Résumé
An 83-year-old woman presented with dropped head syndrome (DHS), that had been progressing during the previous 6 months. She had no history of neuromuscular diseases and, on examination, no neuromuscular abnormalities were observed except for isolated weakness of the neck extensors, mainly of the semispinalis cervicis. On the paravertebral sites of the T1-T5 spine on both sides, a total of eight points with marked tenderness were noted, four on each side. These eight points coincided with the anatomically narrow spaces through which the posterior rami emerged from their deep exits in the spine (i.e., the intervertebral foramina) to the superficial paravertebral sites, where they bifurcated into the lateral and medial branches, the latter innervating the semispinalis cervicis. Repeated local corticosteroid injections once a week on these eight tender points, with 3.3 mg Decadron (dexamethasone sodium phosphate) mixed with 20 mL of 0.5% xylocaine divided among the eight tender points, improved DHS in 3 months. This case suggests that the anatomically narrow pathway of the medial branches of the posterior rami at the upper thoracic spine could induce inflammations of the passing nerves, resulting in neck extensor weakness.
Résumé
[Objective]To verify whether or not the modified open-door laminoplasy preserving semispinalis cervicis insert into axis is effective in preventing postoperative axial symptom and maintaining postoperative cervical sagittal alignment.[Method]Since March 2002 to December 2003,forty-eight patients underwent modified open-door laminoplasy preserving semispinalis cervicis insert into Axis,among them,thirty-two patients who were followed up for more than 2 years were included in this study.Preoperative and postoperative JOA score,degree of axial symptom,ranges of neck motion,cervical curvature index were recorded and compared.[Result]Preoperative and postoperative JOA score was(9.04?2.9)and(12.5?3.1)respectively,with recovery rate as(44.9?26.9).There was significant difference between preoperative evident axil symptom rate(46.8%)and postoperative evident axil symptom rate(18.7%),while no significant difference between preoperative and postoperative ranges of neck motion,cervical curvature index was seen.[Conclusion]Modified open-door laminoplasy is less invasive to the posterior extensor mechanism especially the semispinalis cervicis than conventional open-door laminoplasy.This new procedure is effective in preventing postoperative morbidities often seen after conventional laminoplasy with adequate decompression of the spinal cord.