STUDY DESIGN: This is a prospective study of 85 patients. OBJECTIVES: We wanted to identify the changes of ROM and sagittal alignment of the cervical spine after laminoplasty, and we wanted to determine the preoperative factors affecting the ROM and sagittal alignment of the cervical spine after laminoplasty. SUMMARY OF THE LITERATURE REVIEW: Cervical laminoplasty is an effective procedure for decompressing multilevel spinal cord compression. It has been reported that the ROM of the cervical spine was decreased after laminoplasty. It is well known that preoperative lordosis of the cervical spine is prerequisite for performing laminoplasty. Maintaining the postoperative lordosis of the cervical spine is also important for decompressing the spinal cord after laminoplasty. MATERIALS AND METHODS: Eighty-five patients who underwent open door laminoplasty from the C3 to C7 levels were prospectively studied. The minimum follow-up was two-years. The preoperative diagnosis was cervical spondylotic myelopathy (CSM) for 52 patients, ossification of the posterior longitudinal ligament (OPLL) for 29 patients and multilevel cervical disc herniation for 4 patients. Plain cervical spine lateral radiography in the neutral, flexion and extension positions was performed preoperatively and at the two-year follow-up. The cervical lordosis or kyphosis was measured by Cobb's method. The diagnosis, degree of preoperative lordosis in the neutral position, and the degree of preoperative sagittal alignment in flexion and extension were studied as the risk factors for postoperative kyphosis. RESULTS: The preoperative ROM of the cervical spine was 29.2 degrees and the postoperative ROM was 20.3 degrees. Therefore, 30.5% of the preoperative ROM was decreased after laminoplasty. A decreased ROM of more than 50% was found in 13 patients (15.3%). Their diagnosis was CSM in 11 patients (11/52, 21.1%) and OPLL in 2 patients (2/29, 6.9%). There were no significant differences in preoperative ROM between the two groups with decreased ROM being noted in more than 50% of the patients and decreased ROM being noted in less than 50% of the patients. The preoperative lordotic angle in the neutral position was 16.2 degrees and the postoperative lordotic angle was 11.4 degrees. Kyphosis (mean: 12.2 degrees) developed in 9 patients (9/85, 10.6%) after the surgery. Their preoperative diagnosis was CSM in all patients. The preoperative lordotic angle was significantly less in the kyphotic group than in the lordotic group. The preoperative flexion was 10.2 degrees greater and the preoperative extension was 10.3 degrees less in the kyphotic group than in lordotic group. The preoperative flexion angle was 19.3 degree kyphosis and the extension angle was 8.7 degree lordosis in the kyphotic group. CONCLUSIONS: The ROM of the cervical spine was decreased 30.5% after laminoplasty. Kyphosis developed in 10.6% of the patients. The preoperative factors affecting postoperative kyphosis were the diagnosis of CSM, a preoperative lordosis less than 10 degrees and a greater preoperative flexion angle than the extension angle. Therefore, kyphosis after laminoplasty was expected in a patient with the above three preoperative factors, so other treatment options such as instrumented fusion should be considered.
Animals ; Diagnosis ; Follow-Up Studies ; Humans ; Kyphosis ; Longitudinal Ligaments ; Lordosis ; Prospective Studies ; Radiography ; Range of Motion, Articular* ; Risk Factors ; Spinal Cord ; Spinal Cord Compression ; Spinal Cord Diseases ; Spine*

CT myelography of the T11-L2 region was performed in 8 large-breed dogs with a clinical diagnosis of degenerative myelopathy (DM) and 3 large-breed dogs that were clinically normal. CT myelographic characteristics were recorded for each dog, at each disc level. Area measurements of the spinal cord, dural sac, vertebral canal, and vertebral body were recorded at 4 slice locations for each disc level. Mean area ratios were calculated and graphically compared, by slice location and group. In all dogs, CT myelography identified morphologic abnormalities that were not suspected from conventional myelograms. Characteristics observed with higher frequency in DM versus normal dogs were: spinal stenosis, disc protrusion, focal attenuation of the subarachnoid space, spinal cord deformity, small spinal cord, and paraspinal muscle atrophy. Mean spinal cord: dural sac, spinal cord: vertebral canal, dural sac: vertebral canal, and vertebral canal:vertebral body ratios were smaller in DM versus normal dogs at more than one disc level. Some CT myelographic characteristics in DM dogs were similar to those previously reported in humans, dogs and horses with stenotic myelopathy.
Animals ; Dog Diseases/*radiography ; Dogs ; Female ; Lumbar Vertebrae/radiography ; Male ; Myelography/*veterinary ; Spinal Cord Diseases/radiography/*veterinary ; Thoracic Vertebrae/radiography ; Tomography, X-Ray Computed/*veterinary

