PubMed · 14349027
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A REUTER. 1954-10-15. [Cervical intervertebral disk displacement].. https://pubmed.ncbi.nlm.nih.gov/14349027/
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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.
Syringomyelia is generally associated with Chiari type malformations, spinal tumors, or spinal trauma. Cervical spondylosis is only rarely involved. We here present a case of a 64-year-old woman with severe radicular pain in the right arm and the syringomyelic syndrome. Lateral radiographs of the cervical spine demonstrated spondylotic change at the C4/5 and C6/7 levels, and instability at C4/5. Dynamic magnetic resonance (MR) imaging revealed the spinal cord to be compressed at C5 and C6 with the body in extension, and the syrinx extended from C2 to the Th3 level on sagittal images. It was reduced remarkably after anterior decompression and stabilization at C4/5 and C6/7, and her symptoms also improved after surgery. We concluded that the syrinx in this case might have developed due to craniospinal pressure dissociation caused by intermittent spinal cord compression.
PURPOSE: To investigate the influence of the cranial border of electively irradiated Level II lymph nodes on xerostomia in patients with oropharyngeal cancer using three-dimensional conformal and intensity-modulated radiotherapy (3D-CRT and IMRT). METHODS AND MATERIALS: The target volumes and organs at risk were delineated on the planning CT scans of 12 patients. Two elective target volumes were delineated. The first had the transverse process of the C1 atlas and the second had the transverse process of the C2 axis as cranial border of the Level II lymph nodes. 3D-CRT and IMRT planning were performed for both elective volumes, resulting in two plans per patient and technique, called the C1 and C2 plans, respectively. Irradiation of the ipsilateral elective volume up to C1 and the contralateral up to C2 was also performed for IMRT. The normal tissue complication probability (NTCP) for xerostomia 1 year after RT was calculated using the parotid mean dose. RESULTS: The average mean dose +/- standard deviation (SD) to the contralateral parotid gland was reduced from 33 +/- 5 Gy for the IMRT C1 plans to 26 +/- 4 Gy for the IMRT C2 plans and from 51 +/- 6 Gy to 49 +/- 7 Gy for the 3D-CRT C1 and C2 plans, respectively. The associated NTCP +/- SD for xerostomia was 38% +/- 10% for IMRT C1 plans and 24% +/- 6% for IMRT up to C2 on the contralateral side, regardless of which cranial border was irradiated on the ipsilateral side. For the 3D-CRT C1 and C2 plans, an NTCP value of 74% +/- 12% and 71% +/- 15% was obtained, respectively. The NTCP for xerostomia of the ipsilateral parotid gland was 53% +/- 17% and 45% +/- 20% for the IMRT C1 and C2 plans and 89% +/- 11% and 87% +/- 12% for the 3D-CRT C1 and C2 plans, respectively. CONCLUSION: Lowering the cranial border of the Level II lymph nodes from C1 to C2, in the case of bilateral elective neck irradiation, could be considered on the contralateral side when the risk of metastasis on that side is very low. This is especially true when IMRT is used, because the relative reduction of NTCP for xerostomia 1 year after RT could be up to 68% compared with conventional conformal RT up to C1.