Disfagia devido a osteoitose cervical: relato de caso / Dysphagia due to cervical osteophytosis: case report

Doenças degenerativas na coluna cervical são comuns nos pacientes idosos. Os autores apresentam caso de paciente do sexo feminino, 44 anos, com quadro de disfagia progressiva relacionada à osteofitose cervical anterior em (C5-C6 e C6-C7). Esofagograma mostrou a compreensão esofágica pelos osteófitos anteriores. O tratamento realizado foi brocagem dos osteófitos, discectomia cervical em dois níveis e artrodese cervical, resultando na remissão completa do sintoma. Embora seja uma causa de disfagia, osteófito deve ser incluído como diagnóstico diferencial pois é uma causa tratável e reversível do sintoma.

Degenerative diseases of the cervical spine are common in elderly patients. The authors present a case report of female, 44 years old, with progressive dysphagia due to anterior cervical osteophytes (C5-C6 and C6-C7). Esophagogram showed esophageal compression by anterior osteophytes. The treatment was removal of osteophytes by drill, cervical discectomy on two levels and cervical arthrodesis, resulting in complete remission of symptoms. Although it is an un-common cause of dysphagia, osteophytes should be included in the differential diagnosis because it is a reatable and reversible cause of the symptom.

Young adult and giant cervical exostosis

Degenerative changes in the spine can result in the formation of osteophytes on the anterior surface of the cervical spine. Depending on their site, osteophytes can bring on clinical manifestations such as dysphagia, hoarseness, and stridor. We discuss an interesting case of a young adult patient who presented with dysphagia along with neck discomfort, and on investigation was found to be suffering from diffuse idiopathic skeletal hyperostosis. Here, we briefly portray the presenting features, radiographic findings, and management options

Role of magnetic resonance imaging in lumbar spondylosis

To assess the frequency of various MRI findings in patients with lumbar spondylosis and determine their association with symptoms of patients. Cross-sectional analytical study. Radiology Department,The Aga Khan University Hospital, Karachi, from January to December, 2002. The study included 120 patients who presented with low back and leg pain. Segmental classification system was used to classify the pain distribution. All patients underwent lumbar MRI using 1.5 T-scanner. MRI scans was evaluated for magnitude and location of nerve compression, disc extrusion and the nature of nerve and thecal sac deformation in the central canal, lateral recess and intervertebral foramen at each spinal level. Statistical analysis was performed using computer program SPSS [Version; 10]. Chi-square test was also used to determine significance of association between degree of compression, duration of symptoms, site of pain and presence of weakness and numbness. Independent samples test [Levenes test] and Chi-square test were used to determine the significance of associations between age, gender, chronicity of symptoms and MRI findings. A p-value of <0.05 was considered to indicate statistically significant association. The study included 120 patients, the age range was 22 to 88 years [mean 47 years]. Twenty-three patients had acute pain of less than 2 months, 40 patients had recurrence of previous symptoms within past 2 months and 57 patients had chronic pain. Disc herniation was most frequent finding seen in 107 patients [89%]. Eighty-eight patients [73%] had MRI evidence showing some degree of nerve or thecal sac compression. Severe nerve compression was present in 48 patients [40%]. Disc extrusion was present in 22 patients [18%]. There was no significant association between segmental distribution of symptoms and presence of anatomic impairment. However, severe nerve compression and disc extrusion were significantly associated with pain distal to the knees. The presence of disc extrusion or ipsilateral severe nerve compression at one or multiple side is strongly associated with distal leg pain. There should be a correlation between patient symptoms and signs of sciatica and imaging demonstration of nerve root compression before invasive therapy is undertaken

Painful neck movement: an additional differentiating sign between cervical spondylosis and myofascial pain syndrome

To find any specific pattern of pain severity during various neck movements in cervical spondylosis versus the myofascial pain syndrome. The study was carried out on 50 myofascial pain syndrome patients and 60 cervical spondylosis patients. Neck pain during neck flexion, extension, rotation and lateral flexion was measured using a numerical rating scale. Pain score during neck flexion was more in myofascial pain syndrome than in cervical spondylosis patients. On the other hand, neck pain during neck extension was more in cervical spondylosis patients than in myofascial pain syndrome patients. There was no statistical significant difference between both groups as regard rotation and lateral flexion. Moreover, neck extension was more painful than neck flexion in 90% of patients with cervical spondylosis. On the other hand, neck flexion was more painful than extension in myofascial pain syndrome patients. This study suggested that comparing pain severity during neck flexion to that during neck extension could be of help not only in differentiating pain of cervical spondylosis from that of MPS, but also in identifying the main cause of neck pain in patients with clinical signs suggestive of MPS and who have concomitant radiological evidence of cervical spondylosis. This could be of therapeutic value

Evaluation of surgical treatment of cervical disc and spondylosis

One hundred and forty patients with cervical disc disease and spondylosis treated surgically in the period between 1990 to 1996 at Al-Azhar University Hospitals. They were 110 males and 30 females. The surgical approach was depended on clinico-radiological presentation. Anterior diskectomy was performed in 50 cases and decompressive posterier laminectomy in 90 cases. In anterior diskectomy group, 84% showed improvement, 10% remained unchanged and 6% worsened. In decompressive laminectomy group, 58.8% improved, 18.4% unchanged and 22.2% worsened. Anterior diskectomy had less risk of overall complication than decompressive laminectomy. The indication of surgery is the presence of substantially disc [proved radiologically] of obliterating the subarachnoid space and it should be indenting the cord itself with one of the clinical syndromes. The surgery is urgent once the case is diagnosed to stop further neurological deficits

Síndrome del angular de la escápula de Barré-Liéou / Syndrome of the angle of the scapula or Barré-Liéou

El síndrome de Barré-Liépu o del angular de la escápula, es una entidad poco conocida caracterizada por dolor en el ángulo superomedial de la escápula, mareos, náuseas, zumbido en los oídos, parestesias en las manos y dolor retrosternal. Se describe una técnica de diagnóstico y tratamiento consistente en la infiltración de novocaína al nivel de la inserción distal del músculo angular del omóplato. Se informa de la experiencia adquirida en el manejo de 200 pacientes