Search

Introduction The specific morphology and differences between patients with cervical spondylotic myelopathy (CSM) and those with normal spines remain unclear. This study aimed to evaluate and determine the features of cervical spine morphology on reconstructive CT. Methods We investigated that axial reconstructive CT scans of the cervical spine at C3 to C7 were obtained from 309 individuals (97 CSM patients and 212 controls). Those of the optimal pedicle diameter were selected, and the following parameters were measured: (a) sagittal diameter of the spinal canal (b) transverse diameter of the spinal canal, (c) pedicle width, (d) lateral mass thickness, (e) transverse diameter of the foramen, (f) sagittal diameter of the vertebral body, and (g) transverse diameter of the vertebral body. The following ratios were calculated using these values: the sagittal-transverse ratio and the canal-body ratio. Results Most parameters differed significantly between the sexes in both groups. The parameters without the mean sagittal diameter of the spinal canal were significantly larger in men than in women. However, the mean sagittal diameter of the spinal canal did not differ significantly between the sexes in CSM patients. The sagittal-transverse ratio and canal-body ratio were significantly smaller in the CSM patients at all levels. According to relative operating characteristic curves of the sagittal diameter of the spinal canal, sagittal-transverse ratio, and canal-body ratio, the sensitivity from C3 to C7 in both sexes was > 60% at the threshold. In men, the specificity from C3 to C7 was also >60% at the threshold. Conclusions The morphometry of the sagittal diameter of the spinal canal, sagittal-transverse ratio, and canal-body ratio on axial reconstructive CT images appears useful for distinguishing cervical spinal canal stenosis involving myelopathy.

Cervical spine spondylosis is so prevalent in almost all because it is a degenerative disease. Cervical spine spondylosis is a condition caused by the narrowing of the space required for the spinal cord and the nerve roots that pass through the spine to the rest of the body. Suspected cases or warranted cases are advised to avoid trauma or stress to prevent a dreadful complication that is myelopathy. This research is to study and assess the Cervical Spine Canal Body Ratio in healthy individuals and also in patients with myelopathy. The cervical spinal canal and body with disc space ratio are measured using lateral view plain X-ray of the cervical spine, placed over a graph paper. This test was done both in healthy individuals from the age group of twenty-five to thirty-five of female and male. Out of these, twelve patients were with cervical myelopathy. Cervical Spinal canal stenosis may be either congenital or acquired. The content of the canal that is the Spinal cord is more likely to get compromised when the canal is shallow even a minimal trauma or degenerative arthrosis can precipitate myelopathy. In healthy individuals it is unit and when

Introduction: Cervical myelopathy a debilitating degenerative condition occurs due to cervical spinal canal stenosis, the incidence of which increases significantly with age and is more common above the age of 50 years. Imaging of the spinal canal is an indispensable procedure for evaluation of cervical myelopathy and standard lateral radiographs remain the recommended initial imaging study of choice. The present study was undertaken to measure the cervical spinal canal diameter by lateral radiographs of the cervical spine and to study the degree of cervical spinal canal stenosis in symptomatic patients and asymptomatic cases. The canal body ratio and its reliability to assess cervical spinal canal stenosis and risk of cervical myelopathy was evaluated. Materials and Methods: In this study 200 cases who presented to the radiology department for radiographs of cervical spine, were divided into symptomatic and asymptomatic cases and were grouped age wise. Measurements of the cervical vertebral body and cervical spinal canal were taken. Torg ratio was assessed. The measurements were analyzed statistically and results tabulated. Results: Cervical spinal canal diameter was lower in symptomatic cases as compared to asymptomatic cases across all age groups and the lowest value was measured at C3 level. All the symptomatic cases had Torg ratio of less than 0.82, and that of C3 was lowest. The data analysis showed the sensitivity of the Torg ratio as 100%. 40% of patients above 50 years were symptomatic and had cervical spinal canal stenosis on lateral radiographs. Conclusions: Our results suggest that plain films can estimate the cervical spinal canal midsagittal diameter and be used as a first step examination for the evaluation of cervical spinal stenosis. The importance of canal body ratio in lateral cervical radiographs for determining the stenosis of cervical spinal canal is confirmed. Keywords: Cervical spine, Canal stenosis, Radiographs.

Objective Normal cervical spine canal morphometry is critical for understanding the pathology of certain diseases and for proper preoperative planning. Computerized tomography (CT) scan can replace older conventional radiography techniques by providing more accurate morphometric measurements. This study was aimed to find out various dimensions of the cervical spinal canal of central Indian population. Materials and Methods A prospective study was conducted including 100 consecutive cervical spine CT scan of asymptomatic adult subjects. The anteroposterior sagittal canal diameter (SCD), transverse canal diameter (TCD), canal surface area (CSA), and Pavlov-Torg Ratio (PTR) from C2 to C7 were calculated. Statistical Analysis Data were entered in Microsoft Excel Sheet 2007 and statistical analysis was performed by IBM SPSS statistics 2.0 version. p-Value < 0.05 was considered as significant. Results Age ranged from 18 years to 77 years with mean age 39.5 years. There was no significant difference in all the dimensions (SCD, TCD, CSA) in male and female except at C2 level, where SCD, TCD, and CSA were significant larger in male. The mean SCD, TCD, and CSA is largest at C2 level (14.4 ± 1.63 mm, 21.57 ± 1.59 mm, and 156.20 ± 24.98 mm 2, respectively) and smallest at C4 level (12.77 ± 1.48 mm, 20.37 ± 1.72 mm, and 130.42 ± 21.20 mm 2). PTR showed very little variation. Conclusion Normal values of cervical spinal canal could serve as a future reference. CT scan provides more accurate measurement. More studies are needed as there could be variations in dimensions in different regions in India.

