Sensitivity of Pyramidal Signs in Patients with Cervical Spondylotic Myelopathy

STUDY DESIGN: This was a retrospective study. PURPOSE: The purpose of this study was to study the relationship between prevalence of pyramidal signs and the severity of cervical myelopathy. The study is focused on patients having increased signal intensity in T2-weighted magnetic resonance imaging. OVERVIEW OF LITERATURE: Cervical spondylotic myelopathy is the most common cause of spinal cord dysfunction in elderly population. It is the consequence of spondylotic changes leading to cervical cord injury with resulting clinical deficits. Diagnosis in such patients is made based on clinical and radiographic features. A patient must have both symptoms and signs consistent with cervical cord injury as well as radiographic evidence of damage to spondylotic cord. METHODS: Forty-six patients with complaint of cervical spondylotic myelopathy with increased signal intensity in T2-weighted magnetic resonance imaging were included in the study. The neurological finding of the patients was reviewed for the presence of pyramidal signs. The prevalence of each pyramidal sign was calculated and correlated to severity of cervical myelopathy. The motor function scores of the upper and lower extremities for cervical myelopathy set by the Japanese Orthopedic Association (motor Japanese Orthopaedic Association score, m-JOA) scores were used to assess severity of myelopathy. RESULTS: The most prevalent signs were hyperreflexia (89.1%), Hoffmann reflex (80.4%), Babiniski sign (56.5%), and ankle clonus (39.1%). Babiniski sign, ankle clonus, and Hoffmann reflex showed significant association with the lower m-JOA score. CONCLUSIONS: In patients with cervical myelopathy, hyperreflexia exhibited highest sensitivity whereas ankle clonus demonstrated lowest sensitivity. The prevalence of the pyramidal signs is correlated with increasing severity of myelopathy.

Retraction: Sensitivity of Pyramidal Signs in Patients with Cervical Spondylotic Myelopathy

I am retracting our article "Sensitivity of Pyramidal Signs in Patients with Cervical Spondylotic Myelopathy".

Percutaneous Selective Vertebroplasty: State of the Art Management in Well-Confined Metastatic Vertebral Lesions

STUDY DESIGN: Prospective cohort study. PURPOSE: To evaluate the clinical and radiological results of percutaneous selective vertebroplasty (PSV) as first-line treatment options in the setting of well-confined spinal metastases. OVERVIEW OF LITERATURE: Recent technological advances combined with innovative interventional techniques enable an alternative less invasive treatment option for many patients with malignant vertebral body infiltration. Percutaneous vertebral augmentation procedures offer less invasive but effective pain relief to many patients with symptomatic spinal metastatic disease. METHODS: Eleven patients with 21 well-confined metastatic vertebral lesions that had been treated with PSV were included. Pain was evaluated one week, one month, 3 months and 6 months post-procedure using a 10-point visual analogue scale (VAS). A statistical analysis including repeated measures analysis of variance test was used to collectively indicate the presence of any significant differences between different time sequences. Medication usage and range of mobility were also evaluated. RESULTS: The 11 patients had an average age of 42 years and 54.5% were male. Highly significant improvements in VAS scores at rest and with activity (p<0.001) were evident. There was a significant decrease in rate of medication consumption post-procedure (p<0.05). CONCLUSIONS: PSV can be used successfully as the first-line treatment for well-confined metastatic vertebral lesions. It is also an effective method to decrease pain, increase mobility, and decrease narcotic administration in such patients.

Percutaneous Vertebroplasty: A New Serial Injection Technique to Minimize Cement Leak

STUDY DESIGN: This is a prospective cohort study. PURPOSE: This study discusses a new technique for injecting cement in the affected vertebrae. OVERVIEW OF LITERATURE: Since introduction of vertebroplasty to clinical practice, the cement leak is considered the most frequent and hazardous complication. In literature, the cement extravasation occurred in 26%-97% of the cases. METHODS: A hundred and twenty-three patients underwent vertebroplasty using the serial injection technique. The package of the cement powder and the solvent was divided into five equal parts. Each part of the powder and the solvent was mixed as a single dose and injected to the affected vertebra. The duration between subsequent injections was 10 minutes. Each injection consisted of 1-1.5 mL of cement. RESULTS: This new technique gives the surgeon enough time to make multiple separate injections using the same package. The time interval between injections hardens the cement just enough so that it does not get displaced by the next cement injection. This technique gives time to the preceding injected cement to seal off the cracks and cavities in the vertebra, and subsequently leads to a significant decrease in cement leak (p<0.001), as compared to literature. CONCLUSIONS: This study demonstrates a previously unreported technique for vertebroplasty that adds more safety to the procedure by significantly decreasing cement leak. It also makes the surgeon more relaxed due to time intervals, giving him more self-confidence whilst performing the procedure.

Percutaneous Vertebroplasty: A First Line Treatment in Traumatic Non-Osteoporotic Vertebral Compression Fractures

STUDY DESIGN: This was a prospective cohort study. PURPOSE: The purpose of this study was to document and evaluate the clinical and radiological results of percutaneous vertebroplasty (PV) as a first line treatment in traumatic non-osteoporotic vertebral compression fractures (TNVCFs). OVERVIEW OF LITERATURE: PV is commonly used for osteoporotic and neoplastic compression fractures, however its use in traumatic non-osteoporotic compression fractures is uncertain. METHODS: We included 23 patients with traumatic non-osteoporotic TNVCFs and normal bone mineral densitometry scores who were treated with PV. Pain was evaluated at 2 hours, 1 week, 1 month, 6 months, 1 year, and 2 years post procedure using the 10-point visual analogue scale (VAS). Ronald-Morris disability Questionnaire (RDQ) scores were also collected. Statistical analysis included a 2-tailed t test comparing postoperative data with preoperative values. Range of mobility was also evaluated. RESULTS: The 23 patients had an average age of 36 years, and 69.5% were female. There was a significant improvement in VAS scores of pain at rest and in motionand in RDQ scores (p<0.05). CONCLUSIONS: The results of this study proved that PV can be used successfully as a first line treatment in patients with non-osteoporotic compression fractures. It is also, an effective method to decrease pain, increase mobility, and decrease narcotic administration.