Assessing hand dysfunction in cervical spondylotic myelopathy.

METHODS: Twenty patients with CSM and 17 controls were recruited. Clinical scores of modified Japanese Orthopedic Association (mJOA) and Nurick were collected. MRI based compression grades such as cord distortion were assessed. Hand dysfunction was tested using a custom motorized apparatus. Subject's forearm was placed in a cast and positioned such that their metacarpophalangeal (MCP) joint was vertically aligned with the motor shaft. Surface electromyographic sensors were placed on flexor digitorum superficialis (FDS) and extensor digitorum communis muscles. Hyperreflexia was measured as the FDS muscle activation during reflex when the MCP joint was moved from flexion to extension at 300°/sec. Proprioception was quantified as the angle of detection in absence of visual or auditory cues (subjects were blindfolded and given noise-cancelling headphones). Strength was measured as the maximum isometric force at the MCP joint. 2-sample t-test (p<0.05) were performed to assess significant differences in reflexes, proprioception and strength among patients and controls (SPSS software version 24). RESULTS: Patients reported higher Nurick (1.90±1.0 vs 0±0, p<0.001) and lower mJOA scores (14.3±1.9 vs 18.0±0, p<0.001) as compared to controls. Similarly, patients with CSM had increased reflexes (peak FDS EMG) (0.073±0.096 vs. 0.014±0.010, p = 0.019). Patient proprioception was significantly worse; mean angle of detection was greater than twice as high in patients (9.6± 9.43°) compared to controls (4.0± 2.3°), p = 0.022. MRI based compression ratio (CR) was a significant predictor of hyperreflexia, CR<0.44 resulted in steep increase in reflex activity. Fifteen of the 20 patients who completed follow up testing at 6 months after surgery show substantial clinical improvement in reflexes and proprioceptive angle, while repeated testing in controls were unchanged. CONCLUSION: In conclusion, hyperreflexia and decline in proprioception are the main drivers of hand disability in patients with CSM. Of multiple scales, only a select few MRI scales (such as compression ratio) were predictive of increased reflexes. The study describes a pre-clinical testing apparatus to quantitatively and objectively assess primary presenting symptoms in CSM. This pilot apparatus has the potential to evaluate treatment efficacy through repeated testing. Objective testing of hand dysfunction can help inform the design of clinically feasible devices, guide MRI biomarker analysis, and improve our understanding of the progression of neurological injury in this patient population.

Relationship between spinal osteoarthritis and vertebral fractures in men older than 50 years: data from the Camargo Cohort Study.

Spinal osteoarthritis has been suggested as a risk factor for vertebral fractures. However, results are conflicting: most of the data are focused on the lumbar region, and referred to postmenopausal women, whereas data for men are scarce. The aim of this study is to assess the relationship between spinal osteoarthritis and vertebral fractures in men over 50 years of age. We conducted a cross-sectional study, nested in a prospective population-based cohort, including 507 community-dwelling men, 93 of them with at least one vertebral fracture. Vertebral fractures, osteophytosis, and disc space narrowing (DSN) were assessed by lateral thoracic and lumbar radiographs. Anthropometric, clinical, and densitometric variables were also analyzed. A multiple logistic regression model was performed. Eighty-five percent of vertebral fractures were located at the thoracic spine. Osteophytosis and DSN showed a bimodal distribution, with major frequency peaks at mid- and distal lumbar spine. The three distributions overlapped around the T9 vertebra. We did not find any relationship between lumbar osteoarthritis and vertebral fractures. Nevertheless, thoracic osteophytosis (OR, 1.84; 95 % CI, 1.05-3.17; p = 0.03) and DSN (OR, 2.52; 95 % CI, 1.43-4.46; p = 0.001) were found to be independently associated with prevalent vertebral fractures, after adjusting for confounders. Our results suggest a positive relationship between radiologic osteoarthritic changes at the thoracic spine and prevalent vertebral fractures in men more than 50 years of age. Osteoarthritis may act as a local risk factor, in addition to other mechanical factors, resulting in a greater propensity to fracture, especially at the mid-thoracic region.