PURPOSE This study aimed to assess the effects of additional C2 decompression of the cervical spinal canal on the postoperative outcomes after cervical laminoplasty in patients with cervical stenosis caused by ossification of the posterior longitudinal ligament (OPLL). MATERIALS AND METHODS This retrospective cohort study included patients with cervical stenosis due to OPLL and treated between April 2014 and December 2015. The patients who underwent C2-7 (additional C2 decompression) and C3-7 posterior decompression were compared using the Japanese Orthopedic Association (JOA) scores, visual analog scale (VAS) scores, axial symptom scores, and intervals between the posterior margin of the vertebral body and the K-line. RESULTS There were 36 and 24 patients in the additional C2 decompression and control groups, respectively. The JOA scores were higher in the additional C2 decompression group than the controls at 1 and 3 years (p

Chordomas are rare, locally aggressive bone malignancies with poor prognoses. However, those with minimal or no bone involvement are more easily resectable because of their well-delineated margins and thus have better prognoses. Such extraosseous chordomas of the spine are localized both intradurally and extradurally. Only a few case reports have focused on extraosseous, extradural spinal chordomas. Radiologically, this type of chordoma has a dumbbell shape; however, dumbbell-shaped spinal tumors are traditionally thought to be neurogenic tumors (i.e., schwannomas or neurofibromas). We herein report a unique case involving a woman with a dumbbell-shaped extraosseous chordoma protruding predominantly into the retropharyngeal space. A 44-year-old woman presented for evaluation of a left submandibular mass. A T2-hyperintense, gadolinium-enhancing mass was found in her cervical spinal canal, protruding through the C2/3 neural foramen into the retropharyngeal space with minimal vertebral involvement. The initial diagnosis was a neurogenic tumor, most likely a schwannoma. After subtotal removal, the pathologic diagnosis was a chordoma. Because chordomas and schwannomas have significantly different prognoses, caution is warranted when a dumbbell-shaped tumor is identified in the spine with minimal or no vertebral deterioration on radiology. This report also provides the first thorough review of extraosseous dumbbell-shaped intraspinal–extraspinal chordomas.

This study defined different anatomic zones within the cervical spinal canal and provides detailed anatomical quantitative data for an accurate diagnosis of cervical spondylosis and a safe and effective anterior decompression surgery.A dissection-based study of 10 embalmed human cadavers. To provide an anatomic basis to examine the underlying mechanisms of cervical spondylosis. Detailed anatomical quantitative data of cervical spine is limited in current literature. Ten cervical spines from C2 to T1 were obtained. We defined three zones from midline to lateral part (zone I, II, and III) and two zones from cranial to caudal (zone P and zone IP) on the coronal plane within the cervical spinal canal. Quantitative anatomy of the zones at different cervical segments were measured including: (1) horizontal widths of zone I, II, and III; (2) length of the cervical spinal cord segment at the ventral rootlets (LV); (3) the pedicle height (PH, zone P) and the inter-pedicle height (IPH, zone IP); (4) the distance between the superior margin of pedicle and the exit of the uppermost ventral nerve rootlet (PN). The value of zone II at C4 was significantly less than that at other levels. The value of zone III increases from C4 to C8, and the values at C7 and C8 were significantly higher than those at C4, C5, and C6. PHs and IPHs were not significantly different between different levels. The values of LV at C4 and C8 were smaller than those of C5, C6, and C7. The value of PN showed an increasing trend. At C4, the uppermost ventral rootlet was at about the same height as C3 pedicle, while C8 uppermost ventral rootlet was at the same level as the inferior part of C6 pedicle. Ventral intradural intersegmental connections were found in three intersegments out of 20 intersegments. The current definition of anatomic zones may be useful for an accurate diagnosis of cervical spondylosis and a safe and effective anterior decompression surgery. Level of Evidence: N/A.

