A case of bow hunter's syndrome and a systematic literature review / 中华骨科杂志

Objective:A clinical case of rotational vertebral artery occlusion (bow hunter's syndrome, BHS) caused by left C 1 osteophyte was reported, and the epidemiological characteristics, diagnosis and treatment methods, and clinical outcomes of BHS were further analyzed. Methods:The clinical data, diagnostic methods, treatment options, and clinical outcomes of the above-mentioned BHS patient are described. The literature from 1978 to 2021 was retrieved, the BHS patients involved were taken as the research objects, and the data of onset age, gender, etiology, site of onset, diagnosis method, treatment method, and clinical outcomes of each selected patient were collected. The data were subdivided through systematic analysis.Results:A patient with rotational compression of the left vertebral artery associated with the left osteophyte of the atlas was presented. 3D-CT showed that the vertebral artery was compressed by the left osteophyte of the atlas. Dynamic digital subtraction angiography (dDSA) showed mild stenosis of the distal V2 segment of the left vertebral artery. When his head turned to the left, the distal V2 segment of the left vertebral artery was compressed and the blood flow was interrupted. After his head was in a neutral position, the blood flow was restored. Because the symptoms could not be relieved after conservative treatment, posterior C 1 osteophyte resection was used to decompress the vertebral artery, and the symptoms disappeared after the operation, and the short-term follow-up results were good. All of the 87 articles and 126 patients have been studied. The median age was 55.0 years (IQR: 43.5, 65.0 years) and the peak age of onset was 51 to 60 years old. The gender difference has been uncovered and the sex ratio was 1.9∶1 (male∶female). Among the 126 patients, 65 patients had vertebral artery occlusion or stenosis located in the C 1-C 2 segment; 66 patients involved the left vertebral artery, 45 patients involved the right vertebral artery, and 15 patients involved bilateral vertebral arteries. DSA was used to confirm BHS in 114 of 126 patients. The follow-up time was 0.25-114 months, with an average of 16.6 months. Thirty-six patients were treated conservatively, and 12 patients had residual symptoms; 33 patients underwent fusion surgery, and all patients' symptoms were relieved after surgery; 54 patients underwent simple decompression surgery, and 4 patients had residual symptoms after surgery; 4 patients received endovascular surgery, and their symptoms were relieved after surgery. Conclusion:Patients with BHS are rare clinically, often involving C 1-C 2 and the left vertebral artery is more likely to be involved. The peak age of onset was 51 to 60 years old. DSA is the gold standard for the diagnosis of BHS. For BHS caused by abnormal bone structure, intervertebral disc herniation, joint instability, etc., decompressive surgery of the vertebral artery or C 1-C 2 segment fusion is the most common treatment modality.

Disfagia por osteofitose cervical anterior: relato de caso / Dysphagia due to anterior cervical osteophytosis: case report

RESUMO Osteofitose cervical anterior é uma condição não inflamatória caracterizada por calcificação ou ossificação dos ligamentos paravertebrais anterolaterais da coluna cervical. Acomete 20 a 30% dos idosos, sendo responsável por 1,6% das etiologias identificáveis da disfagia na população senil. Em estados avançados, a disfagia por osteofitose cervical pode levar a complicações como desnutrição, perda de peso e pneumonia aspirativa. Este estudo visa alertar para a suspeição desse diagnóstico à equipe multidisciplinar que cuida do idoso disfágico, possibilitando tratamento oportuno e precoce da condição. É relatado o caso de um paciente masculino de 66 anos com disfagia tipo engasgo para sólidos e refluxo nasal de alimentos há 1 ano. Videoendoscopia da deglutição evidenciou abaulamento da parede posterior da faringe e, à oferta de alimento sólido, restrição à retroflexão da epiglote, refluxo nasal do alimento e grande quantidade de resíduo alimentar sobre a lesão. Tomografia computadorizada de coluna cervical identificou a presença de osteófitos cervicais anteriores entre as vértebras C3 e C6, o maior com comprimento anteroposterior de 12 milímetros, estreitando a coluna aérea ao nível da oro- e hipofaringe. O paciente foi adequadamente tratado com fonoterapia da deglutição. A estratégia inicial de tratamento para a osteofitose sintomática deve ser conservadora, geralmente com boa resposta à fonoterapia da deglutição. Apesar de raramente estarem implicados na etiologia da disfagia, considerando sua alta prevalência, é importante que otorrinolaringologistas e fonoaudiólogos estejam atentos a esse diagnóstico, permitindo tratamento precoce e efetivo para o paciente assistido, melhor prognóstico e menos complicações da disfagia orofaríngea no idoso.

