Changes in Spinal Canal Diameter and Vertebral Body Height with Age

PURPOSE: All structures of the spine, including the spinal canal, change continuously with age. The purpose of this study was to determine how the spinal canal of the lumbar spine changes with age. The L4/5 is the most common site of spinal stenosis and has the largest flexion-extension motion, whereas the T5/6 has the least motion. Therefore, we measured the spinal canal diameter and vertebral body height at T5, T6, L4, and L5 with age. MATERIALS AND METHODS: This was a retrospective study of aged 40 to 77 years. We reviewed whole spine sagittal MRIs of 370 patients with lumbar spinal stenosis (LSS) (Group 2) and 166 herniated cervical disc (HCD) (Group 1). Each group was divided into four age groups, and demographic parameters (age, gender, height, weight, BMI), the mid-spinal canal diameter, and mid-vertebrae height at T5, T6, L4, L5 were compared. Within- and between-group comparisons were made to evaluate changes by age and correlations were carried out to evaluate the relationships between all parameters. RESULTS: Height, weight, and all radiologic parameters were significantly lower in Group 2 than Group 1. Group 1 did not show any differences, when based on age, but in Group 2, height, weight, and T6, L4, and L5 height were significantly decreased in patients in their 70's than patients in their 40's, except for spinal canal diameter. Age was associated with all parameters except spinal canal diameter. CONCLUSION: Vertebral height decreased with age, but spinal canal diameter did not change in patients with either LSS or HCD. Mid-spinal canal diameter was not affected by aging.

Current concept on the operative treatment for degenerative cervical disc disease

Degenerative changes in the cervical spinal column are common in the adult population. Although most patients respond well to initial nonsurgical management, those who continue to have symptoms or patients with clinically evident myelopathy are candidates for surgical intervention. The objective of this article is to review and discuss the surgical treatment for degenerative cervical spine disease. Anterior cervical spine surgery is commonly used to treat numerous pathologic entities and is expected to increase with the development of surgical techniques and instruments. Autogenous tricortical iliac crest struts are the best option for anterior fusion, but they are associated with donor site morbidity. Equivalent fusion rates have been reported after allografting and autografting, combined with the use of anterior plates. Artificial disc replacement, one of the emerging motion-sparing technologies, is currently used and has shown excellent results. However, longer follow-up is needed to determine whether these devices can function well over time. Surgical treatments in degenerative cervical disease have shown excellent results. Appropriate methods that take into account the pathologic status of the patient and the surgeon's surgical experience can prevent complications and lead to excellent surgical outcomes.

Comparing the Outcome of Conservative Treatment between Soft Herniated Cervical Disc with Radiculopathy and Cervical Spondylotic Radiculopathy

OBJECTIVE: To compare the long-term clinical outcome of conservative treatment between herniated soft cervical disc with radiculopathy (HCD-R) and cervical spondylotic radiculopathy (CSR) METHOD: Clinical outcomes of each twenty patients with foraminal stenosis and with herniated cervical disc in magentic resonance image were evaluated prospectively for one year. All patients received cervical transforaminal epidural steroid injection. Clinical outcomes were measured by visual analogue scale (VAS), Neck Disability Index (NDI) at initial, one, three, six, and twelve months after injection. Twelve months after injection, we categorized patients' satisfaction. RESULTS: All assessements were significantly reduced (p < 0.05). The averages of VAS for upper extremity and neck pain decreased from 6.7, 5.1 to 1.5, 1.2 in the CSR group, and also decreased from 5.6, 6.3 to 1.3, 2.3 in the HCD-R group, respectively. The averages of NDI in the CSR group decreased from 42% to 8%, and in the HCD-R group from 53% to 14%, respectively. 88.8% in the CSR group and 88.1% in the HCD-R group were satisfied at posttreatment 12 months. There was no difference between groups in all comparison. CONCLUSION: CSR responded very well to conservative treatment as well as HCD-R, and the effects sustained for long- term.

CT Guided Cervical Transforaminal Steroid Injection: 2 Months Follow-up / 대한통증학회지

BACKGROUND: A cervical transforaminal steroid injection is an effective therapeutic modality for radiculopathy of a herniated cervical disc or a cervical foraminal stenosis. However, there is some debate regarding the safety of the transforaminal approach under C-arm guidance compared with the posterior interlaminar approach. We report a new technique for cervical transforaminal steroid injection guided by MDCT. METHODS: Patients presenting with radiating pain on their shoulder or arm were diagnosed using CT or MRI of a cervical herniated disc or a foraminal stenosis. Each patient whose symptoms were compatible with the image scan was enrolled in this study. They received a cervical transforaminal steroid injection under CT guidance, and the effectiveness and complications of this technique were evaluated over a 2-month period. RESULTS: According to the CT scan, none of the participants had an internal jugular vein or a carotid artery invasion during the procedure. No vertebral artery injection was noted, and no patient developed a hematoma after the injection. The VAS score had improved significantly by 2, 4 and 8 weeks after the injection. CONCLUSIONS: While a conventional C-arm guided cervical transforaminal steroid injection does not appear to differentiate between the major vessels and structures in images, a CT guided approach is a more useful and safer technique for the precise placement of a needle.

