Cause Of Compressive Myelopathy Research Articles

Gout-Induced Cervical Deformity and Progressive Myelopathy Mimicking Infection Requiring Cervical Reconstruction

IntroductionThis study describes a rare case where gout, a condition primarily associated with joint inflammation, initially manifested as a progressive cervical kyphotic deformity, mimicking infection and causing myelopathy. The patient, a previously healthy 56-year-old female, presented with severe jaw pain and a temporomandibular joint (TMJ) abscess, alongside two months of worsening balance and arm/hand tingling. Extensive clinical and radiographic assessments revealed a severe cervical kyphotic deformity with bony erosion at multiple vertebral levels, raising suspicion of an infectious cause of compressive myelopathy. MethodsThe patient underwent an urgent staged surgical intervention involving multilevel cervical decompression and fusion, coupled with cervical deformity correction. Post-surgery, she received antibiotics for seven days, during which pathological analysis unveiled collections of macrophages reacting to urate crystal deposition in a pattern consistent with gouty tophus. This unexpected diagnosis marked a novel case of undiagnosed gout-induced severe cervical deformity presenting with myelopathic symptoms and successfully managed through cervical spine deformity correction. ConclusionThis report underscores the significance of considering gout as a potential cause when encountering unusual spinal pathologies, especially in cases where gout-related symptoms are atypical. The presented 540-degree surgical approach effectively addressed both the cervical deformity and gout-induced myelopathic symptoms. To the best of our knowledge, this study represents the first documented instance of a patient with undiagnosed gout-induced severe cervical deformity successfully treated through cervical spine deformity correction, emphasizing the importance of vigilance and innovative management approaches in such rare clinical scenarios. As of the two-year follow-up, the patient exhibited significant symptom improvement and overall well-being.

PATTERN RECOGNITION ,APPROACH AND CLINICO-RADIOLOGIC EVALUATION OF MYELOPATHIES

INTRODUCTION Myelopathy, the rapid or insidious onset of motor and sensory abnormalities referable to the spinal cord, occurs as a result of a variety of causes that may be classied on the basis of their location of origin (intramedullary, intradural-extramedullary, and extradural). Osteophytic spurring and disc herniation may also produce myelopathy localised to the thoracic spine, though less commonly. Degenerative cervical myelopathy (DCM) is a progressive spine disease and the most common cause of spinal cord dysfunction in adults worldwide. AIM OF THE STUDY: 1. To study the clinical prole of cases of Myelopathy 2. To study the pattern of spinal cord involvement 3. To compare the clinical diagnosis with MRI diagnosis MATERIALS AND METHODS Ÿ Study setting: The study was conducted on patients admitted in the departments of neurology and neurosurgery with clinical suspicion of spinal cord disease Ÿ Study design: The current study was a prospective stud Ÿ Study period: The study was conducted between august 2021 to July 2022 Ÿ Sample size: The present prospective study included 30 patients admitted in the departments of neurology and neurosurgery with clinical suspicion of spinal cord disease. INCLUSION CRITERIA: Inclusion criteria include patients with clinical suspicion of spinal cord disease of age group 20-80 years were included as study participants in the present study. EXCLUSION CRITERIA: The current study excluded patients with seizures, abnormal higher mental functions, and children. RESULTS Ÿ In the present series, the patient's age ranged from 20 years to 80 years Ÿ The majority of 53.33% of participants were aged between 51 to 60 years, followed by 61 to 70 years was 13.33%, 21 to 30 years and 41 to 50 was 10% for each Ÿ Distribution of cases according to etiology: Among the study population, 17 (57%) participants had cervical spondylosis, 4 (13%) participants had caries spine, 3 (10%) participants had a vertebral fracture and others for each, 2 (7%) participants had uorosis and only 1 (3%) participant had spinal tumor Ÿ Clinico-radiological patterns of spinal cord syndromes: The majority of 50% of participants had Anterior + Posterior Cord involvement. The proportion of posterior cord, pan cord, and the central cord was 20%, 13.33%, and 10% respectively CONCLUSION: Ÿ The present study results have analyzed the prole of myelopathies and found more male preponderance Ÿ The commonest cause of compressive myelopathy was Cervical spondylosis Ÿ Anterior plus posterior cord syndrome was the commonest pattern seen which was followed by posterior cord syndrome and the least observed pattern was anterior cord syndrome. Hence, it can be concluded that MRI could suggest the location of the lesion and correlated well with clinical diagnosis.