ABSTRACT Anterior cervical osteophytosis is a noninflammatory condition characterized by calcification or ossification of the anterolateral paravertebral ligaments of the cervical spine. It affects 20 to 30% of the elderly, being responsible for 1.6% of the identifiable etiologies of dysphagia in the senile population. In advanced states, dysphagia due to cervical osteophytosis can lead to complications such as malnutrition, weight loss and aspiration pneumonia. This study aims to alert to this diagnosis, enabling early treatment of the condition. The case of a 66-year-old male patient with choking dysphagia for solids and nasal food reflux for 1 year is reported. Fiberoptic Endoscopic Evaluation of Swallowing showed bulging of the posterior pharyngeal wall and, with solid food supply, restriction to the retroflexion of the epiglottis, nasal reflux of the food and a large amount of food residue on the lesion. Cervical spine Computed Tomography identified the presence of anterior cervical osteophytes between the C3 and C6 vertebrae, the largest with anteroposterior length of 12 millimeters, narrowing the air column at the level of the oro- and hypopharynx. The patient was adequately treated with swallowing therapy by speech-language pathologist. The initial treatment strategy for symptomatic osteophytosis should be conservative, usually with a good response to swallowing therapy. Although they are rarely implicated in the etiology of dysphagia, considering its high prevalence, it is important that otolaryngologists and speech-language pathologists are attentive to this diagnosis, allowing early and effective treatment for the assisted patient, better prognosis and fewer complications of oropharyngeal dysphagia in the elderly.

Cervical spondylotic myelopathy: is a combined approach necessary? / Mielopatia cervical espondilótica: a abordagem combinada é necessária? / Mielopatía cervical espondilótica: ¿el abordaje combinado es necesario?

ABSTRACT Objective: Cervical spondylotic myelopathy (CSM) is the main cause of spinal dysfunction in adults. The type of surgical approach to treatment is not well defined in the literature. The objective is to report the results obtained through isolated posterior decompression in patients with a previous indication of the combined approach for the treatment of cervical spondylotic myelopathy. Methods: This is a therapeutic study with level of evidence II, according to the Oxford classification table. Ten patients who underwent isolated posterior approach surgery for the treatment of cervical spondylotic myelopathy were evaluated through imaging and questionnaires (visual analog scale, mJOA-Br scale - Brazilian Portuguese version of the Modified Japanese Orthopedic Association Scale, and Neck Disability Index (NDI)), comparing pre- and postoperative results. Results: Late evaluation of the 10 patients was performed in the period ranging from 24 to 36 months (mean of 30.3 months ± 7.25) following surgery. The comparison of the clinical and radiological parameters in all patients showed a statistical difference in relation to the preoperative scales applied and to the degree of cervical lordosis (p <0.05), evidencing improvement after decompression and posterior fixation of the cervical spine. Conclusions: The isolated posterior approach (decompression, fixation and arthrodesis) allowed the clinical and radiological improvement of patients with cervical spondylotic myelopathy and who had an indication of the complementary anterior approach. Level of evidence II; Retrospective study.

RESUMO Objetivo: A mielopatia cervical espondilótica (MCE) é a principal causa de disfunção medular nos adultos. O tipo de abordagem cirúrgica para o tratamento não é bem definido na literatura. O objetivo é relatar os resultados obtidos por meio da descompressão posterior isolada nos pacientes com indicação prévia da abordagem combinada para o tratamento da mielopatia cervical espondilótica. Métodos: Trata-se de um estudo terapêutico com nível de evidência II, conforme a tabela de classificação Oxford. Dez pacientes submetidos apenas à abordagem cirúrgica posterior para tratamento de mielopatia cervical espondilótica foram avaliados por meio de exames de imagem e de questionários (escala visual analógica, escala mJOA-Br - Versão em Português da Escala Modificada da Sociedade Japonesa de Ortopedia e escala de incapacidade cervical - Neck Disability Index - NDI), comparando os resultados pré e pós-operatórios. Resultados: A avaliação tardia dos 10 pacientes foi realizada no período que variou de 24 a 36 meses (média de 30,3 meses ± 7,25) de pós-operatório. A comparação dos parâmetros clínicos e radiológicos em todos os pacientes mostrou diferença estatística com relação ao pré-operatório para as escalas aplicadas e para o grau de lordose cervical (p < 0,05), evidenciando a melhora depois da descompressão e da fixação posterior da coluna cervical. Conclusões: A abordagem posterior isolada (descompressão, fixação e artrodese) permitiu a melhora clínica e radiológica de pacientes com mielopatia cervical espondilótica e que tinham indicação da abordagem anterior complementar. Nível de evidência II; Estudo retrospectivo.

