OBJECTIVE: The objective of this study was to compare the clinical outcomes of the cervical interlaminar epidural steroid injection (CIESI) for unilateral radiculopathy by the midline or paramedian approaches and to determine the prognostic factors of CIESI. MATERIALS AND METHODS: We retrospectively analyzed 182 patients who underwent CIESI from January 2009 to December 2012. Inclusion criteria were no previous spinal steroid injection, presence of a cross-sectional image, and presence of follow-up records. Exclusion criteria were patients with bilateral cervical radiculopathy and/or dominant cervical axial pain, combined peripheral neuropathy, and previous cervical spine surgery. Short-term clinical outcomes were evaluated at the first follow-up after CIESI. We compared the clinical outcomes between the midline and paramedian approaches. Possible prognostic factors for the outcome, such as age, gender, duration of radiculopathy, and cause of radiculopathy were also analyzed. RESULTS: Cervical interlaminar epidural steroid injections were effective in 124 of 182 patients (68.1%) at the first follow-up. There was no significant difference in the clinical outcomes of CIESI, between midline (69.6%) and paramedian (63.7%) approaches (p = 0.723). Cause of radiculopathy was the only significant factor affecting the efficacy of CIESI. Patients with disc herniation had significantly better results than patients with neural foraminal stenosis (82.9% vs. 56.0%) (p < 0.001). CONCLUSION: There is no significant difference in treatment efficacy between the midline and paramedian approaches in CIESI, for unilateral radiculopathy. The cause of the radiculopathy is significantly associated with the treatment efficacy; patients with disc herniation experience better pain relief than those with neural foraminal stenosis.
Adrenal Cortex Hormones/*therapeutic use ; Adult ; Aged ; Cervical Cord/physiopathology ; Cross-Sectional Studies ; Female ; Humans ; Injections, Epidural ; Intervertebral Disc Displacement/*drug therapy/radiography ; Male ; Middle Aged ; Radiculopathy/*drug therapy/radiography ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo research the clinical application of lower cervical pedicle screw fixation procedure.

METHODSFrom September 2011 to July 2013,32 patients underwent posterior pedicle screw-rod system fixation were retrospective analyzed includinig 20 males and 12 females with an average age of 56.4 years old ranging from 21 to 78 years. Among them, 10 patients were traumatic cervical spinal injury, 9 patients were cervical spinal canal tumors, 7 cases were posterior longitudinal ligament ossification of cervical vertebrae, 6 cases were multiple segmental cervical spondylopathy. Preoperatively, X-ray, computed tomography, magnetic resonance imaging and magnetic resonance angiography of the vertebral artery were performed in all patients. After the operation and during the follow-up,X-ray and computed tomography were performed to confirm the pedicle screw position. The accuracy of the pedicle screw placement was evaluated by 4 grades classification from Lee. The spinal cord function was assessed by ASIA impairment scale for traumatic patients and JOA score for non traumatic patients.

RESULTSTotally 144 pedicle screws performed on 32 patients from C3 to C7 involving 132 screws of grade 0,5 screws of grade 1,5 of screws grade 2 and 2 screws of grade 3 according to postoperative CT. There were 12 screws penetrating the pedicle cortex including 8 screws at lateral,2 screws at caudal, 1 screw at medial and 1 screw at cranial. The follow-up time was 12 to 33 months with an average of (21.0±1.5) months. The spinal cord function was not improved in 6 complete cervical spinal cord injury patients,but their paraplegic level descended 1 to 3 segments. Four incomplete cervical spinal cord injury patients' ASIA impairment scale was increased by 1 to 2 grades in average. The JOA score of 22 atraumatic patients increased from preoperative 11.5±0.8 to 15.9±0.6 of postoperative at 6 months (P<0.01). There were no screw loosening,screw pullout and screw-rod breakage.

CONCLUSIONThe lower cervical pedicle screw fixation can provide excellent 3D stability of the vertebral column. The operation risk and Complication could be minimized by adequate preoperative evaluation for appropriate cases and individual pedicle screw placement. It deserved the clinical expansion.

Adult ; Aged ; Cervical Vertebrae ; injuries ; surgery ; Female ; Humans ; Male ; Middle Aged ; Pedicle Screws ; Retrospective Studies ; Spinal Cord Injuries ; physiopathology ; surgery

