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PubMed2001

Cervical spondylosis: the role of anterior instrumentation after decompression and fusion.

The role of plate stabilization after anterior decompression and fusion of the cervical spine for cervical spondylosis remains controversial. This study aimed to justify the use of instrumentation to stabilize anterior cervical fusion for cervical spondylosis through a risk-benefit analysis and comparison of the results with those reported in the literature on the outcome of fusion without instrumentation. The authors retrospectively reviewed the charts and radiographs of 47 patients with symptoms secondary to cervical spondylosis who underwent anterior cervical decompression and instrumented fusion. After operation, patients were mobilized early, and neither neurologic injury nor infection developed in any patient. At an average 3.4 years after surgery, the rate of graft complications, including nonunion (4.26%), was low, whereas the rate of hardware-related morbidity was minimal (6%). An average 0.4 degrees loss of the intraoperative correction of cervical lordosis was observed at the last follow-up examination. Accelerated degenerative changes at levels adjacent to the fusion were seen in 17% of patients, but only two patients required repeat operation for persistent symptoms. The use of instrumentation to stabilize the cervical spine in patients with cervical spondylosis after anterior decompression and fusion is relatively safe. It permits early pain-free mobilization, successfully maintains sagittal cervical spine alignment, and promotes consistent and reliable spinal fusion.

Adult↗

PubMedDate not supplied

The developmental segmental sagittal diameter in combined cervical and lumbar spondylosis.

Spondylosis diffusely affects the vertebral column but is more pronounced in the cervical and lumbar regions where mobility is greatest. Of 214 patients treated for symptomatic spinal spondylosis, 63 patients (29%) were found to have symptoms related to the cervical spine alone: 123 (58%) had symptoms relative to the lumbar spine alone; 28 (13%) were found to have symptoms relative to both the cervical and lumbar spine in a retrospective clinical study. The incidence of occurrence of a narrow spinal canal was determined. In the patients with cervical spondylosis alone, 40 patients (64%) were found to have midcervical sagittal diameters below average. Eighty-seven patients (71%) with lumbar spondylosis had spinal canals below the average measurements. In the group of patients with combined disease of the cervical and lumbar spine, 18 of the 28 patients (64%) had spinal canal diameters below the accepted average values.

Cervical Vertebrae↗

PubMed1998

The role of decompression for acute incomplete cervical spinal cord injury in cervical spondylosis.

STUDY DESIGN: A prospective study was conducted in 37 patients with cervical spondylosis with incomplete cord injury to assess the role of decompression in these patients. OBJECTIVES: To evaluate surgical and nonsurgical outcomes in patients with pre-existing cervical spondylosis of the spine, in whom an incomplete spinal cord syndrome developed after a minor neck injury. SUMMARY OF BACKGROUND DATA: The benefits of surgical treatment of incomplete cord injury with cervical spondylosis is controversial but remains a treatment option. The results of this study clarified the benefits of surgery in such patients. METHODS: Radiographic findings and outcomes based on post-spinal injury motor function score were compared retrospectively in 37 patients with cervical spondylosis. Sixteen patients were treated operatively and 21 were treated nonoperatively. RESULTS: The neurologic conditions of 13 of the 16 patients (81.2%) treated surgically improved within 2 days of surgery. Comparing the improvement of the two groups at defined intervals, there were statistically significant differences (P < 0.006) between the surgical and nonsurgical patients at 1-month and 6-month follow-ups. Nevertheless, 13 of the 21 patients (62%) treated nonoperatively had recovered to at least muscle Grade 3 at the 2-year follow-up, but their recovery was slower than that of the surgical group. CONCLUSION: Although neurologic improvement after an incomplete spinal cord injury when no bony lesion was present was slow during the first few months after trauma, more than 60% of the patients showed neurologic recovery with a muscle grade higher than 3 at 2-year follow-up. Surgical decompression, however, was associated with immediate neurologic improvement, faster recovery of neurologic function, early mobilization, better long-term neurologic outcome, briefer hospital stays, and fewer complications related to long confinements in bed than was nonoperative treatment.

