Autophagy ; Cervical Cord ; injuries ; Humans ; Magnetic Resonance Imaging ; Spinal Cord Injuries ; complications ; diagnosis ; pathology

BACKGROUNDCervical spondylotic myelopathy (CSM) is a common cause of disability in elderly patients. Previous studies have shown that spinal cord cell apoptosis due to spinal cord compression plays an important role in the pathology of myelopathy. Although changes in magnetic resonance imaging (MRI) T2 signal intensity ratio (SIR) are considered to be an indicator of CSM, little information is published supporting the correlation between changes in MRI signal and pathological changes. This study aims to testify the correlation between MRI T2 SIR changes and cell apoptosis using a CSM animal model.

METHODSForty-eight rabbits were randomly assigned to four groups: one control group and three experimental chronic compression groups, with each group containing 12 animals. Chronic compression of the cervical spinal cord was implemented in the experimental groups by implanting a screw in the C3 vertebra. The control group underwent sham surgery. Experimental groups were observed for 3, 6, or 9 months after surgery. MRI T2-weighted SIR Tarlov motor scores and cortical somatosensory-evoked potentials (CSEPs) were periodically monitored. At each time point, rabbits from one group were sacrificed to determine the level of apoptosis by histology (n = 6) and Western blotting (n = 6).

RESULTSTarlov motor scores in the compression groups were lower at all time points than the control group scores, with the lowest score at 9 months (P < 0.001). Electrophysiological testing showed a significantly prolonged latency in CSEP in the compression groups compared with the control group. All rabbits in the compression groups showed higher MRI T2 SIR in the injury epicenter compared with controls, and higher SIR was also found at 9 months compared with 3 or 6 months. Histological analysis showed significant apoptosis in the spinal cord tissue in the compression groups, but not in the control group. There were significant differences in apoptosis degree over time (P < 0.001), with the 9-month group displaying the most severe spinal cord apoptosis. Spearman's rank correlation test showed that there was close relation between MRI SIR and degree of caspase-3 expression in Western blotting (r = 0.824. P < 0.001).

CONCLUSIONSClear apoptosis of spinal cord tissue was observed during chronic focal spinal compression. Changes in MRI T2 SIR may be related to the severity of the apoptosis in cervical spinal cord.

Animals ; Apoptosis ; physiology ; Cervical Cord ; metabolism ; pathology ; Magnetic Resonance Imaging ; Male ; Rabbits ; Spinal Cord Compression ; metabolism ; pathology

Cervical Vertebrae ; pathology ; surgery ; Humans ; Laminoplasty ; methods ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Spinal Cord Diseases ; pathology ; surgery

OBJECTIVETo discuss the correlation between the degree of cervical spinal cord compression and gender, age, height of intervertebral space and the abnormality curvature of cervical vertebrae. The multivariable linear regression was used to build the prediction model of cervical spinal cord compression.

METHODSOne hundred and twenty patients with cervical spondylosis were divided into 4 groups according to the degree of spinal cord compression. To measure the sagittal diameter of spinal cord (a) and medulla-pons junction (M) in MRI individually, and then calculate the ratio of a/M; according to the ratio to evaluate the degree of cervical spinal cord compression. In X-ray films to measure the height and angle of intervertebral space, curvature of cervical vertebrae (according to Borden's method and double line method of C2-7 Cobb angle to abtain data of curvature of cervical vertebrae). To performe linear regression and multiple linear regression to analyze the correlation above the data and build the prediction model of cervical spinal cord compression.

RESULTS(1) With the exacerbation of cervical spinal cord compression, all measured data gradually decreased; there was significant difference in the anterior height and angle of intervertebral space, the ratio of a/M between any two groups (P < 0.05). (2) The ratio of a/M showed positive corrrelation with the anterior height of intervertebral space (R = 0.296, P < 0.001) and the curvature of cervical vertebrae (are to chord distance, R = 0.241, P < 0.001), but showed negative corrrelation with the proportion of cervical spinal cord compression (R = -0.821, P < 0.001); Borden's method are to chord distance) showed positive correlation with the double line method of C2-7 Cobb angle (R = 0.840, P < 0.001). The predictive equation of the ratio of a/M by multiple linear regression was obtained, and the F = 8.959, R = 0.434, P < 0.001, in which the age, the anterior height of intervertebral space and the curvature of cervical vertebrae were risk factors of cervical spinal cord compression.

