Background: Diagnosis of cervical spondylotic myelopathy (CSM) can be challenging due to subtle symptoms and insidious onset; however, there is a relationship between signal intensity change of the spinal cord on MRI and cervical spondylotic myelopathy. Objective: The purpose of this present study was to find out the relationship between signal intensity change of the spinal cord on MRI and motor myelopathic severity in patients with CSM. Methodology: This cross-sectional study was carried out in the Department of Neurosurgery at Banghabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from October, 2011 to March, 2013 for a period of one and half year. All patients presented with cervical spondylotic myelopathy were included in this study. MRI of cervical spine was performed to all patients. Results: A total number of 36 patients with cervical spondylotic myelopathy were included in this study. Among the 36 study patients, all had normal intensity in the spinal cord on sagittal T 1 WI of MRI; however, there was variable intensity on sagittal T2WI of MRI. Low Nurick score was found in 24(66.6%) patients who had type 0 signal intensity on (T 2 WI) MRI. High Nurick score was found in 3(8.3%) patients who had type 0 signal intensity on (T 2 WI) MRI. Low Nurick score was found in 2(5.5%) patients who had type 1 signal intensity on (T2WI) MRI. High Nurick score was found in 6(16.6%) patients who had type 1 signal intensity on (T 2 WI) MRI. Only 1 patient (2.7%) having high Nurick score (3-5) had type-2 signal intensity on (T 2 WI) MRI (p<0.001). Conclusion: There is a direct relationship between signal intensity change of the spinal cord on MRI and motor myelopathic severity in patients with cervical spondylotic myelopathy. [Journal of National Institute of Neurosciences Bangladesh, 2015;1(2): [37][38][39][40]
A 55 year old female patient presented with progressive back pain of 6 month duration,aggravated on lying down, associated with weakness and numbness of the bothlower limbs for since 4 months. On neurological examination, the tone was foundincreased in both the lower limbs with a subjective power of grade 3/5 in both thelower limbs. Ankle and knee jerks were brisk with hypoaesthesia below D12dermatomes bilaterally, plantars were extensor. A clinical diagnosis of involvement ofD9 spinal level lesion was made. Magnetic resonance imaging (MRI) of the dorsolumbarspine showed an intraduralextramedullary ventrally placed lesion at the D8–D9 vertebral level with significant compression of the spinal cord [Figure 1, 2, 3]. Thelesion appeared hyperintense on T2W image with no contrast enhancement and withsignificant compression and shifting of the cord to the left. After preoperative routinehematological investigations, she underwent operation by laminectomy of D8–D9vertebrae and total excision of the cystic lesion was performed [Figure 4, 5]. Histologicalexamination revealed respiratory type pseudostratified ciliated columnar cells and apathological diagnosis of bronchogenic cyst was rendered [Figure 6]. The patient hadan uneventful postoperative period with subjective improvement of her symptomswith reduced spasticity & improvement of motor grade to 4/5 in both lower limbs. Bang. J Neurosurgery 2020; 9(2): 146-150
Objectives: The aim of this study is to compare patients undergoing single level anterior cervical discectomy without fusion (ACD) versus anterior cervical discectomy with fusion (ACDF). Methods: A retrospective analysis of 50 patients with degenerative cervical spondylosis of them 25 had undergone ACD without fusion and remaining 25 undergone ACDF at either C4-C5, C5- C6 level or at C6-C7 level. Results: The kinematic analysis included the range of motion, intervertebral angulations, anteroposterior translation and disc height assessed for the cervical functional spinal units at the operated level and adjacent levels. At the operated level of C4-C5, C5-C6 and C6-C7, the range of motion and the translation were minimal in the anterior cervical discectomy without fusion (ACD) group, but absent in the cervical discectomy with fusion (ACDF) group. The superior adjacent levels range of motion and the translation were greater in the ACDF group compared with the ACD group. But both groups had almost similar results in term of hospital stay, mean time for improvement and patient satisfaction. Conclusion: The clinical results of anterior cervical discectomy without fusion (ACD) and anterior cervical discectomy with fusion (ACDF) were comparable. In cervical discectomy without fusion, the elastic fibrous intradiscal scar at the operated level allows a small degree of mobility and the adjacent cervical levels are not overstressed. Fusion is not routinely required in single level cervical disc herniation until it is associated with instability, loss of cervical lordosis, hard disc, osteophytic bar and multi-segmental disease. So ACD is a better option in single level cervical disc disorder than ACDF. J Dhaka Medical College, Vol. 27, No.1, April, 2018, Page 29-35
Introduction: Surgical outcome of spinal tumours varies depending on a number of factors such as: site of tumour compression within the spinal canal, the histological characteristics of tumours, the neurological progression and initial response to corticosteroid therapy, patient’s age, comorbidity, tumour extension, involvement of neighbor structures and organs etc. Materials & Methods: The 46 patients with intradural extramedullary (IDEM) spinal tumour underwent surgery by our team in 7 years (2010-2017) were reviewed retrospectively. Discussion: Analysis of the surgical outcome of our spinal tumour patients was done on different variables like age, sex, presenting symptoms, neuro imaging, comorbidities etc. The aim of surgery was decompression of the spinal cord and total removal of the tumour. Conclusion: The aim of this study is to analyze the data to make conclusion for more effective strategy as per site, size, type, resectibility and histological variety to establish an effective treatment protocol and prevention of per-operative and post-operative complications. Intradural extramedullary tumor can be radically resected with no mortality and minimal peri-operative morbidity J Dhaka Medical College, Vol. 27, No.2, October, 2018, Page 205-208
Introduction: Surgical outcome of spinal tumour varies depending on a number of factors such as: site of tumour, compression within the spinal canal, the histological characteristics of tumour, the neurological progression and initial response to corticosteroid therapy, patient’s age, comorbidity, tumour extension, involvement of neighboring structures and organs etc. Materials & Methods: The 86 patients with spinal tumour underwent surgery by our team in 7 years (2011-2018) were reviewed retrospectively. Discussion: Analysis of the surgical outcome of our spinal tumour patients was done on different variables like age, sex, presenting symptoms, neuroimaging, comorbidities etc. The aim of surgery was decompression of the spinal cord, total removal of the tumour when possible and spinal stabilization when needed. Out of our 86 patients with spinal tumour, extradural tumour comprises 18, intradural tumour 56 and intramedullary tumour 12. Conclusion: The aim of this study is to analyze the data to made conclusion for more effective strategy as per site, size, type, resectibility and histological variety to establish and effective treatment protocol and prevention of per-operative and post-operative complications. Intradural extramedullary tumour can be radically resected with no mortality and minimal peri-operative morbidity. But resection of intramedullary spinal tumour is difficult, hazardous and usually incomplete, so needs much more skilled and meticulous surgical hands. Bang. J Neurosurgery 2019; 8(2): 63-67
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