EVALUATION OF COMPRESSIVE MYELOPATHY BY USING MRI AS THE MODALITY OF CHOICE

The primary purpose of the study is to discuss the causes of compressive myelopathy, characterize compressive lesions, and to localize the lesion either to extramedullary or intramedullary compartment using magnetic resonance imaging (MRI) as the modality of choice. A hundred patients who came to the hospital and are clinically suspected of having compressive myelopathy underwent MRI. The leading common cause of compressive myelopathy in this study was found to be extradural compression over the cord due to degenerative changes (50%). The second most common cause was found to be infectious spondylitis (20%), third being post-traumatic compressive myelopathy (12%), followed by primary neoplasms & metastases (12%) and other causes like hindbrain and craniovertebral abnormalities(6%). MRI detected cord signal changes in cases with cord compression and also assessed the integrity of the spinal cord, intervertebral discs, and ligament after acute spinal trauma. MRI, though expensive, is a non-invasive, radiation-free modality with high sensitivity, specificity, and accuracy for the evaluation of compressive myelopathy.

Compressive myelopathy presenting with paraparesis in pediatric age

Compressive myelopathy is a common presentation of the adult age group secondary to degenerating etiologies. Trauma is a rare cause of compressive myelopathy, especially in the pediatric age group as the pediatric spine is more elastic than that of adults, especially below 8 years of age. Boys are more commonly injured as compared to girls. The present study reports a case of a six-year-old female patient of compressive myelopathy presenting with jerks with progressive paraparesis. MRI shows posterior subluxation of dens (C2) attached to C2 vertebral effacing anterior – subarachnoid space and indenting spinal cord.

Evaluating the causes of compressive myelopathy by MRI in PMCH, Patna

Evaluating the causes of compressive myelopathy by MRI in PMCH, Patna

A study to find the various causes for compressive myelopathy

Introduction: Myelopathy was the term that describes any neurologic defect related to the spinal cord. A study was conducted to evaluate various causes of compressive myelopathy and also MR characterization of spinal cord compressive lesions. Materials and Methods: It is a hospital-based cross-sectional study, conducted in the department of radiodiagnosis, GSL Medical College, Rajahmundry from December 2014 to August 2016. All patients referred to the department of radiology with symptoms of compressive myelopathy of the spine were included. Pre-contrast scanning was done using TiWI, T2WI, FLAIR Sagittal, STIR sagittal. A Chi-square test was used to find the statistical significance, P > 0.05 was considered to be statistically significant. Results: During the study period total of 30 participants were included, spinal TB was diagnosed to be the most common cause of myelopathy (13; 43.3%) Extradural myelopathy was diagnosed in 23 (76.6%) participants and intradural in 7 (23.3%) members. Statistically, there was no significant difference between the age and cause for myelopathy and also between the gender. Conclusion: The most common cause of compressive myelopathy was identified to be extradural compression form TB followed by trauma. Spinal TB was the commonest site involved. In spine injury, the common site involved was the thoracic.

Pattern recognition approach and clinico-radiological evaluation of compressive myelopathies at a tertiary care hospital

Background: Neuroimaging is indicated in most instances of new-onset myelopathy for clinico-radiological correlation in terms of diagnosis, recovery, and prediction of recurrence. Aim: This study was conducted to study the clinical profile of cases of Compressive Myelopathy and the pattern of spinal cord involvement, also to compare the sites of localisation of clinical diagnosis with MRI diagnosis. Methodology: The present study was a prospective study involving 30 patients. Patients with clinical suspicion of spinal cord disease of age group 20-80 years were included as study participants. The primary pulse sequences included T1 and T2 weighted images on MRI, the location of the lesion, its margins, signal intensity on both T1 and T2 weighted images was noted. Results: The majority of 53.33% of participants were aged between 51 to 60 years. Difficulty in walking was observed in 97% of participants. Men were more often affected than women. Cervical spondylosis was the commonest cause of compressive myelopathy in 57%. A most common pattern of spinal cord involvement was combined Anterior + Posterior cord involvement. The cervical site of localisation (54%) was the commonest followed by the thoracic and lumbar spinal cord. Conclusion: Myelopathies have male preponderance. The commonest cause of compressive myelopathy was Cervical spondylosis. Anterior plus posterior cord syndrome was the commonest pattern seen, followed by posterior cord syndrome, anterior cord syndrome being the least observed. MRI correlates well with a clinical diagnosis and is useful in suggesting the location of the lesion.