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

OBJECTIVE: To investigate the standard value of foot tapping test (FTT) in healthy population and FTT for lower extremity motor function in patients with cervical compressive myelopathy. METHODS: Totally 124 patients [68 males, (58.49±14.60) years old; 56 females, (57.55±18.27) years old] diagnosed of cervical myelopathy and 160 healthy volunteers [80 males, (45.43±17.98) years old; 80 females, (45.2±17.47) years old] participated in our study. The patients who underwent surgery were evaluated both before and 1 year after the surgery. We performed FTT and Grip and Release Test and evaluated with the modified Japanese Orthopaedic Association (JOA) score for cervical myelopathy. RESULTS: The value of FTT was (22.23±2.53) in myelopathic patients, significantly lower than (33.23 ±3.17) in the healthy group (decreasing with age) (P<0.05). The value of FTT was positively correlated with the lower extremity motor function of modified JOA score and the value of Grip and Release Test. In the patients who underwent surgery, the value of FTT was (22.23±2.53) preoperatively and was improved to (28.48±1.99) at one year postoperatively (P<0.05). CONCLUSION The FTT score has been improved by surgery. The FTT is an easy and useful quantitative assessment for lower extremity motor function in patients with cervical myelopathy, especially those who cannot walk.
Adult ; Aged ; Cervical Vertebrae ; Female ; Foot ; Humans ; Lower Extremity ; physiopathology ; Male ; Middle Aged ; Movement ; Orthopedics ; methods ; Postoperative Period ; Spinal Cord Compression ; diagnosis ; physiopathology ; Treatment Outcome

In this case report, we present an 18-year-old girl with occipital and infratorcular meningocele and coexisting split cervical cord. She had been admitted into the hospital for cosmetic considerations due to an inborn swelling in the back of the head and neck. Her mental status and neurologic examination were surprisingly intact. We discuss a very rare case of meningocele associated with split cord anomaly in the light of the current literature.
Adolescent ; Cerebrospinal Fluid ; metabolism ; Cervical Vertebrae ; physiopathology ; Diagnostic Imaging ; methods ; Female ; Humans ; Meningocele ; complications ; diagnosis ; Spinal Cord ; physiopathology ; Tomography, X-Ray Computed ; methods

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

OBJECTIVETo study the change of motor evoked potential of the diaphragm after graded upper cervical cord injuries and analyze the prognosis of the respiratory function after upper cervical cord injuries by MEP.

METHODSThe C(3, 4) spinal cord of 40 SD rats were injured with modified Allen method by weight drop force of 30 gcf, 50 gcf, 80 gcf, 100 gcf. The change of latent and amplitude of MEP of the diaphragm was observed before and after the spinal cord injuries (followed up for 1 month). At the same time, the femoral arterial blood of 0.2 ml was drawn. The pH value, the partial pressure of oxygen, the partial pressure of carbon dioxide, and the saturation of the blood oxygen were monitored. The change of the respiratory function was evaluated in the rats after cervical cord injuries. The relationship between the recovery of the respiratory function and the latent or amplitude was analyzed.

RESULTSThe MEP wave of the diaphragm was stable before the upper cervical spinal cord injury in the rats. It was usually composed of a positive and negative wave. The latent period and peak-peak amplitude of wave were (3.13 +/- 0.29) ms and (6.78 +/- 3.48) mv. The latent period of the diaphragms MEP in rats change with graded upper cervical cord injuries significantly, the more sever the injury, the longer the latent period. There were obvious relationship between the change of the latent period and the recovery of the respiratory function. When the latent period prolonged 101%, the respiratory function is hardly to recovery.

CONCLUSIONSMEP can objectively and sensitively reflect the injury extent of the respiratory function when upper cervical cord is injured. It would be a reliable index to evaluate the long-term prognosis of respiratory function.

Abdominal Muscles ; physiopathology ; Animals ; Blood Gas Analysis ; Cervical Vertebrae ; Disease Models, Animal ; Evoked Potentials, Motor ; physiology ; Male ; Prognosis ; Rats ; Rats, Sprague-Dawley ; Respiration ; Spinal Cord Injuries ; blood ; diagnosis ; physiopathology

OBJECTIVETo evaluate the surgical outcome for acute central cervical spinal cord injuries without fracture and dislocation.

METHODSA retrospective study was performed on 52 patients with acute central cervical cord injuries without fracture and dislocation from 2000 to 2005. All of patients underwent cervical anterior or posterior decompression, fusion and inter fixation. Spinal function was evaluated by ASIA (American Spinal Injury Association) guidelines. Pre- and post-operation ASIA scores were analyzed using liner correlation and regression. The neurological function was recorded during followed-up. The average follow-up was 29 months (range, 12 to 42).

RESULTSAfter operation, the ASIA scores increased significantly (P<0.01). Finally, ASIA motor, pin pricking and light touching scores of the 41 patients were 91 +/- 7, 107 +/- 6 and 107 +/- 6 respectively.

CONCLUSIONDecompression and inter fixation for injured segment can make a stable and broad space for spinal cord, promoting early neurological recovery and long-term improvement.

Acute Disease ; Adult ; Aged ; Cervical Vertebrae ; Decompression, Surgical ; instrumentation ; methods ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Spinal Cord Compression ; etiology ; prevention & control ; Spinal Cord Injuries ; complications ; physiopathology ; surgery ; Spinal Fusion ; instrumentation ; methods ; Treatment Outcome

OBJECTIVETo investigate the clinical characteristics and results of cervical spinal cord injury (SCI) in the patients with ossification of the posterior longitudinal ligament (OPLL).

