1/9. Surgical management of dissociated motor loss following complex cervical spine reconstruction.STUDY DESIGN: A case of surgical management of dissociated motor loss after decompression of the cervical spine is reported. OBJECTIVES: To present a rationale for surgical treatment of postdecompressive cervical radiculopathy with an illustrative case example. SUMMARY OF BACKGROUND DATA: The unusual complication of radiculopathy after multilevel cervical decompressive procedures is characterized by pain or dissociated motor weakness of the C5 and C6 nerve roots. Conservative management paradigms, including analgesics and steroids, are the rule, but symptoms often persist for many months. There are currently no reports describing foraminotomy as a means of more rapidly alleviating the symptoms of radicular pain and deltoid and biceps brachii weakness seen in the postoperative setting. methods: We present a case of bilateral C5 and C6 radiculopathy following multilevel cervical decompression for cervical spondylotic myelopathy, which we treated with posterior foraminotomies. RESULTS: The patient reported complete resolution of his dermatomal pain and demonstrated rapid improvement in upper extremity strength as compared to traditional conservative treatments. The historical experience and pathogenesis regarding this postoperative complication are reviewed. The rationale of root-specific posterior decompression for this debilitating complication is discussed. CONCLUSIONS: Foraminal decompression of the affected nerve roots as demonstrated here has not been described for postdecompressive dissociated motor loss. Such an approach may offer earlier and more complete relief to patients suffering from this unfortunate complication.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
2/9. A case report of postulated 'Barre Lieou syndrome'.The case history presented is of a 32 year old woman suffering with severe occipital and bilateral temporal pain together with autonomic disturbances affecting her vision, balance and breathing, symptoms which have been postulated as 'Barre Lieou syndrome'. She complained of pain referred to the left arm and associated circulatory and sensory disturbance in keeping with the diagnosis of complex regional pain syndrome type I. Traditional Chinese and Western trigger point acupuncture techniques were used in order to treat her pain and autonomic dysfunction. acupuncture was successful in reducing, but not totally alleviating, her pain, and was particularly effective in reducing the majority of autonomic symptoms.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
3/9. low back pain disorders: lumbar fusion?The role of lumbar spine arthrodesis in the treatment of low back pain disorders remains a highly disputed and controversial subject. There are no clear-cut indications for lumbar spine fusion in lumbar degenerative disc disease. In fact, lumbosacral fusion when added to appropriate decompressive surgery has failed on careful statistical analysis to significantly improve the results over decompressive surgery alone. Moreover, in several large series in the literature of lumbosacral fusion in conjunction with discectomy, the results in patients who developed a pseudoarthrosis did as well as matched cases who obtained an excellent arthrodesis. These results should not be surprising since there does not appear to exist a generally accepted operational definition of mechanical (lumbar instability) pain. The author, however, is of the opinion that lumbosacral arthrodesis will prove to have a definite, albeit small, role in the management of the intractable and incapacitating low back pain disorders. This is based on personal clinical experience and the belief that the phenomenon of intractable and incapacitating mechanical low back pain syndromes do exist. Carefully performed prospective clinical studies are requisite to define the mechanical low back pain syndrome and the role of lumbar arthrodesis in the treatment of the low back pain disorders. Given our present limitations, the author suggests that lumbosacral arthrodesis be reserved for patients suffering spondylotic low back pain syndromes who have the following characteristics: intractable and disabling pain; primary complaint of segmental mechanical pain; radiologic evidence consistent with "instability"; minimal or no segmental disease above proposed site of arthrodesis; and minimal or absent psychosocial-economic pain.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
4/9. Myelopathy hand characterized by muscle wasting. A different type of myelopathy hand in patients with cervical spondylosis.While the authors have often observed the hand presenting spastic dysfunction and deficient pain sensation in patients with cervical compression myelopathy, which has been termed "Myelopathy hand," they have occasionally seen a different type of myelopathy hand characterized by muscle wasting and motor dysfunction in patients with cervical spondylosis. This type of myelopathy hand they have termed "amyotrophic type of myelopathy hand." Because it is similar to the hand of a patient suffering from motor neuron disease, and yet is treatable, the authors thought it worthwhile to report this type of hand in detail. The main clinical features are localized wasting and weakness of the extrinsic and intrinsic hand muscles, but not accompanied by either sensory loss or spastic quadriparesis. For an accurate diagnosis, attention should be paid to the narrow anteroposterior (AP) canal diameter of the cervical spine (less than 13mm), multisegmental spondylosis in C5-6 and C6-7 disc levels and a reduced transectional area of the spinal cord at the C7, C8, or T1 spinal cord segments. To date the authors have seen 15 patients with this hand; seven underwent either spondylectomy or laminoplasty. In six patients who were satisfied with surgical results, recovery from muscle wasting and weakness was seen.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