Surgical clipping of flow related giant unruptured anterior spinal artery aneurysm secondary to co-arctation of aorta: Management challenges and lessons learnt

Abstract Background Anterior spinal artery aneurysms (ASAA) are extremely rare. While these aneurysms are very well known to cause spinal subarachnoid haemorrhage/hematomyelia secondary to sudden rupture, presentation with chronic myelopathy remains extremely rare. Case report A 50-year-old gentleman presented with chronic upper thoracic myelopathy for 1 year. MRI of the dorsal spine revealed an intradural T2 hypointense mass with prominent vessels at T1 level. During intra-arterial angiography, accidental diagnosis of a co-existent co-arctation of the aorta was made. The intradural spinal mass turned out to be a giant, partially thrombosed ASA aneurysm on angiography. This patient underwent surgical clipping of the aneurysm utilizing a posterolateral approach. The patient experienced a stormy early postoperative period due to acute renal failure and pulmonary edema that settled down by the time of discharge. Conclusion ASAA remains an extremely rare cause of compressive myelopathy. Its association with co-arctation of aorta increases treatment related mortality. Posterolateral approach provides a good exposure of the aneurysm for surgical clipping with minimal retraction of the cord.

Intervertebral Disc Extrusion between T8 and T9 in a Dachshund

Background: Intervertebral disc extrusion with consequent spinal compression or intervertebral disc disease (IVDD) is one of the most common causes of compressive myelopathy in dogs, and the thoracolumbar spine discs between T12 and L2 are most affected. Extrusions in cranial thoracic region are rare, and there is few cases in literature reporting this situations, this rarity is attributed to the presence of the intercapital ligament connecting the rib heads between T2 and T10, which strengthens this region both mechanically and anatomically. The aim of this article is report the clinical signs, diagnosis and treatment of a case of Type I Hansen IVDD between T8 and T9 in a Dachshund breed dog.Case: An 8-year-old Dachshund male dog was presented for investigation of pelvic limb incoordination and back pain, which started 10 days prior to the consultation. It had a history of a similar condition 3 months earlier that showed improvement after clinical treatment. On neurological examination was identified in both pelvic limbs proprioceptive ataxia, absence of proprioception, increased muscle tone, presence of interdigital reflex and increased patellar reflex. Cutaneous trunci reflex was absent below T11 on the left side, and pain was noted upon palpation of T7 through the T12 vertebrae. A grade II asymmetric thoracolumbar lesion with hyperesthesia was diagnosed. On suspicion of IVDD, cerebrospinal fluid (CSF) collection and CT scan analysis of the thoracolumbar region were performed. CT scan showed the presence of hyperattenuating and mineralized material, 1 cm long, on the floor of the spinal canal, mainly on the left side, occupying 80% of the diameter of the spinal canal between T8 and T9. The patient was then submitted to decompression surgery through hemilaminectomy and showed a good recovery. As the occurrence of disc extrusion in cranial thoracic region of chondrodystrophic breeds is rare, we report the clinical signs, diagnosis and treatment of a case of Type I Hansen intervertebral disc disease (IVDD) between T8 and T9 in a Dachshund breed dog.Discussion: All spinal discs can undergo a process of degeneration causing IVDD, in which the cervical and thoracolumbar regions are the most affected due to reasons not yet fully understood, however spinal cord compression between the T1 and T9 vertebrae is very rare, probably due to the strengthening provided by the intercapital ligament to the posterior annulus fibrosus. Disc extrusion in unusual locations in chondrodystrophic breeds is mainly reported as extrusion between vertebrae T1 and T2, and T9 and T10, with some cases was attributed to an anatomical abnormality of the intercapital ligament. The evaluation of intervertebral discs of the German shepherd breed dogs using MRI showed disc degeneration processes in thoracic vertebras. Disc extrusions often result in more severe clinical signs than protrusions, and occur acutely or subacutely, which was different from the case described here, maybe because the presence of the intercapital ligament permitted gradual extrusion allowing the spinal cord to adapt to the compression. Despite surgical access to this region being described as more complex due to the presence and proximity of the rib head to the vertebral body and the possibility of injuring the intercostal muscles causing pneumothorax, the hemilaminectomy and rib head excision at T9 could be performed without any complications. Thus, although unusual, the cranial thoracic region should not be overlooked as a possible site of occurrence of IVDD, since the diagnosis, treatment and prognosis are similar to those in patients with extrusions in the most common sites.Keywords: intervertebral disc degeneration, dogs, paresis, ataxia.

