Analysis of interleukin-8, interleukin-10, and tumor necrosis factor-alpha in the cerebrospinal fluid of patients with cervical spondylotic myelopathy.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The expression of interleukin-8 (IL-8), IL-10, and tumor necrosis factor-alpha (TNF-alpha) were measured in the cerebrospinal fluid (CSF) of patients with cervical myelopathy. The purpose of this study was to examine whether the CSF levels of those 3 cytokines differ significantly among 3 groups of patients with different diseases. METHODS: IL-8, IL-10, and TNF-alpha levels were analyzed using enzyme-linked immune assay. CSF samples were collected from 3 groups of patients. The cervical spondylotic myelopathy (CSM) group consisted of 35 patients. The ossification of the posterior longitudinal ligament group [(OPLL) group] consisted of 7 patients, and the control group consisted of 12 patients. The concentration of IL-8 was 69.0+/-35.2 pg/mL in the CSM group, 82.1+/-46.7 pg/mL in the OPLL group, and 43.5+/-20.9 pg/mL in the control group. The concentration of IL-8 was significantly higher in the CSM and OPLL groups than in the control group (P<0.05). There was no significant difference between the CSM group and OPLL group. The concentration of IL-10 and TNF-alpha in all groups was below the sensitivity of the measurements. CONCLUSIONS: In this study, the concentration of IL-8 was high in CSM and OPLL patients. However, the concentration of IL-10 and TNF-alpha was below the sensitivity of the measurements.

Line scan diffusion tensor MRI at low magnetic field strength: feasibility study of cervical spondylotic myelopathy in an early clinical stage.

PURPOSE: To implement line scan diffusion tensor MR imaging (LSDTI) on a 0.2 Tesla MR imager, and investigate the findings in the spinal cord of patients with cervical spondylotic myelopathy in an early clinical stage. MATERIALS AND METHODS: Fourteen patients with clinical symptoms of cervical myelopathy underwent LSDTI. The signal-to-noise ratio (SNR) in the spinal cord and cerebrospinal fluid (CSF) was evaluated. The apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were measured. We classified the ROIs into two groups: 1) unaffected (no clinical symptoms and no abnormality on conventional images) and 2) affected (some clinical symptoms but no abnormal signal on conventional images). Three-dimensional (3D) fiber-tracking was also studied. RESULTS: The isotropic ADC values (10(-3)mm2/sec) were 1.28 +/- 0.11 in group 1 and 1.59 +/- 0.23 in group 2. The FAs were 0.55 +/- 0.07 in group 1, and 0.47 +/- 0.11 in group 2. The ADC value in group 2 increased (P < .001, Mann-Whitney U-test) and the FA in group 2 decreased (P = 0.24) on average, compared to those in group 1. 3D fiber-tracking was successful in 64% (9/14) of the cases. CONCLUSION: LSDT images at low field strength may be a sensitive method for elucidating the structural characteristics of spinal cord pathology in vivo. However, clinical correlation and a long-term follow-up study will be needed.

Significance of CSF area measurements in cervical spondylitic myelopathy.

Mild clinical myelopathy can occur without cord compression, and asymptomatic cord compression seen on MRI is common. The aim of this study was to ascertain the MRI features which best correlate with early clinical myelopathy. The study was conducted on three groups: group A, 20 patients with clinical myelopathy and MRI evidence of cervical spondylosis; group B, 20 patients without myelopathy, but with other clinical and MRI evidence of cervical spondylosis; and group C, 10 normal volunteers with no MRI evidence of spondylosis. The cross-sectional area (CSA) of the spinal cord (SP-CSA), spinal canal (SC-CSA) and CSF space (CSF-CSA) were measured on T1-weighted axial images at the level of the most severe spinal canal stenosis. The severity of myelopathy was assessed using a simple scoring system giving a score from 0 (normal) to 11 (severe). Subjective demonstration of cord compression on sagittal images was an insensitive indicator of clinical myelopathy. All three measures of cross-sectional area were significantly smaller in Group A than in B (p<0.01). The reduction in SP-CSA was the only independent prognosticator for severity of myelopathy (p<0.005) accounting for 63% of the variation in myelopathy score. All three variables showed a significant correlation with the presence of myelopathy (p<0.01); however, logistic regression analysis showed a decrease in CSF-CSA to be the only independent significant prognosticator of the presence of clinical myelopathy (p<0.02). Reduction of the CSF space to less than 0.7 cm2 was associated with a 90% chance of clinical myelopathy (specificity 83%).

