STUDY DESIGN: Retrospective. OBJECTIVES: To investigate factors related to early postoperative complications of surgery for cervical spondylotic myelopathy (CSM). SUMMARY OF LITERATURE REVIEW: Factors associated with increased risk of complications from surgery for CSM are greater age, greater estimated blood loss, longer operative duration, and anterior-posterior combined procedures. MATERIALS AND METHODS: The records of patients (male 32, female 19, mean age 61 years) who underwent surgery for CSM between November 2004 and December 2014 were investigated for early postoperative complications and potentially related factors. Factors considered were age, gender, duration of symptoms, diabetes, smoking, comorbidity, preoperative Japanese Orthopedic Association (JOA) score, numbers of cervical levels involved, ossification of the posterior longitudinal ligament (OPLL), operative approach, fusion, operative duration, estimated blood loss (EBL), maximal cord compression ratio on MRI, and cord signal intensity change on T2-weighted MRI. RESULTS: Early postoperative complications were observed in 12 of 51 patients and included motor weakness in 3, pneumonia in 2, and delirium, dysphagia, hematoma, pulmonary thromboembolism, sore, seizure, wound dehiscence, and superficial infection, each in 1. Factors associated with early postoperative complications were operative duration (p=0.024), maximal cord compression ratio on MRI (p=0.009), and cord signal intensity change on T2-weighted MRI (p=0.009). The other factors were not found to correlate significantly. CONCLUSIONS: Factors associated with early postoperative complications for CSM are operative duration, compression ratio at the level of maximal cord compression on MRI, and cord signal intensity change on T2-weighted MRI.
Asian Continental Ancestry Group ; Comorbidity ; Deglutition Disorders ; Delirium ; Female ; Hematoma ; Humans ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Orthopedics ; Pneumonia ; Postoperative Complications* ; Pulmonary Embolism ; Retrospective Studies ; Seizures ; Smoke ; Smoking ; Spinal Cord Diseases* ; Wounds and Injuries

Spinal cord injury without radiographic abnormality (SCIWORA) is a rare injury and reported less frequently in adults than children. The symptoms and prognosis of SCIWORA are associated with injury level of the spinal cord, neurologic impairment, resolution rate, etc. High level injury of the spinal cord can lead to development of quadriplegia, paraplegia, spinal shock, cardiac dysfunction, and respiratory arrest. However initial presenting cardiac arrest is extremely rare in SCIWORA. Therefore we report on a cardiac arrest patient due to SCIWORA after a motorcycle accident. A 50-year-old male was an out of hospital cardiac arrest in a transferred hospital. At the time of local hospital arrival, he was in cardiac arrest state. Therefore he received endotracheal intubation and cardiopulmonary resuscitation for 5 minutes, and spontaneous circulation returned. In our hospital, he underwent whole body computed tomography and echocardiography. He had a fibular fracture and simple multiple rib fractures without pneumothorax and hemothorax. Magnetic resonance imaging showed spinal cord edema from the cervicomedullary junction to C3 level and ossification of the posterior longitudinal ligament at C2-3 level without bony abnormality. In unknown cause of traumatic cardiac arrest, high level spinal cord injury and further evaluation of the cervical spine may be needed.
Adult ; Cardiopulmonary Resuscitation ; Child ; Death, Sudden, Cardiac ; Echocardiography ; Edema ; Heart Arrest* ; Hemothorax ; Humans ; Intubation, Intratracheal ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Motorcycles ; Out-of-Hospital Cardiac Arrest ; Paraplegia ; Pneumothorax ; Prognosis ; Quadriplegia ; Rib Fractures ; Shock ; Spinal Cord ; Spinal Cord Injuries ; Spine