Adult↗

PubMed1995

Spondylosis deformans in the boxer: estimates of heritability.

This study presents the estimates of heritability for spondylosis deformans in the boxer based on 353 offspring from 24 randomly selected sires, each with at least three radiographically investigated offspring. The estimated heritability (h2) for maximum degree of osteophyte development was high, both when estimated by paternal half-sib correlation (0.42) and by the regression of offspring based on the parents (0.62). The heritability for the number of affected discs estimated by paternal half-sib correlation was also high (0.47). The estimate of heritability for the number of affected discs based on regression of offspring on the parents was lower at 0.13. All heritabilities had large standard errors. A positive phenotypic correlation between spondylosis deformans and hip dysplasia was observed. Assuming a significant portion of the correlation is genetic, this fact may permit selection against spondylosis deformans without negatively influencing the incidence of hip dysplasia. Since the incidence of spondylosis deformans is high even in young dogs, it should be possible to detect a large proportion of genetically predisposed animals by radiographic examination of the spine at one year of age; at the same time that dogs are presented for a routine test for hip dysplasia.

Animals↗

PubMed1989

Anterior cervical vertebrectomy and interbody fusion for multi-level spondylosis and ossification of the posterior longitudinal ligament.

Multi-level cervical spondylosis and ossification of the posterior longitudinal ligament (OPLL) are well-documented causes of myelopathy. The choice of surgical procedures remain controversial. Between January 1983 and December 1987, we have performed anterior cervical vertebrectomy in 45 patients with cervical myelopathy caused by multi-level spondylosis and OPLL. They consisted of 19 patients with cervical spondylosis, 12 with OPLL, and 14 with combined lesions of both cervical spondylosis and OPLL. There were 32 men and 13 women. The mean age was 55 years, ranging from 35 to 70 years. In all of our 45 patients, anterior vertebrectomy, discectomy, removal of posterior osteophytes and OPLL, and interbody fusion were done for progressive myelopathy refractory to conservative treatment. In 2 of 45 patients, 5 vertebral bodies were resected; in 3 patients, 4 vertebral bodies were resected; in 12 patients, 3 vertebral bodies were resected, in 19 patients, 2 vertebral bodies were resected; and in 9 patients, 1 vertebral body was resected. Thirty-nine of 45 patients (87%) had good results. Neurological signs did not improve in 5 patients (11%). One patient died because of agranulocytosis secondary to treatment with antibiotics. In conclusion, cervical cord compression caused by lesions located principally in the anterior aspect of the spinal canal may be completely relieved via anterior vertebrectomy, discectomy, removal of the calcified ligament, and fusion.

Adult↗

PubMed2001

Distribution of genes for bone morphogenetic protein-4, -6, growth differentiation factor-5, and bone morphogenetic protein receptors in the process of experimental spondylosis in mice.

OBJECT: Because little is known about the molecular mechanisms underlying the process of spondylosis, the authors examined the extent of genetic localization of several members of bone morphogenetic protein (BMP) and BMP receptors in chondrogenesis during the process of inducing spondylosis in their previously established experimental mice model. METHODS: Experimental spondylosis was induced in 5-week-old ICR mice. The cervical spine was harvested chronologically, and histological sections were prepared. Messenger RNA for BMP-4, growth and differentiation (GDF)-5, BMP-6, and BMP receptors (ALK-3, -6, and BMP-RII) was localized in the tissue sections by in situ hybridization. In the early stage, BMP-4-derived mRNA was localized mainly in cells in the anterior margin of the cervical discs, together with ALK-6 and BMP-RII mRNA. No GDF-5 and BMP-6 mRNA was detected at this stage. In the late stage, cells positive for BMP-4 decreased, whereas GDF-5 and BMP-6 mRNA were localized in cells undergoing chondrogenesis. The ALK-3 mRNA began to appear in this stage, as did ALK-6 and BMP-RII. CONCLUSIONS: The localization of transcripts for BMP-4, -6, and GDF-5 as well as BMP receptors shown during the present experimental model indicate the possible involvement of molecular signaling by these BMPs in the chondrogenic progress in spondylosis.