5/9. Subcortical vascular encephalopathy in a normotensive, young adult with premature baldness and spondylitis deformans. A clinicopathological study and review of the literature.Progressive subcortical vascular encephalopathy (PSVE) usually occurs in elderly individuals, suffering from hypertension. We here describe a male, born of consanguineous parents, who first showed signs of PSVE at the age of 30. Despite the absence of hypertension or known metabolic causes, the degenerative cerebral vascular disease developed progressively. Several cases, surprisingly identical to the one reported here, were traced using Japanese medical records. They are clinically characterized by: early onset of PSVE (at age 25-30), absence of persistent hypertension, diffuse alopecia since youth, spondylitis deformans with early onset, often so severe as to necessitate surgery, and the possible existence of an autosomal recessive transmission. Cases with these features appear to constitute a distinct clinical entity, possibly a new form of premature aging syndrome.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
6/9. Large cervical osteophyte--another cause of difficult flexible fibreoptic intubation.A patient suffering from ankylosing spondylitis required surgical excision of a large anterior osteophyte of the cervical spine. Fibreoptic nasal intubation was difficult due to distortion of the airway by the osteophyte. This cause of difficult flexible fibreoptic intubation has not been described previously.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
7/9. Cervical spondylotic myelopathy.OBJECTIVE: To present the clinical and neurological features of a patient suffering from cervical spondylotic myelopathy. CLINICAL FEATURES: Cervical spondylotic myelopathy (CSM) is a condition in which the vascular and neural structures are compressed by bony spurring and soft tissue hypertrophy, causing ischemic damage to the spinal cord. Although cervical spondylotic myelopathy is the most common cord disorder in older adults, the diagnosis is often missed because the initial symptoms are subtle and the condition usually presents with associated conditions such as nerve root involvement. INTERVENTION: The patient was referred to a neurosurgeon for a posterior decompressive laminectomy. The advancing symptoms of CSM were apparently halted by the surgery in this case, until complication from a fall resulted in quadriplegia. CONCLUSION: Appropriate testing can aid differential diagnosis of the condition and expedite appropriate management of the condition. Treatment may include surgical cervical decompression of the involved area. An untreated progressive spondylotic myelopathy may cause permanent neurological damage to the spinal cord. attention should be paid to the clinical signs and treatment of this underdiagnosed condition.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
8/9. Management of cervical disc herniation with upper cervical chiropractic care.OBJECTIVE: To discuss the chiropractic management of a patient suffering from multiple complaints, including a herniated nucleus pulposus in the cervical spine diagnosed by magnetic resonance imaging (MRI). CLINICAL FEATURES: A 34-yr-old man suffered from severe neck, lower back and radicular pain of 1 yr duration. He had previously received care from multiple medical specialists, with little or no results. An MRI of the cervical spine demonstrated a C6-C7 herniated nucleus pulposus. A needle electromyogram examination confirmed the presence of a C6-C7 radiculopathy with radiculopathic changes from C4-C7. X-ray analysis showed that the atlas and axis were misaligned. These x-rays were read manually (with a template) and with computer-assisted digitization. Computerized analysis also measured misalignments at the levels of L4-L5. INTERVENTION AND OUTCOME: The patient was managed primarily with the Grostic Procedure of upper cervical adjusting by hand. After a period of about 1 month, a series of re-examinations revealed a dramatic improvement in all subjective and objective findings. A follow-up of > 1 yr has shown that surgery was not necessary. CONCLUSION: This single case study suggests that chiropractic care may be a viable treatment option for patients with cervical disc herniation. Further investigation into chiropractic adjustments as a treatment for this condition should be pursued.- - - - - - - - - - ranking = 1keywords = suffering (Clic here for more details about this article) |
9/9. The Bi-Digital O-Ring Test used in the successful diagnosis & treatment (with antibiotic, anti-viral agents & oriental herbal medicine) of a patient suffering from pain & weakness of an upper extremity & Barre-Lieou syndrome appearing after whiplash injury. A case report.A patient with a whiplash injury suffering from prolonged symptoms, including pain and weakness of the right upper extremity and the symptoms of Barre-Lieou syndrome, was diagnosed and treated with the Bi-Digital O-Ring Test as a supplement to standard medical examinations. Radiological findings showed spondylotic canal stenosis with osteophytes and disc protrusions. The Bi-Digital O-Ring Test indicated a strong abnormal response around the right side of his neck and right shoulder, including the area of the vertebral artery and at acupuncture point GB 21, where positive resonant responses to cytomegalovirus and streptococcus faecalis were detected. Antibiotic and anti-viral agents, as well as Ku-Oketsu-Zai, a type of Oriental herbal medicine for overcoming blood stagnation or stasis, were administered according to the drug compatibility test using the Bi-Digital O-ring Test and the following clinical results were obtained. infection at the site of the vertebral artery and the peri-arterial sympathetic nerve plexus was considered as a cause of the prolongation of the symptoms including Barre-Lieou syndrome, in this case. In addition we especially noted, in this clinical case, that the patient's impaired grasping force dramatically improved from 8 kg to 52 kg in a very short periods of time when the patient held suitable medicine selected with the Bi-Digital O-Ring Test drug compatibility test. We assume that the drug action was transferred electromagnetically, by which the pathological electromagnetic oscillations caused by trauma and following infections were scavenged. This effect might lead to an improvement in the coordination of the neuromuscular system.- - - - - - - - - - ranking = 5keywords = suffering (Clic here for more details about this article) |