Degenerative Pathways of Lumbar Motion Segments--A Comparison in Two Samples of Patients with Persistent Low Back Pain.

BACKGROUND: Magnetic resonance imaging (MRI) is used to identify spinal pathoanatomy in people with persistent low back pain. However, the clinical relevance of spinal degenerative MRI findings remains uncertain. Although multiple MRI findings are almost always present at the same time, research into the association with clinical outcomes (such as pain) has predominantly focused on individual MRI findings. This study aimed to: (i) investigate how multiple MRI lumbar spine findings cluster together within two different samples of patients with low back pain, (ii) classify these clusters into hypothetical pathways of degeneration based on scientific knowledge of disco-vertebral degeneration, and (iii) compare these clusters and degenerative pathways between samples. METHODS: We performed a secondary cross-sectional analysis on two dissimilar MRI samples collected in a hospital department: (1) data from the spinal MRI reports of 4,162 low back pain patients and (2) data from an MRI research protocol of 631 low back pain patients. Latent Class Analysis was used in both samples to cluster MRI findings from lumbar motion segments. Using content analysis, each cluster was then categorised into hypothetical pathways of degeneration. RESULTS: Six clusters of MRI findings were identified in each of the two samples. The content of the clusters in the two samples displayed some differences but had the same overall pattern of MRI findings. Although the hypothetical degenerative pathways identified in the two samples were not identical, the overall pattern of increasing degeneration within the pathways was the same. CONCLUSIONS: It was expected that different clusters could emerge from different samples, however, when organised into hypothetical pathways of degeneration, the overall pattern of increasing degeneration was similar and biologically plausible. This evidence of reproducibility suggests that Latent Class Analysis may provide a new approach to investigating the relationship between MRI findings and clinically important characteristics such as pain and activity limitation.

Can Modified Kurokawa's Double-Door Laminoplasty Reduce the Incidence of Axial Symptoms at Long-term Follow-up?: A Prospective Study of 152 Patients With Cervical Spondylotic Myelopathy.

STUDY DESIGN: A prospective cohort study. OBJECTIVE: The purpose of this study was to determine whether the modified procedure reduces long-term axial symptoms (AS) and to understand better why the AS occur. SUMMARY OF BACKGROUND DATA: Following Kurokawa's double-door laminoplasty, postoperative AS reduce the quality of life of patients with cervical spondylotic myelopathy. The etiology of AS remains unclear. Some studies report that preservation of the C7 spinous process can reduce the frequency of AS. The modified Kurokawa procedure prevents AS by preserving the semispinalis cervicis insertion in the spinous process of C2. However, it remains unclear whether the modified procedure lowers the incidence of AS in the long term (ie, >3 y). MATERIALS AND METHODS: This prospective cohort study investigated preoperative and postoperative v, cervical intervertebral range of motion, postoperative neurological recovery, neck disability index, visual analog scale, surgical cost, and time and blood loss. RESULTS: Both groups had satisfied improvement of neurological functions (P>0.05). At 3 months and 1 year after surgery, the difference in frequency between no symptoms and mild/severe symptoms was significant (traditional group, 39.06%; modified group, 20.45%) (P<0.05). Interestingly, 3 years after surgery, there were no significant between-group differences (P>0.05). CONCLUSIONS: This modified approach reduced the incidence of postoperative ASs at 3 months and 1 year after the operation; however, the between-group difference was not significantly different at the 3-year follow-up. The reason for this finding is unclear; it may indicate that the incidence of AS is caused by other factors, such as the preservation of the C7 spinous process rather than the C2 spinous process.

Age-related changes in osteometry, bone mineral density and osteophytosis of the lumbar vertebrae in Japanese macaques.