OBJECTIVE: The purpose of this study is to evaluate the efficacy and necessity of combined anterior approach (discectomy and fusion) and posterior approach(open-door laminoplasty) in the treatment of cervical spondylotic myelopathy. METHODS: The authors reviewed 14 cases in whom combined anterior and posterior approach performed for cervical myelopathy due to simultaneous anterior and posterior pathology such as huge central disc herniation with narrow spinal canal between January 2000 and December 2002. Clinical symptoms were evaluated by Japanese Orthopaedic Association (JOA) score and then the cervical curvature, change of spinal canal to vertebral body(SC/VB) ratio and canal widening were measured and compared to the clinical symptoms. RESULTS: The mean JOA score increased from 10.4+/-3.1 preoperatively to 14.8+/-1.2 at the final follow up with a mean recovery rate 66.4%. In all cases, there were not neurologic deterioration. Mild postoperative complications developed in two cases. One patient had a limitation of range of neck motion and the other one showed kyphotic change. Postoperative radiography showed an improvement of body to canal ratios (average 0.70+/-0.08 before surgery to 1.05+/-0.12 after surgery) and mainte nance or recovery of cervical lordosis. Canal widening of antero-posterior diameter and dimension after operation is 6.8 mm, 116.61 mm2. CONCLUSION: Combined anterior and posterior procedure could be helpful in decompression of the spinal cord and good functional recovery in spondylotic myelopathy patients with combined anterior and posterior pathology such as huge disc herniation accompanying narrow spinal canal.
Animals ; Asian Continental Ancestry Group ; Decompression ; Follow-Up Studies ; Humans ; Lordosis ; Neck ; Pathology ; Postoperative Complications ; Radiography ; Spinal Canal ; Spinal Cord ; Spinal Cord Diseases*

OBJECTIVE: To study the incidence and degree of the cervical instability in the cerebral palsied patients and to investigate the cause of the high incidence of cervical myelopathy in these patients. METHOD: The static and dynamic radiography of the cervical spine in the sagittal plane was performed in seventy-two patients with athetoid and spastic cerebral palsy and the incidence of spondylolisthesis, range of motion(by the Penning Method), sagittal diameter of the cervical canal, and posture of the cervical spine were evaluated. RESULTS: The incidence of the cervical spondylolisthesis was fifty percent with athetoid cerebral palsy and twenty-seven percents with spastic cerebral palsy. The incidence of spondylolisthesis was especially high at the level of C3/4 and C4/5. The excessive range of motion in flexion/extension by the sagittal plane was observed in 66.7% of athetoid patients and 53.3% of spastic patients, especially at the C2/3 and C3/4 levels. The abnormal curvature was noted in 66.6% of athetoid and spastic patients. C-curve and S-curve were more common in athetoid patients and straightening of the C-spine was more common in spastic type. A sagittal diameter of the cervical spinal canal was significantly decreased in patients with athetoid patients with C3/4 spondylolisthesis and/or abnormal curvature such as a C-curve or S-curve(P<0.05). Height of the vertebral body was decreased in both athetoid and spastic patients. CONCLUSION: The combination of a cervical instability and a narrow spinal canal predisposes the neurological progression to a cervical myelopathy in cerebral palsied patients.
Adolescent* ; Cerebral Palsy* ; Humans ; Incidence ; Muscle Spasticity ; Posture ; Radiography ; Range of Motion, Articular ; Spinal Canal ; Spinal Cord Diseases ; Spine ; Spondylolisthesis

OBJECTIVE: The purpose of this study was to demonstrate the usefulness of digital subtraction cystography to identify communicating holes between a spinal extradural arachnoid cyst (SEAC) and the subarachnoid space prior to cyst removal and hole closure. MATERIALS AND METHODS: Six patients with SEAC were enrolled in this retrospective study. Digital subtraction cystography and subsequent CT myelography were performed for every patient. The presence and location of the communicating holes on cystography were documented. We evaluated the MRI characteristics of the cysts, including location, size, and associated spinal cord compression; furthermore, we reviewed cystographic images, CT myelograms, procedural reports, and medical records for analysis. If surgery was performed after cystography, intraoperative findings were compared with preoperative cystography. RESULTS: The location of the communicating hole between the arachnoid cyst and the subarachnoid space was identified by digital subtraction cystography in all cases (n = 6). Surgical resection of SEAC was performed in 4 patients, and intraoperative location of the communicating hole exactly corresponded to the preoperative identification. CONCLUSION: Fluoroscopic-guided cystography for SEAC accurately demonstrates the presence and location of dural defects. Preoperative digital subtraction cystography is useful for detection of a communicating hole between a cyst and the subarachnoid space.
Adult ; Arachnoid Cysts/*radiography ; Female ; Fluoroscopy ; Humans ; Image Processing, Computer-Assisted/*methods ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiography, Abdominal ; Retrospective Studies ; Spinal Cord Compression/radiography ; Spinal Cord Diseases/*radiography ; Tomography, X-Ray Computed ; Young Adult

