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PubMedDate not supplied

The developmental segmental sagittal diameter of the cervical spinal canal in patients with cervical spondylosis.

The role of the narrow cervical spinal canal in the expression of clinical syndromes in the cervical spine was investigated in a retrospective review of 63 patients with symptomatic cervical spondylosis refractory to conservative therapy. The measurement of the developmental segmental sagittal diameter, determined at the level of the pedicle, and of the spondylotic segmental sagittal diameter, determined at the level of the disc, were applied. When divided into groups based on anatomic variance around an average size midcervical diameter of 17 mm, 40 patients were found to have less than the average size of midcervical canal. A spondylosis index was computed for the narrow canal group at 2.08 mm per segment and for the wide canal group at 3.29. Canal dimensions are determinants of symptom production and neurologic compromise.

Adult↗

PubMed1988

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.

Electromyography↗

PubMed2004

Angiogenesis in osteoarthritis and spondylosis: successful repair with undesirable outcomes.

PURPOSE OF REVIEW: Osteoarthritis and spondylosis are frequently described as "wear-and-tear" arthritis, apparently contradicting modern management, which focuses on continuing and progressive exercise. Laboratory findings, including the growth of new blood vessels, encourage comparisons with repair processes. This review aims to place recent evidence in the context of previous work emphasizing the dynamic nature of tissues in these conditions. RECENT FINDINGS: Synovitis has now become recognized as a common and important feature of osteoarthritis, and vascular growth is enhanced in osteoarthritic synovia when infiltrating macrophages generate angiogenic factors. As the molecular balance between angiogenic and antiangiogenic factors is disturbed, new blood vessels are permitted to grow into normally avascular structures, such as the articular cartilage and intervertebral disc. Angiogenesis is a key factor in new bone formation in osteophytes and at the osteochondral junction, thereby contributing to radiologic disease progression. Innervation of new blood vessels may contribute importantly to chronic pain. SUMMARY: Reconceptualizing osteoarthritis and spondylosis as reparative processes provides a pathologic model consistent with current advice to exercise, when exercise facilitates repair. Repair does not, however, lead to normal tissue, and understanding the mechanisms by which changes in joint innervation may occur as a consequence of angiogenesis should lead to novel therapies that alleviate the common symptoms of these highly prevalent conditions.

Cartilage, Articular↗

PubMed2005

Cost-effectiveness of single-level anterior cervical discectomy and fusion for cervical spondylosis.

STUDY DESIGN: Cost-effectiveness analysis with retrospective cost analysis and literature review. OBJECTIVE: To determine the relative cost-effectiveness of anterior cervical discectomy and fusion (ACDF) with autograft, allograft, and allograft with plating for single-level anterior cervical spondylosis. SUMMARY OF BACKGROUND DATA: There are several accepted methods of surgically treating single-level cervical spondylosis anteriorly. No study has clearly demonstrated the superiority of one method over the alternatives. The techniques may differ in their operative risks and resource use, perioperative complications, short-term outcome, and long-term outcome and complications. Formal cost-effectiveness analysis (CEA) provides a structure for analyzing many variables and comparing different treatment outcomes. Sensitivity analysis is used to test the robustness of the model and to determine variables that have significant effects on the results. Future areas of research and refinements of the CEA model can be developed from these findings. METHODS: A retrospective review of hospital charges was performed for 78 patients who underwent single-level ACDF with allograft alone or ACDF with allograft and plating (ACDFP). The charges were converted to estimated costs for fiscal year 2000 using the ratio of costs to charges method. A CEA model was developed consisting of a decision-analysis model for the first year postsurgery and a Markov model for the next 4 years after surgery. Probabilities and outcome utilities were estimated from the literature. Outcome was measured in quality-adjusted life years (QALYs), and incremental CEA was performed. Several variables were tested in one-way sensitivity analysis. RESULTS: Compared with ACDF with autograft, ACDF with allograft offered an improvement in quality of life at a cost of 496 dollars per QALY. ACDFP provided additional gains in quality of life compared with ACDF with allograft at a cost of 32,560 dollars per QALY in the base case analysis. In sensitivity analysis, these estimates varied between 417 dollars and 741 dollars per QALY and between 19,090 dollars per QALY and domination of ACDFP by ACDF with allograft, respectively. The results were most sensitive to assumptions regarding differences in the length of the postoperative recovery period. CONCLUSIONS: ACDF with allograft offers a benefit relative to ACDF with autograft at a cost of 496 dollars per QALY. ACDFP has a benefit relative to ACDF with allograft at an approximate cost of 32,560 dollars per QALY. CEA provides a method for comparing the benefits and risks of these three procedures. Further research needs to be performed regarding these procedures, particularly examining the postoperative recovery period.