The age-related changes in lumbar vertebrae were studied in 77 young/full adult Japanese macaques (Macaca fuscata) (40 females, 37 males), in terms of their morphometry, density and osteophytosis, and the interrelationship between these three aspects. The most common age-related pattern of morphometric changes was an initial increase during young adulthood until reaching the peak and then a subsequent decrease with age. Most of the peaks were in the age group 15-20 and 10-15 years in females and males, respectively. In both sexes, the age-related decrease in the vertebral body depth (ventro-dorsal) was greater than in the height and width. The ventral height of the vertebral body relative to the dorsal height continuously decreased with age. The trabecular bone mineral density (BMD) continuously decreased after young adulthood. However, the magnitude of the decreased trabecular BMD with age was greater in females than in males, especially in the older age groups. Osteophytosis clearly increased with age in both sexes, but males showed an earlier appearance of osteophytes and females tended to have more severe osteophytes from 15 years old upwards. A correlation between the osteometry, density, and osteophytosis severity appeared in all vertebrae, but not all of these reached statistical significance after controlling for the influence of age. Although Japanese macaques showed the higher prevalence and rapid increase of osteophytosis, a similar age change profile was observed in the lumbar vertebrae of Japanese macaques and humans.

The predictors of development of new syndesmophytes in female patients with ankylosing spondylitis.

OBJECTIVES: The formation of spinal syndesmophytes is an important outcome measure in ankylosing spondylitis (AS) but the predictors of new syndesmophyte development in female AS patients are unknown. This longitudinal study aimed to assess the rate and predictors of development of new syndesmophytes over a 2-year period in female AS patients. METHOD: Clinical and radiographic data were collected at baseline and after 2 years in 67 female AS patients. Spinal radiographs were scored using the Stoke AS Spinal Score (SASSS). Univariate logistic regression analyses were performed to identify predictors associated with new syndesmophyte development. RESULTS: Eleven (16%) patients had syndesmophytes at baseline. Nine (13.4%) patients had developed new syndesmophytes in their lumbar spines after 2 years. In the univariate logistic regression analyses, older age, longer disease duration, severe sacroiliitis, elevated C-reactive protein (CRP) levels at baseline, and one or more pre-existing syndesmophytes were associated with the occurrence of new syndesmophytes. After adjustment for baseline SASSS, increases in SASSS were statistically significantly higher in patients with elevated baseline CRP levels (p = 0.002) than in patients with normal CRP at baseline. CONCLUSIONS: Older age, longer disease duration, severe sacroiliitis, the baseline presence of syndesmophytes, and elevated levels of CRP are predictors of the development of new syndesmophytes in female AS patients.

[The prevalence of spinal osteoporosis in relation to the clinical forms and advance of cervical spondylosis in male patients]. / Czestosc wystepowania osteoporozy kregoslupa w zaleznosci od rodzaju i stopnia nasilenia choroby zwyrodnieniowej kregoslupa szyjnego u mezczyzn.

The research was performed on 36 male patients between 65 and 83 years who were either hospitalised or treated in the out-patients clinic due to cervical spondylosis. The aim of the research was to evaluate the frequency of spinal osteoporosis relating to the type and severity of degenerative lesions in cervical spine. The study showed significant relation between the degree of advance of cervical spondylosis and the prevalence of osteoporosis in the study group. The authors have emphasized the need of precise evaluation and differentiation of presented forms of degenerative spine disease.

Inflammatory and degenerative sacroiliac joint disease in a primary back pain cohort.

