European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Review Case Reports
Cervical hyperostosis: a rare cause of dysphagia. Case description and bibliographical survey.
Dysphagia can be caused by disorders of the cervical spine. Very seldomly, prominent osteophytes of the ventral spine are responsible. ⋯ Up to now there have been many different opinions about the etiology of this disease. In this special case, a diffuse idiopathic skeletal hyperostosis, also known as Forestier's disease or diffuse idiopathic skeletal hyperostosis, seems to be the most likely cause.
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The potential for clinical instability following thoracolumbar fractures has evoked a progressive increase in interest in the surgical treatment of unstable thoracolumbar fractures. From September 1988 to October 1991, 44 thoracolumbar burst fractures were treated surgically by the AO Spinal Internal Fixator at the Orthopaedics and Traumatology Clinics of Ankara Social Security Hospital. Mean follow-up period was 28.8 (range 12-48) months. ⋯ Also, postoperatively 15.9% of improvement was obtained in the mean kyphosis angle. The mean compression angle, which was 19.5 degrees preoperatively, was corrected by 12.3 degrees and came to an average of 7.1 degrees postoperatively. In light of these data, it is suggested that the AO Spinal Internal Fixator effectively restores three-dimensional alignment of the spine and provides a rigid fixation.
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An anatomical study of the cervical spinal cord and root to investigate the mechanism of paralysis of the arm after posterior decompression was performed using 14 cadavers of Japanese adults. It revealed that in the intervertebral foramen, extradural portions of the anterior and posterior roots of the cervical spinal cord lay separately in caudal-rostral relation, and the anterior root passed through the narrowest portion of the foramen isolatedly, i.e. the superior notch of the superior articular process. After laminectomy, a posteromedial shift of the dura-root junction occurred in combination with the posterior enlargement of the dual tube, and it showed two effects on the roots, one a relaxing effect on rootlets and the other, a traction effect on the extradural portion of a root. ⋯ With anchoring of the anterior root inside the foramen, a traction injury of the anterior root develops. The predominance of paralysis at the middle cervical level could be explained by the higher degree of anterior protrusion of the superior articular process and the more frequent degenerative changes here than at other levels. These factors might inhibit the gliding abilities of the roots inside the foramina, with the formation of perineural fibrosis, predisposing the roots to damage by the traction force.
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Surgical treatment of unstable traumatic injuries of the cervical spine can be carried out by a posterior or anterior approach, with different advantages and disadvantages. Twenty patients were treated with anterior decompression, interbody fusion with autogenous iliac bone graft, and osteosynthesis with a Louis anterior plate. The screws were inserted in the vertebral body without reaching the posterior vertebral wall. ⋯ Anterior plate instrumentation has proved itself mechanically adequate, even if it is less stable than posterior constructs. The advantages of anterior surgery compared to those of posterior surgery are such that several specific risks are acceptable. Posterior surgery is nevertheless indicated if the lesion cannot be reduced preoperatively under closed conditions.
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Summary. The results of 23 patients with symptomatic spondylolysis or mild isthmic spondylolisthesis treated by Scott's direct repair of the defect (secclusion) were analyzed with particular reference to spinal mobility and the condition of the intervertebral discs, and compared with the outcome of 25 patients treated by posterolateral segmental fusion without instrumentation. The two groups were comparable as to age at operation (17.4 +/- 5.7 vs. 15.6 +/- 2.6 years), follow-up time (54 +/- 8 vs. 54 +/- 25 months), gender, and preoperative subjective symptoms. ⋯ At this point of follow-up it is impossible to say which of the two procedures should be preferred for operative treatment of this condition in young patients. Direct repair does not protect the disc of the lytic/olisthetic segment from further degeneration. Pathologic disc changes in MRI should be interpreted with caution because their clinical relevance is still unclear.