1/9. 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.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/9. Adjacent segment disease: an uncommon complication after cervical expansile laminoplasty: case report.OBJECTIVE AND IMPORTANCE: Adjacent segment disc disease is a well-described phenomenon that occurs after anterior cervical spinal fusion. One of the advantages of cervical laminoplasty over anterior approaches is that although the treated segments are stiffened, no formal fusion is performed. This is thought to reduce the biomechanical stresses placed on adjacent levels and thus decrease the likelihood of adjacent level degeneration. CLINICAL PRESENTATION: A 62-year-old man presented with myelopathy attributable to cervical spondylosis and underwent a C3-C7 laminoplasty. Improvements in gait were followed 2 years later by symptomatic disc degeneration and spinal cord compression at T1-T2, which rendered him wheelchair bound. INTERVENTION: The patient was treated with a laminectomy at the level of stenosis accompanied by posterior instrumentation and fusion from C5 to T3. This resulted in clinical improvement, and the patient was returned to his baseline ambulatory status. CONCLUSION: Adjacent segment disease is an uncommon complication that occurs after laminoplasty. Careful attention to preserving facet joint motion in the cervical spine may minimize the stresses placed on adjacent motion segments.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
3/9. Klippel-Feil anomaly with associated rudimentary cervical ribs in a human skeleton: case report and review of the literature.Anomalies of the cervical spine are intriguing anatomically and often come to clinical attention. Fusion of one or more cervical vertebral segments, the Klippel- Feil anomaly (KFA), often causes increased motion at the vertebral segments superior to and inferior to the fused level with a resultant premature wear of these joints. We report an adult male skeleton with fusion of his C6 and C7 vertebral bodies (Type II KFA). A remnant of the intervertebral disc space was noted and bilateral rudimentary cervical ribs were observed emanating from the C7 vertebrae. Excessive joint degeneration was noted between the vertebral bodies of C5 and C6. Following our review of the literature and case report, it appears that there is an increased incidence of the presence of cervical ribs in KFA. We review the literature for coexistent KFA and cervical ribs and discuss their dysembryology.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/9. Bilateral open laminoplasty using ceramic laminas for cervical myelopathy.Evaluation was done of 65 patients with cervical myelopathy treated by bilateral open laminoplasty using artificial laminas, between 1984 and 1988, who had been followed for more than 2 years. The mean recovery rate on the Japanese Orthopaedic association scoring system was 65% in all cases, and 72% in the cases with no other complications. The artificial laminas appeared well adapted to the laminas in computed tomography and dynamic radiographic examinations, and there were no cases of reduction of the enlarged canal. Postoperative restriction of the range of motion of the cervical spine was lessened by the positioning of lateral grooves, more appropriate external fixation, and posterior flexion exercise after operation. This procedure is not technically complicated, it does not involve appreciable blood loss during operation, it prevents grafted free fat from migrating into the spinal canal, and is advantageous for posterolateral bone chip grafting.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/9. Subtotal vertebrectomy and spinal fusion for cervical spondylotic myelopathy.To perform decompression of the spinal cord and stabilization of the cervical spine in the patients with cervical spondylotic myelopathy, subtotal vertebrectomy and spinal fusion of the cervical spine were carried out in 30 patients. In 18 patients, three vertebrectomies and a spinal fusion were carried out, and in 12 patients, four vertebrectomies and a spinal fusion were carried out. Neurologic symptoms that were present before the operations ranged from transverse lesion type myelopathy to motor system syndrome. The patients' symptoms improved significantly after the operations. By the final consultation, the cervical spine motion reduced by about half in the four level vertebrectomy patients and about one third in the three level vertebrectomy patients. No patients reported cervical pain or pain in the arms.