An isotropic expanded Planning Target Volume (PTV) neglects patient’s off-axis rotation. This study designs a rotational PTV that is used instead of the standard 3-mm Clinical Target Volume (CTV) expanded PTV in oropharyngeal cancers with the goal to reduce pharyngeal constrictor muscle (PCM) mean dose. 10 patients were retrospectively evaluated. For off-axis rotation, the image was rotated around the longitudinal axis (cervical spinal canal) ± 5 degrees. These new CTVs were combined to form the rotational PTV. The standard and rotational treatment plans were designed with the goal to keep the superior and middle PCM-CTV70 mean dose to less than 50 Gy. There were a 355 cGy reduction in the superior PCM mean dose (form 5332 to 4977 cGy) and a 506 cGy reduction in middle PCM mean dose (from 4185 to 3679 cGy). 60% of patients may have at least a 20% reduction in dysphagia probability based on a Normal Tissue Complication Probability (NTCP) formula. The superior and middle PCM mean dose were reduced to less than 50 Gy in 40 and 20% of cases. There was an association between superior PCM mean dose and overlap volume of PTV70 and superior PCM in both standard (r = 0.92, p = 0.001) and rotational (r = 0.84, p = 0.002) plans. This association was present for middle PCM and PTV70 (r = 0.52, p = 0.02 and r = 0.62, p = 0.006). Rotational PTV can lower the mean dose to superior and middle PCMs, ultimately leading to lower dysphagia rates.

Background: the morphological features of the cervical spinal nerves (C1-C8), their dimensions, and their anatomical relations with the vertebral artery are important for safe spinal surgery. The aim of the present study is to give detailed morphological data of the region to avoid complications. Methods: five formalin-fixed adult cadavers were studied. The cervical spinal nerves and the vertebral artery were exposed via the posterior approach, and detailed anatomy and morphometric measurements were evaluated. The following measurements were documented: angles between the spinal nerve and the spinal cord of C1 to C8, width of the C1 to C8 spinal nerves at their origin, distance of the spinal cord to the vertebral artery, number of dorsal rootlets, length of the dorsal root entry zone of C1 to C8, and distance between respective spinal nerves. Further, the average length and width of the transverse foramen were measured. Results: the average angle between the spinal cord and the spinal nerve within the vertebral canal ranged between 54 and 87 degrees and were most acute at C5 (54 degrees) compared to the rest of the cervical spinal nerves. The average width of the spinal nerves (mean 6 SD), was thickest at C5 (5.7 6 1.2 mm) and C6 (5.8 6 0.7 mm). The average largest distance between the vertebral artery and the spinal cord was at C2 (14.3 6 1.7 mm) and the smallest at C5 (7.3 6 0.9 mm) and C6 (7.3 6 2.2 mm) spinal levels. The number of dorsal rootlets was most numerous at C6 (8.25 6 0.6) and C7 (7.25 6 0.9). The dorsal root entry zone length was the largest at C5 (13.0 6 1.6 mm) and C6 (13.75 6 0.5 mm). The distance between respective spinal nerves was largest between C2 and C3 (11.8 6 2.2) and C7 and C8 (11.5 6 0.6). Conclusion: the knowledge of detailed anatomy of the cervical spine (C1-C8) and its relations with the vertebral artery will reduce the unwanted damage to the vital structures of the region., NA

Introduction Gunshot wounds (GSW) to the cervical spine remain uncommon. Surgery often does not yield significant neurological improvement and the decision to utilize surgery depends on a number of factors. We describe the case of a 28 year-old male suffering a complete spinal cord injury (SCI) secondary to a bullet lodged in the cervical spinal canal. We present the unique radiological findings and review the indications for and utility of spine surgery for cervical GSW. Case presentation The patient was a 28 year-old male involved in a motor vehicle accident immediately after sustaining a gunshot wound to the cervical spine. Neurologic exam revealed a complete SCI at the C4 level. CT scan revealed a retained bullet in the spinal canal at the C4/5 level without vascular injury or unstable vertebral fracture. He was managed nonoperatively, however, he remained ventilator dependent and ultimately expired secondary to cardiac arrest from a suspected pulmonary embolism. Discussion We present a case of complete SCI secondary to a retained bullet in the cervical spine. These cases can be managed both operatively and nonoperatively. Given the high risk of morbidity and overall poor neurological recovery after surgical intervention for SCI secondary to GSW, physicians must understand the appropriate indications for surgical intervention. These indications include, but are not limited to, progressive neurological deficit, cerebrospinal fluid leak, spinal instability, and acute lead toxicity.

Background Planning target volume (PTV) has been used to account for variations in tissue, patient and beam position. In oropharyngeal cancers, an isotropic expanded PTV has been used. Aim The aim of this study was to design a new margin formula that would cover the space occupied by an oropharyngeal clinical target volume (CTV) with ±5-degree rotation around the spine in order to reduce the pharyngeal constrictors overlap with PTV compared to an isotropic expanded PTV. Methods We retrospectively evaluated 20 volumetric-modulated arc therapy (VMAT) plans. In order to perform an off-axis rotation, a hypothetical point was placed through the center of the cervical spinal canal and the image was then rotated around the longitudinal axis ±5 degrees. This created a new set of CTVs that were combined to form the new rotational PTV. The overlap between the pharyngeal constrictor muscles (PCMs) and both PTVs was then evaluated. Results The new rotational PTV causes reduction in the superior PCM overlap in the base of tongue (BOT) lesions compared to tonsillar lesion, 57.8% vs 25.8%, P = 0.01, as well as middle PCM overlap, 73% vs 49%, P = 0.04. Average percent change for PTV volume and overlap with the superior, middle, and inferior PCMs are as followed: -19%, -37%, -59.4%, and -45.2. The smallest isotropic expansion that covers the new rotational PTV was between 3 and 5mm with the average tumor center shift of 0.49 cm. Conclusion This new rotational PTV causes significant reduction of the overlap volume between PCMs and PTVs in order to spare the PCMs compared to isotropic expanded PTV.