Animals↗

PubMed2002

Distribution of genes for parathyroid hormone (PTH)-related peptide, Indian hedgehog, PTH receptor and patched in the process of experimental spondylosis in mice.

OBJECT: Little is known about the molecular mechanisms underlying the process of spondylosis. The authors determined the extent of genetic localization of major regulators of chondrogenesis such as Indian hedgehog (Ihh) and parathyroid hormone (PTH)-related peptide (PTHrP) and their receptors during the development of spondylosis in their previously established experimental mouse model. METHODS: Experimental spondylosis was induced in 5-week-old ICR mice. The cervical spines were chronologically harvested, and histological sections were prepared. Messenger (m) RNA for PTHrP, Ihh, PTH receptor (PTHR; a receptor for PTHrP), patched (Ptc; a receptor for Ihh), bone morphogenetic protein (BMP)-6, and collagen type X (COL10; a marker for mature chondrocyte) was localized in the tissue sections by performing in situ hybridization. In the early stage, mRNA for COL10, Ihh, and BMP-6 was absent; however, mRNA for PTHrP, PTHR, and Ptc was detected in the anterior margin of the cervical discs. In the late stage, evidence of COL10 mRNA began to be detected, and transcripts for Ihh, PTHrP, and BMP-6 were localized in hypertrophic chondrocytes adjacent to the bone-forming area in osteophyte. Messenger RNA for Ptc and PTHR continued to localize at this stage. In control mice, expression of these genes was absent. CONCLUSIONS: The localization of PTHrP, Ihh, BMP-6, and the receptors PTHR and Ptc demonstrated in the present experimental model indicates the possible involvement of molecular signaling by PTHrP (through the PTHR), Ihh (through the Ptc), and BMP-6 in the regulation of chondrocyte maturation leading to endochondral ossification in spondylosis.

Animals↗

PubMed2005

Expression of c-fos in gastric myenteric plexus and spinal cord of rats with cervical spondylosis.

AIM: To determine the expression of c-fos in gastric myenteric plexus and spinal cord of rats with cervical spondylosis and its clinical significance. METHODS: A cervical spondylosis model was established in rats by destroying the stability of cervical posterior column, and the cord segments C(4-6) and gastric antrum were collected 3, 4 and 5 mo after the operation. Rats with sham operation were used as controls. c-fos neuronal counter-staining was performed with an immunohistochemistry method. Every third sections from C(4-6) segments were drawn. The 10 most labeled c-fos-immunoreactive (Fos-IR) neurons were counted, and the average number was used for statistical analysis. The mean of Fos-IR neurons in myenteric plexus was calculated after counting Fos-IR neurons in 25 ganglia from each antral preparation, and expressed as a mean count per myenteric ganglion. RESULTS: There were a few c-fos-positive neurons in the cervical cord and antrum in the control group. There was an increased c-fos expression in model group 3, 4 and 5 mo after operation, whereas there was no significant increase in c-fos expression in the control group at 3, 4 and 5 mo. More importantly, there was a significant difference in c-fos expression between rats followed up for 3 mo and those for 5 mo in the model group (11.20+/-2.26 vs 27.68+/-4.36, P<0.05, for the cervical cord; and 11.3+/-2.3 vs 29.3+/-4.6, P<0.05, for the gastric antrum). There was no significant difference between rats followed up for 3 mo and those for 4 mo and between rats followed up for 4 mo and those for 5 mo in the model group. CONCLUSION: c-fos expression in gastric myenteric plexus was dramatically associated with that in the spinal cord in rats with cervical spondylosis, suggesting that the gastrointestinal function may be affected by cervical spondylosis. If this hypothesis is confirmed by further studies, functional gastrointestinal diseases such as functional dyspepsia and irritable bowel syndrome could be explained by neurogastroenterology.

