obtained during surgery were studied histopathologically and immunostained by using anti-CD68, anti-beta2-microglobulin (beta2m), and anti-advanced glycation end product (AGE) antibody. congo red stain showed diffuse or nodular amyloid deposition, and immunostaining with anti-beta2m and anti-AGE antibodies also demonstrated the same distribution pattern. Thus, beta2m-positive amyloid tissue in the extradural thickness (extradural amyloid deposition) was immunohistochemically demonstrated to be modified with AGE. Inflammatory reaction with histiocytic and giant cell infiltration was also shown around the amyloid tissues. There were CD68-positive cells, and some cells were positive for AGE and beta2m. These findings suggest that beta2m accumulation and inflammatory reaction finally promote destruction of connective tissues. MRI, CT and/or myelography are necessary for diagnosing spinal canal stenosis accompanied by DRA. In conclusion, we propose a more comprehensive concept of dialysis-related spinal canal stenosis, which includes both DSA and myeloradiculopathy induced by extradural thickness.
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9/92. Cervical myelopathy and congenital stenosis from hypoplasia of the atlas: report of three cases and literature review.

    STUDY DESIGN: case reports of patients with cervical myelopathy to hypoplasia of the atlas. OBJECTIVES: To report cases of cervical myelopathy due to congenital hypoplasia of the atlas and to review the literature. SUMMARY OF BACKGROUND DATA: Six previously documented cases of congenital hypoplasia of the atlas as a cause of cervical myelopathy are reported in the literature. methods: Three patient's clinical record and radiologic imaging studies as well as a thorough literature search are reported. Plain radiographs, computed tomography scans, magnetic resonance images, as well as somatosensory-evoked potential changes are displayed. RESULTS: Cervical myelopathy developed in three patients who were found to have congenital hypoplasia of the atlas. laminectomy of C1 provided neurologic improvement in all three patients presented. CONCLUSION: Congenital hypoplasia of the atlas is a rare cause of cervical myelopathy. This report should broaden the radiographic differential diagnosis when seeking an explanation for the signs and symptoms of cervical myelopathy.
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10/92. Clinics in diagnostic imaging (55). Ossification of the posterior longitudinal ligament.

    Ossification of the posterior longitudinal ligament (OPLL) of the cervical spine associated with diffuse idiopathic skeletal hyperostosis is described in a 70-year-old Caucasian man presenting with a rapidly progressive myelopathy. The acute nature of his myelopathic symptoms and cervical canal stenosis necessitated posterior decompressive surgery. Four other patients with OPLL are presented to illustrate the spectrum of imaging findings. The computed tomographic features of OPLL are distinctive.A 2-5 mm thick linear ossified strip along the posterior vertebral margin usually at mid cervical (C3 to C5) level characterises the condition. Magnetic resonance (MR) imaging is valuable in excluding possible cord damage and associated disc lesions prior to surgery. A calcified central sequestrated disc is the only condition that may be mistaken for the segmental and retrodiscal forms of OPLL In a clinical setting of compressive myelopathy, it is pertinent to distinguish between these two conditions since a sequestrated disc has a more favourable surgical prognosis. The merits and relevance of anterior and posterior surgery together with their possible complications are outlined.
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