Bone Plates↗

PubMed2006

Surgical outcome of posterior decompression for cervical spondylosis with unilateral upper extremity amyotrophy.

STUDY DESIGN: Case studies of patients with cervical spondylosis with unilateral upper extremity amyotrophy. OBJECTIVE: To clarify the surgical outcome of posterior decompression for this amyotrophy. SUMMARY OF BACKGROUND DATA: Cervical spondylosis sometimes causes a characteristic severe muscular atrophy without sensory disturbance or lower-extremity dysfunction, which is the so-called "cervical spondylotic amyotrophy." However, response to treatment, especially to posterior decompression, has not been well understood. METHOD: This study included 32 patients. All underwent posterior cervical laminoplasty, and 22 patients had an additional foraminotomy. Preoperative and postoperative muscle power and results of imaging and electrophysiologic studies were evaluated. The follow-up period averaged 78 months. Whether impingement was against the ventral nerve root (VNR) or anterior horn (AH) in the spinal cord was assessed according to these findings. These cases were divided into proximal type and distal type according to the most severely atrophic muscle and compared statistically. RESULTS: Severe preoperative muscle atrophy was observed in the deltoid and biceps muscles of 24 patients (proximal type) and in the forearm and hand muscles of 8 patients (distal type). Impingements against the VNR and AH were observed in 21 and 28 cases, respectively, and 17 cases had impingement of both the VNR and AH. Improvements in muscle atrophy after surgery were observed in 25 cases. In proximal-type patients, muscle power improved in 92% of cases but was improved in only 38% of the distal-type cases. CONCLUSIONS: Laminoplasty and foraminotomy were effective in the treatment of most patients with this syndrome, although the outcome in the distal type was inferior to that in the proximal type.

Adult↗

PubMed1999

Surgical outcome in patients with coexisting multiple sclerosis and spondylosis.

OBJECTIVES: Multiple sclerosis (MS) is a neuro-degenerative disease of unknown etiology which results in destruction of myelin. A variety of neurologic signs and symptoms are associated with MS and include myelopathy, extremity weakness, low back pain, sciatica and paresthesias. Many of these signs and symptoms are identical to those experienced by patients with spondylosis (e.g. spinal stenosis, disc herniations). The coexistence of MS with spondylosis can be problematic both for diagnosis and treatment. MATERIALS AND METHODS: During the period 1992 to 1996 we identified 7 patients with previously diagnosed MS who developed new syndromes which were thought to be related to a variety of degenerative spine conditions. The diagnosis of MS was based on standard clinical, immunological and neuroradiological criteria. RESULTS: Five of 7 patients demonstrated significant improvement after surgery. One patient experienced a transient MS exacerbation after surgery. CONCLUSIONS: From our series we concluded that surgery for degenerative spine conditions can be performed in a safe and effective manner in patients with coexisting multiple sclerosis.

Adult↗

PubMed1976

Lumbar spondylosis and neuropathic bladder: investigation of 73 patients with chronic urinary symptoms.

Seventy-three patients presented with either chronic urinary symptoms such as incontinence, retention, and recurrent urinary infection or chronic low back pain and neurogenic claudication. Lumbar spondylosis was considered to be the major cause of the urological and skeletal symptoms; the diagnosis of a neuropathic bladder depended as much on features in the history as on the results of urological and neurological investigations. The preoperative demonstration of significant lumbar spondylosis was often difficult, but decompressive laminectomy in 34 patients produced relief of urinary symptoms and improvement in bladder function in 75%.

Adult↗

PubMed1988

Electrical stimulation of the motor tracts in cervical spondylosis.

Motor action potentials evoked by percutaneous electrical stimulation of the scalp and of the cervical (or lumbar) vertebral region were recorded from the biceps, thenar and tibialis anterior muscles in 30 patients with cervical spondylosis. Twelve normal controls were matched for age and height. Abnormalities of central motor conduction (absence or increased central delay of cortical responses) for at least one muscle were observed in all (but one) the patients with myelopathy alone or combined with radiculopathy. An increase in latency of the responses evoked by cervical stimulation occurred in 40% of patients with radiculopathy or myelo-radiculopathy. Changes of motor conduction occurred even in the absence of abnormalities of somatosensory evoked potentials, while the opposite was never observed. Direct stimulation of the motor tracts may be of value in the functional assessment of the motor pathways in cervical spondylosis.