STUDY DESIGN: Retrospective analysis of surgical treatment in patients with osteoporotic vertebral fracture associated myelopathy. OBJECTIVES: To evaulate the clinical outcome of anterior decompression and fusion for osteoporotic vertebral fracture associated with myelopathy. SUMMARY OF LITERATURE REVIEW: Major treatment of osteoporotic vertebral fracture were conservative methods. In patients with myelopathy, surgical treatment is recommanded. MATERIALS AND METHODS: From January 1995 to December 1998, twelve patients who had osteoporotic vertebral fracture associated with myelopathy and treated by operation were evaluated retrospectively. With simple roentgenography and dual energy absorptiometry, osteoporosis was evaluated. And with MRI and nerve conduction velocity test, we could diagnosed myelopathy. In ten patients, anterior approach was used, and in two patients, posterior approach was used. RESULTS: In all patients after operation, the neurologic symptoms according to the Frankel grading scale were improved over one grade and follow-up X-ray showed bone union finding unrelated to the site, shape, and severity of fracture. No significant complications such as increasing of kyphotic angle and metal loosening were existed in all cases. CONCLUSIONS: For the osteoporotic vertebral fracture associated with myelopathy, we can treat properly with spinal decompression and interbody fusion with internal fixation.
Decompression ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Neural Conduction ; Neurologic Manifestations ; Osteoporosis ; Radiography ; Retrospective Studies ; Spinal Cord Diseases* ; Spine

OBJECTIVE: To assess the performance of diffusion tensor imaging (DTI) for the diagnosis of cervical spondylotic myelopathy (CSM) in patients with deformed spinal cord but otherwise unremarkable conventional magnetic resonance imaging (MRI) findings. MATERIALS AND METHODS: A total of 33 patients who underwent MRI of the cervical spine including DTI using two-dimensional single-shot interleaved multi-section inner volume diffusion-weighted echo-planar imaging and whose spinal cords were deformed but showed no signal changes on conventional MRI were the subjects of this study. Mean diffusivity (MD), longitudinal diffusivity (LD), radial diffusivity (RD), and fractional anisotropy (FA) were measured at the most stenotic level. The calculated performance of MD, FA, MD∩FA (considered positive when both the MD and FA results were positive), LD∩FA (considered positive when both the LD and FA results were positive), and RD∩FA (considered positive when both the RD and FA results were positive) in diagnosing CSM were compared with each other based on the estimated cut-off values of MD, LD, RD, and FA from receiver operating characteristic curve analysis with the clinical diagnosis of CSM from medical records as the reference standard. RESULTS: The MD, LD, and RD cut-off values were 1.079 × 10⁻³, 1.719 × 10⁻³, and 0.749 × 10⁻³ mm²/sec, respectively, and that of FA was 0.475. Sensitivity, specificity, positive predictive value and negative predictive value were: 100 (4/4), 44.8 (13/29), 20 (4/20), and 100 (13/13) for MD; 100 (4/4), 27.6 (8/29), 16 (4/25), and 100 (8/8) for FA; 100 (4/4), 58.6 (17/29), 25 (4/16), and 100 (17/17) for MD∩FA; 100 (4/4), 68.9 (20/29), 30.8 (4/13), and 100 (20/20) for LD∩FA; and 75 (3/4), 68.9 (20/29), 25 (3/12), and 95.2 (20/21) for RD∩FA in percentage value. Diagnostic performance comparisons revealed significant differences only in specificity between FA and MD∩FA (p = 0.003), FA and LD∩FA (p < 0.001), FA and RD∩FA (p < 0.001), MD and LD∩FA (p = 0.024) and MD and RD∩FA (p = 0.024). CONCLUSION: Fractional anisotropy combined with MD, RD, or LD is expected to be more useful than FA and MD for diagnosing CSM in patients who show deformed spinal cords without signal changes on MRI.
Adult ; Aged ; Aged, 80 and over ; Cervical Vertebrae ; *Diffusion Tensor Imaging ; Echo-Planar Imaging ; Female ; Humans ; Male ; Middle Aged ; ROC Curve ; Sensitivity and Specificity ; Severity of Illness Index ; Spinal Cord Compression/*diagnosis/pathology/radiography ; Spinal Cord Diseases/*diagnosis/pathology/radiography