CONCLUSIONThe ratio of a/M can be a standard to evaluate degree of cervical spinal cord compression; the changes of the height of intervertebral disc, curvature of cervical vertebrae in X-ray films maybe have values to predict the degree of cervical spinal cord compression.

Adult ; Aged ; Cervical Vertebrae ; pathology ; Female ; Humans ; Intervertebral Disc ; pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Spinal Cord Compression ; pathology ; Spondylosis ; pathology

OBJECTIVE: To evaluate the long-term clinical therapeutic effect of polyaxial screw-rod system for posterior cervical arthrodesis on patients with upper cervical spinal cord tumors.
 METHODS: From March 2007 to May 2013, 22 patients with upper cervical spinal cord tumors underwent tumor resection and posterior cervical arthrodesis in our institution. The medical records of these patients were reviewed respectively. There were 10 males and 12 females with ages ranging from 16 to 60 years old. Posterior cervical arthrodesis by polyaxial screw-rod was performed at the upper cervical spine (C1-3). All patients were followed-up clinically and radiographically.
 RESULTS: The average follow-up was 65.5 months. Twenty-two patients were enrolled and a total of 114 screws were placed in this study. Histopathology revealed neurinoma, meningioma, ganglioneuroma and ganglioglioma in 16, 3, 1 and 1 case (s), respectively. The mixed tumor with component of ganglioneuroma and neurinoma was observed in 1 case. All patients received tumor resection and posterior athrodesis by polyaxial screw-rod system. Cervical kyphosis was encountered in one patient and this patient suffered the recurrence of tumor. Solid fusion was achieved in all patients. The average postoperative Japanese Orthopaedic Association (JOA) score was 13.9 and the average recovery rate was 51.4%. Neurologic deterioration was found in 2 patients. No complications, such as spinal cord or vertebral artery injury, postoperative radiculopathy or instrumentation failure, were observed.
 CONCLUSION The long-term clinical therapeutic effects of posterior cervical arthrodesis using polyaxial screw-rod system on upper cervical spinal cord tumors are satisfactory, with no severe complication.
Adolescent ; Adult ; Bone Screws ; Cervical Cord ; pathology ; surgery ; Cervical Vertebrae ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Spinal Fusion ; Spinal Neoplasms ; surgery ; Young Adult

STUDY DESIGN: Retrospective study. PURPOSE: The purpose of this study was to investigate the influence of sagittal alignment of the strut graft on graft subsidence and clinical outcomes after anterior cervical corpectomy and fusion (ACCF). OVERVIEW OF LITERATURE: ACCF is a common technique for the treatment of various cervical pathologies. Although graft subsidence sometimes occurs after ACCF, it is one cause for poor clinical results. Malalignment of the strut graft is probably one of the factors associated with graft subsidence. However, to the best of our knowledge, no prior reports have demonstrated correlations between the alignment of the strut graft and clinical outcomes. METHODS: We evaluated 56 patients (33 men and 23 women; mean age, 59 years; range, 33–84 years; 45 with cervical spondylotic myelopathy and 11 with ossification of the posterior longitudinal ligament) who underwent one- or two-level ACCF with an autogenous fibular strut graft and anterior plating. The Japanese Orthopaedic Association (JOA) score recovery ratio for cervical spondylotic myelopathy was used to evaluate clinical outcomes. The JOA score and lateral radiograms were evaluated 1 week and 1 year postoperatively. Patients were divided into two groups (a straight group [group I] and an oblique group [group Z]) based on radiographic assessment of the sagittal alignment of the strut graft. RESULTS: Group I showed a significantly greater JOA score recovery ratio (p<0.05) and a significantly lower graft subsidence than group Z (p<0.01). CONCLUSIONS: Our findings suggest that a straight alignment of the strut graft provides better clinical outcomes and lower incidence of graft subsidence after ACCF. In contrast, an oblique strut graft can lead to significantly increased strut graft subsidence and poor clinical results.
Asian Continental Ancestry Group ; Bone Transplantation ; Cervical Vertebrae ; Clinical Study ; Female ; Humans ; Incidence ; Male ; Pathology ; Retrospective Studies ; Spinal Cord Compression ; Spinal Cord Diseases ; Spinal Fusion ; Transplants*