Symptomatic Large Spinal Extradural Arachnoid Cyst: A Case Report

Spinal extradural arachnoid cysts (SEACs) are relatively rare cause of compressive myelopathy. SEACs can be either congenital or acquired, but the etiology and the mechanism for their development are still unclear. A number of cases have been reported in the literature, and the one-way valve mechanism is the most widely accepted theory which explains the expansion of cysts and spinal cord compression. We report two cases of SEAC in this article. Patients had intermittent, progressive cord compressing symptoms. MRI image showed large SEAC which caused compression of the spinal cord. Pre-operative cystography and CT myelography were performed to identify the communicating tract. Pre-operative epidural cystography showed a fistulous tract. The patients underwent primary closure of the dural defect which was a communicating tract. The operative finding (nerve root herniation through the tract) suggested that the SEAC developed through a checkvalve mechanism. Postoperatively, the patients had no surgical complications and symptoms were relieved. Based on our experience, preoperative identification of the communicating tract is important in surgical planning. Although surgical excision is the standard surgical treatment, primary closure of the dural defect which was a communicating tract can be an acceptable surgical strategy.

An unusual cause of progressive quadriparesis

Thyroid carcinoma is a rare cause of compressive myelopathy. Quadriparesis as the presenting manifestation of follicular carcinoma of thyroid without any preceding features of malignancy is quite uncommon. We describe a case of a 55-year-old woman who presented with progressive quadriparesis of 2 months duration, on evaluation was found to have a large tumor destroying C1, C2 vertebrae and occupying craniovertebral junction. Histopathological examination of excised tumor was follicular thyroid carcinoma. She was successfully managed with surgical excision, stabilization of spine followed by radiotherapy.

Spinal Extradural Arachnoid Cyst

Spinal extradural arachnoid cyst (SEAC) is a rare disease and uncommon cause of compressive myelopathy. The etiology remains still unclear. We experienced 2 cases of SEACs and reviewed the cases and previous literatures. A 59-year-old man complained of both leg radiating pain and paresthesia for 4 years. His MRI showed an extradural cyst from T12 to L3 and we performed cyst fenestration and repaired the dural defect with tailored laminectomy. Another 51-year-old female patient visited our clinical with left buttock pain and paresthesia for 3 years. A large extradural cyst was found at T1-L2 level on MRI and a communication between the cyst and subarachnoid space was illustrated by CT-myelography. We performed cyst fenestration with primary repair of dural defect. Both patients' symptoms gradually subsided and follow up images taken 1-2 months postoperatively showed nearly disappeared cysts. There has been no documented recurrence in these two cases so far. Tailored laminotomy with cyst fenestration can be a safe and effective alternative choice in treating SEACs compared to traditional complete resection of cyst wall with multi-level laminectomy.

A rare case of chronic idiopathic spinal epidural haematoma

Spinal epidural haematoma (SEH) though rare is the most frequent cause of spinal haemorrhage. It is an important cause of compressive myelopathy, frequently presents as an emergency and requires prompt diagnosis and management. SEH can be classified as secondary (e.g., secondary to coagulopathies or anticoagulant therapy), spontaneous (absence of any definite cause but associated with risk factors like minor trauma) and idiopathic (no attributable risk factors identified) or acute and chronic.1 The spontaneous and idiopathic groups comprise about 50% of cases.2 The chronic form is the rarest and its most frequent location is the lumbar spine. Magnetic resonance imaging (MRI) is the imaging modality of choice for diagnosis. Irrespective of the aetiology, the mainstay of treatment is urgent surgical decompression and evacuation of the haematoma. There are only a few reports of successful conservative treatment in this condition where symptoms and signs have resolved without surgery.3,4 Here we present an unusual case of chronic idiopathic spinal epidural haematoma where the patient was only symptomatic with chronic low backache. This article aims to discuss the pathogenesis, clinical and radiological features, and differential diagnosis in this condition.

Calcification of the ligamentum flavum in the thoracolumbar spine: an unusual cause of compressive myelopathy

The focal calcification or ossification of the ligamentum flavum is a rare cause of thoracic myelopathy and most often occurs among individuals of Japanese descent. It is rare in other ethnic groups and in individuals below the age of 50. It is most often described at the lower thoracic level, being uncommon in the lumbar region and rare in the cervical region. Here, we present the case of a 44-year-old White female patient who sought medical attention with an eightmonth history of paraesthesia of the lower limbs and progressive difficulty in walking. The clinical profile, together with computed tomography and nuclear magnetic resonance imaging of the spine, led to a diagnosis of compressive thoracic myelopathy due to ossification of the ligamentum flavum in the thoracic and lumbar spine. The patient underwent laminectomy and dissection of some of the affected ligamentum flavum, without any intraoperative complications. After three months of clinical follow-up, the patient had progressed favorably, having no sensory complaints and again becoming ambulatory.