OBJECTIVE: The prevalence of sacroiliac (SI) joint abnormalities in a primary low back pain population remains unresolved. The aims of our study were to define the prevalence of SI joint disease in this cohort, and to identify clinical features that might accurately predict radiographic changes in the SI joint and spine. METHODS: Lumbar spine and anteroposterior pelvis radiographs taken over a 3-year period for the evaluation of back pain at a major chiropractic college were scored for the presence of inflammatory or degenerative features. Data were subsequently extracted by means of a predetermined template from the clinical notes. The outcomes were correlated using Spearman's correlation coefficients. RESULTS: We identified 315 patients (173 men, 142 women), ages 18-60 years. Of these, 100 patients (31.7%) demonstrated SI joint abnormalities: 75 (23.8%) degenerative, 25 (7.9%) inflammatory. Sex was strongly associated with type of SI joint pathology; degenerative disease was predominantly found in women (68%), whereas inflammatory disease was predominantly found in men (63%). In women there was no correlation between degenerative SI joint abnormalities and degenerative changes in the lumbar spine. Of the clinical descriptors evaluated, none were associated with the radiographic findings with the exception of buttock pain, which was associated with inflammatory sacroiliitis. Neither being overweight nor pregnancy history was associated with degenerative changes in the SI joint. CONCLUSION: In a primary back pain cohort, degenerative SI joint disease may be an under-recognized clinical entity. It is strongly influenced by sex but is unrelated to degenerative changes in the lumbar spine. Currently proposed clinical discriminators performed poorly in correlating with radiographic changes in the SI joint.

The posterior cervical foraminotomy in the treatment of cervical disc/osteophyte disease: a single-surgeon experience with a minimum of 5 years' clinical and radiographic follow-up.

OBJECT: This study details long-term clinical and radiographic outcomes following single-level posterior cervical foraminotomy for degenerative disc or osteophyte disease. METHODS: The authors conducted a retrospective review of 162 cases involving patients treated by a single surgeon using a posterior cervical foraminotomy. Inclusion criteria were a minimum of 5 years' clinical and radiographic follow-up and unilateral single-level posterior cervical foraminotomy for degenerative disease between C-3 and C-7. Patients who had undergone previous operations, those who underwent bilateral procedures, and those who underwent foraminotomy as part of a larger laminectomy were excluded. The Neck Disability Index (NDI) was used for clinical follow-up, and radiographic follow-up was performed using static and dynamic lateral radiographs to compare focal and segmental alignment and changes in disc-space height. RESULTS: The mean presenting NDI score was 18 (range 2-39). The most common presenting symptoms were radiculopathy (110 patients [68%]), neck pain (85 patients [52%]), and subjective weakness (91 patients [56%]). The mean preoperative focal angulation at the surgically treated level was 4.2 degrees (median 4.1 degrees , range 7.3-15.3 degrees ), and the mean preoperative segmental curvature between C-2 and C-7 was 18.0 degrees (median 19.3 degrees , range -22.1 to 39.3 degrees ). The mean postoperative NDI score was 8 (range 0-39). Improvement in NDI scores was seen in 150 patients (93%). Resolution of radiculopathy was experienced by 104 patients (95% of patients with radiculopathy). The mean radiographic follow-up was 77.3 months (range 60-177 months). No statistically significant changes in focal or segmental kyphosis or disc-space height were seen among the overall cohort with time (Cox proportional hazards analysis and Student t-test, p > 0.05). The mean postoperative focal angulation was 4.1 degrees (median 3.9 degrees , range -9.9 degrees to 15.1 degrees ) and mean postoperative segmental angulation was 17.6 degrees (median 15.4 degrees , range -40.2 to 35.3 degrees ). Postoperative instability on dynamic imaging was present in 8 patients (4.9%); 7 of these patients were clinically asymptomatic and were treated conservatively, and 1 required cervical fusion. Postoperative loss of lordosis (defined as segmental Cobb angle < 10 degrees ) was seen in 30 patients (20%), 9 of whom had clinical symptoms and 4 of whom required further surgical correction. Factors associated with worsening sagittal alignment (Cox proportional hazards analysis, p < 0.05) included age > 60 at initial surgery, the presence of preoperative cervical lordosis of < 10 degrees , and the need for posterior surgery after the initial foraminotomy. CONCLUSIONS: The posterior cervical foraminotomy is highly effective in treating patients with cervical radiculopathy and results in long-lasting pain relief and improved quality-of-life outcomes in most patients. Long-term radiographic follow-up shows no significant trend toward kyphosis, although select patient subsets (patients older than 60 years, patients who had previous posterior surgery, and patients with < 10 degrees of lordosis preoperatively) appear to be at higher risk and require closer follow-up.