A 40-year-old Asian female presented with a 2-month history of right shoulder pain and right triceps weakness. MRI revealed an extramedullary, extradural, dumbbell-shaped spinal cord tumor with C6 to C7 iso- and hyperintensity on T1 and T2 weighted imaging, respectively. Histological examination revealed monomorphous spindle cells with a storiform pattern. Immunohistochemistry was positive for CD34, CD99, and negative for EMA, SMA, and S100; solitary fibrous tumor (SFT) was confirmed.
Adult ; Cervical Vertebrae/*pathology/radiography/surgery ; Female ; Humans ; Immunohistochemistry ; Magnetic Resonance Imaging ; Solitary Fibrous Tumors/*pathology/radiography/surgery ; Spinal Cord Neoplasms/*pathology/radiography/surgery ; Tomography, X-Ray Computed

Adult ; Aged ; Cervical Vertebrae ; pathology ; physiopathology ; surgery ; Female ; Fracture Fixation, Internal ; adverse effects ; Humans ; Intervertebral Disc Displacement ; pathology ; Male ; Middle Aged ; Radiculopathy ; Spinal Cord Diseases ; etiology ; Spinal Cord Injuries ; pathology ; Spinal Diseases ; pathology ; Spinal Osteophytosis ; etiology ; Transplants ; adverse effects

The authors describe a case of an 80-year-old man with a gradual weakness of the lower extremities not linked to any known traumatic episode over the 2 weeks before admission. CT scan and MRI of the spine revealed a cystic formation, measuring about 1cm in diameter, at C7-T1 at the left posterolateral site at the level of the articular facet. During surgery, the mass appeared to be in the ligamentum flavum at the level of the articular facet and was in contact with the dura mater. After the removal of the mass, there was an immediate and significant improvement of the patient's symptoms. Histopathologic examination showed the cyst to be composed of nonspecific degenerative fibrous tissue with mild inflammatory change and confirmed the cyst as a synovial cyst. Synovial cyst in the cervical region is a very rare lesion causing myelopathy. Surgical removal of the cyst and decompression of the spinal cord results in good neurological recovery.
Aged ; Aged, 80 and over ; Cervical Vertebrae ; Decompression, Surgical ; Human ; Magnetic Resonance Imaging ; Male ; Spinal Cord Compression/*etiology/*pathology/surgery ; Synovial Cyst/*complications/*pathology/surgery ; Tomography, X-Ray Computed

OBJECTIVETo explore the correlation among prevertebral hyperintensity (PVH), sagittal canal diameter on MRI and neurologic function of patients after cervical vertebral hyperextension injury without fracture and dislocation.

METHODSThe clinical data of 100 patients with cervical vertebral hyperextension injury without fracture and dislocation were retrospectively analyzed from September 2010 to December 2013. The patients were divided into PVH group and non-PVH group according to the presence of PVH on T2-weighted magnetic resonance imaging. There were 39 patients in PVH group, including 31 males and 8 females, aged from 21 to 83 years old with an average of (58.10 ± 14.78) years; and the other 69 patients in non-PVH group, including 49 males and 12 females, aged from 32 to 77 years old with an average of (55.05 ± 10.36) years. The sagittal disc level canal diameters of subaxial cervical spine were measured on mid-sagittal magnetic resonance imaging. The age, sex, cause of injury, and the segments of spinal stenosis were recorded. American Spinal Injury Association (ASIA) impairment scale and motor score were used to evaluate the neurological status.

RESULTSThe ASIA motor score of the group with PVH was 52.56 ± 31.97 while the ASIA motor score was 67.70 ± 22.83 in non-PVH group (P = 0.013). More patients with intramedullary hyperintensity signal on MRI were observed in the PVH group than in non-PVH group (P = 0.006). There was a significant positive correlation between ASIA motor score and sagittal disc level canal diameter of injury segment (P = 0.003). The neurological status was worse in patients with multi-level sagittal canal diameters below 8 mm.

CONCLUSIONThe PVH and the disc-level canal sagittal diameter of the injury segment are associated with neurological status. The patients with multi-level sagittal canal stenosis are vulnerable to severe cervical spinal cord injury.

Adult ; Aged ; Aged, 80 and over ; Cervical Vertebrae ; injuries ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Spinal Canal ; pathology ; Spinal Cord Injuries ; pathology ; physiopathology