Foramen Magnum and High Cervical Cord Compression

Taylor, Amanda R.; Byrnes, D. P.

doi:10.1093/brain/97.1.473

Cited by 106 publications

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“…Transynaptic degeneration of motor neurons secondary to injury of descending tracts with a loss of input upon these neurons was felt to be an important pathophysiologic mechanism. Stein 25 and Taylor 26 have shown motor neuron loss in one patient with chronic high cervical spinal cord compression resulting in hand dysfunction. Using strict morphological criteria, a detailed analysis of motor neurons in traumatic spinal cord injury by Kaelan et al 27 demonstrated the opposite result.…”

Section: Discussionmentioning

confidence: 99%

A histopathological analysis of the human cervical spinal cord in patients with acute traumatic central cord syndrome

2000

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Study design: We have applied conventional histochemical and morphometric techniques to study the changes within the human spinal`hand' motor neuron pool after spinal cord injury in patients who presented with acute traumatic central cord syndrome (ATCCS). Objective: To determine whether a reduction of large alpha motor neurons at the C7, C8 and T1 spinal cord levels underlies the mechanism which causes hand dysfunction seen in patients with (ATCCS). Background: The etiology of upper extremity weakness in ATCCS is debated and injury and/ or degeneration of motor neurons within the central gray matter of the cervical enlargement has been advanced as one potential etiology of hand weakness. Methods: The spinal cords of ®ve individuals with documented clinical evidence of ATCCS and three age-matched controls were obtained. The ATCCS spinal cords were divided into acute/sub-acute (two cases) and chronic (three cases) groups depending on the time to death after their injury; the chronic group was further subdivided according to the epicenter of injury. We counted the motor neurons using light microscopy in 10 randomly selected axial sections at the C7, C8 and T1 spinal cord levels for each group. We also analyzed the lateral and ventral corticospinal tracts (CST) in all groups for evidence of Wallerian degeneration and compared them to controls. Results: A primary injury to the lateral CST was present in each case of ATCCS with evidence of Wallerian degeneration distal to the epicenter of injury. There was minimal Wallerian degeneration within the ventral corticospinal tracts. In the chronic low cervical injury group, there was a decrease in motor neurons supplying hand musculature relative to the other injury groups where the motor neurons sampled at the time of death were not reduced in number when compared to the control group. Conclusions: We hypothesize that hand dysfunction in ATCCS can be observed after spinal cord injury without any apparent loss in the number of motor neurons supplying the hand musculature as seen in our acute/sub-acute (n=2) and our chronic high injury (n=1) groups. The motor neuron loss seen in the chronic low level injury was felt to be secondary to the loss of C7, C8, and T1 neurons adjacent to the injury epicenter. Spinal Cord (2000) 38, 532 ± 537

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Section: Discussionmentioning

confidence: 99%

A histopathological analysis of the human cervical spinal cord in patients with acute traumatic central cord syndrome

2000

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“…3,5,43 The pathophysiology of spinal cord injury in the setting of infection is an area of active research; however, a monkey model elucidated that high cervical cord compression from tumors leads to venous stasis and hypoxic changes in the spinal cord. 52 These data prove that arterial and venous compromise from both compression and direct thrombophlebitis contribute to spinal cord injury in the setting of epidural abscesses. Even in neurologically intact patients with abscess above the conus, serious acute to subacute complications can occur from direct compression or these vascular changes.…”

Section: Discussionmentioning

confidence: 64%

Holospinal epidural abscess of the spinal axis: two illustrative cases with review of treatment strategies and surgical techniques

Smith

Kochar

Manjila

et al. 2014

FOC

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Despite the increasing prevalence of spinal infections, the subcategory of holospinal epidural abscesses (HEAs) is extremely infrequent and requires unique management. Panspinal imaging (preferably MRI), modern aggressive antibiotic therapy, and prompt surgical intervention remain the standard of care for all spinal axis infections including HEAs; however, the surgical decision making on timing and extent of the procedure still remain ill defined for HEAs. Decompression including skip laminectomies or laminoplasties is described, with varied clinical outcomes. In this review the authors present the illustrative cases of 2 patients with HEAs who were treated using skip laminectomies and epidural catheter irrigation techniques. The discussion highlights different management strategies including the role of conservative (nonsurgical) management in these lesions, especially with an already identified pathogen and the absence of mass effect on MRI or significant neurological defects. Among fewer than 25 case reports of HEA published in the past 25 years, the most important aspect in deciding a role for surgery is the neurological examination. Nearly 20% were treated successfully with medical therapy alone if neurologically intact. None of the reported cases had an associated cranial infection with HEA, because the dural adhesion around the foramen magnum prevented rostral spread of infection. Traditionally a posterior approach to the epidural space with irrigation is performed, unless an extensive focal ventral collection is causing cord compression. Surgical intervention for HEA should be an adjuvant treatment strategy for all acutely deteriorating patients, whereas aspiration of other infected sites like a psoas abscess can determine an infective pathogen, and appropriate antibiotic treatment may avoid surgical intervention in the neurologically intact patient.

