Resonance Imaging Of Cervical Spine Research Articles

Treatment of a Patient with Ossification of Ligamentum Flavum of Cervical Spine and Literature Review

<i>Background</i>: The ossification of ligamentum flavum occurs frequently in the thoracic vertebra, and the incidence of ossification of cervical ligamentum flavum is relatively low. It is easy to cause misdiagnosis and mistreatment due to lack of understanding in clinical practice. <i>Object</i>: To understand the diagnosis and treatment of cervical ossification of ligamentum flavum through the treatment of one case. <i>Material</i>: A 65-year-old female patient was hospitalized due to "lumbar discomfort with numbness of both lower limbs for 1 year, and aggravation with numbness and weakness of both upper limbs for the last 3 months". Physical examination showed cervical flexion, extension and lateral flexion activities were limited, post extension limitations were obvious, limb muscle strength was grade 4, right knee tendon reflex was active, and bilateral Hoffman sign and right Babinski sign were positive. Cervical JOA score was 8 points. Magnetic resonance imaging of cervical spine showed that there were pressure objects protruding to the spinal canal between C3/4, C5/6, and C6/7 laminae. Sagittal MRI showed segmental or focal nodular space occupying and protruding into the spinal canal from the rear of the spinal canal. Cross sectional MRI showed nodular or "M" shaped occupying space. T1 weighted image was equal signal, and T2 weighted image showed low signal shadow, suggesting high-density ossification and severe spinal cord compression. The effective sagittal diameter was less than 8mm. <i>Method</i>: Hemilaminectomy was performed for a single segmental OLF of C3/4, and a total laminectomy was performed for bilateral and multi-segmental OLF of C5/6, 6/7. According to the range of intraoperative decompression, C5 and 6 posterior lateral mass screws and C7 pedicle screws were fixed. <i>Result</i>: After the operation, the patient indicated that his upper limbs were relaxed, the umbilical horizontal band disappeared, and the muscle strength of his limbs was stronger than that before the operation. She could move freely on the ground, and her holding was more flexible and powerful than before. The postoperative JOA score was 12 points. The postoperative pathological result was fibrous connective tissue and ossification. The follow-up JOA score was increased to 15 points 8 months after operation, and the improvement rate was 78%. The patient could completely take care of herself, and the treatment was satisfactory. <i>Conclusion</i>: Surgical resection of cervical olf and canal decompression is an effective method for the treatment of Cervical OLF and can achieve good clinical results.

Tremors as an atypical presentation of cervical myelopathy

Tremors are common especially in the elderly population. However, tremors occurring secondary to cervical myelopathy are rarely reported. We report the case of a 91-year-old gentleman who was admitted to the neurology service with chief complaints of bilateral upper- and lower-limb tremors. This had progressed rapidly over 2 weeks to the extent that he was not able to feed himself and was unable to walk without support. An initial working diagnosis of Parkinson's disease was made but was later dismissed because of the atypical features. A magnetic resonance imaging of cervical spine was subsequently performed which revealed a large disc herniation at C3–C4 level, causing severe spinal canal stenosis and cord compression. Given this radiological presentation and the absence of other objective pathologies on further investigations, we correlated his symptoms to the underlying cervical cord compression. He underwent anterior cervical discectomy and fusion which led to complete resolution of tremors by 8 weeks postsurgery. His unsteadiness eventually resolved, and there was no recurrence of tremors throughout our follow-up period. This case highlights a rare atypical presentation of cervical myelopathy as peripheral limb tremors. The diagnostic dilemma, management strategies, and hypothesis to explain this phenomenon are discussed.

Hirayama disease: Study of clinical, electrophysiological & radiological characteristics at tertiary care centre from north-west India

Abstract Introduction Dynamic cervical cord compression as the pathogenetic mechanism of Hirayama disease has been recently evaluated on dynamic magnetic resonance imaging of cervical spine. Objectives To study clinical, radiological and electrophysiological profile of patients with Hirayama disease. Materials and Methods This was a prospective study of 17 cases of Hirayama disease carried out at SMS hospital, Jaipur, from June 2016 to October 2017. Results In our study, predominantly male (94.1%) patients were affected and average age of onset was 23.1 years. Unilateral involvement was seen in 71% cases (n = 12). Brisk deep tendon reflexes and dysesthesia, not characterstics of Hirayama disease, were found in 3 patients (18%) and 2 patients (12%) respectively. Long neck was found in our study in 7 patients (41%). On dynamic cervical spine MRI, anterior shifting of posterior cervical dura on flexion, asymmetric cord flattening and loss of cervical lordosis were found in 82% patients. Nerve conduction study was abnormal in 14 patients (82%) and electromyographic evidence of neurogenic affliction was present in all patients in involved segments (C5-T1). Conclusion Hirayama disease, a benign variant of motor neuron disorder can be diagnosed with increasing sensitivity with use of dynamic cervical MRI spine study.