Occurrence of vertebral osteophytosis in a museum sample of white-beaked dolphins (Lagenorhynchus albirostris) from Danish waters.

The occurrence of pathologic new bone formation in the vertebral column was studied in 46 skeletons of the white-beaked dolphin (Lagenorhynchus albirostris) stranded in Denmark between 1903 and 2002 and held in the collections of the Zoological Museum, University of Copenhagen. New bone formation was evident in 18 (72%) of 25 physically mature specimens and in one of 21 physically immature specimens. This pattern of occurrence is consistent with spondylosis deformans, which is caused by degeneration of the intervertebral disk. In general, females seemed to be more susceptible, exhibiting a higher number of affected vertebrae and more severe cases. Lesions were predominantly detected in the lumbar and cranial caudal vertebra. Data on blubber thickness were available for part of the sample; one of the most heavily afflicted specimens had the thickest recorded blubber, indicating that secondary bone formation leading to blocks of fused vertebrae had not necessarily impaired the body condition of afflicted specimens. However, age determinations conducted on the sample revealed that none of the most severe cases occurred among the oldest animals, implying that these severe cases may cause premature fatality.

The prevalence and characteristics of thoracic magnetic resonance imaging findings in men.

STUDY DESIGN: A cross-sectional study of thoracic magnetic resonance image (MRI) findings. OBJECTIVE: To examine the prevalence of different thoracic MRI findings for T6-T12 and their associations with age and one another by level. SUMMARY OF BACKGROUND DATA: There is a dearth of descriptive epidemiology of thoracic MRI findings in the general population. METHODS: Thoracic MRIs of 524 men were assessed qualitatively and quantitatively for a variety of findings, including disc bulging, height and signal, vertebral deformities, endplate irregularities, osteophytes, and hemangiomas. Descriptive statistics, correlation coefficients and STATA's survey analysis were used. RESULTS: In the lower thoracic spine, 5.4% to 9.5% of the discs, depending on level, were qualitatively assessed as moderately to severely narrowed. Anterior bulging was more common than posterior, which was relatively rare and mild when present. Signal was lower in the midthoracic than lower discs. At least 1 moderate or severe vertebral deformity was found in 6.1% of the subjects, suggesting fracture, and hemangiomas were identified in 2.3% of subjects. Disc signal correlated most highly with age (r = 0.31-0.42). Qualitatively assessed disc height narrowing (r = 0.29-0.46) and quantitative disc height (r = 0.11-0.29) were associated with disc signal. Upper and lower endplate irregularities were associated with one another (r = 0.17-0.32), as were bulging and osteophytes, anteriorly (r = 0.35-0.61) and posteriorly (r = 0.26-0.45). CONCLUSION: Degenerative MRI findings beyond a mild grade were not commonly observed in the thoracic spine among 35-70-year-old men. Posterior bulges, in particular, were rare. The highest correlation with age existed for disc signal. Different MRI findings were associated with one another, but the magnitude of association varied by level. The effects of individual judgments and disc level on prevalence rates were apparent.

[Tinnitus diagnosis and treatment on the basis of our experiences]. / Diagnostyka i leczenie szumów usznych na podstawie wlasnych doswiadczen.

INTRODUCTION: The aim of the study was to analise tinnitus diagnosis and treatment on the basis of our experiences. MATERIAL AND METHODS: 137 patients hospitalizated in Otolaryngology and Laryngological Oncology Clinic because of tinnitus (88 women - 64% and 49 men - 35,8%) were included to the study. The diagnostic procedures were unified that enabled put forward correct diagnosis. After history and otoscopy, detailed audiologic diagnostic procedures (pure tone audiometry, suprathreshold audiometry, speech audiometry, acoustic immittance measures, auditory brainstem responses) were taken. Electronystagmography and videonystagmography, tinnitus loudness match, head and neck radiologic examinations supplemented diagnostic procedures. Alternative tinnitus treatment options were applied. RESULTS: Study confirmed that tinnitus is the most frequent in patients above 50 years old (67,8% of participants). Tinnitus frequently coexist with bilateral sensorineural hearing impairment (69,1% of participants). 40,1% from asalysed group of patients complained of tinnitus of medium frequencies and 30,6% of patients complained of high frequency tinnitus. 42,3% of participants suffered from vertigo. CONCLUSIONS: The risk of tinnitus increases in patients above 55 years old that suffer from metabolic conditions and cervical spondylosis. Tinnitus frequently coexist with bilateral sensorineural hearing impairment and are bilateral or they are noticeable in better hearing ear. The most beneficial to tinnitus is causal and symptomatic treatment with several methods application.