Adult↗

PubMed1983

Early onset of disk degeneration and spondylosis in sand rats (Psammomys obesus).

The sand rat is a desert animal which feeds mainly on salt bush, a shrub with a high salt content in its leaves. Sand rats have been used for the study of renal function, and since they may develop diabetes if kept on a laboratory diet without a supplement of salt bush, they have been used for investigation of diabetes-related disorders as well. Older diabetic and non-diabetic sand rats are prone to develop severe degeneration of the intervertebral disks, disk herniation, and subsequent hyperostotic spondylosis. This report is concerned with the relation of these processes to aging. The vertebral columns of 25 sand rats which were fed a standard laboratory diet and a supplement of salt bush ad libitum were examined. The sand rats ranged from 12 to 18 months of age. The vertebral columns were dissected, prepared for microscopic examination, and the findings were compared with those obtained previously in sand rats from 1 1/2 to 2 1/2 years of age. Both disk degeneration and spondylosis were comparable in course and frequency to the changes found in the older sand rats. It was concluded that factors other than age are involved in the pathogenesis of disk degeneration in the sand rat.

Animals↗

PubMed1987

Metrizamide-enhanced computed tomography as an adjunct to metrizamide myelography in the evaluation of lumbar disc herniation and spondylosis.

Eighty patients with operatively proven lumbar disc herniation or lumbar spondylosis were preoperatively evaluated with metrizamide myelography followed by metrizamide-enhanced computed tomography (CT). The x-ray films were reviewed without knowledge of the operative findings, and the patients were subdivided into those with disc extrusions, spondylosis, or recurrent abnormalities. For the group as a whole, CT was correct in 82% and myelography was correct in 77%. Both CT and myelography together were accurate in 91%, a significant improvement (P less than 0.02). The authors conclude that, if both studies are performed, the percentage of cases correctly diagnosed is increased. Therefore, both metrizamide myelography and metrizamide-enhanced CT should be obtained in selected cases. A review of the literature is included.

Adult↗

PubMed1987

Thoracic spondylosis: an unusual cause of myelopathy.

Narrowing or stenosis of the spinal canal may result in myelopathy, radiculopathy, and neurogenic claudication. Degenerative changes, or spondylosis, are the most common causes of these symptoms throughout the spinal axis, but these changes are encountered least frequently in the thoracic region. The pathological changes consisting of laminar, articular process, and ligamentum flavum hypertrophy, with a variable degree of disc degeneration, are the same in the thoracic spine as the changes found in the lumbar and cervical regions. We present seven patients with symptomatic thoracic spondylosis evaluated over the past 4 years. Spinal computed tomography readily defined the abnormality. A predilection for the T10-T-12 levels is evident. The prognosis for at least partial recovery is good, even in those with long-standing disease and severely impaired function. The previous literature concerning this unusual cause of thoracic compression is reviewed, and the differential diagnostic possibilities are discussed.

Aged↗

PubMed2006

A case of syringomyelia associated with cervical spondylosis.

Cervical spondylosis is an extremely common condition causing spinal cord compression, and yet it very rarely causes secondary syrinx formation. We report a case of cervical spondylosis with associated syringomyelia and review the possible pathogenesis of this condition.

Aged↗

PubMed1979

Scheuermann's disease or spinal osteochondrosis: its frequency and relationship with spondylosis.

Spinal osteochondrosis, previously known as Scheuermann's disease and spinal osteochondritis, is common and is probably becoming increasingly prevalent. Its incidence in patients whose primary complaint was of backache was shown to be twice as great as that in the general population. There was also a significantly higher incidence of lower lumbar spondylosis in patients with previous osteochondrosis compared with those without. Osteochondrosis is thereby shown to be an important aetiological factor in spondylosis.

Adolescent↗

PubMed2005

The Bryan cervical disc prosthesis as an alternative to arthrodesis in the treatment of cervical spondylosis: 46 consecutive cases.

We present data relating to the Bryan disc arthroplasty for the treatment of cervical spondylosis in 46 patients. Patients with either radiculopathy or myelopathy had a cervical discectomy followed by implantation of a cervical disc prosthesis. Patients were reviewed at six weeks, six months and one year and assessment included three outcome measures, a visual analogue scale (VAS), the short form 36 (SF-36) and the neck disability index (NDI). The results were categorised according to a modification of Odom's criteria. Radiological evaluation, by an independent radiologist, sought evidence of movement, stability and subsidence of the prosthesis.A highly significant difference was found for all three outcome measurements, comparing the pre-operative with the post-operative values: VAS (Z = 6.42, p < 0.0001), SF-36 (mental component) (Z = -5.02, p < 0.0001), SF-36 (physical component) (Z = -5.00, p < 0.0001) and NDI (Z = 7.03, p < 0.0001). The Bryan cervical disc prosthesis seems reliable and safe in the treatment of patients with cervical spondylosis.