Animals↗

PubMed1999

[The clinical features of cervical spondylosis with boule musculaire].

To clarify the pathophysiology of boule musculaire associated with cervical spondylosis, we investigated the 13 patients (11 males and 2 females) with cervical radiculopathy caused by cervical spondylosis. None of the patients had any subjective symptoms such as sensory disturbance, weakness in the boule musculaire, and muscle atrophy of the insurround region near the boule musculaire. Among 21 tendon reflexes of the biceps muscle of the arm, 9 were normal, 8 were decreased and 4 were increased. Among the 13 patients there was only 2 clinical cases of cervical myelopathy. MRI obtained from 3 patients demonstrated a compressed cervical cord. Electromyography obtained from 7 patients demonstrated mild neurogenic changes such as polyphasic or prolonged motor unit potential (MUP) in the boule musculaire and in the atrophic regions. However, there was no giant MUP, fasciculation, fibrillation, nor positive sharp waves suggesting denervating lesions below the anterior horn in any patient. It was considered that the boule musculaire observed in cervical spondylosis gradually developed from a relatively mild disturbance of the ventral root. Moreover, the boule musculaire developed more often in the male patients, and predominantly on the right side. Cervical spondylosis accompanying boule musculaire may be a prodromal stage or a mild type of cervical spondylotic amyotrophy.

Aged↗

PubMed2002

Effect of cervical instability in sympathetic cervical spondylosis.

OBJECTIVE: To investigate the etiology and treatment of sympathetic cervical spondylosis (SCS). METHODS: Twenty patients who with SCS had undergone operations for sympathetic cervical spondylosis were reviewed retrospectively from 1988 to 2000. Lateral views in flexion and extension of pre- and postoperative cervical X-ray were analyzed to quantify cervical instability. RESULTS: Cervical instability was detected at one level in seven patients, two levels in ten patients, three levels in three. Cervical instability mainly occurred at C(3)-C(4) and C(4)-C(5). Cervical epidural block had a short time effect in the greater part of patients. Cervical discectomy and fusion at unstable segment was carried out in all 20 cases. The effective rate was 90%. CONCLUSIONS: Cervical instability at C(3)-C(4) or C(4)-C(5) maybe an important factor in the etiology of sympathetic cervical spondylosis. Cervical epidural block may provide diagnostic information. Anterior cervical fusion were effective to treat sympathetic cervical spondylosis.

Adult↗

PubMed2003

[Role of motor evoked potentials in the diagnosis of myelopathy associated with cervical spondylosis].

INTRODUCTION: Motor evoked potential (MEP) is the only method that is able to assess the function of the corticospinal tract in various neurological conditions, such as myelopathies. Myelopathy associated with cervical spondylosis, especially at an early stage, has often slight and non-specific clinical signs, pointing to the importance of the electrophysiological assessment of the spinal cord. The authors' aim was to investigate the sensitivity of MEP examination in the detection of myelopathy secondary to cervical spondylosis. PATIENTS AND METHODS: Patients were classified into three groups according to clinical signs and symptoms: Group I includes patients who have cervical spondylosis as demonstrated by MRI (narrowing of the spinal canal, discal herniation, spinal cord compression) but no complaints or signs suggestive of myelopathy. RESULTS: In Group II patients had minor, non-specific complaints, such as paraesthesia of the legs and gait disturbance raising the possibility of myelopathy, but neurological examination revealed no pyramidal signs. In Group III patients had pyramidal signs as well. In Group I corticospinal function was normal in all patients, as assessed by MEP examination. In Group II all patients had prolonged central motor conduction time or absent responses to cortical stimulation. Likewise, in Group III MEP revealed abnormal corticospinal function in all patients but one. CONCLUSIONS: In summary, MEP proved sensitive in the detection of corticospinal dysfunction in myelopathy associated with cervical spondylosis at a stage when clinical signs of pyramidal lesion are not yet present and patients have only minor complaints. On the other hand, if patients are completely symptom free with regard to myelopathy, MEP is also unlikely to disclose corticospinal dysfunction. If pyramidal lesion is evident already by clinical examination, MEP provides no further help. 'False-negative' results are also possible.