C5 nerve root palsy after cervical laminoplasty and posterior fusion with instrumentation.

STUDY DESIGN: Consecutive case series. OBJECTIVE: To compare the incidence and clinical characteristics of postoperative fifth cervical nerve root palsy (C5 palsy) in patients with cervical myelopathy treated by laminoplasty alone and laminoplasty with posterior instrumentation. SUMMARY OF BACKGROUND DATA: In patients who have multilevel cervical myelopathy with reducible kyphosis or instability, the authors have performed laminoplasty together with instrumented fusion to restore lordosis and stability. There seems to be a high incidence of postoperative C5 palsy in these patients. METHODS: Seventy-three patients with a mean age of 60.5 years and multilevel cervical myelopathy treated by laminoplasty from 1995 to 2005 were reviewed. Incidence, side, and severity of muscle weakness from patients with C5 palsy after posterior instrumented fusion (instrumented group) was compared with those without instrumentation (noninstrumented group). Radiologic parameters were assessed to identify predisposing factors. RESULTS: Overall 10 of 73 (14%) patients developed the C5 palsy, of which 5 (50%) of 10 patients were in instrumented group, and 5 of 63 (8%) patients were in noninstrumented. Three of 5 (60%) had the palsy on the same side of the opened lamina in the instrumented group, in the same proportion as the noninstrumented. Three (60%) patients in instrumented group developed deltoid weakness grade 1, but none in the noninstrumented had weaker than grade 3. All of the palsied in the instrumented group recovered within 2 years after surgery without removal of implant. Of the 5 patients with the palsy in the instrumented group, 3 had anterolisthesis before surgery and posterior translation of C4 on C5 by the surgery, and no patient without the palsy had the anterolisthesis. CONCLUSIONS: Posterior cervical fusion using instrumentation for restoration of lordotic alignment combined with laminoplasty is highly associated with severe postoperative C5 palsy in patients with multilevel cervical myelopathy and C4 anterolisthesis.

Apolipoprotein E gene polymorphism and the risk of cervical myelopathy in patients with chronic spinal cord compression.

STUDY DESIGN: Prospective evaluation of apolipoprotein E (APOE) genotypes in 106 consecutive patients with stenosis of the cervical spinal canal. OBJECTIVE: To determine the association between cervical spondylotic myelopathy (CSM) in patients with chronic spinal cord compression and the APOE genotype. SUMMARY OF BACKGROUND DATA: The APOE allele epsilon 4 is a risk factor for the occurrence, progression, and poor outcome in several neurologic diseases. Information of the association between APOE genotype and CSM in the literature are lacking so far. METHODS: One hundred six consecutive patients with chronic cervical spinal cord compression due to stenosis of the spinal canal were evaluated prospectively. APOE genotypes were determined by polymerase chain reaction followed by restriction enzyme digestion and sodiumdodecylsulfate poyacrylamide gel electrophoresis (SDS PAGE) of digested fragments. Clinical and radiologic variables evaluated were age, occurrence of CSM, duration of symptoms, number of affected segments, and diameter of spinal canal of most affected segment. Univariate association between variables was tested. A backward stepwise method was used to construct multivariate logistic regression models in relation to the occurrence of CSM as dependent variable. RESULTS: The following distribution of APOE genotypes was found: epsilon 2 epsilon 2 3 patients (2.8%), epsilon 2 epsilon 3 9 patients (8.5%), epsilon 2 epsilon 4 1 patient (0.9), epsilon 3 epsilon 3 67 patients (63.2%), epsilon 3 epsilon 4 24 patients (22.6%), epsilon 4 epsilon 4 2 patients (1.9%). Univariate analysis showed that patients with chronic spinal cord compression and homo- or heterozygous allele epsilon 4 are more likely to develop CSM than patients without allele epsilon 4 (65.0% vs. 35.0%, P < 0008; OR 3.5; 95% CI 1.3-9.8). This effect remained significant in a binary logistic regression model adjusted to other known risk factors for CSM. Inclusion of the variable homo- or heterozygous epsilon 4 allele led to an increased goodness of fit of the model compared with the model without epsilon 4. CONCLUSION.: This study supports the hypothesis that the APOE epsilon 4 allele increases the risk of CSM in patients with chronic cervical spinal cord compression; however, a larger prospective population-based study is needed to answer this question definitively.