STUDY DESIGN: Two case reports. OBJECTIVES: We present two cases of quadriplegia after posterior decompression with fusion caused by a suspicious reperfusion injury of spinal cord without remarkable surgical insult. SUMMARY OF LITERATURE REVIEW: Posterior decompression and posterolateral fusion have been reported as effective procedures in patients with multilevel myelopathy. However, postoperative spinal cord injury without remarkable intraoperative technical damage has been reported in a few articles. Reperfusion mechanism was suggested as one of the leading causes and reported in some animal models. MATERIALS AND METHODS: There was one case of ossification of the posterior longitudinal ligament and one developmental multilevel stenosis that underwent laminectomy with lateral mass instrumentation. After surgery, the patients presented with quadriplegia; MRI demonstrated swelling of the spinal cord and intramedullary lesion in two cases. RESULTS: After surgery, the patients presented with quadriplegia; MRI demonstrated swelling of the spinal cord and intramedullary lesion in two cases. CONCLUSION: Although patients with such a medical condition are rare, it is difficult to predict postoperative swelling of the spinal cord before surgery. The surgeon should thus be aware of such rare disease conditions involving the spinal cord before the surgical procedure.
Constriction, Pathologic ; Decompression* ; Humans ; Laminectomy ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Models, Animal ; Quadriplegia ; Rare Diseases ; Reperfusion ; Reperfusion Injury* ; Spinal Cord Diseases ; Spinal Cord Injuries ; Spinal Cord*

We present a case of acute hydrocephalus secondary to cervical spinal cord injury in a patient with diffuse ossification of the posterior longitudinal ligament (OPLL). A 75-year-old male patient visited the emergency department with tetraparesis and spinal shock. Imaging studies showed cervical spinal cord injury with hemorrhage and diffuse OPLL from C1 to C4. We performed decompressive laminectomy and occipitocervical fusion. Two days after surgery, his mental status had deteriorated to drowsiness with dilatation of the right pupil. Findings on brain computed tomography revealed acute hydrocephalus and subarachnoid hemorrhage in the cerebellomedullary cistern, therefore, extraventricular drainage was performed immediately. Acute hydrocephalus as a complication of cervical spine trauma is rare, however, it should be considered if the patient shows deterioration of neurologic symptoms.
Aged ; Brain ; Dilatation ; Drainage ; Emergencies ; Hemorrhage ; Humans ; Hydrocephalus ; Laminectomy ; Longitudinal Ligaments ; Male ; Neurologic Manifestations ; Ossification of Posterior Longitudinal Ligament ; Pupil ; Shock ; Sleep Stages ; Spinal Cord ; Spinal Cord Injuries ; Spine ; Subarachnoid Hemorrhage

OBJECTIVETo compare the efficacy difference in the treatment of supraspinous ligament injury between floating acupuncture at Tianying point and the conventional warm needling therapy.

METHODSNinety patients were randomized into a floating acupuncture group and a warm needling group, 45 cases in each one. In the floating acupuncture group, the floating needling technique was adopted at Tianying point. In the warm needling group, the conventional warm needling therapy was applied at Tianying point as the chief point in the prescription. The treatment was given 3 times a week and 6 treatments made one session. The visual analogue scale (VAS) was adopted for pain comparison before and after treatment of the patients in two groups and the efficacy in two groups were assessed.

RESULTSThe curative and remarkably effective rate was 81.8% (36/44) in the floating acupuncture group and the total effective rate was 95.5% (42/44), which were superior to 44.2% (19/43) and 79.1% (34/43) in the warm needling group separately (P < 0.01, P < 0.05). VAS score was lower as compared with that before treatment of the patients in two groups (both P < 0.01) and the score in the floating acupuncture group was lower than that in the warm needling group after treatment (P < 0.01). Thirty-six cases were cured and remarkably effective in the floating acupuncture group after treatment, in which 28 cases were cured and remarkably effective in 3 treatments, accounting for 77.8 (28/36), which was apparently higher than 26.3 (5/19) in the warm-needling group (P < 0.01).

CONCLUSIONThe floating acupuncture at Tianying point achieves the quick and definite efficacy on supraspinous ligament injury and presents the apparent analgesic effect. The efficacy is superior to the conventional warm-needling therapy.

