Conservative treatment with hyperbaric oxygen therapy for cervical spondylotic amyotrophy.

STUDY DESIGN: Small case series of patients with cervical spondylotic amyotrophy (CSA) managed by conservative treatment with hyperbaric oxygen (HBO) therapy. OBJECTIVE: To study the effects of conservative treatment with HBO therapy of CSA patients. SETTING: Department of Orthopaedic Surgery, Imakiire General Hospital, Kagoshima, Japan. METHODS: This study included 10 patients with CSA who underwent rehabilitation, including cervical traction and muscle exercise, for some period of time but did not respond well to it, and were then managed by additional HBO therapy for rehabilitation. Information was obtained on the duration of symptoms and strength of the most atrophic muscle, intramedullary high-signal-intensity changes on T2-weighted magnetic resonance imaging, presence of 'snake-eyes' appearance and the number of stenotic canal levels. RESULTS: The mean duration of symptoms before HBO treatment was 3.1 months. The axial T2-weighted magnetic resonance images of all 10 patients showed a 'snake-eyes' appearance. The mean number of stenotic canal levels was 0.3. There was marked improvement on manual muscle testing from a mean of 1.9 pretreatment to a mean of 4.4 at the last follow-up after HBO therapy. The outcomes of all 10 patients, whose results were classified as excellent or good, were considered clinically satisfactory. CONCLUSION: To our knowledge, conservative treatment with HBO therapy for CSA patients has not previously been described. It appears that HBO therapy might improve ischemic injury of the anterior horns in CSA patients with short duration of symptoms.

Spinal cord infarction following endoscopic variceal ligation.

STUDY DESIGN: A case report of spinal cord infarction following endoscopic variceal ligation. OBJECTIVES: To describe an exceedingly rare case of spinal cord infarction following endoscopic variceal ligation. SETTING: Department of Orthopaedic Surgery, Kagoshima, Japan. METHODS: A 75-year-old woman with cirrhosis caused by hepatitis C virus, who was admitted to our hospital for the treatment of esophageal varices, experienced numbness of the hands and lower extremities bilaterally following an endoscopic variceal ligation procedure. Sensory and motor dysfunction below C6 level progressed rapidly, resulting in inability to move the lower extremities the following day. Magnetic resonance imaging of the spine revealed abnormal spinal cord signal on T2-weighted images from approximately C6 through T5 levels, which was diagnosed as spinal cord infarction. RESULTS: The patient underwent hyperbaric oxygen treatment. Her symptoms and signs related to spinal cord infarction gradually remitted, and nearly complete disappearance of neurological deficits was noted within 3 months after the start of treatment. CONCLUSION: We speculate that the pathogenesis of the present case may have involved congestion of the abdominal-epidural-spinal cord venous network owing to ligation of esophageal varices and increased thoracoabdominal cavity pressure.

Hypoplasia of the atlas causing cervical myelopathy with situs inversus totalis.

STUDY DESIGN: A case report of myelopathic hypoplasia of the atlas with situs inversus totalis. OBJECTIVES: To describe a case of cervical myelopathy caused by hypoplasia of the atlas with situs inversus totalis, and to briefly review the pertinent literature. SETTING: Department of Orthopaedic Surgery, Kagoshima, Japan. METHODS: The history, results of examination, and findings of radiographic imaging studies for a 56-year-old man with a 10-year history of progressive myelopathy who presented to our hospital are described. RESULTS: Imaging studies revealed congenital hypoplasia of the atlas, ossification of the posterior longitudinal ligament at the levels of C3-C4, and situs inversus totalis. He underwent laminectomy of the atlas and laminoplasty of C3-C7 for decompression of the spinal cord. Operative intervention resulted in significant neurological improvement and relief of occipital neuralgia. CONCLUSION: To our knowledge, no case of myelopathic hypoplasia of the atlas with situs inversus totalis has previously been described. When encountering inherited disorders such as situs inversus totalis, a thorough search must be made for anomalies of the craniovertebral junction.