RESUMEN Objetivo: La mielopatía cervical espondilótica (MCE) es la principal causa de disfunción medular en los adultos. El tipo de abordaje quirúrgico para el tratamiento no está bien definido en la literatura. El objetivo es relatar los resultados obtenidos por medio de la descompresión posterior aislada en los pacientes con indicación previa del abordaje combinado para el tratamiento de la mielopatía cervical espondilótica. Métodos: Se trata de un estudio terapéutico con nivel de evidencia II, conforme a la tabla de clasificación Oxford. Diez pacientes sometidos únicamente al abordaje quirúrgico posterior para el tratamiento de la mielopatía cervical espondilótica fueron evaluados mediante exámenes de imagen y cuestionarios (escala analógica visual, escala mJOA-Br - versión en portugués de la escala modificada de la Sociedad Japonesa de Ortopedia y escala de incapacidad cervical - Neck Disability Index - NDI), comparando los resultados pre y postoperatorios. Resultados: La evaluación tardía de los 10 pacientes fue realizada en el período que varió de 24 a 36 meses (promedio de 30,3 meses ± 7,25) de postoperatorio. La comparación de los parámetros clínicos y radiológicos en todos los pacientes mostró diferencia estadística con relación al preoperatorio para las escalas aplicadas y para el grado de lordosis cervical (p <0,05), evidenciando la mejora después de la descompresión y de la fijación posterior de la columna cervical. Conclusiones: El abordaje posterior aislado (descompresión, fijación y artrodesis) permitió la mejora clínica y radiológica de pacientes con mielopatía cervical espondilótica y que tenían indicación del abordaje anterior complementario. Nivel de evidencia II; Estudio retrospectivo.

Relationship between cervical spondylotic radiculopathy and carpal tunnel syndrome / 中华神经科杂志

Objective To explore the relationship between cervical spondylotic radiculopathy (CSR) and carpal tunnel syndrome (CTS) by investigating their electrophysiological characteristics and the incidence of CSR root injury and root injury complicating with CTS.Methods One hundred and twenty-four cases of CSR diagnosed in Peking Union Medical College Hospital from September 2013 to February 2014 by electromyography (EMG) were recruited.According to the results of EMG,patients were divided into root injury and root injury complicating with CTS groups.The distal motor latency (DML),motor nerve conduction velocity (MCV),sensory nerve conduction velocity (SCV),sensory nerve action potential (SNAP),compound muscle action potential (CMAP) and spontaneous potential (SP) were compared between the two groups.Results There were 81 (65.3％) cases with root injury,11 cases with double sides injury and 29 cases with normal EMG among these 124 patients.The CMAP,DML,MCV,SCV and SNAP were normal in 76 cases,CMAP lowered 5％-12％ in 3 cases,DML extended 3％ and 9％ in 2 cases.There were 14 cases (11.3％) with concomitant CTS (female 10 cases and male 4 cases,double sides CTS 10 cases).Among the 14 cases with concomitant CTS,there were 9 cases with simply sensory nerve conduction abnormality,SCV slowing down 26％-47％,SNAP reducing 58％-86％ or normal,while other 5 cases with motor conduction abnormality as well as sensory nerve conduction abnormality,CMAP reducing 21％-78％,DML extending 27％-39％ in 3 cases,MCV slowing down 32％ and 40％ in 2 cases.Five cases had spontaneous electricity position movement in the abductor pollicis brevis.The incidence of root injury complicating with CTS in C6 (27.4％,9/33),C7 (26.9％,7/26) and C8 (5/7) showed statistically significant difference (x2 =5.96,P ＜ 0.01).Conclusions There is a high incidence of root injury and CTS in CSR patients,indicating a possible double crush between CSR and CTS.