Background: Detailed anatomical information is important for identifying the origin and anatomic basis of symptoms in cervical spondylosis patients, but very little quantitative data have been reported. This study characterized the morphologic features of cervical spinal nerve rootlets and defined different zones at cervical spinal canal to provide an anatomic basis for studying cervical spondylosis. Methods: Ten cervical spines from C2 to T1 were obtained for the present study. We defined three zones from midline to lateral part (zone I, II and III) and two zones from cranial to caudal (zone P and zone IP) on the coronal plane within the cervical spinal canal. Quantitative anatomy of the zones at different cervical segments were measured including: 1) horizontal widths of zone I, II and III; 2) Length of the cervical spinal cord segment at the ventral rootlets (LV); 3) The pedicle height (PH, zone P) and the inter-pedicle height (IPH, zone IP); 4) The distance between the superior margin of pedicle and the exit of the uppermost ventral nerve rootlet (PN). Results: There was a trend that the horizontal widths of zone I gradually decrease from C4 to C8 but without significant differences (P=0.98). The value of zone II at C4 was significantly less than that at other levels (P=0.008). The value of zone III increases from C4 to C8, and the values at C7 and C8 were significantly higher than those at C4, C5 and C6 (P=0.032). PHs and IPHs were not significantly different between different levels (P1=0.365; P2=0.240). The values of LV at C4 and C8 were smaller than those of C5, C6 and C7 (P=0.001). The value of PN showed an increasing trend. At C4, the uppermost ventral rootlet was at about the same height as C3 pedicle, while C8 uppermost ventral rootlet was at the same level as the inferior part of C6 pedicle. Ventral intradural intersegmental connections were found in three intersegments (two specimens) out of 20 intersegments (15%). Conclusions: The current definition of anatomic zones may be useful for an accurate diagnosis of cervical spondylosis and a safe and effective anterior decompression surgery.

Introduction: Decline in the size of Spinal canal would increase chance of compression of important structures and might lead to many symptoms including neck pain, and radiculopathy. Diagnosis of Spinal stenosis based on clinical findings along with the radiological assessing of the canal size measuring antero-posterior diameter and cross-sectional area which are different for each population. Many factors suggested affecting the spinal canal diameters such as race, sex, height and age which is still a controversial factor. Aim of the work: The present study carried out to provide normal values of the cervical spinal canal dimensions in male Egyptian population and to evaluate the effect of aging. Subjects and methods: MRI of 24 and CT of 32 male Egyptian subjects in different ages from 20 to 70 years. The population divided into three age groups (20-39 years, 40-59 years and 60 years and older). For each age group; Mid-sagittal antro-posterior diameter and Cross sectional area was measured from C2-C7. Results:Mean values of the cervical canal diameters found to be widely variable fromC2 to C7, and normal diameters defined as antero-posterior (APD) ranged (from 9.60to20mm), and (from 11.2to19.5mm) in CT and MRI respectively. Mid-sagittal antero-posterior canal diameter and Cross sectional area, decreased steadily with age at all levels. Conclusion: Mean values for the cervical canal diameters decreased steadily at all levels with increase in age.

Narrowness of the spinal canal is associated with the development of cervical myelopathy. While studies have addressed the sagittal diameter of the cervical spinal canal, few evaluated the correlation between the size of the spinal canal and the vertebral level. We addressed this issue.Our retrospective study included 102 patients with cranial or spinal disorders. We examined the correlation between the cervical spinal canal diameter (SCD) at C1 to C7 and the inner anteroposterior diameter (IAPD) of the atlas on CT images.At C1, the SCD was largest, at C4 it was smallest. While there was a strong correlation between the IAPD and the SCD at C1 (r = 0.8), the correlation between the size of the atlas and the SCD at C4 to C7 was weak (r = 0.2-0.3). We divided our patients into a normal group (n = 34, SCD ≥ 12 mm at any levels) and a stenosis group (n = 68, SCD 12 mm at all levels). The mean SCD at C2 to C7 was significantly larger in the normal group. There was no significant difference between the two groups with respect to the IAPD and the SCD at C1.The size of the subaxial spine does not necessarily affect the size of the atlas. The pathophysiology of spinal canal stenosis should be considered separately at the C1- and the subaxial level.