Cervical giant pseudomeningocele presented with neck pain: conventional MRI and MR myelography findings

A 12-year-old boy with neck pain was admitted to our clinic. He had a history of head and neck trauma 3 years before presentation. Laboratory and neurologic examination was unremarkable. Conventional magnetic resonance imaging of cervical spine showed a giant multiloculated cystic lesion with the size of 7.5 cm×2.5 cm. The lesion was hypointense on T1weighted images and hyperintense on T2-weighted images such as cerebrospinal fluid (Fig. 1A, B). The cystic lesion was extending through neural foramens around the spinal nerve roots (Fig. 1C, D). Magnetic resonance myelography demonstrated the pseudomeningocele in detail anterior to spinal cord and thecal sac (Fig. 2). The spinal nerves of cervical and brachial plexus were intact. Conservative management of the lesion was decided because the patient showed no evidence of progressive neurologic deficit. Pseudomeningocele is defined as an extradural collection of cerebrospinal fluid that results from a tear in dura and arachnoid layer. It becomes encapsulated in a fibrous sac. Common etiologic factors are congenital, traumatic, and iatrogenic [1–3]. References

A case of progressive tetraparesis due to cervical epidural abscess

Introduction: cervical epidural abscess (cEA) is a rare entity with varied clinical presentations. this can lead to significant delay in the timely diagnosis. case report: We report a rare case of sudden onset progressive tetra paresis in a 54-year-old male. Magnetic resonance imaging of cervical spine was suggestive of acute cervical spinal epidural abscess. Emergent surgical evacuation of the abscess resulted in gradual improvement of the neurological status in the patient. conclusion: spinal epidural abscess may present with constellation of signs and symptoms. timely diagnosis and intervention may prevent permanent deficits to the patients.

Occipito-thoracic fusion in incidental dystropic os odontoideum in a patient suspected with osteogenesis imperfecta: A case report

Introduction: Os odontoideum is a rare lesion of the axis. Described as an ossicle, consisting of smooth and separate caudal portions of the odontoid process wherein its etiology has remained controversial. Os odontoideum complicating a possible osteogenesis imperfecta has not been reported before in the literature. Methods: We report the case of a 14-yr male patient presented with progressive weakness of both lower and upper extremities after a head trauma 10 months prior to admission, which presented as transient quadreparesis. Results: Magnetic resonance imaging of cervical spine showing cervicomedullary junction compression. Patient underwent surgical intervention and 3 months post operation, patient was reported to have steady gait and muscle grading of 5/5 on all extremities. Conclusion: Surgical fixation and fusion in patients with instability may prevent catastrophic neurologic insult after minor trauma in the future.

Longitudinal cortex reorganization and white matter tracts structural changes analysis in relapsing-remitting multiple sclerosis patients with hand palsy

Motor disorders are a frequent syndrome in multiple sclerosis (MS), leading to severe disability, possibly associated with inefficiency of adaptive mechanisms, probably because of widespread structural changes. Hand palsy with fine motor skills damage influences greatly on quality of life, because hand function plays an important role in everyday activities and working practices. Thus the aim of the study was to investigate functional and structural features of hand palsy in homogenous sample of MS patients during the relapse and in three months. Data were acquired from 25 relapsing-remitting MS patients during relapse also characterized by unilateral light hand palsy, and in three months. 12 age-matched healthy controls entered the control group. All patients underwent neurologica examination, including nine-hole peg test and dynamometry, and magnetic resonance imaging of cervical spine and brain, including functional MRI and diffusion tensor imaging (DTI) sequences. All patients had lesions in spinal cord on cervical spine MRI. fMRI data analysis during relapse showed differently directed activation changes and allowed to divide all patients in two subgroups. These subgroups differed from each other and control group by deep sensitivity and DTI values. In three months patients in the first subgroup had less complete fine motor skills recovery, which was accompanied also by preservation of activation changes and deep sensitivity asymmetry in comparison with the second subgroup. Received data allow us to assume that clinically similar palsy, caused by spinal cord lesion, could be characterized by greater or lesser sensation impairment contribution. In three months heterogeneous structural and functional changes were observed, depending, possibly, on initially different pathologic mechanisms. Revealed differences should be taken into consideration while rehabilitation planning.

