Cases reported "Spinal Osteophytosis"

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1/312. Analysis of the cervical spine alignment following laminoplasty and laminectomy.

    Very little detailed biomechanical examination of the alignment of the cervical spine following laminoplasty has been reported. We performed a comparative study regarding the buckling-type alignment that follows laminoplasty and laminectomy to know the mechanical changes in the alignment of the cervical spine. Lateral images of plain roentgenograms of the cervical spine were put into a computer and examined using a program we developed for analysis of the buckling-type alignment. Sixty-four patients who underwent laminoplasty and 37 patients who underwent laminectomy were reviewed retrospectively. The subjects comprised patients with cervical spondylotic myelopathy (CSM) and those with ossification of the posterior longitudinal ligament (OPLL). The postoperative observation period was 6 years and 7 months on average after laminectomy, and 5 years and 6 months on average following laminoplasty. Development of the buckling-type alignment was found in 33% of patients following laminectomy and only 6% after laminoplasty. Development of buckling-type alignment following laminoplasty appeared markedly less than following laminectomy in both CSM and OPLL patients. These results favor laminoplasty over laminectomy from the aspect of mechanics. ( info)

2/312. Cervical foraminotomy: an effective treatment for cervical spondylotic radiculopathy.

    Between 1983 and 1994, posterior cervical foraminotomy as described by Frykholm was performed on 89 patients with exclusively radicular symptoms caused by cervical osteophytes. The main presenting feature was arm pain. Objective neurological signs were present in 50% of the patients. At mean postoperative follow-up of 8.6 months, 95.5% of patients reported excellent or good results, while 4.5% were not improved. No patient was rendered worse following the procedure. There were no deaths and the complication rate was 2.2%. Further surgery for recurrent root symptoms was required by 6.7% of patients. Our findings are in keeping with the good results and low complication rate of this procedure as described in other studies. Informal inquiries suggest that this procedure is not widely used, at any rate in the United Kingdom, and we present this series in order to emphasize the efficacy and safety of this procedure. ( info)

3/312. Fatal cervical spondyloarthropathy in a hemodialysis patient with systemic deposition of beta2-microglobulin amyloid.

    Destructive spondyloarthropathy is a serious complication in patients with end-stage renal disease. We report a case of fatal cervical spondyloarthropathy in a patient on hemodialysis who presented with severe pain in the cervical area. magnetic resonance imaging (MRI) of the cervical spine showed a soft tissue mass at the cervico-occipital hinge with spinal cord compression and destructive lesions of the cervical vertebrae. The patient became quadriplegic during the MRI procedure and died a few days later. Postmortem examination showed deposition of beta2-microglobulin in the cervico-occipital hinge. A unique feature of this case was the documented presence of systemic beta2-microglobulin amyloid deposits involving the spleen that to our knowledge has not been reported previously. Clinical suspicion and early detection of lesions caused by dialysis-related amyloidosis (DRA) may help to prevent significant morbidity and mortality in long-term dialysis patients. ( info)

4/312. Can intramedullary signal change on magnetic resonance imaging predict surgical outcome in cervical spondylotic myelopathy?

    STUDY DESIGN: A retrospective study evaluating magnetic resonance imaging, computed tomographic myelography, and clinical parameters in patients with cervical spondylotic myelopathy. OBJECTIVES: To investigate whether magnetic resonance imaging can predict the surgical outcome in patients with cervical spondylotic myelopathy. SUMMARY OF BACKGROUND DATA: No previous studies have established whether areas of high signal intensity in T2-weighted magnetic resonance images can be a predictor of surgical outcomes. methods: Fifty patients with cervical spondylotic myelopathy were examined by magnetic resonance imaging and computed tomographic myelography before surgery and by delayed computed tomographic myelography after surgery. The correlation between the recovery rate and the clinical and imaging parameters was analyzed. RESULTS: The best prognostic factor was the transverse area of the spinal cord at maximum compression (correlation coefficient, R = 0.58). The presence of high signal intensity areas on T2-weighted magnetic resonance images correlated poorly with the recovery rate (R = -0.29). However, patients with multisegmental areas of high signal intensity on T2-weighted magnetic resonance images tended to have poor surgical results associated with muscle atrophy in the upper extremities. Postoperative delayed computed tomographic myelography showed that multisegmental areas of high signal intensity on T2-weighted magnetic resonance images probably represent cavitation in the central spinal cord. CONCLUSIONS: patients with multisegmental areas of high signal intensity on T2-weighted magnetic resonance images tended to have poorer surgical results. However, the transverse area of the spinal cord at the level of maximum compression was a better prognostic indicator. ( info)

5/312. High cervical disc lesions in elderly patients--presentation and surgical approach.