Intradural arachnoid cysts involving the spine are uncommon and especially rare in an anterior cervical location. In the literature, among 15 patients, 8 were in the paediatric age group and in 3 patients the cyst was localized to the full length of the cervical spinal canal. Although they occur secondary to trauma, haemorrhage, surgery or inflammation, most of them are known to be idiopathic or congenital. Although the disease shows a dramatic neurological course, early diagnosis and treatment could provide good results. In the paediatric age group, cervical anterior intradural arachnoid cyst is an unusual cause of quadriparesis. The rarity of this condition and the relevance of MRI in the accurate and early diagnosis is discussed here. A 4 year-old girl with a intradural arachnoid cyst extending from C4 to C7 situated anteriorly is reported here; diagnosis and treatment modalities are discussed.Journal of National Institute of Neurosciences Bangladesh, 2017;3(1): 52-56

Studies on the canal dimensions of the cervical spinal are rare in Africa. The aim of this study is to provide normal values of the cervical spinal canal and spinal cord dimensions of adult people in Togo. It was about a twelve-year prospective study conducted in the main Hospitals of Campus Teaching Hospital. This study involved people of more than 18 years who neither presented any clinical sign nor rachis defect. The distances measured were antero-posterior 1 (APD1) and inter-pedicular (IPD) of the cervical spinal canal, the antero-posterior 2 (APD2) and the transverse (TD) diameters of the cervical spinal cord, followed with APD2/APD1 (R1) and TD/IPD (R2) research reports. The mean age was 38 +/- 9.34 years old. The average of APD1 of the cervical spinal canal stood at 15.41 ± 0.55 mm, with a minimum of 10.48 ± 0.57 mm and a maximum of 25.00 ± 2.60 mm. The IPD average stood at 23.27 ± 1.67 mm with a minimal average of 13.68 ± 1.46 mm and a maximal average of 33.68 ± 1.46 mm. The average of DAP2 was 11.66 ± 0.66 mm, with a minimum of 10.7 ± 0.66 mm and a maximum of 12.77 ± 0.66 mm. The DT average stood at 15.55 ± 1.54 mm, with a minimal average of 14.03 ± 2.43 mm and a maximal average of 17.63 ± 1.82 mm. The ratio R1 (APD2/APD1) average was 0.80 ± 0.04, with a minimum of 0.76 ± 0.06 and a maximum of 0.85 ± 0.07. The ratio R2 (TD/IPD) average stood at 0.69 ± 0.14, with a minimum of 0.5 ± 0.12 and a maximum of 0.84 ± 0.08. The cervical spinal canal and the cervical spinal cord diameters in Togo are not significantly different from those described above.

Objective: To evaluate and compare the cervical spinal canal (CSC) morphology among healthy people, cervical spondylosis myelopathy (CSM), and latent cervical spondylosis (LCS, people with cervical spine degeneration on medical imaging but without clinic symptoms). Patients and Methods: We reviewed MRI data describing cervical spinal morphology in healthy persons, LSC patients and CSM patients. All cases underwent cervical MRI. In transverse image, anteroposterior diameter (A–P diameter), area of cervical spinal canal (CSC) and area of cervical spinal cord were measured. In sagittal image, A–P diameter was measured. Dural sac area = the area of CSC in the transverse position – the area of cervical spinal cord in transverse position. Results: There’re 8 cases in the healthy group, 18 cases in the group of LCS, and 13 cases in CSM group. Generally, the measured indicators at two ends of CSC (C2/3 and C7) are larger than those at C3–C6. A–P diameters on axial and sagittal position show a decrease trend from healthy group to LCS group and to CSM group. CSC area and dural sac area on axial position of CSM group are significantly lower than those in healthy group and LCS group. Almost all measured indicators of CSM group are significantly lower than healthy group and LCS group. Every two measured indicators in each group are significantly corelated. Conclusions: The results suggested that CSC size of CSM was smaller than that of LCS, and A–P diameter

To investigate the recovery of neurological function of limbs and anal sphincter after surgical decompression for cervical spondylotic myelopathy (CSM). A retrospective study of CSM patients who had spinal canal decompression surgery to evaluate the neurological functional recovery of the upper and lower limbs and anal sphincter before and after the surgery. After the surgery, the overall neurological function of patients was improved and the average recovery rate was high. The neurological improvement was statistically significant at three months postoperatively, and reached the plateau at six months postoperatively. Most of the patients with CSM undergoing surgical decompression have improved neurological functions.

Rationale: Retention of foreign objects in spinal canal usually results from penetrating spinal trauma or failed internal instruments. However, entrapment of a foreign body in cervical spinal canal during surgery is rare, and whether such an object may cause neurological complications remains unknown in literature. Patient concerns: A 50-year-old man underwent C5 corpectomy and instrumentation surgery due to cervical myelopathy. During the surgery, the cutting edge of a Kerrison rongeur was broken and the metal tip was retained behind C4 vertebra. Diagnosis: Retention of foreign body in the cervical spinal canal. Interventions: To remove the metal object, multiple strategies were tried but all failed. As such a metal object was thought to be dangerous to the spinal cord, a remedy C4 corpectomy was performed to remove it. Accidentally, however, the metal fragment further migrated to C2/3 canal. At last, the metal fragment had to be retained in the cervical spinal canal. Outcomes: At 2-year follow-up, the metal fragment remained in situ and no delayed complications occurred. Lessons: We reported a rare case of metal object retention in cervical spinal canal due to rongeur fatigue fractures. Under certain circumstances, retention of a small foreign object in spinal canal may not lead to neurological complications. If failed to remove an entrapped foreign body, it may be safe to leave it in the spinal canal for further observation.