Neglected Fracture-Dislocation of the Cervical Spine without Neurological Deficits

Dear Sir, Neglected spinal injuries, either secondary to overlooked diagnosis [1] or due to circumstantial and socio-economic factors [2], are not uncommon but discussed infrequently in the literature [1,2]. A 72-year-old male had history of a slip and fall episode three years ago in a construction field. At that time, he had weakness of all four limbs with bowel and bladder involvement. He was managed conservatively because of financial instruments. He recovered completely over a period of six months. Now, he presented with mild persistent neck pain. On examination, except mild spasticity, there were no motor or sensory deficits. Initial magnetic resonance imaging of the cervical spine showed dislocation of C5 over C6, and the spinal cord was stretched over the dislocated vertebral bodies (Fig. 1). There was no evidence of cord edema or cord contusions. He had one follow up X-ray of the cervical spine at one year after the injury, and it showed a fusion of the C5 and C6 vertebral bodies (Fig. 2A). Recent X-ray of the cervical spine showed increased and complete ossification of the C5 and C6 vertebral bodies (Fig. 2B). In view of the solid fusion and no neurological deficits, the patient continued with conservative management with analgesics. Fig. 1 Initial magnetic resonance imaging of cervical spine showing dislocation of C5 over C6 and the spinal cord was stretched over the dislocated vertebral bodies. Fig. 2 (A) One follow-up X-ray of the cervical spine at one year after the injury showed fusion of C5 and C6 vertebral bodies, and (B) Recent X-ray of the cervical spine showed increased and complete ossification of the C5 and C6 vertebral bodies. Patients with neglected spinal injuries can present with neck pain, restricted neck movements, or clinical features of progressive myelopathy [2-4]. Treatment of neglected spinal injuries needs to be individualized, depending on patient's age, medical condition, severity of myelopathy, and stability spine [5-8]. Aggressive surgical treatment is reserved for younger patients with progressive myelopathy, secondary to dynamic instability [9]. Conservative approach has been suggested for elderly patients with stable, non-progressive deformity [5-8]. In the present case, the reactive new bone formation around the fractured segments might have helped in preventing abnormal movements and development of myelopathy. Neglected spinal injuries are defined as injuries not treated in a timely fashion and found late when options for care are limited [1]. Also, neglected spinal injuries may result when the comprehensive management is not initiated in a timely fashion [2]. These lesions have a much higher incidence of complications, which are more severe and difficult to manage, requiring longer hospitalization, adding to the costs and adversely affecting the functional outcomes [1,2]. In summary, for neglected spinal injuries, either untreated or inadequately treated with progressive deformity, persistent pain and late presentation are more often seen in the developing countries [1]. In rare circumstances (as in present case), neglected complete fracture-dislocations patients can make excellent recovery without neurological deficits [10].

A Weak And Painful Shoulder In A Professional Volleyball Player

HISTORY: A 29-year old professional volleyball player, without history of recent trauma, surgical procedures, infections, complained of a dull ache in the right lateral base of the neck, exacerbated by digital pressure on the region and associated with episodes of vagal reaction (asthenia, dizziness, nausea) after training sessions and cold air exposure. After 3 days, the athlete exhibited deficiency of right scapula adduction, mild limitation of scapula elevation, right shoulder weakness, mild pain in the right lateral base of the neck, radiated to the right shoulder, without sensitivity deficits. PHYSICAL EXAMINATION: Physical exam revealed an asymmetrical neckline with drooping of the affected shoulder, lateral displacement and minimal winging of the right scapula, that was displaced laterally, rotating downward and outward. Winging disappeared during forward flexion of the arm. A moderate pain on the right neck base persisted for about 20 days. Both deep reflexes and strength of upper right limb were normal, and no contractures were present. The athlete complained of weakness in abduction of right arm and inability of scapula adduction, but he could shrug the shoulders, elevate forward the right arm and move the neck in any direction. After 1 week hypotrophy of superior trapezius was evident. DIFFERENTIAL DIAGNOSIS: -paralysis of the rhomboid and serratus anterior muscles; -herniated nucleus pulposus of cervical disks; -progressive neuromuscular disease; -scapular osteochondroma; -herpes zoster infection; -thoracic outlet syndrome; -suprascapular nerve injury. TEST AND RESULTS: Magnetic resonance imaging of cervical spine and shoulder: - no signs of mass lesions nor disk disease; - signs of infraspinatus chronic tendinopathy and acromioclavicular arthrosis. EMG right upper limb: -denervation in the upper, middle and lower components of the right trapezius muscle, due to axonotmesis of spinal accessory nerve. Blood tests: - protein profile and complete blood count were normal; Varicella-Zoster and Herpes virus IgM antibodies were negative. FINAL/WORKING DIAGNOSIS: Idiopathic spinal accessory nerve palsy. TREATMENT AND OUTCOMES: - Rest from playing volleyball for 3 months - Formal physical therapy. - Neurocognitive Rehabilitation - Transition to sport specific movements and return to play