Adult↗

PubMed2002

Effects of cervical traction and exercise therapy in cervical spondylosis.

A randomised clinical trial was conducted in the Department of Physical Medicine, Chittagong Medical College Hospital from July, 2001 to June, 2002. The objectives of the study were to find out the effects of cervical traction (CT) and exercise on the patients with chronic cervical spondylosis. A total of 199 patients with cervical spondylosis were included in the clinical trial. One hundred patients were treated with cervical traction plus exercise and 99 patients were treated with non-steroidal anti-inflammatory drug (NSAID). Posture correction advice was given to all patients. The patients were treated for 6 weeks. There was a marked improvement in both the groups after treatment (P<0.001). But there was nearly significant difference regarding improvement in treatment with CT plus exercise than with NSAID (P = 0.06). The results indicate that the improvement of the patients with chronic cervical spondylosis was more in CT plus exercise than analgesics. So, CT & neck muscle strengthening exercise may have some more beneficial effects than NSAIDs on chronic cervical spondylosis.

Adult↗

PubMed1989

The pathogenesis of cervical spondylosis.

Cervical spondylosis is a generalized disease process affecting all levels of the cervical spine. Cervical spondylosis encompasses a sequence of degenerative changes in the intervertebral discs, osteophytosis of the vertebral bodies, hypertrophy of the facets and laminal arches, and ligamentous and segmental instability. The natural history of cervical spondylosis is associated with the aging process. Senescent and pathologic processes are thus morphologically indistinguishable. Clinical manifestations of cervical spondylosis may arise when morphologic sequelae are superimposed on a developmentally narrow spinal canal. The two clinical syndromes of spondylotic radiculopathy and myelopathy are distinct, yet they may overlap.

Cervical Vertebrae↗

PubMed1977

Increased frequency of HLA B8 in hyperostotic spondylosis.

HLA antigens were determined in 50 patients with hyperostotic spondylosis (Forestier's disease), and compared with 1244 normal controls. There was no significant difference in the distribution of HLA B27 between the two groups. However, there was an increased incidence of HLA B8 among the patients with hyperostotic spondylosis (42 per cent), as compared to the normal controls (17.5 per cent). This difference was statistically significant (p less than 0.005). Sixteen of the 50 patients with hyperostotic spondylosis had evidence of diabetes mellitus, 12 of whom also had the HLA B8 antigen. Thus patients with hyperostotic spondylosis have an increased incidence of HLA B8, associated with an increased incidence of diabetes mellitus.

Diabetes Complications↗

PubMed1987

Cervical spondylosis and headaches.

The incidence of headaches in well documented cases of cervical spondylosis with neurological disability was reviewed. This was compared to that in a series of cases with a clinical diagnosis of tension headache in order to determine if there were any identifiable differences between the two types of headache. Fifty-nine cases of cervical spondylosis were reviewed. Five of these patients had headaches. Fifty patients with tension headaches were also reviewed. No differences were seen when location or other qualitative features of the headaches were compared between the two groups of patients. We conclude that the incidence of headache is low in cervical spondylosis and that the pattern of headache has no features that distinguish it from that of tension headache, suggesting that the pathogenesis is similar. We therefore suggest that the basis of headache in patients with cervical spondylosis is secondary muscle contraction.