Doença de Forestier e suas implicações otorrinolaringológicas: revisão de literatura / Forestier's disease and its implications in otolaryngology: literature review

Introdução: A Doença de Forestier afeta a coluna vertebral, preferencialmente em homens Coluna vertebral; idosos. Não é rara, mas é frequentemente não reconhecida e pode levar a relevante morbimortalidade. Quando acomete a coluna cervical, pode gerar importantes manifestações otorrino-Transtornos de laringológicas. Objetivo: Destacar os sintomas faringolaríngeos da doença de Forestier. Método: Revisão da literatura nas bases de dados Web of Knowledge, PubMed e SciELO e entre os dez periódicos de maior número de citações na área de otorrinolaringologia e também busca manual por publicações nas listas de referências dos artigos selecionados, principalmente os de cunho histórico. Resultados: A doença não tem etiologia clara. Os sintomas das complicações são mais exuberantes que os da doença propriamente dita. A disfagia é o sintoma cervical mais conhecido. Outros sintomas discutidos são a apneia do sono, globus faríngeo, tosse, disfonia, dispneia, otalgia reflexa e sintomas medulares compressivos. O diagnóstico é efetuado com apropriado estudo radiológico. O tratamento é baseado em estratégia conservadora. Pacientes com disfagia refratária e comprometimento respiratório podem ser submetidos a tratamento cirúrgico. Conclusão: A doença de Forestier deve ser suspeitada em pacientes idosos com os principais sintomas das complicações, os quais são comuns na prática otorrinolaringológica, para o início precoce de acompanhamento multidisciplinar. .

Introduction: Forestier's disease affects the spinal column of primarily elderly men. It is not rare, but it is often undiagnosed and can lead to significant morbidity and mortality. When it affects the cervical spine, it can result in important otorhinolaryngological manifestations. Objective: To analyze the pharyngeal and laryngeal symptoms of the Forestier's disease. Methods: Literature review of the Web of Knowledge, PubMed, and SciELO databases and of the ten most frequently cited journals in the field of otorhinolaryngology. Additionally, a manual search was performed for publications in the reference lists of selected articles, mostly those of a historical nature. Results: The etiology of the disease is still unclear. Symptoms of complications are more significant than the disease itself. Dysphagia is the most common cervical symptom and has several involved mechanisms. Other symptoms are sleep apnea, pharyngeal globus, coughing, dysphonia, dyspnea, otalgia, and medullary compression. The diagnosis is verified by appropriate radiological study. Treatment is based on a conservative strategy. Patients with refractory dysphagia and respiratory impairment can be surgically treated. Conclusion: Forestier's disease should be suspected in elderly patients with the major symptoms of complications, which are common in otorhinolaryngology practice and when identified, a multidisciplinary approach should be instituted as soon as possible. .

Is the Cross-sectional Area after Unilateral Open Door Laminoplasty Wider than that after Midline Splitting Laminoplasty ? : Mathematical Approach

OBJECTIVE: The aim of this study was to compare geometrically cross-sectional areas of two different laminoplasty techniques in same opening size. Some investigators have studied the expanded areas of the two different techniques using imaging study. Although it is unclear that postoperative spinal canal is correlated with the surgical outcome we just focused on mathematical and geometrical correlation of the expandable area with surgical opening size in different laminoplasty techniques. METHODS: To predict the expandable area by a midline splitting technique and a unilateral open door technique, we placed an imaginary isosceles triangle in the spinal canal and drew graphs for the equation of the expandable areas in same opening size using the Pythagorean theorem and mathematical program. To substitute the constant figures of mathematical formula we estimated the normal cervical spine CT scans of 50 Korean adults. RESULTS: We subtracted the imaginary triangle from the spinal canal and were left with the remaining area of the spinal canal that was not changed before and after surgery. In same opening size the expandable area by the midline splitting technique was same but slightly wider than the unilateral open door technique, irrespective of the triangular shape. For a normal isosceles triangle the results were the same. CONCLUSION: Using mathematical proof, the expandable area after the midline splitting technique was same but slightly larger than that after the unilateral open door technique, irrespective of the size of the lamina opening.

A Longitudinal Study About the Morphology of the Cervical Vertebral Body in Collegiate American Football Players / 体力科学

The purpose of this study is to investigate the degenerative change of the cervical spine in American football (AF) players. The subjects were 27 collegiate AF players who had an annual radiological examination of the cervical spine. X-ray films of the lateral view were read by digital scanner and the anterior and posterior height of each spine (C 3-C 6) was measured. The subjects were divided into two groups based on experience of AF in high school (inexperienced and experienced) or the position played (lines and backs) .<BR>Although the anterior height did not change from the first grade to fourth grade, the posterior height of C 4, C 5 and C6 significantly increased (P <0.05) . The experienced group showed a faster increase in the rate of posterior height than the inexperienced group. Also, the backs group showed a faster increase in the rate of posterior height than the lines group. The increased posterior height, which sometimes includes bony spur, results in kyphotic change of cervical alignment and impingement of the cervical nerve root. The faster growth rate in experienced or backs groups suggests that higher mechanical stress to the cervical spine and younger start of AF caused degeneration.