    The incidence of high cervical disc lesions is extremely rare, and the mechanism of their development is unclear. We report these three cases, and discuss the possible mechanisms. We also describe surgical strategies for these lesions. The first and second cases were an 82-year-old male and an 84-year-old male with retro-odontoid disc hernia. The third was an 83-year-old female with a herniated disc at C2/C3. To investigate Aetiological mechanisms of these lesions, we examined the findings on cervical images in extension and flexion, and compared the results in a younger than 80-year-old group and an older than 80-year-old group. The patients underwent surgery via a posterolateral intradural approach. Wide laminectomy and incision of the dentate ligaments enabled access to the ventral space of the upper cervical spinal canal and sufficient decompression. All patients became ambulatory postoperatively without special fixation of the cervical spine. In the younger group, the level mostly loaded during cervical movement was C5/6, however, the levels in the older group were C2/3 and C3/4. In elderly patients, less mobilization of the middle and/or lower cervical spine due to spondylotic change causes overloading at higher levels resulting in high cervical disc lesions. Retro-odontoid disc lesions can be caused by a herniated disc at C2/C3, which migrates upward. Regarding surgical strategy, the posterolateral intradural approach is less invasive and more advantageous for these lesions. ( info)

6/312. Spondyloptosis and multiple-level spondylolysis.

    An unusual case of a combination of multiple bilateral spondylolyses (L2, 3 and 4), spondylolisthesis at L3/4, spondyloptosis at L4/5 and sacralization of L5 in a teenage female is described. The patient had severely increasing lower back pain radiating to the left lower limb. radiography identified the abnormalities and myelography revealed complete obstruction and compression of the thecal sac at the L4/5 level. The case was treated surgically by posterior decompression, corpectomy and fusion in a three-stage operation. The follow-up was extended to 2 years with no complications. No similar case has previously been reported. ( info)

7/312. Posterior decompression of the vertebral artery narrowed by cervical osteophyte: case report.

    BACKGROUND: Symptomatic vertebral artery compression caused by cervical spondylosis usually is caused by compression of the artery by osteophytes arising from the uncinate process. Compression from facet joint osteophytes is seldom reported. CASE DESCRIPTION: A 69-year-old male developed symptomatic vertebral artery stenosis secondary to an osteophyte arising from the superior facet of the sixth cervical vertebra posterior to the artery. A posterior decompression of the vertebral artery with removal of the offending facet joint complex relieved the patient's transient neurologic events. CONCLUSION: Symptomatic vertebral artery stenosis may be caused by osteophytes compressing the vertebral artery anteriorly from the uncinate process or posteriorly from the facet complex. ( info)

8/312. Hemiparesis in cervical spondylosis.

    Two patients with hemiparesis were thought to have intracranial lesions. Cervical spondylosis was discovered, and the condition of both patients improved after laminectomy. Although it has been rarely emphasized in the past, cervical spondylosis should be considered in the differential diagnosis of hemiparesis. ( info)

9/312. Clinical observations on 278 cases of cervical spondylopathy treated with electroacupuncture and massotherapy.

    From Dec. 1990 to Dec. 1993, 278 cases of cervical spondylopathy were treated with electroacupuncture and massotherapy. The cure rate was 82.7%; but in the control group, it was only 61%, indicating that electroacupuncture may enhance the cure rate (P < 0.05). Of the 278 cases treated by three to five sessions, the pain and numbness disappeared in about 96% of the patients. ( info)

10/312. Lumbar spine pain originating from vertebral osteophytes.

    BACKGROUND AND OBJECTIVES: Axial spine pain originates from a number of structures. Putative pain generators include facet joints, intervertebral disks, sacroiliac joints, and myofascial structures. Osteophytes originating from lumbar vertebral bodies in the area of the intervertebral disks may be a source of nociceptive low back pain which may respond to local injection. methods: Five patients with axial low back pain unresponsive to traditional treatment modalities were treated with fluoroscopic guided injection of local anesthetic and corticosteroid near large intervertebral osteophytes. RESULTS: All 5 patients experienced relief. CONCLUSION: Vertebral osteophytes may be a source of axial spine pain. Injection of painful osteophytes with a local anesthetic and corticosteroid solution may produce pain relief. ( info)
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