Dynamic cervical stabilization: a multicenter study.

Purpose: The dynamic cervical implant (DCI) is a novel motion-preserving concept for the treatment of degenerative cervical disorders. The aim of this prospective clinical study was to validate the concept and analyse clinical and radiological performance of the implant.

Materials/methods: One hundred seventy-five consecutive patients with degenerative cervical disorders, median age, 47 years, were treated with discectomy and DCI, and followed for 2 years.

Open microsurgical tumor excavation and vertebroplasty for metastatic destruction of the second cervical vertebra-outcome in seven cases.

Background Context: Metastatic osteolytic involvement of the second cervical vertebra (C2) is rare, but usually very painful. Percutaneous vertebroplasty has shown to be effective regarding pain control, but carries the risk of cement leakage.

Purpose: To describe an alternative microsurgical procedure suitable for patients suffering from C2 osteolysis who are considered to be high risk with respect to cement leakage.

Hypermetabolism in 18F-FDG PET predicts favorable outcome following decompressive surgery in patients with degenerative cervical myelopathy.

Unlabelled: The aim of this study was to prospectively assess the regional changes of glucose metabolism of the cervical spinal cord in patients with degenerative cervical spine stenosis and symptomatic cervical myelopathy after decompressive surgery using (18)F-FDG PET.

Methods: Twenty patients with symptomatic degenerative monosegmental cervical stenosis with neuroradiologic signs of spinal cord compression underwent decompressive surgery. The clinical course using a functional status score (Japanese Orthopedic Association [JOA] score), (18)F-FDG uptake, and MR imaging were assessed before and at follow-up 12 mo after surgery.

Transtubular microsurgical approach to treating extraforaminal lumbar disc herniations.

Object: Approaches to treating extraforaminal lumbar disc herniations can be challenging due to the unique anatomy and the need to prevent spinal instability. Numerous approaches, including conventional midline, paramedian, minimally invasive, and full endoscopic approaches, have been described. The purposes of this study were to point out the outcome and clinical advantages of a transtubular microsurgical approach and to describe and illustrate this technique.

Clinical value of 2-deoxy-[18F]fluoro-D-glucose positron emission tomography in patients with cervical spondylotic myelopathy.

Cervical spondylotic myelopathy (CSM) is one of the most common spinal cord disorders in the elderly. It is usually diagnosed by MRI, but in a significant number of patients the clinical course of CSM does not correlate with the extent of the spinal cord compression. Recent studies have suggested that a distinct metabolic pattern of the cervical cord, as assessed by PET with 2-deoxy-[(18)F]fluoro-D-glucose ((18)F-FDG) may predict a patient's clinical outcome after decompressive surgery for cervical spine stenosis.

Chronic dura erosion and intradural lumbar disc herniation: CT and MR imaging and intraoperative photographs of a transdural sequestrectomy.

Introduction: A 47-year-old male with a history of recurrent low-back pain presented with acute left radiculopathy.

Material And Methods: The CT and MR scans showed a severe osteochondrosis of the L4/5 segment, a broad protrusion of the disc annulus and extrusion of nucleus material into the spinal canal on the left side.

Results: The caudally dislocated sequester pieces were visualised intradurally and the intraoperative finding confirmed this rare pathology.

Prognostic value of 18F-FDG PET in monosegmental stenosis and myelopathy of the cervical spinal cord.

Unlabelled: MRI offers perfect visualization of spondylotic stenosis of the cervical spine, but morphologic imaging does not correlate with clinical symptoms and postoperative recovery after decompression surgery. In this prospective study, we investigated the role of (18)F-FDG PET in patients with degenerative stenosis of the cervical spinal cord in relation to postsurgical outcome.

Methods: Twenty patients with monosegmental spondylotic stenosis of the middle cervical spine (C3/C4 or C4/C5) showing intramedullary hyperintensity on T2-weighted MRI and clinical symptoms of myelopathy (myelopathic patients) were investigated by (18)F-FDG PET.

Regional impairment of 18F-FDG uptake in the cervical spinal cord in patients with monosegmental chronic cervical myelopathy.

Objective: The aim of this preliminary report was to assess glucose metabolism in the cervical spine of patients with chronic compressive myelopathy by using FDG PET.

Methods: Ten patients with monosegmental chronic degenerative stenosis and local cord compression of the upper/middle cervical spine with signs of myelopathy on MRI and 10 control patients without known cervical abnormalities were investigated by FDG PET. Maximum standardised uptake values (SUV(max)) were measured at all levels of the cervical spine (C1-C7).

Intralesional hemorrhage and thrombosis without rupture in a pure spinal epidural cavernous angioma: a rare cause of acute lumbal radiculopathy.

Pure spinal epidural cavernous angiomas are extremely rare lesions, and their normal shape is that of a fusiform mass in the dorsal aspects of the spinal canal. We report a case of a lumbo-sacral epidural cavernous vascular malformation presenting with acute onset of right-sided S1 radiculopathy. Clinical aspects, imaging, intraoperative findings, and histology are demonstrated.

Paraparesis due to pressure erosion of the thoracic spine by an aortic aneurysm: remission of symptoms following resection of the aneurysm and vertebral reconstruction.

Background: There are only a few descriptions in the literature of thoraco-abdominal aortic aneurysms responsible for erosion of the vertebral column and compression of the spinal cord. This case is therefore presented to provide an opportunity to discuss the pathomechanic aspects and to demonstrate the feasibility of total surgical repair by an interdisciplinary approach.

Methods: A thoraco-abdominal aortic aneurysm caused extensive erosion of vertebral bodies T5-8, leading to invasion of the spinal canal and compression of the cord.