Mielopatia torácica por calcificação do ligamento amarelo cursando com hiperproteinorraquia e resposta à corticoterapia: relato de caso

Calcification and ossification of the ligamentum flavum or of the posterior longitudinal ligament are causes of compressive myelopathy, more frequent in the lower thoracic levels, and extremely rare in Western populations. Surgical decompression is the only therapy, but the disease is usually progressive, and its recurrence after surgery is common. Inflammatory mediators might play a role in the progression of compressive myelopathy, but, to our knowledge, the therapeutic approach involving anti-inflammatory agents has never been tried before. We report a case of compressive myelopathy due to calcification of the ligamentum flavum, in which hyperproteinorachia and response to steroid therapy have been observed. Those data have not been published before and might provide new ideas for the disease understanding.

Intra-dural spinal arachnoid cysts: a short series of 10 patients

Objective. To describe intra-dural arachnoid cysts as the cause of compressive myelopathy.Material and methods. A short series of 10 patients harbouring intra-dural arachnoid cysts is described. A detailed description of symptomatology, radiological findings, surgical approach, techniques and outcome is discussed. Microsurgical excision was performed in all patients. In two patients, intra- and extra-spinal communications of cysts were found and were ligated.Results. Good long-term results were achieved in all 10 patients, after surgical intervention.Conclusion. Rarely, intradural, extramedullary lesions like arachnoid cysts may lead on to compressive myelopathy causing spastic paraparesis. Except for the catastrophic complication like intra-cystic haemorrhage or subdural haematoma, the fatal complication is unlikely. The congenital dural defect is considered the cause behind the development of these cysts. Though uncommon, but intradural arachnoid cysts are important cause of compressive myelopathy. These lesions are curative, if excised surgically with precision.

Acute spontaneous cervical epidural hematoma with neurological deficit after low-molecular-weight heparin therapy: role of conservative management

Background Context Spontaneous spinal hematoma (SSH) after low-molecular-weight heparin (LMWH) therapy is a rare cause of compressive myelopathy with neurological deficit. Emergent surgical decompression is commonly advocated for optimal neurological recovery. Only three cases of spontaneous spinal subdural hematomas after LMWH therapy have been reported in the literature, and this is the first report of a spontaneous cervical epidural hematoma (EDH). Purpose To highlight the importance of conservative management in an unusual case of cervical EDH with neurological deficit after LMWH therapy. Study Design Clinical case report. Methods A 65-year-old man presented with weakness of upper and lower limbs with bowel and bladder dysfunction after LMWH therapy for an acute coronary syndrome. Magnetic resonance imaging (MRI) revealed an anterior cervical EDH extending from C4 to T1 with significant cord compression. Associated comorbidities precluded emergent surgical intervention, and the patient was managed conservatively with cessation of LMWH therapy. Results The patient showed signs of early neurological recovery within 24 hours (ASIA C [American Spinal Injury Association] to ASIA D) of cessation of LMWH, and hence surgery was deferred. Complete motor and sensory recovery was observed at 1-month follow up with resolution of the cervical EDH without any cord compression evident on the MRI. Conclusions LMWH therapy is an important cause of SSH leading to significant neurological deficits. Conservative management is a viable treatment option in patients who demonstrate early and sustained neurological recovery with the cessation of LMWH therapy.

Idiopathic chronic hypertrophic pachymeningitis causing thoracic cord compression

Chronic idiopathic pachymeningitis is a rare cause of compressive myelopathy, especially of the thoracic spinal cord. The hypertrophic dura causes symptoms either by pressure on the spinal cord or by vascular compromise. The authors report the diagnostic dilemmas in a 48-year-old lady who presented with progressive spastic paraparesis of 4 months duration. MRI showed an extradural hypointense band, surrounding and flattening the thoracic cord in the anteroposterior direction, extending from C7 to T11. Neither the CT scan nor the myelogram provided any clue to the diagnosis. A T1 - T10 laminectomy was performed. The dura was hypertrophied and found compressing the cord. The posterior dura was excised and the spinal cord was decompressed. The histopathology showed hypertrophic pachymeningitis. The patient improved neurologically. She was started empirically on anti-tubercular chemotherapy, though she was serologically negative for all known causes of pachymeningitis.