The expansive open-door laminoplasty is an effective, simple and reliable method in decompression of posterior spinal elements, but this technique also has some pitfalls such as progressive narrowing of the opened spinal canal and collapse of the laminae leadin to deterioration of clinical status. To prevent these complications, the author as performed open-door laminoplasty using titanium miniplate in eight patients of multiple cervical canal stenosis with myelopathy and/or myeloradiculopathy. The clinical outcomes were evaluated according to the Japanese Orthopaedic Association(JOA) score and the postoperative sagittal diameter of the cervical spinal canal on plain radiography were measured. The clinical outcomes were excellent in 25.5% and good n 50.0% on 3 months after the operation and the average postoperative sagittal diameters of the spinal canal were 18.3mm(43% larger than preoperative diameters) 1 month after the operation and 18.1mm(42% larger than preoperative diameters) 3months after operation. Despite limited cases and short follow-up periods, the open-door laminoplasty using titanium miniplate is thought to be simple, durable and effective technique for maintaining increased sagittal diameter of the spinal canal. The titanium plates are easy to apply, and have advantage of the magnetic resonance imaging compatibility in the postoperative examination.
Asian Continental Ancestry Group ; Constriction, Pathologic ; Decompression ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Radiography ; Spinal Canal ; Spinal Cord Diseases ; Titanium*

The expansive open-door laminoplasty is an effective, simple and reliable method in decompression of posterior spinal elements, but this technique also has some pitfalls such as progressive narrowing of the opened spinal canal and collapse of the laminae leadin to deterioration of clinical status. To prevent these complications, the author as performed open-door laminoplasty using titanium miniplate in eight patients of multiple cervical canal stenosis with myelopathy and/or myeloradiculopathy. The clinical outcomes were evaluated according to the Japanese Orthopaedic Association(JOA) score and the postoperative sagittal diameter of the cervical spinal canal on plain radiography were measured. The clinical outcomes were excellent in 25.5% and good n 50.0% on 3 months after the operation and the average postoperative sagittal diameters of the spinal canal were 18.3mm(43% larger than preoperative diameters) 1 month after the operation and 18.1mm(42% larger than preoperative diameters) 3months after operation. Despite limited cases and short follow-up periods, the open-door laminoplasty using titanium miniplate is thought to be simple, durable and effective technique for maintaining increased sagittal diameter of the spinal canal. The titanium plates are easy to apply, and have advantage of the magnetic resonance imaging compatibility in the postoperative examination.
Asian Continental Ancestry Group ; Constriction, Pathologic ; Decompression ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Radiography ; Spinal Canal ; Spinal Cord Diseases ; Titanium*

OBJECTIVE: Ankylosing spondylitis is an inflammatory rheumatic disease mainly affecting the axial skeleton. The rigid spine may secondarily develop osteoporosis, further increasing the risk of spinal fracture. In this study, we reviewed fractures in patients with ankylosing spondylitis that had been clinically diagnosed to better define the mechanism of injury, associated neurological deficit, predisposing factors, and management strategies. METHODS: Between January 2003 and December 2013, 12 patients with 13 fractures with neurological complications were treated. Neuroimaging evaluation was obtained in all patients by using plain radiography, CT scan, and MR imaging. The ASIA Impairment Scale was used in order to evaluate the neurologic status of the patients. Management was based on the presence or absence of spinal instability. RESULTS: A total of 9 cervical and 4 thoracolumbar fractures were identified in a review of patients in whom ankylosing spondylitis had been diagnosed. Of these, 7 fractures were associated with a hyperextension mechanism. 10 cases resulted in a fracture by minor trauma. Posttraumatic neurological deficits were demonstrated in 11 cases and neurological improvement after surgery was observed in 5 of these cases. CONCLUSIONS: Patients with ankylosing spondylitis are highly susceptible to spinal fracture and spinal cord injury even after only mild trauma. Initial CT or MR imaging of the whole spine is recommended even if the patient's symptoms are mild. The patient should also have early surgical stabilization to correct spinal deformity and avoid worsening of the patient's neurological status.
Asia ; Causality ; Congenital Abnormalities ; Humans ; Magnetic Resonance Imaging ; Neuroimaging ; Osteoporosis ; Radiography ; Rheumatic Diseases ; Skeleton ; Spinal Cord Injuries ; Spinal Fractures ; Spine ; Spondylitis, Ankylosing* ; Tomography, X-Ray Computed