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/9. Anterolateral extrapharyngeal approach for cervical osteophyte-induced dysphagia. literature review.While it is estimated that hypertrophic cervical osteophytes occur in up to 20% to 30% of the population, they are only rarely associated with dysphagia. Pathophysiologically, dysphagia may occur secondary to 1) mechanical compression with partial obstruction, or 2) periesophageal inflammation caused by pharyngoesophageal motion over the osteophytes. A careful history, indirect laryngoscopy, cineesophagography, and lateral cervical spine films establish the diagnosis in most patients. While routine rigid endoscopy is potentially hazardous in view of the recognized risk of inadvertent pharyngoesophageal perforation, it may be necessary in selected patients to rule out the presence of other more common causes of dysphagia. Conservative management consisting of sedation, antiinflammatory medication, and reassurance is often sufficient in patients with only mild to moderate and often transient symptoms. The value of surgical therapy for this disorder has been debated, but most agree that surgical excision is appropriate in selected patients whose symptoms are severe and progressive. In this report, two patients illustrate the dichotomy between and value of both conservative and surgical approaches. While both transoropharyngeal and transcervical extrapharyngeal surgical approaches have been used, a comprehensive review of the results of such procedures has not been reported. In this report a detailed description of the anterolateral extrapharyngeal approach for the excision of these osteophytes is given, and its value compared to other surgical techniques discussed.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/9. Dysphagia complications in ankylosing spinal hyperostosis and ossification of the posterior longitudinal ligament. Roentgenographic findings of the developmental process of cervical osteophytes causing dysphagia.This is the first report of the process of formulation of a cervical osteophyte causing dysphagia. The patient had ankylosing spinal hyperostosis and OPLL and was followed radiographically for a long time before the onset of dysphagia. The radiological observation suggested that dysphagia was produced when the immobile part of the esophagus was compressed by the anterior projecting cervical osteophyte. The immobility of the esophagus is an important factor in determining whether dysphagia occurs. Another possible contributing factor to dysphagia in this patient was the ossification of the cervical anterior and posterior longitudinal ligaments. The OPLL affected intervertebral segmental motion and induced the formation of anterior projecting cervical osteophytes.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/9. Anterior interbody fusion with the BAK-cage in cervical spondylosis.BAK-C is a new autostabilizing interbody cage which is implanted during an anterior cervical procedure to provide stability to the motion segment and allow fusion to occur. Special instrumentation is provided with a bone collecting reamer. The system utilizes surgical site bone graft as the osteo-inductive material within the implant. Biomechanical testing indicates improved stability and animal studies show good fusion. The basic principle is distraction-compression using the tension forces of the annulus fibrosus. Operative material concerns a two years experience with 80 patients (101 levels), 72 with cervical radiculopathy, 8 with myelopathy. Clinical evaluation is assessed on a ten point analogue pain scale for neck and arm/shoulder pain, with neurological examination. Radiological evaluation includes dynamic x-rays, myelo-CT and MRI. patients are re-evaluated at 1, 6, 12 months postoperatively. Results for neck and radicular pain is excellent, but neurological recovery for radiculopathy and myelopathy is quite different. Radiological results are also good with (except one case) no instability, no cage migration, no kyphosis, no pseudarthrosis. Bone fusion is assessed at 6 and 12 months. Complications are few with proper technique, mainly correct distraction, symmetrical endplate drilling and lateral X-ray control. Only one patient needed an early re-operation with additional miniplate fixation. Immediate stability with good clinical response and no graft morbidity are the advantages of this implant compared to conventional cervical interbody grafting techniques.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/9. Radiculitis distress as a mimic of renal pain.It is the experience of the urological author that radiculitis secondary to costovertebral joint derangement is the most common cause of lower abdominal pain. However, this pain is sometimes made worse when the patient is subjected to a flank incision for presumed renal disease, since the aftermath of a flank incision may be a downward pull on a rib owing to detachments of muscles attached to its superior surface. Emotional problems, too, befall many patients with radiculitis--despondency over delayed diagnoses or sensitivity at having been told their complaints are psychosomatic. Most often these difficulties disappear spontaneously once the pain is relieved. Definitive diagnosis requires orthopedic techniques. Unfortunately, few orthopedists are well versed or interested in the syndrome of renal pain. When they are, erroneous diagnosis can be corrected and a course of conservative or surgical treatment prescribed, with excellent results.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |