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Objective In this study,we aim to evaluate the risk and incidence of traumatic cervical spinal cord injury (CSCI) in patients with traumatic cervical spinal canal stenosis (CSCS) without major fracture or dislocation,and evaluate the feasibility of preventive decompression surgery. Methods This study included eighty?seven patients with traumatic CSCI without major fracture or dislocation treated in our department between 2005 and 2012. Mann?Whitney U test was used for statistical analyses. Analysis of variance (ANOVA) was used to calculate the relative and absolute risks for the incidence of traumatic CSCI without major fracture or dislocation related with CSCS. Results The relative risk for the incidence of traumatic CSCI with CSCS was 145.7 times higher than that for the incidence without CSCS. However ,only 0.000026% of patients with CSCS may be able to avoid developing traumatic CSCI if they underwent decompression surgery before trauma. Conclusions Prophylactic surgical management for CSCS might not significantly affect the incidence of traumatic CSCI.
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STUDY DESIGN: Retrospective case series. PURPOSE: To clarify the influence of cervical spinal canal stenosis (CSCS) on neurological functional recovery after traumatic cervical spinal cord injury (CSCI) without major fracture or dislocation. OVERVIEW OF LITERATURE: The biomechanical etiology of traumatic CSCI remains under discussion and its relationship with CSCS is one of the most controversial issues in the clinical management of traumatic CSCI. METHODS: To obtain a relatively uniform background, patients non-surgically treated for an acute C3-4 level CSCI without major fracture or dislocation were selected. We analyzed 58 subjects with traumatic CSCI using T2-weighted mid-sagittal magnetic resonance imaging. The sagittal diameter of the cerebrospinal fluid (CSF) column, degree of canal stenosis, and neurologic outcomes in motor function, including improvement rate, were assessed. RESULTS: There were no significant relationships between sagittal diameter of the CSF column at the C3-4 segment and their American Spinal Injury Association motor scores at both admission and discharge. Moreover, no significant relationships were observed between the sagittal diameter of the CSF column at the C3-4 segment and their neurological recovery during the following period. CONCLUSIONS: No relationships between pre-existing CSCS and neurological outcomes were evident after traumatic CSCI. These results suggest that decompression surgery might not be recommended for traumatic CSCI without major fracture or dislocation despite pre-existing CSCS.
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Humans , Cerebrospinal Fluid , Cervical Cord , Constriction, Pathologic , Decompression , Joint Dislocations , Magnetic Resonance Imaging , Retrospective Studies , Spinal Canal , Spinal InjuriesABSTRACT
Backgroud: Osteophyte occurrence in cervical vertebral column is leading cause of cervical spondylosis. The aim of the present study was to estimate the average anatomical changes in cervical vertebral column due to occurrence of osteophytes and changes in the sagittal diameters of the cervical vertebral canal in Indian population to establish a clue to the underlying causes of the neck pain of unknown etiology. Methods: We dissected the cervical part of the vertebral column of 50 human adult cadavers (25 males and 25 females) and obtained 200 plain X-rays of lateral view of cervical spine of living patients (100 males and 100 females) for both morphometric and radiological analyses. Results: We found posterior osteophytes more frequently than anterior. The highest frequency of posterior osteophytes was found in the fifth cervical vertebra and of anterior osteophytes in the sixth cervical vertebra. The mean sagittal diameter of the cervical vertebral canal of cadavers ranged from 29.6 mm at C1 to 15.2 mm at C7 in males and 26.6 mm at C1 to 14.5 mm at C7 in females. The mean sagittal diameters of the cervical spinal canal in lateral radiograph of the cervical spine were ranged from 20.7 mm at C1 to 14.4 mm at C7 in males and from 19.9 mm at C1 to 13.4 mm at C7 in females. In general the sagittal diameters in female were less than that of male at all vertebral levels. The canal-body ratio at all vertebral levels was found to be less than 0.8 and was significant to develop cervical spondylotic myelopathy.Conclusion: This study has shown the effects of occurrence of osteophytes in cervical vertebra column and its impact on cervical spondylotic myelopathy.
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Objective To explore surgical techniques and curative effects of microsurgical treatment for neurilemmoma in upper cervical spinal canal. Methods From Jan. 2004 to Nov. 2007, 59 cases of schwannoma was resected through microoperation, the operation was conducted through a posteromedial approach, using German Laika microscope resection of the tumor, large tumors cannot complete resection,block or sac, resection postoperative neck activity conventional neck restrictions, with following observation of 6 months-2 years. Results A complete recovery was achieved in 54 cases, an improvement of symptoms was achieved in 5 cases, no death was encountered. Follow-up observations were carried out in 55 cases from 3 months-2 years (6.5 ± 1.5 months). MRI examinations 3-12 months after operation in 35 cases found no residual or recurrent tumor. X-ray radiography under anteroposterior, lateral, and open-mouth view 6 months after operation in 42 cases showed no spinal deformation and good vertebral stability. Conclusions As long as neurilemmoma in upper cervical spinal canal are diagnosed, a microsurgical treatment should be given as early as possible. Appropriate selection of surgical approach, skillful microsurgical techniques in accordance with pathological types of lesions, and principles of minimal invasion are critical for the operation safety.
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hyperflexion,and the differentiation was significant(P
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Objective To explore surgical techniques and curative effects of microsurgical treatment for tumors in upper cervical spinal canal.Methods A total of 81 cases of tumors in upper cervical spinal canal had received microneurosurgery from January 1990 to December 2005.The operation was conducted through a posteromedial approach.A total tumor resection was performed in 73 cases of neurofibroma or neurilemmoma,3 cases of spinal meningioma,and 3 cases of ependymoma.A subtotal tumor resection was conducted in 2 cases of astrocytoma.Results A complete recovery was achieved in 75 cases,an improvement of symptoms was achieved in 4 cases,and no improvement in 2.No death was encountered.Follow-up observations were carried out in 52 cases for 3 months ～ 3 years(8.5?1.5 months).MRI examinations 3 months after operation in 15 cases found no residual or recurrent tumor.X-ray radiography under anteroposterior,lateral,and open-mouth view 6 months after operation in 32 cases showed no spinal deformation and good vertebral stability.Recurrence of intramedullary tumor was seen in 3 cases. Conclusions As long as tumors in upper cervical spinal canal are diagnosed,a microsurgical treatment should be given as early as possible.Appropriate selection of surgical approach,skillful microsurgical techniques in accordance with pathological types of lesions,and principles of minimal invasion are critical for the operation safety.
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Comparision diameter of the cervical spinal canal and calculate Pavloc index of 40 nomal adults aged 25 to 55 in standard lateral radiographs and MRI showed that: The average indexs in MRIs are: from C3 to C10: 12,82 ±0,93mm and 0,95 ± 0,10. From C3 toC7: 12,9 ± 0,91mm and 0,95 ± 0,10. From C1 to C7: 13,6 ± 0,83mm and 1,25± 0,10, in radiographs are: From C3 to C6: 17,35 ± 1,12mm and 0,98 ±0,08. From C3 to C7: 17,46 ±1,26mm and 0.98 ± 0,08. From C1 to C7: 18,5 ±1,19mm and 1,26 ± 0,09. The pavlov index in MRI are smaller than that in standard lateral radiographs but they are not different significally