Acupuncture Points ; Acupuncture Therapy ; methods ; Adolescent ; Adult ; Aged ; Female ; Humans ; Longitudinal Ligaments ; injuries ; Male ; Middle Aged ; Pain Management ; Treatment Outcome ; Young Adult

Massage is generally accepted as a safe and a widely used modality for various conditions, such as pain, lymphedema, and facial palsy. However, several complications, some with devastating results, have been reported. We introduce a case of a 43-year-old man who suffered from tetraplegia after a neck massage. Imaging studies revealed compressive myelopathy at the C6 level, ossification of the posterior longitudinal ligament (OPLL), and a herniated nucleus pulposus (HNP) at the C5-6 level. After 3 years of rehabilitation, his motor power improved, and he is able to walk and drive with adaptation. OPLL is a well-known predisposing factor for myelopathy in minor trauma, and it increases the risk of HNP, when it is associated with the degenerative disc. Our case emphasizes the need for additional caution in applying manipulation, including massage, in patients with OPLL; patients who are relatively young (i.e., in the fifth decade of life) are not immune to minor trauma.
Adult ; Facial Paralysis ; Humans ; Longitudinal Ligaments ; Lymphedema ; Massage ; Neck ; Ossification of Posterior Longitudinal Ligament ; Quadriplegia ; Spinal Cord ; Spinal Cord Compression ; Spinal Cord Diseases ; Spinal Cord Injuries

A 77-year-old man presented with severe dyspnea, neck pain, tingling sensation in both hands, and weakness after an acute prevertebral soft tissue hematoma due to distractive-extension injury. Magnetic resonance images demonstrated an extensive hematoma accumulation, anterior longitudinal ligament and longus colli muscle injuries. We report here a case of dyspnea due to an extensive prevertebral hematoma by soft tissue injury without cervical vertebral fracture and/or dislocation and a review the relevant literature.
Aged ; Dislocations ; Dyspnea ; Hand ; Hematoma ; Humans ; Longitudinal Ligaments ; Magnetic Resonance Spectroscopy ; Muscles ; Neck Pain ; Sensation ; Soft Tissue Injuries ; Spine

Traumatic retropharyngeal hematoma is a rare condition and may be lethal in some cases. In patients with this condition, the absence of a vertebral fracture or a major vascular injury is extremely rare. We present the case of a 92-year-old man who hit his forehead by slipping on the floor in his house. He had no symptoms at the time; however, he experienced throat pain and dyspnea at 6 hours after the injury. On arrival, he complained of severe dyspnea; therefore, an emergency endotracheal intubation was performed. A lateral neck roentgenogram after intubation showed dilatation of the retropharyngeal and retrotracheal space and no evidence of a cervical vertebral fracture. Cervical computed tomography (CT) with contrast medium revealed a massive hematoma extending from the retropharyngeal to the superior mediastinal space but no evidence of contrast medium extravasation or a vertebral fracture. However, sagittal magnetic resonance imaging (MRI) revealed an anterior longitudinal ligament (C4-5 levels) injury. We determined that the cause of the hematoma was an anterior longitudinal ligament injury and a minor vascular injury around the injured ligament. Therefore, we recommend that patients with retropharyngeal hematoma undergo sagittal cervical MRI when roentgenography and CT reveal no evidence of injury.
Aged ; Aged, 80 and over ; Hematoma ; diagnosis ; etiology ; Humans ; Longitudinal Ligaments ; injuries ; Magnetic Resonance Imaging ; Male ; Pharyngeal Diseases ; diagnosis ; etiology ; Tomography, X-Ray Computed

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

PURPOSE: To diagnose the extent of soft tissue damage with MRI, and to evaluate the relationship between soft tissue damage and a spinal cord injury in an extension injury to the lower cervical spine trauma. MATERIALS AND METHODS: Eighty-one patients who treated surgically for an anextension injury to the cervical spine over the past 5 years, were analyzed. All patients had undergone MRI after the injury, and for the specific grading of soft tissue damage, the grades were defined from grades 1 to 5. RESULTS: The spinal cord injury developed with more than grade 3 soft tissue damage associated with a rupture of the posterior longitudinal ligament (p<0.01). The changes in signal intensity of the spinal cord also developed according to the severity of soft tissue damage (p<0.01). There was no relationship between the soft tissue damage and the spinal cord injury in spinal stenosis (p=0.75). CONCLUSION: The extent of soft tissue damage was diagnosed precisely with MRI, and there was an close relationship between the soft tissue damage and spinal cord injury in the distractive- extension injury to the lower cervical spine trauma.
Humans ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Rupture ; Spinal Cord ; Spinal Cord Injuries ; Spinal Stenosis ; Spine*