Paroxysmal Kinesigenic Dyskinesia and Cervical Disc Prolapse With Cord Compression: More Than a Coincidence?

Paroxysmal Kinesigenic Dyskinesia and Cervical Disc Prolapse With Cord Compression: More Than a Coincidence?

Paroxysmal Kinesigenic Dyskinesia and Cervical Disc Prolapse With Cord Compression: More Than a Coincidence?

Paroxysmal Kinesigenic Dyskinesia and Cervical Disc Prolapse With Cord Compression: More Than a Coincidence?

Hyperintense splenium in vitamin B12 deficiency

A 15-year-old female vegan was hospitalized for 6 days of fever, abdominal pain, and loose stools. The patient was found to have gross difficulty in walking, normal higher functions with MMSE of 28/30, absence of apraxia, dysarthria, and nystagmus; she had normal power in the limbs, normal deep jerks, and negative Babinski response. The touch, pain, joint position, and vibration sense were grossly normal; she showed severe finger to nose and gait ataxia. The Romberg sign was unequivocally and strongly positive and her gait ataxia would worsen on eye closure. The laboratory values were: hemoglobin: 5.7 g%; packed cell volume: 14%; mean corpuscular volume: 109 fl; red blood cell count: 1.34 x 10 6 /ml; white blood cell count: 1.9 x 10 3 /ml; platelets: 4.1 x 10 3 /ml; peripheral smear showed macrocytes and macro-ovalocytes; LDH: 918 U/l (N 90–200 U/l); serum vitamin B 12 : 78 pg/ml (N 200–950 pg/ ml); serum folic acid: 0.81 ng/ml (N 3–17 ng/ml); serum homocysteine: 32 mmol/l (N 2–7 mmol/l). The results of the thyroid, liver, and renal function tests were normal. The workup for collagen vascular disease, malabsorption and for fever was negative. The nerve conduction velocities were normal, save for absent F responses from the tibial and peroneal nerves on both sides. The lumbar puncture was deferred, as the platelet count was low. The T2 and diffusion weighted images (DWI) of brain magnetic resonance imaging showed hyperintensity in the splenium [Figures 1 and 2]. Subtle hyperintense signal was noted in bi-frontal and parietal white matter on T2W images. The magnetic resonance imaging of cervical spine showed posterior column hyperintensity extending from C2 to C5 vertebrae on T2W images, both in sagittal and axial planes. The acute presentation of sensory ataxia was likely to be due to aggravation of the nutritional deficiency of vitamin B 12 by the febrile illness. The MRI was repeated 1 month after injectable and oral cyanocobalamine treatment, and it showed persistence of the hyperintense signal in the splenium; however, its intensity was reduced. Hyperintense signal from splenium of corpus callosum has been observed in hypoxic–ischemic encephalopathy, Marchiafava–Bignami syndrome, [1] high-altitude cerebral edema, [2] antiepileptic drug toxicity, [3] following epileptic attacks, [4] radiation therapy, [5] hemolytic uremic syndrome, [6] CNS lymphoma, astrocytoma, and demyelinating disease. [7] The hyperintense signal from the splenium of corpus callo

Synovial cyst of dens causing spinal cord compression. Case report

We report a rare case of synovial cyst of the dens (odontoid process) in a 61 year old women with no previous history of trauma. She had progressive symptoms of 1 year's duration due to spinal cord compression. Magnetic resonance imaging of cervical spine revealed a large mass posterior to the dens which was compressing the spinal cord near the cervicomedullary junction. This lesion was at first considered radiologically to represent an exuberant pannus formation or a meningioma of the foramen magnum, but subsequent surgical intervention and pathological examination revealed that it was a synovial cyst. Similar cases reported in the literature are reviewed and discussed.