Adult↗

PubMed1999

The efficacy and safety of eperisone in patients with cervical spondylosis: results of a randomized, double-blind, placebo-controlled trial.

A randomized, double-blind, clinical trial was undertaken to assess the activity of eperisone hydrochloride (50 mg t.i.d.), a commonly used muscle relaxant, as a treatment for cervical spondylosis in 157 patients. The results showed a clear benefit of eperisone treatment with regard to pain in the nuchal region, back pain, pain in arms and shoulders, stiffness and other symptoms of cervical spondylosis, while the tolerability of the treatment was optimal.

Adult↗

PubMed1976

Cervical spondylosis. Prognostic value of preoperative signs and symptoms.

One hundred and forty-one patients with cervical spondylosis were studied, looking for a possible prognostic value in preoperative signs and symptoms. Duration of symptoms lasting from one month to five years until surgical treatment and spinal fluid protein level had no prognostic value in these patients. In those with radiculopathy, the degree of upper limb pareses, muscle atrophy, absent or diminished reflexes, sensory involvement, number of myelographic defects and age had prognostic value. In those with myelopathy, the degree of lower limbs pareses and spasticity, sensory involvement, number of myelographic defects and age had prognostic value. Surgery is a definite method of treatment for patients with progressive signs and symptoms due to cervical spondylosis; some of the preoperative signs and symptoms are valuable in establishing their prognosis.

Cervical Vertebrae↗

PubMed1986

Cervical spinal cord injuries in patients with cervical spondylosis.

Eighty-eight patients over age 40 with traumatic cervical spinal cord injuries were clinically and radiographically evaluated, and comparison was made with 35 spinal cord injury patients under age 36. While most older patients sustained obvious bony and/or ligamentous damage commensurate with their neurologic findings, 25 (28%) of the 88 patients had no demonstrable bony abnormalities and 17 (20%) of the 88 patients had only minimal evidence of bony injury. Of particular interest are the patients with severe cord injuries, yet no bony abnormalities, who seem to form a distinct subgroup of the cervical spinal cord injury patient on the basis of radiographic and clinical features. Of these 25 patients, 24 (96%) had severe cervical spondylosis. Fourteen (56%) of the 25 patients were injured in falls, five (36%) of these 14 being of a seemingly trivial nature. Of the 42 patients with minimal or no demonstrable bony abnormalities, 33 (79%) were evaluated with plain tomography and no occult fractures or other significant pathology was demonstrated. Pantopaque myelography in 27 (64%) of the 42 cases revealed no extruded disk or other surgical lesion in any patient. In large measure, these injuries can be attributed to cervical spondylosis, which narrows the canal and makes the cord more susceptible to compression by the bulging ligamenta flava during hyperextension.

Adolescent↗

PubMed1996

The comparison of a rapid screening MR protocol with a conventional MR protocol for lumbar spondylosis.

PURPOSE: To assess the degree of agreement between a rapid T2-weighted fast spin-echo protocol and a detailed protocol for the detection of lumbar spondylosis and to determine the sensitivity and specificity of the rapid protocol with respect to the detailed protocol. MATERIALS AND METHODS: Forty-eight patients with low back pain were studied with both a detailed four-sequence protocol and a two-sequence rapid screening protocol (acquisition time of 28 and 2.5 min for the detailed and screening protocols, respectively). The two protocol groups were numerically graded for the findings of lumbar spondylosis. RESULTS: Agreement for presence or absence of disc abnormality was 87% for the two techniques. The screening protocol showed a disc abnormality in 91% of all disc herniations and 84% of all disc bulges seen on the detailed study. All moderate and severe (grades two and three in this protocol) bulges and herniations were detected by the screening protocol. Foraminal narrowing, annular tear of the disc, degenerative changes of the facet joints, and nerve root swelling were all better shown on the detailed protocol. CONCLUSION: A rapid, two-plane, single-echo fast spin-echo sequence protocol is adequate to detect potentially significant degenerative disease of the lumbar spine. Its 2.5-min acquisition time allows a complete patient study (including patient preparation) to be performed in less than 10-15 min.

Humans↗