Background and aims: The cervical region is the most mobile portion of the spinal column and it is here that the earliest disc degenerations are encountered. Hence it is of great interest to neurologists and neurosurgeons. Degenerative arthritic changes in the cervical spine secondary to ageing may result in bony and soft tissue overgrowth causing encroachment on the cervical spinal canal resulting in cervical canal stenosis. This may predispose to compressive myelopathy. The study aims to determine the predictability of myelopathy based on the dimensions of spinal canal at the cervical region. Materials and methods: The study included 600 patients who underwent MRI scan of cervical spine in the Department of Imaging Sciences and Interventional Radiology, Sree Chithra Thirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, Kerala. It included patients of different age groups of both sexes who were classified into six groups. T1 weighted axial images were obtained using spin echo sequence. The axial slices were made at the mid vertebral levels from C2-C7 vertebrae. The anteroposterior diameters of spinal canal in axial images at mid cervical vertebral levels from C2-C7 were measured. Analysis of data was done by mean, standard deviation, independent sample t test, ANOVA and Chi­ square test. Results: The mean anteroposterior diameter of the canal at different cervical vertebral levels decreases as age advances. Tbe premyelopathic changes were more in males which may be attributed to change in canal shape. Conclusion: Cervical spinal canal dimensions are useful to predict premyelopathic changes of cervical spinal cord.

espanolLos especialistas en dolor cronico nos enfrentamos habitualmente a situaciones en las que los pacientes que van a ser sometidos a procedimientos intervencionistas estan bajo tratamiento antiagregante o anticoagulante. Las complicaciones hemorragicas pueden ser catastroficas cuando se trata de bloqueos profundos y tecnicas dentro del canal espinal. Sin embargo, el riesgo de eventos tromboembolicos aumenta con la suspension inadecuada de los farmacos antiagregantes y anticoagulantes en estos pacientes. A dia de hoy no existen unos algoritmos o recomendaciones actualizadas para el manejo de estos pacientes en el area de dolor cronico. El objetivo de este documento es ofrecer unas recomendaciones de seguridad sobre el manejo de estos farmacos segun el tipo de intervencion y el tipo de paciente, con el objetivo de minimizar el riesgo de complicaciones hemorragicas sin aumentar el riesgo de eventos tromboembolicos. Para ello, se han revisado las ultimas publicaciones sobre el manejo farmacos que alteran la hemostasia en anestesia regional y otras tecnicas de dolor cronico, incluyendo diferentes guias de manejo perioperatorio (ASRA, ESA, SEDAR...). Existe buena evidencia en el incremento del riesgo de eventos tromboembolicos en pacientes que suspenden la terapia antiagregante, y que este riesgo es mayor que el de la incidencia de hematomas epidurales en pacientes que continuan con el tratamiento, si bien ambos riesgos son significativos. Asi mismo, existe buena evidencia de la incidencia de hematomas epidurales espontaneos asociados o no a puncion traumatica, en pacientes con o sin terapia antitrombotica. Estos hematomas epidurales espontaneos estan asociados a factores favorecedores como la manipulacion excesiva, el uso de agujas de mayor calibre, el uso de cateteres, los procedimientos sobre el canal cervical, la edad avanzada, y las anormalidades vasculares y anatomicas del paciente. Hay una tendencia menos conservadora hacia los intervalos de interrupcion de los farmacos antiagregantes en pacientes de alto riesgo (Aspirina® 3 dias, clopidogrel 5 dias), si bien el manejo de heparinas y anticoagulantes orales clasicos practicamente no ha cambiado. Recientemente han surgido nuevos anticoagulantes orales no contemplados en muchas de estas guias (dabigatran, rivaroxaban, apixaban) con mayor perfil de seguridad que el Sintrom®, habitualmente sin necesidad de terapia puente con heparinas tras la suspension del farmaco. El inconveniente es que existe escasa documentacion en la literatura sobre su manejo perioperatorio, por lo que su suspension se basa actualmente en sus caracteristicas farmacocineticas y farmacodinamicas estrictas (2 dias, siendo mayor si existe insuficiencia renal). EnglishInterventional pain physicians usually face situations were, the patients that are going to be under an interventional procedure, are undergoing an antiplatelet or anticoagulant therapy. Bleeding complications can be catastrophic when we talk about deep blocks and interventions into the spinal canal. However, the risk of thromboembolic events increases with the improper discontinuation of antiplatelet and anticoagulant drugs in those patients. Nowadays, there are no algorithms or updated recommendations on the handling of those patients in the chronic pain area. The goal of this article is to offer some recommendations on how to use, in a safety way, those drugs depending on the type of intervention and patient, with the objective of minimizing the risk of bleeding complications without increasing the risk of thromboembolic events. To do this, the latest news on the use of drugs which alters the hemostasis in regional anesthesia and other chronic pain technics had been reviewed, including different guides on the perioperative management (ASRA, ESA, SEDAR, etc.). There is fair evidence that the risk of thromboembolic phenomenon increases on those patients whom discontinues their antiplatelet therapy, and that this risk is even higher than the risk of epidural hematomas on those patients whom continues with their treatment, even though both risks are significant. There is also good evidence of the incidence of spontaneous epidural hematomas, associated or not to a traumatic puncture, in patients with or without an antithrombotic therapy. Those spontaneous epidural hematomas are more likely associated to favorable factors such as: Excessive manipulation, the use of larger gauge needles, the use of catheters, procedures into the cervical spinal canal, elderly patients, and vascular and anatomical abnormalities of the patient. There is a less conservative tendency about intervals of discontinuation of antiplatelet drugs in high risk patients (3 days for Aspirin®, 5 days for clopidogrel), while the use of heparin and classic oral anticoagulants practically has not changed. Recently, new oral anticoagulants, not included in most of these guides, have appeared (dabigatran, rivaroxaban and apixaban) with a higher security profile than Sintrom®, usually without the need of heparin bridging therapy after discontinuation of the drug. The inconvenience is that there is limited evidence about its perioperative use. That is why it's suspension is actually based on its strict pharmacokinetic and pharmacodynamics characteristics (2 days, being higher if there exists a decline in renal function).