Cervical Vertebrae↗

PubMed1986

Comparative retrospective study of patients operated for cervical disc herniation and spondylosis.

173 patients suffering from symptoms of cervical disc herniation or spondylosis were surgically treated during 1975 through 1984 by Cloward's method via the anterior route or by total or hemilaminectomy with Epstein's foraminotomy via the posterior route. Of the 41 patients with disc herniation, 37 had radiculopathy as the main disorder and only 4 myelopathy. Of the 132 spondylosis cases radiculopathy was the main disorder in 92 and myelopathy in 40 cases. The operative route was selected according to the site of the osteophytes or disc herniation. The criteria for operative treatment were persistent radicular pain, motor weakness and progressive muscle atrophy, or evidence of cord compression. All patients underwent myelography preoperatively and sometimes also x-ray computed tomography. A clear correlation between the roentgenographic findings, clinical signs and symptoms served as the prerequisite for operative treatment. Follow-up review an average of 55 months after the operation showed excellent or good results in 80% of the disc herniation cases, but in only 35% of those with spondylosis. However, in the latter group pain relief was obtained in 76% of cases. In the spondylosis series there were significant correlations between the parameters of severity of disease and duration of symptoms and the surgical results, whereas in the disc herniation series no clear correlations were observed. Gait disturbances associated with myelopathy were only minimally relieved. There was no clear correlation after surgery between the degree of the disease and working capacity, but the duration of preoperative disability was significant in this respect. Postoperative complications were infrequent and no severe complications occurred.

Adult↗

PubMedDate not supplied

Relationship between load carrying on the head and cervical spondylosis in Ghanaians.

Three hundred and five patients (164 males and 141 females) with mean age 39.9 with standard deviation 7.3 and a range of 29-78 years were involved in a study to find out the relationship between load carrying on the head and cervical spondylosis. Out of 225 patients who carried loads on their head, 143 (63.6%) had cervical spondylosis, and of the 80 people who did not carry load on their head, 29 (36%) had cervical spondylosis. 131 (58%) of those who carried load did so regularly with an average weight of about 15 kg or more over a period 10-15 years or more. It is concluded that cervical spondylosis is not exclusively an ageing phenomenon, but that regular heavy load carrying on the head plays an aetiological role.

Adult↗

PubMed1994

Extensive anterior decompression for mixed cervical spondylosis. Resection of uncovertebral joints, neural and transverse foraminotomy, subtotal corpectomy, and fusion with strut graft.

STUDY DESIGN: This study examined a new operative procedure for treating mixed cervical spondylosis. OBJECTIVES: To relate postoperative results with extensive decompression using a surgical microscope. SUMMARY OF BACKGROUND DATA: Based on the dissection cadavers and clinical practice, extensive anterior decompression has been designed for mixed cervical spondylosis. It has not been reported that the cervical cord, nerve roots, and vertebral arteries have been decompressed thoroughly at the same time. METHODS: Fifteen patients with mixed cervical spondylosis were treated with extensive anterior decompression using an operative microscope. The pathologic segments in all patients were identified preoperatively with cervical radiography, myelography, computed tomography, computed tomographic myelography, and magnetic resonance imaging. The Japanese Orthopaedic Association classification was used to assess the follow-up results. The operative results demonstrated the efficacy of the surgical approach. RESULTS: All patients improved neurologically, with the average Japanese Orthopaedic Association score improving from 6.3 points preoperatively to 12.4 points at follow-up examination. The plain radiography, computed tomography, and magnetic resonance imaging follow-up examination showed that the anterior part of the cervical canal and the transversaria or neural foramina were enlarged, and that there was satisfactory bony fusion without signs of nonunion and other complications. CONCLUSIONS: Extensive anterior decompression (resection of uncovertebral joints, neural and transverse foraminotomy, subtotal corpectomy, and fusion with strut graft), a new surgical procedure for treating mixed cervical spondylosis, led to excellent follow-up results.

Adult↗