Forensic Review of the Iatrogenic Injury of Carotid Artery: The Report of an Autopsy Case / 대한법의학회지

One case of the iatrogenic injury of carotid artery is reported. The deceased person was a 54-yearold woman. She visited a local clinic because she had the severe pain on back and neck and the radiating pain of left lower extremity. Under the diagnosis of the herniated cervical disc, the operation was performed. After five hours from starting the operation, respiratory difficulty, facial cyanosis and syncope were found, suddenly. Cardiopulmonary resuscitation was performed, however eventually she died. The autopsy was performed. In the neck, large hematoma at the posterior portion of neck organ and perforation of right carotid artery were noted.

Brown-Sequard Syndrome due to Herniated Cervical Disc

The Brown-Sequard syndrome is commonly related with a traumatic injury to the spinal cord. Degenerative spine disease is not often reported as the cause of the Brown-Sequard syndrome, and most reports document cervical spondylosis. There are few citation, describing herniated cervical disc as the cause of a Brown-Sequard syndrome. We report a rare case of Brown-Sequard syndrome produced by herniated cervical disc.

Brown-Sequard Syndrome due to Herniated Cervical Disc

The Brown-Sequard syndrome is commonly related with a traumatic injury to the spinal cord. Degenerative spine disease is not often reported as the cause of the Brown-Sequard syndrome, and most reports document cervical spondylosis. There are few citation, describing herniated cervical disc as the cause of a Brown-Sequard syndrome. We report a rare case of Brown-Sequard syndrome produced by herniated cervical disc.

Economical Analysis of Cervical Disc Disease by Anterior Inter-body Fusion Methods - Comparing of Bone Graft vs Plating -

OBJECTIVES: The purpose of this study was to assess the complications, duration of admission, cost effectiveness, radiologic stabilization of the anterior cervical bone fusion in the treatment of cervical disc disease with and without plating. MATERIALS AND METHODS: Fifty-two surgically treated patients for cervical disc disease were reviewed. Group I consisted of consecutive treated patients with iliac auto-bone graft without instrumentation after anterior cervical discectomy. Group II consisted of consecutive treated patients with iliac autologous-bone graft with CASPER cervical plate fixations. Radiologic fusion was decided when loss of end plate boundary between graft bone and vertebral body and immobile, maintenance of the disc space were evident on simple dynamic plain films. The patients were discharged after the stabilization of cervical motion by films was of tained. These groups were analysed multiple variably with Mann-Whitney U-test. RESULTS: Group I consisted of 18 patients, group II consisted of 34 patients. Mean age was 49.0+/-8.1 years, mean duration of admission was 17.27+/-10.51 days, mean costs for treatment was 1,970,000+/-475,000 won. In group I, mean age was 47.7(34-60) years, 16 patients had undergo on one-level operation, 2-patients had undergo on two-level operation, mean duration of admission was 28.7+/-10.4 days, mean costs for treatment was 2,194,473+/-561,639 won. The periods of stabilization was 6.6+/-3.36 weeks on radiologic study. Mean periods of out patient follow up was 16.8(6-64) weeks after discharge. Mean period of radiologic follow up was 17.3(4-6) weeks after surgical operation. In group II, mean age was 49.7(37-62) years and 18 patients one-level operation, 14-patients had undergo on two-level operation and 2-patients three-level operation. Mean duration of admission was 11.24+/-3.29 days, mean costs for treatment was 1,850,823+/-389,372 won. The periods of stabilization was 5.88+/-7.07 weeks on radiologic study. Mean period of out patients follow up was 16.7(4-60) weeks after discharge. Mean period of radiologic follow up was 12.4(3-52) weeks after surgical operation. The duration of admission showed statistical significance in Group II but other items showed no significant difference between two groups. CONCLUSIONS: The more economic, early life return and effective method of cervical disc disease in our series were evident in patients who had undergone, iliac bone graft and plate fixations after anterior discectomy.

A Brown-Sequard Syndrome Resulting from a Ruptured Cervical Disc Herniation: A Case Report

We present a case of Brown-Sequard syndrome due to a massive cervical disc herniation at C5/6 level, presenting sings of sudden and severe spinal cord compression. The lesion was diagnosed by MRI and herniated cervical disc was removed under the surgical microscope via anterior route. The result of operation was good. A brief review of the literature is given.

Clinical Evaluation of Cervical Water-soluble Metrizamide Myelography via C1-2 Puncture

A total of 32 cases of cervical myelography via lateral c1-2 puncture using water-soluble metrizamide was evaluated. Twenty seven cases were suspected to have herniated cervical disc and five cases, spinal cord tumor. Patients were placed in prone position with head and neck slightly extended on the radiolucent operating table. Puncture was performed using 22-guage spinal puncture needle placed at the junction of the middle and posterior one-third of the bony spinal canal and 4-6mm inferior to the arch of atlas on lateral projection. The needle was positioned posterior to the spinal cord into the subarachnoid space. The author could obtain more clear images with less amount of contrast medium than doses used in conventional cervical myelography via lumbar route. The were relatively few adverse reactions and no considerable complications have been encountered with a new cervical water-soluble metrizamide myelography via C1-2 puncture.