Foreign bodies inside the cervical spinal canal causing injury to spinal cord are seen very rarely. Very few cases of glass fragments in the cervical spinal canal were reported till date. In this report, a 17-year-old boy, who was accidentally injured by a glass piece, which penetrated into the cervical spinal cord, was operated upon and, he recovered dramatically. This case report is to emphasize the morbidity caused by small foreign bodies accidentally introduced by trivial injuries.

Symptoms of cervical myelopathy are caused by the compression of the cervical spinal cord in the narrowed spinal canal. Several techniques including less invasive and minimally invasive methods have been developed with the aim of decompressing the cervical spinal canal, preserving posterior motion segments and paraspinal muscles as much as possible, reducing iatrogenic consequences and promoting faster recoveries of patients. The purpose of this article is to summarize these procedures and evaluate their efficacy with comparing them to each other. The applicable methods are presented shortly but the differences between them are discussed in details. Comprehensive examination did not reveal the proven superiority of any techniques and in most cases the less invasive or minimally invasive treatment choices should be individually determined, considering the location and extension of pathology and the familiarity of surgeon with techniques.

Direct visualization of rapid cerebrospinal fluid movements is a topical task of neurosurgery, which has applications such as evaluating hydrocephalus and the effectiveness of 3rd ventriculostomy.The study purpose was to evaluate the capabilities of a modified Time-SLIP pulse MRI sequence for visualization of fluid (CSF) movements in the phantom, healthy subject, and patient.The study was performed in a phantom simulating pulsed CSF movements, healthy volunteers (9 people), and patients without impaired CSF dynamics (12 people), whose data were used to determine mean CSF flow parameters, as well as in 1 patient after 3rd ventriculostomy. A 1.5 T MRI instrument was used. The Time-SLIP parameters were as follows: TR = 8,500 ms; TEeff = 80 ms; Thk = 5.0 mm; tag spacing = 30 mm; NEX 7; inversion time (BBTI) = 2,000/3,000 ms; no cardiosynchronization. Scanning time was 2:16 min. The estimated parameter was the length of motion (LOM) of CSF.According to a study on a phantom simulating various conditions of oscillatory fluid motion, the mean LOM determination error in the modified Time-SLIP mode was 20%. This technique provided the following LOM data for the cerebral aqueduct (median, 25-75% quartiles): 13.0 (9.5-16.0) mm for BBTI of 2,000ms and 30.2 (23.7-35.3) mm for BBTI of 3,000 ms, i.e. 2.3-fold higher. This difference may be explained by an intense turbulent current leading to rapid CSF exchange between the 3rd and 4th ventricles and prolonged CSF movement during several heart contractions. Quantitative parameters of CSF movement at the C1-C2 level were determined. Additionally, Time-SLIP was used to evaluate performance of a third ventricle fistula.We have proposed a modified Time-SLIP pulse sequence that does not require cardiosynchronization. The mean relative error in determining the CSF movement distance was 20%. The mean quantitative parameters of CSF movement in the cerebral aqueduct and at the C1-C2 level were obtained. Turbulent CSF flow is found in the cerebral aqueduct, which leads to rapid exchange between the 3rd and 4th ventricles.Прямая визуализация быстрых перемещений ликвора - актуальная задача нейрохирургии, имеющая такие приложения, как оценка наличия и степени тяжести гидроцефалии, эффективности вентрикулостомии III желудочка. Цель исследования - оценить возможности модифицированной импульсной МРТ последовательности Time-SLIP для визуализации движения жидкости (ликвора) в водопроводе мозга и шейном отделе позвоночного канала с помощью регистрации перемещения ликвора (LOM) на фантоме, у здоровых и больных людей. Материал и методы. Исследования проводились на фантоме, имитирующем пульсовые движения ликвора, у здоровых добровольцев (9 человек) и у 12 пациентов без нарушений ликвородинамики со средними показателями ликворотока, а также у 1 больного после вентрикулостомии III желудочка. Использовали магнитно-резонансный (МР) томограф 1,5 Тл. Параметры Time-SLIP: TR 8500 мс; TEeff 80 мс; Thk 5,0 мм; ширина tag-зоны 30 мм; NEX 7; время инверсии (BBTI) 2000/3000 мс, без кардиосинхронизации. Время сканирования 2:16 мин. Оцениваемый параметр - длина перемещения ликвора (Length Of Motion, LOM). Результаты. По данным исследований на фантоме, моделирующем различные условия колебательных движений жидкости, средняя ошибка определения LOM для модифицированного режима Time-SLIP составила 20%. С помощью данной методики для водопровода мозга получены следующие данные LOM (медиана, 25-75-процентный квартили): для BBTI 2000 мс - 13 мм (9,5-16,0 мм), для BBTI 3000 мс - 30,2 мм (23,7-35,3 мм), т.е. в 2,3 раза больше. Эта разница может быть объяснена интенсивным турбулентным током, приводящим к быстрому обмену ликвором между III и IV желудочками головного мозга и протяженным распространением ликвора в течение несколько сердечных сокращений. Определены количественные показатели перемещения ликвора на уровне C