Surgical outcomes of elderly patients with cervical spondylotic myelopathy.

BACKGROUND: Cervical spondylotic myelopathy is a potentially serious neurologic disorder that commonly presents with gait difficulty and hand dysfunction. Because the development of CSM is in large part related to advanced spondylosis and degenerative disk disease, elderly patients appear to be at an increased risk to develop this condition. The surgical outcomes of this patient population have been understudied; the authors seek to report their clinical results in a series of patients with CSM older than 75 years who underwent surgical treatment. METHODS: This report is composed of a cohort of 36 elderly patients (older than 75 years) and 34 younger patients (younger than 65 years) who underwent decompressive surgery for CSM at one institution between 2001 and 2005. The patients' functional status was evaluated preoperatively and postoperatively using the mJOA disability scale. RESULTS: The mean follow-up time in the elderly group was 24 months, with a range from 12 to 48 months. There was a statistically significant improvement between mean preoperative (11.3) and postoperative (14.4) mJOA scores (P< .0001). The younger group had a higher neurologic recovery rate (71%) than the elderly group (59%); however, this was not statistically significant (P= .29). The postoperative complication rate in the elderly population (38%) was higher than in the younger group (6%; P= .002). CONCLUSION: Elderly patients with CSM are likely to obtain neurologic improvement after decompressive surgery. Their postoperative complication rate is higher than that of younger patients, yet most complications appear to be self limiting and do not adversely affect neurologic outcome.

Self-reported hard physical work combined with heavy smoking or overweight may result in so-called Modic changes.

BACKGROUND: Recently, the MRI finding of "Modic changes" has been identified as pathologic spinal condition that probably reflects a vertebral inflammatory process (VIP), which coincides with spinal pain in most. We hypothesized that heavy smoking in combination with macro- or repeated microtrauma could lead to VIP. The objectives were to investigate if combinations of self-reported heavy smoking, hard physical work, and overweight would be more strongly linked with VIP than with other spinal conditions, such as degenerated discs and non-specific low back pain (LBP). METHODS: Secondary analysis was made of a data base pertaining to a population-based cross-sectional study. A population-generated cohort of 412 40-yr old Danes provided questionnaire information on smoking, weight, height, type of work, and LBP. MRI was used to determine the presence/absence of disc degeneration and of VIP. Associations were tested between three explanatory variables (type of work, smoking, and body mass index) and four outcome variables (LBP in the past year, more persistent LBP in the past year, disc degeneration, and VIP). Associations with these four outcome variables were studied for each single explanatory variable and for combinations of two at a time, and, finally, in a multivariable analysis including all three explanatory variables. RESULTS: There were no significant associations between the single explanatory variables and the two pain variables or with disc degeneration. However, VIP was found in 15% of non-smokers vs. 26% of heavy smokers. Similarly, VIP was noted in 11% of those in sedentary jobs vs. 31% of those with hard physical work. Further, the prevalence of VIP in those, who neither smoked heavily nor had a hard physical job was 13%, 25% in those who either smoked heavily or had a hard physical job, and 41% in those who both smoked heavily and worked hard. The odds ratio was 4.9 (1.6-13.0) for those who were both heavy smokers and had a hard physical job as compared to those who were classified as "neither". Similar but weaker findings were noted for the combination of overweight and hard physical work but not for the combination of smoking and overweight. CONCLUSION: Hard physical work in combination with either heavy smoking or overweight is strongly associated with VIP. If this finding can be reproduced in other studies, it may have consequences in relation to both primary and secondary prevention of LBP, because blue collar workers, who are most likely to experience the consequences of LBP, also are those who are most likely to smoke.