Quantitative analysis of cerebrospinal fluid flow in patients with cervical spondylosis using cine phase-contrast magnetic resonance imaging.

OBJECTIVE: To investigate changes in the cerebrospinal fluid flow in patients with cervical spondylosis using cine phase-contrast magnetic resonance (MR) imaging. METHODS: The participants included 44 healthy volunteers, 11 asymptomatic patients with evidence of degenerative changes of the cervical spine revealed by MR imaging but no neurological symptoms referable to those abnormalities, and 23 symptomatic patients with myelopathy who underwent surgery. Cervical spondylotic myelopathy was evaluated using the Japanese Orthopedic Association scores, and the percentage reduction of the transverse cord area at the level of maximum cord compression was measured on T1-weighted magnetic resonance images. A cine phase-contrast MR pulse sequence with peripheral gating was used to measure the cerebrospinal fluid flow direction and velocity in the ventral subarachnoid spaces at the C1 and T1 levels. RESULTS: The velocity waveforms produced by plotting flow velocity at 16 intervals during one cardiac cycle significantly differed among the healthy volunteers, asymptomatic patients, and preoperative symptomatic patients. However, velocity waveforms did not differ between the healthy volunteers and the postoperative patients at the C1 level. Decreases of flow velocity were significantly correlated with the severity of myelopathy and the percentage reduction of cord area. Patients with severe myelopathy (Japanese Orthopedic Association score of 0-9 points) or greater than 30% reduction of cord area showed significantly decreased flow velocity compared with those with mild myelopathy (Japanese Orthopedic Association score of 10-17 points) or less than 30% reduction of cord area. Changes in flow velocity were not correlated with multiplicity of the lesion or the level of maximum cord compression. Postoperative improvement of flow velocity was not correlated with neurological recovery. CONCLUSION: Cine phase-contrast MR imaging allows quantitative and noninvasive assessment of changes in cerebrospinal fluid flow in patients with cervical spondylosis.

Increased cerebrospinal fluid nitrite and nitrate levels in patients with lumbar spondylosis.

Nitric oxide is thought to mediate the cytotoxic effects of certain neurologic diseases. To investigate whether overproduction of nitric oxide may play a role in lumber spondylosis, we compared the levels of nitrite and nitrate in the cerebrospinal fluid (CSF) from patients with lumbar spondylosis with those from a control group by automated flow injection analysis. CSF levels of nitric oxide metabolites were significantly higher in patients with lumbar spondylosis compared with the control (p < 0.01). Nitric oxide may play a role in lumbar pain or nerve damage in sciatic and the CSF nitrite/nitrate may be used as a diagnostic parameter of spinal diseases.

Increased CSF C4d in demyelinating neuropathy indicates the radicular involvement.

Plasma and cerebrospinal fluid (CSF) levels of C4d and the circulating immune complex (CIC) to C1q were measured in 12 patients with chronic inflammatory demyelinating polyneuropathy and Guillain-Barré syndrome. CSF C4d values more than 2 SD from the mean of 8 cervical spongylosis cases were demonstrated in the patients with proximal demyelination. The CSF C4d probably originated from both intrathecal synthesis and the systemic circulation. CSF levels of C4d may serve as a sensitive indicator for the radicular involvement in demyelinating polyneuropathy.

[Neuron-specific enolase (NSE) and S-100b protein in cerebrospinal fluid of patients with cervical spondylosis--the relations with MRI findings and the changes of NSE and S-100b protein levels through Glisson's traction].

We have previously reported that NSE and S-100b protein (S-100) could be used as reliable markers to evaluate the damage of the spinal cord in cervical spondylosis (CS) and ossification of posterior longitudinal ligament (OPLL). In the present study we made MRI in 21 patients with CS. There was a positive correlation between the NSE level in CSF and the degree of the spinal cord compression shown by MRI. In 10 cases of CS we examined these specific protein levels in CSF before and after the Glisson's traction therapy for one month. In seven of them the NSE levels decreased with the clinical improvements. On the other hand, 2 cases showed the rise of NSE levels after the traction. One of them became clinically worse during the therapy, while in another case the NSE levels changed within the normal range. The level of NSE in the other case was unchanged. In 57-year-old patient with CS myelopathy we examined the NSE levels chronologically. The NSE level changed in parallel with his clinical features. We suggest that NSE level in CSF may be a useful marker to estimate the change of the degree of the spinal cord damage in CS.