Cervical myelopathy: clinical and neurophysiological evaluation.

The overall frequency of troublesome neck pain is estimated to be about 34%, and it was observed that the frequency of complaints lasting 1 month or longer was higher in women than in men. The prevalence increased with age, with regard to both pain duration and chronic pain. Approximately 14% of a randomly selected population meets the criterion for chronic neck pain: complaints lasting more than 6 months.

Classification and management of early complications in open lumbar microdiscectomy.

Complications and side effects in any kind of surgery, especially in spine surgery, should be evaluated to prevent those problems in the future. Since retrospective studies are of minor value and randomized controlled studies for complications are impossible to perform because of ethical and legal reasons, so-called "expert opinion" has to take their place in evidence-based medicine. On the basis of an analysis of the results of three spine centers together with the opinions of experienced spine surgeons, the authors have drawn up a classification of complications in open lumbar disc surgery and recommendations on how to manage common complications such as excessive bleeding, dural opening, nerve root lesions and recurrent disc herniation.

[Treatment of spinal fracture in ankylosing spondylitis].

Clinical guidelines for the treatment of vertebral fractures associated with ankylosing spondylitis are derived from case reports and a review of literature. The coincidence of paravertebral calcifications and fracture formations leads to problems in the establishment of a proper initial diagnosis. Therefore computed tomography and magnetic resonance imaging have to be employed to define the extent of fracture and the presence of spinal lesions.

Enlargement of a chronic aseptic lumbar epidural abscess by intraspinal injections--a rare cause of progressive paraparesis.

The frequent use of invasive procedures at the spinal cord such as epidural injections has led to an increased incidence of iatrogenic abscesses. We report the case of a patient who suffered from low back pain. During epidural lumbar injections of steroids the patient developed severe radicular symptoms, resulting in severe paraparesis.

Spinal cord and nerve root monitoring in spine surgery and related procedures.

Intensive research in the field of intraoperative neurophysiologic monitoring has been performed directed at finding reliable stimulating and recording techniques and adequate anesthetic regimes applicable to spinal procedures. The aim is a comprehensive monitoring not only of afferent and efferent spinal cord pathways but also of sensory and motor nerve roots and cauda equina fibers. Conventional somatosensory evoked potentials (SEPs) are complemented by motor evoked potentials, dermatomal sensory evoked potentials, spinal cord evoked potentials, evoked electromyography, sensory and motor fiber mapping of the cauda equina, bulbocavernosus reflex testing, and neurogenic evoked potentials.

Speed and pressure characteristics of external anal sphincter contractions.

The principle of isochronism reflects constant contraction time for varying strengths of muscle contraction. This principle was studied for the innervation of the pelvic floor in humans using motor-evoked potentials (MEPs) and evoked pressure curves (EPCs) from the external anal sphincter muscle (EAS). MEPs and EPCs were simultaneously recorded after transcranial magnetic stimulation of the motor cortex.

Neurophysiological techniques in the evaluation of disorders of the spine.

Neurophysiological investigations are indispensable tools in evaluating and quantifying functional impairment of spinal cord structures and adjacent nervous tissue in any disorder of the spine accompanied by neurological symptoms. In this review the relevant neurophysiological techniques will be briefly described and their differential value for diagnosis and prognosis of spinal cord damage discussed. Typical case reports of spine disorders at different spinal levels are presented to illustrate results and interpretations of neurophysiological investigations.

Magnetic stimulation for monitoring of motor pathways in spinal procedures.

Transcranial magnetic stimulation was used for intraoperative motor evoked potential monitoring during surgery of intramedullar, extramedullar, and extradural spinal tumors in 13 patients. Anesthesia was based on etomidate. Magnetic stimulation for motor evoked potential monitoring was successful in 10 of 13 patients, 12 of whom were neurologically impaired.

Neurophysiological evaluation of disorders and procedures affecting the spinal cord and the cauda equina.

Neurophysiological tests that asses afferent or efferent pathways of the spinal cord and of nerve roots are used for clinical diagnosis, intraoperative monitoring, and judgement of prognosis. Most tests can readily be performed in awake subjects, whereas many difficulties arise in anesthetized patients in whom neurophysiological testing is the only way of monitoring functional integrity of neural tissue. The research, therefore, that has been carried out in this field during the past year is of special interest.

Motor evoked potentials in patients with spinal disorders: upper and lower motor neurone affection.

Motor evoked potentials (MEP) following magnetoelectric stimulation allow for detection and quantification of a lesion of the central and peripheral motor pathways. MEP latency is a very sensitive parameter, irrespective whether the lesion affects the upper motor neurone, e.g.

Magnetic stimulation of motor cortex and motor roots for painless evaluation of central and proximal peripheral motor pathways. Normal values and clinical application in disorders of the lumbar spine.

Magnetic stimulation of the motor cortex, motor roots, and proximal nerve trunks was performed in 46 healthy adults and in 73 consecutive patients with disorders of the lumbar spine. In combination with neurography and F-wave recordings, the fractionated stimulation of the motor pathways allowed calculation of conduction times of the pyramidal tract fibers, of the motor roots (ie, caudal fibers), and of the motor fibers of the lumbosacral plexus. Normal values for motor conduction times to the quadriceps, anterior tibial, and extensor digitorum brevis muscles were established.

Quantification of motor pathways to the pelvic floor in humans.

The motor innervation of the pelvic floor plays a major role in defecation disorders such as fecal incontinence. It consists of central motor pathways and peripheral nerve fibers. Transcranial magnetoelectric stimulation of the brain and magnetoelectric stimulation of the lumbosacral motor roots were performed in 10 healthy volunteers.