Incidência de osteófitos na coluna vertebral / Osteophyte incidence on vertebral column

Ao longo do processo de evolução o homem adquiriu a postura ereta. Devido à ação da gravidade surgiram algumas complicações decorrentes dessa postura; entre elas o aparecimento de osteófitos. O objetivo do presente estudo foi verificar a incidência de osteófitos em exames laudados da coluna vertebral e qual a região da coluna mais acometida. Para isso foram utilizados 1089 laudos de 636 indivíduos, sendo 55,5% mulheres e 44,5% homens, atendidos em um intervalo de 6 meses, de janeiro a junho de 2006 em uma Clínica de Radiologia particular do Alto Tietê. Os resultados encontrados foram que dos laudos,26,9% foram considerados anormais. Das três regiões da coluna vertebral, foram encontrados osteófitos respectivamente para mulheres e homens: 15,4% e 5,7% região cervical; 13,6% e 12,4% região torácica e 17,9% e 13,7% região lombar. O grau de osteófito mais encontrado foiosteófito marginal para as regiões cervical e lombar e labiação marginal predominou na região torácica. Concluiu-se que a incidência de osteófitos do total de laudos analisados foi 26,9% ea região da coluna mais acometida foi a lombar. Além disso, as mulheres apresentaram mais casos de osteófitos que homens.

With the evolution of mankind appeared the erect posture. Due to gravity actioncomplications appeared because of this posture, like the osteophytes. The aim of this study was to investigate osteophyte incidence on vertebral column and the most affected column region. For this were used 1089 reports of 636 patients: 55.5% women and 44.5% men, attended between january and june of 2006 in a privet Clinic on Alto do Tietê, region of São Paulo. Resultsrevealed that 26.9% of reports had alterations. Region’s analysis revealed osteophytes in men and women, respectively: 15.4% and 5.7% on cervical region; 13.6% and 12.4% on thoracic region and 17.9% and 13.7% on lumbar region. The most common kind of osteophyte was marginal osteophyte on cervical and lumbar regions and marginal labium was predominant on thoracic region. The incidence of osteophytes on vertebral column was 26.9% and lumbar region was the most affected. Besides, women have more osteophytes cases than men.

Severity and distribution of ventral thoracolumbar spondylosis and histological assessment of associated intervertebral disc degeneration in cull rams.

AIM: To conduct a pilot study investigating the incidence and pathology of spondylosis in a sample of cull rams in New Zealand. METHODS: Vertebral columns from 51 cull rams from different properties were assessed radiographically for evidence of spondylosis. They were graded according to severity, using a four-point grading system. Samples of intervertebral discs representing different grades of spondylosis were examined histopathologically. RESULTS: Forty (78%) rams had spondylosis in at least one intervertebral space. Of these, 11 had ankylosis involving one or more intervertebral spaces. The frequency of spondylosis was greater in the thoracic than lumbar region (p<0.001), and was most frequent between T10-T11. Histopathological examination of intervertebral discs associated with all grades of spondylosis revealed degenerative changes in the annulus fibrosis. CONCLUSIONS: Spondylosis appeared to be common in cull rams and affected thoracic and lumbar vertebrae. It often involved ankylosis of adjacent vertebrae, and was associated with degeneration of the intervertebral disc. CLINICAL RELEVANCE: Spondylosis may reduce the serving ability of rams and be an important underlying reason for culling. The pathogenesis of spondylosis is unknown but may involve high mating frequencies during the breeding season.