[Neuron-specific enolase and S-100 protein levels in cerebrospinal fluid of patients with cervical spondylosis and ossification of posterior longitudinal ligaments].

We examined the levels of neuron-specific enolase (NSE) and S-100 protein in the cerebrospinal fluid (CSF) in 39 cases of cervical spondylosis (CS), in 16 cases of ossification of posterior longitudinal ligaments (OPLL), and in 29 control subjects by means of highly sensitive enzyme immunoassay methods. The levels (mean +/- SD) of NSE and S-100 protein in the control subjects, CS cases, and OPLL cases were shown as follows: NSE = 4.7 +/- 2.1, 8.0 +/- 3.4, 6.0 +/- 3.1 ng/ml, S-100b = 0.42 +/- 0.22, 0.72 +/- 0.40, 0.67 +/- 0.27 ng/ml, respectively. CS patients with a muscle atrophy of upper limbs showed a rise in NSE levels and this was especially seen in cases of cervical spondylotic amyotrophy (CSA). There were positive correlations between the distance of the A-P diameters of the spinal canal and the amount of NSE in OPLL cases (r = -0.6915, p less than 0.01). CS patients with severe spinal cord compressions demonstrated by myelo CT showed higher levels of NSE and S-100b. These results suggest that NSE, S-100 protein can be used as reliable markers to evaluate the damage of the spinal cord in CS and OPLL.

Analysis of monoamines in the cerebrospinal fluid of Chinese patients with neurological diseases.

Levels of dopamine (DA), 3-methoxy-4-hydroxy-phenylacetic acid (HVA), 5-hydroxy-indoleacetic acid (HIAA), 5-hydroxytryptamine (HT), 5-hydroxytryptophan (HTP), and 3, 4-dihydroxyphenylalanine (DOPA) in cerebrospinal fluids (CSF) of twenty-four Chinese with or without neurological diseases were determined simultaneously. The level of HIAA in the CSF of myelopathy-spondylosis patients and the level of DA in CSF of the myelopathy-tumor patients were higher than that of the control. No difference in levels of monoamines and their metabolites was observed between the control and patients with dementia.

[The antero-posterior diameter of the cervical spinal canal in cervical spondylosis. (Part 2) (author's transl)].

1. The antero-posterior diameter (APD) of the cervical spinal canals in 96 cases of cervical spondylosis with radiculopathy and radiculomyelopathy was measured for each vertebra by the method of Burrows, and the thecoperiosteal diameter (TPD) of the cervical spinal canals in the same cases was measured from myelograms by the method of Symon. 2. The APD in patients with myelopathy or positive Queckentedt's test was found to be significantly smaller than those of without them. The upper limit of APD at C4 to C6 vertebrae in patients with myelopathy or positive Queckenstedt's test was 15 mm, while the lower limit of APD in patients with radiculopathy or negative Queckenstedt's test was 13 mm. As based on these findings, the following conclusions were drawn: When the APD is smaller than 15 mm, there is always a chance to develop spondylotic myelopathy or spinal subarachnoid block though not absolute, but if the APD is smaller than 12 mm, the patient will have myelopathy and spinal subarachnoid block absolutely without exception. 3. The TPD in patients with myelopathy or positive Queckenstedt's test was also found to be more significantly smaller than those of without them. It could be seen that the smaller the TPD, the more chance to develop myelopathy and also spinal subarachnoid block. The upper limit of the TPD in myelopathy was 11 mm, and that in spinal arachnoid block was 10 mm. The smallest value in radiculopathy was 9 mm, so that it was suggested that a case which has the value smaller than 8 mm might develop myelopathy. 4. The hight of the inter-body spurs was measured from lateral myelograms in individual case. The value in case with myelopathy and positive Queckenstedt's test was much larger than that of radiculopathy or negative Queckenstedt's test. The lower limit of the hight of the inter-body spurs in case with myelopathy and spinal subarachnoid block was 3 mm.

Cervical spondylotic myelopathy: a cooperative study.

A series of 521 cases of CSM in 22 clinics in Spain and Portugal were studied. The severity of the clinical picture, both before and after the operations, was graded following a six point scale (a modification of Nurick's). The operations the patients underwent were classified into eight types and their results expressed by using the same scale. Some improvement has been attained in all grades of myelopathy with all types of operations, but better results, especially in advanced cases, have been obtained when surgical fixation of the spine, as well as laminectomy, has been carried out.