METHODSNineteen patients with cervical SCI associated with OPLL were retrospectively analyzed. Data collection included: pre- and postoperative neurological function, OPLL-type, MRI signal changes and surgical approaches.

RESULTSSpinal cord associated with OPLL was injured severely by mild trauma. Methylprednisolone sodium succinate was used within 8 h after trauma in 12 cases. Two of them died of complications. The neurological functions were markedly improved in the other 10 cases. Seventeen cases had surgical treatment. The neurological functions (Frankel grade) were improved significantly in the operated patients except for one, who died 27 d after operation.

CONCLUSIONSThe patients with OPLL are prone to have severe SCI, which directly associates with the preexisting OPLL-type and hyper-intensity signal change in the spinal cord on MRI. Both of using methylprednisolone sodium succinate administration within 8 h after trauma and surgical decompression may improve the neurological outcomes.

Aged ; Cervical Vertebrae ; Decompression, Surgical ; Female ; Follow-Up Studies ; Glucocorticoids ; therapeutic use ; Humans ; Longitudinal Ligaments ; pathology ; Male ; Middle Aged ; Ossification of Posterior Longitudinal Ligament ; complications ; Retrospective Studies ; Spinal Cord ; drug effects ; physiopathology ; surgery ; Spinal Cord Injuries ; diagnosis ; etiology ; therapy ; Spinal Stenosis ; diagnosis ; etiology ; therapy ; Treatment Outcome

BACKGROUNDCervical spondylotic myelopathy (CSM) is managed by conservative or surgical measures. While surgery is often performed in cases of longstanding or severe CSM, there is a lack of evidence concerning its efficacy. Transcranial magnetic stimulation (TMS) is a quick, safe, painless and non-invasive technique to study conduction in the descending corticospinal pathways in the spinal cord. The conduction time from the motor cortex to the anterior horn cell [central motor conduction time (CMCT)] is a measure of the integrity of corticospinal pathways. We have previously established the role of TMS in diagnosis and screening of CSM. In this study, we further investigate the use MEPs obtained with TMS in the outcome prediction of severe CSM patients requiring operative intervention.

METHODSWe prospectively evaluated 46 consecutive patients (mean age, 57.6 years; range, 36 to 84 years; 28 men) presenting with clinical features of CSM over a 2-year period. Disease duration ranged from 6 to 24 months. A total of 45 healthy controls were studied for comparison. All patients underwent clinical scoring. Patients' initial clinical score (S1) and postoperative scoring at 6 months (S2) were based on a modified Japan Orthopedic Association Scoring Scale. A Modified Recovery Rate (MRR) was calculated based on the formula: (S2 - S1/17 - S1) x 100. We regarded a good surgical outcome as MRR of 50 or above. This was depicted as MRR50. The patients were separated into 4 groups according to the degree of cord compression by degenerative osteo-cartilaginous elements at the most significant level on MRI. TMS studies were performed before surgery. Each investigator was blinded to the results of the other investigators.

RESULTSThe upper limb (UL) CMCT (r = -0.507, P <0.0005) and lower limb (LL) CMCT (r = - 0.452, P = 0.002) were significantly and negatively correlated with S1. Similarly, UL MEP amplitude (r = 0.494, P <0005) and LL MEP amplitude (r = 0.305, P = 0.039) were significantly correlated with S1. Surgery consisted of anterior or posterior decompression with cervical laminoplasty, performed by an experienced team of orthopaedic surgeons. No significant intraoperative or postoperative complications were documented. Surgery resulted in significantly improved clinical scoring (unpaired t test, P <0.0005). No correlation between clinical scoring with patients' age, disease duration, severity or levels of cord compression on MRI was found. ULCMCT and MEP amplitude abnormality were significantly associated with improvement in clinical scoring after surgery (Mann-Whitney test, P <0.05). The UL CMCT was the independent predictor of a good clinical outcome after surgery (odds ratio, 9.09; P = 0.011).

CONCLUSIONSIn early CSM, lateral corticospinal tracts are first to be affected. It is thus possible that UL CMCT abnormality reflect more severe affectation of the corticospinal tracts placed relatively more medially in the cervical cord. Surgical intervention may have then effectively relieved the clinically significant compression, leading to a better outcome. This was further corroborated by our finding of negative correlation of S1 with UL CMCT, suggesting that patients who were clinically more severe were also electrophysiologically more abnormal, and subsequently benefited more from surgical decompression relative to patients with normal UL CMCT. This the largest series, to our knowledge, showing for the first time that UL CMCT abnormality obtained with TMS is an independent predictor of good surgical outcome in severe CSM.

Adult ; Aged ; Aged, 80 and over ; Autonomic Nervous System ; Cervical Vertebrae ; physiopathology ; Electrophysiology ; Evoked Potentials, Motor ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Prospective Studies ; Spinal Cord Compression ; diagnosis ; surgery ; Spinal Osteophytosis ; diagnosis ; physiopathology ; Transcranial Magnetic Stimulation