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“…Furthermore, the clinical deficits are frequently unilateral despite the bilateral supply of the anterior spinal artery. Taylor,8 in an excellent literature review and pathological study provided good evidence that the venous drainage of cervical cord grey matter is upward from T1 to C2, that the grey matter system is separate from the white matter system and that the two sides are to some extent separate from each other. The hygroscopic "tumours" he inserted in the high cervical region in Rhesus monkeys caused obstruction of the paracentral veins below this level with hypoxic changes and pericapillary haemorrhages in the anterior and posterior horns.…”

Section: Discussionmentioning

confidence: 99%

“…Wasting in the C6, C7, C8 and Tl distribution with upper cervical cord compression was first described by Oppenheim 7 in 1913. Taylor 8 reviewed twelve of his own cases and forty-one in the literature of patients with compressive lesions at the foramen magnum or high in the cervical cord. Fifty percent of these patients had atrophy of the hand and forearm muscles.…”

Section: Discussionmentioning

confidence: 99%

Hand Wasting Due to Mid-Cervical Spinal Cord Compression

Goodridge¹,

Feasby²,

Ebers³

et al. 1987

Can. j. neurol. sci.

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Three patients presented with hand wasting and weakness secondary to mid-cervical spinal cord compression. This was due to cervical spondylosis in two patients and a meningioma in one case. This phenomenon is probably similar to that seen with foramen magnum lesions and may be due to spinal cord ischemia distal to the compression, secondary to venous stasis. RESUME: Atrophie de la main due a une compression medullaire localisee a la region cervicale moyenne. Trois patients ont consulte pour de l'atrophie et de la faiblesse a la main secondaires a une compression medullaire a la region cervicale moyenne. Cette symptomatologie etait due a une spondylose cervicale chez deux patients et a un meningiome dans l'autre cas. Ce phenomene est probablement semblable a celui que Ton rencontre dans les lesions du trou occipital et peut etre cause par I'ischemie de la moelle epiniere, secondaire a la stase veineuse, en aval de la compression.Can. J. Neurol. Sci. 1987; 14:309-311 Hand wasting has not been commonly reported with lesions of the middle cervical spinal cord 1 although it is a well known feature of compressive lesions at the foramen magnum.2 " 4 We describe three patients with hand wasting due to mid-cervical cord lesions and discuss the significance of this clinical finding.CASE HISTORIES Patient 1: This 41-year-old woman presented with a sixteen month history of wasting and weakness of her left hand which she first noted after a minor hand injury. She had minimal pain of the left side of her neck and left upper arm. This was not characteristic of radicular pain. On physical examination, movement of the neck was normal. There was marked wasting and weakness of all the intrinsic muscles in the left hand. There was slight wasting and weakness of the left forearm flexors and extensors. The sensory exam and remainder of the neurological examination was normal. The electrophysiological studies on the left revealed a slight reduction of the fifth digit sensory nerve action potential and active denervation in both the abductor pollicus brevis and the first dorsal interosseus. The motor conduction studies were normal in the median and ulnar nerves. X-Rays of the cervical intervertebral foramina were normal. The transverse processes of C7 were prominent bilaterally. A cervical myelogram revealed a large anterior extradural defect at C5-6 (Figure 1). She had an anterior cervical discectomy and fusion at C5-6. Post-operatively she had complete resolution of her preoperative pain and subjectively found that the function of the left hand had improved although no change in strength was noted. Repeat EMG seven months later showed improvement with less denervation in the thenar muscles. At follow-up four years later there was no evidence of any improvement in strength. Patient 2:This 44-year-old woman had an eight year history of pain extending from the right elbow to the wrist. For six years she had mild progressive weakness of the right hand and forearm muscles. There was no neck pain. Examination showed slight was...

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Foramen Magnum and High Cervical Cord Compression

Cited by 106 publications

References 0 publications

A histopathological analysis of the human cervical spinal cord in patients with acute traumatic central cord syndrome

A histopathological analysis of the human cervical spinal cord in patients with acute traumatic central cord syndrome

Holospinal epidural abscess of the spinal axis: two illustrative cases with review of treatment strategies and surgical techniques

Hand Wasting Due to Mid-Cervical Spinal Cord Compression

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