Cervical Myelopathy Secondary to Multiple Spondylotic Protrusions

Ono, Katsuhiko; Ōta, Hiroshi; Tada, Kazuya; Yamamoto, Takaya

doi:10.1097/00007632-197706000-00004

Cited by 135 publications

(53 citation statements)

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“…Long-term cord compression and secondary vascular changes are considered to be possible mechanisms. [11][12][13][14] The fibrous thickening of small veins with narrowing of the lumen around the cysts in this case may indicate that venous infarction plays an important role in the formation of cystic necrosis. Although MR imaging revealed SEA at the central gray matter and the ventrolateral posterior column, damage of anterior horn cells should be considered as a causative lesion for motor dysfunction of the upper limbs.…”

Section: Discussionmentioning

confidence: 76%

Postmortem study of the spinal cord showing snake-eyes appearance due to damage by ossification of the posterior longitudinal ligament and kyphotic deformity

et al. 2005

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Clinical design: A case report. Objectives: To elucidate the clinical role of snake-eyes appearance in this case, correlation between radiological, clinical and postmortem study was performed. Setting: Aichi, Japan. Case report: A 73-year-old man developed weakness and pain in the upper limbs due to kyphotic deformity secondary to laminectomy for cervical ossification of the posterior longitudinal ligament. Axial magnetic resonance imaging revealed snake-eyes appearance from C4 to C6. He died of acute myocardial infarction 3 months after anterior decompressive surgery. Results: A postmortem examination of the cervical spinal cord showed small cystic six necrotic areas at the junction of the central gray matter and the ventrolateral posterior column, one in the right and one in the left, in association with neuronal loss in the anterior horn. Conclusions: Bilateral small intramedullary high-signal areas known as 'snake-eyes appearance' located around the central gray matter and the ventrolateral posterior column, are associated with neuronal loss in the compressed anterior horn that played an important role in worsening weakness of the upper limbs.

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Section: Discussionmentioning

confidence: 76%

Postmortem study of the spinal cord showing snake-eyes appearance due to damage by ossification of the posterior longitudinal ligament and kyphotic deformity

et al. 2005

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“…Using a series of arguments, different groups have expressed their uncertainty as to whether ischemia is a crucial physiological event in CSM. Specifically, a number of clinical and experimental protocols demonstrate that patients or laboratory animals with moderate CSM have no [21] or only mild signs of ischemia [22,23] while pathologic evidence of ischemia is found only when severe canal stenosis is coexisting [24,25]. Moreover, some experimental studies found only minor changes in blood flow during compression and decompression [26].…”

Section: Ischemiamentioning

confidence: 99%

Pathobiology of cervical spondylotic myelopathy

2014

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In this narrative review, we aim to outline what is currently known about the pathophysiology of cervical spondylotic myelopathy (CSM), the most common cause of spinal cord dysfunction. In particular, we note the unique factors that distinguish it from acute spinal cord injury. Despite its common occurrence, the reasons why some patients develop severe symptomatology while others have few or no symptoms despite radiographic evidence confirming similar degrees of compression is poorly understood. Neither is there a clear understanding of why certain patients have a stable clinical myelopathy and others present with only mild myelopathy. Moreover, the precise molecular mechanisms which contribute to the pathogenesis of the disease are incompletely understood. The current treatment method is decompression of the spinal cord but a lack of clinically relevant models of CSM have hindered the understanding of the full pathophysiology which would aid the development of new therapeutic avenues of investigation. Further elucidation of the role of ischemia, currently a source of debate, as well as the complex cascade of biomolecular events as a result of the unique pathophysiology in this disease will pave the way for further neuroprotective strategies to be developed to attenuate the physiological consequences of surgical decompression and augment its benefits.

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“…With respect to blood flow, Ono et al reported ischemic changes in the white matter and gray matter at the stenosis level. 30 In addition, the effect of the speed of compression of components and the impact of aging were not considered. 31 Discontinuity was set in the middle of OPLL.…”

Section: Discussionmentioning

confidence: 99%

Cervical ossification of the posterior longitudinal ligament: factors affecting the effect of posterior decompression

Nishida

Kanchiku

Kato

et al. 2016

The Journal of Spinal Cord Medicine

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Objective: Decompression procedures for cervical myelopathy of ossification of the posterior longitudinal ligament (OPLL) are anterior decompression with fusion, laminoplasty, and posterior decompression with fusion. Preoperative and postoperative stress analyses were performed for compression from hill-shaped cervical OPLL using 3-dimensional finite element method (FEM) spinal cord models. Methods: Three FEM models of vertebral arch, OPLL, and spinal cord were used to develop preoperative compression models of the spinal cord to which 10%, 20%, and 30% compression was applied; a posterior compression with fusion model of the posteriorly shifted vertebral arch; an advanced kyphosis model following posterior decompression with the spinal cord stretched in the kyphotic direction; and a combined model of advanced kyphosis following posterior decompression and intervertebral mobility. The combined model had discontinuity in the middle of OPLL, assuming the presence of residual intervertebral mobility at the level of maximum cord compression, and the spinal cord was mobile according to flexion of vertebral bodies by 5°, 10°, and 15°. Results: In the preoperative compression model, intraspinal stress increased as compression increased. In the posterior decompression with fusion model, intraspinal stress decreased, but partially persisted under 30% compression. In the advanced kyphosis model, intraspinal stress increased again. As anterior compression was higher, the stress increased more. In the advanced kyphosis + intervertebral mobility model, intraspinal stress increased more than in the only advanced kyphosis model following decompression. Intraspinal stress increased more as intervertebral mobility increased. Conclusion: In high residual compression or instability after posterior decompression, anterior decompression with fusion or posterior decompression with instrumented fusion should be considered.

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Cervical Myelopathy Secondary to Multiple Spondylotic Protrusions

Cited by 135 publications

References 0 publications

Postmortem study of the spinal cord showing snake-eyes appearance due to damage by ossification of the posterior longitudinal ligament and kyphotic deformity

Postmortem study of the spinal cord showing snake-eyes appearance due to damage by ossification of the posterior longitudinal ligament and kyphotic deformity

Pathobiology of cervical spondylotic myelopathy

Cervical ossification of the posterior longitudinal ligament: factors affecting the effect of posterior decompression

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