Spine
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This article has had as its purpose the delineation of the complexity of the production of pain on an organic basis as opposed to any psychological amplification. The issues addressed apply directly to the problem of spinal pain. Classical nociception arising in the structures of the spine thus would include the application of mechanical and chemical stimuli to muscles, ligaments, apophyseal joint capsules, bone, and other structures with adequate innervation, particularly the anterior dura and its extensions. ⋯ Further, the fact that the nervous system changes its activities in response to chronic pain, particularly that arising from damaged neural elements, is of paramount importance in understanding how chronic pain syndromes differ so greatly from simple nociceptive events. Insidious deafferentation ongoing in spinal nerve roots subject to chronic compression and fibrosis offers a fertile field for research into the origin of permanent pain in patients in whom application of accepted therapies does not result in relief. All of this material must be considered by the clinician who is challenged with analyzing spinal pain problems in patients.
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Case Reports
Preoperative and postoperative magnetic resonance image evaluations of the spinal cord in cervical myelopathy.
To evaluate the morphologic changes of the spinal cord in patients with cervical myelopathy due to cervical spondylosis and ossification of the posterior longitudinal ligament, the authors measured the thickness and signal intensity of the cervical cord with magnetic resonance imaging in healthy adults and patients with cervical myelopathy, and compared these findings. In patients with cervical myelopathy, the preoperative and postoperative magnetic resonance imaging findings were compared with the severity of myelopathy and postoperative results. In healthy adults, the anteroposterior diameter of the cervical cord was 7.8 mm at the C3 level and decreased at lower levels. ⋯ In the group with ossification of the posterior longitudinal ligament, surgical results were good when the postoperative anteroposterior diameter was increased, whereas in the cervical spondylotic myelopathy group there was no relationship between the two parameters. In the patients with myelopathy, a high intensity area was observed in about 40% of all patients before operation and about 30% after operation. However, the presence or absence of a high intensity area did not correlate with the severity of myelopathy or with surgical results in the group with ossification of the posterior longitudinal ligament and the cervical spondylotic myelopathy groups.