3 months old boy presented with inablility to move upper limb and cries on touching the upper limb from 1 week of age. On examination reflexes were absent in upper limb but hyper reflexia was found in lower limb. Cervical and brain MRI revealed expansion of the cervical spinal canal with smoothly marginated mass within the cervical cord which is hyperintense in T1WI, T2WI and completely loses its signal intensity in FS and gradient weighted sequences. There was no diffusion restriction and appears mostly intramedullary. MRI features were consistent with intramedullary lipoma in cervical spinal cord.Pulse Vol.7 January-December 2014 p.50-52

To compare volume-occupying rate of cervical spinal canal between patients with cervical spondylotic myelopathy (CSM) and normal subjects, and to investigate its significance in cervical spine disease.Spiral computed tomography (CT) scan (C4-C6 cervical spine unit) was performed in 20 normal subjects and 36 cases of CSM at a neutral position, and data were transferred to the Advantage Workstation Version 4.2 for assessment. Bony canal area and fibrous canal area in each cross section, and sagittal diameters of cervical spinal canal and cervical spinal body were measured. Volume-occupying rate of cervical spinal canal was calculated using MATLAB. Cervical spinal canal ratio and effective cervical spinal canal ratio were calculated, and Japanese Orthopaedic Association score was used to assess cervical spinal cord function.Volume-occupying rate of cervical spinal canal at a neutral position was significantly higher in CSM patients as compared to normal subjects (P 0.01). There was no correlation between cervical spinal canal ratio and JOA score in CSM patients, with a Pearson's correlation coefficient of 0.171 (P 0.05). However, sagittal diameter of secondary cervical spinal canal, effective cervical spinal canal ratio and volume-occupying rate of cervical spinal canal were significantly associated to JOA score, with Pearson's coefficient correlations of 0.439 (P 0.05), 0.491 (P 0.05) and -0.613 (P 0.01), respectively.Volume-occupying rate of cervical spinal canal is an objective reflection of compression on cervical spine and spinal cord, and it is associated with cervical spinal cord function. These suggest that it may play a significant role in predicting the development of CSM.

Compressive cervical myelopathy secondary to degenerative changes in the cervical spine is a common cause of neurologic morbidity in the elderly. Identification of canal stenosis and addressing it surgically in addition to the obvious compressive lesions is essential to obtain satisfactory results. We attempt to define the saggital and transverse diameters in a normal adult population presenting at our centre with head injuries. We found that the values were lower than those reported in comparable studies for a western population, and also that the dimensions in women are significantly lower than in men.

A 7-month-old patient presented with cervicothoracic bulge recognized by the parents. Cervicothoracic computed tomography and magnetic resonance imaging were performed to demonstrate the pathology. Distinct anterior displacement and inferior slippage of cervical vertebral block over subjacent thoracic vertebrae, impaction of the thoracic vertebral block into the enlarged cervical spinal canal, and multilevel posterior fusion defects throughout the cervical vertebrae were seen in his CT images (Fig. 1). Spinal cord was angulated and thickened at the level of impaction by the thoracic vertebral block, and there were irregularity and increased focal nodular signal intensity in the anterior part of the distal

BACKGROUND AND PURPOSE: Hypothermia has been shown to be beneficial in the setting of acute SCI. However, widespread use has been hindered by the need for systemic hypothermia as the vehicle for achieving spinal cord hypothermia. This study demonstrates that localized spinal cord hypothermia can be achieved via a percutaneous approach while maintaining systemic normothermia. MATERIALS AND METHODS: Five Yucatan swine underwent catheterization of the subarachnoid space and infusion of room temperature, chilled, and iced PL solutions into the cervical spinal canal, with drainage from the lumbar canal. Thermocouples were placed within the spinal cord and in the subarachnoid space and recorded during infusions and recovery from hypothermia. RESULTS: Results demonstrated that hypothermia as low as 16.8°C is feasible in the spinal cord with retention of systemic normothermia, with strong ( r = 0.95) correlation between the spinal cord temperature and the CSF temperature. Degrees of cooling varied with flow rates and with infusate temperature. CONCLUSIONS: While the data are preliminary in a small group of animals, the ability to rapidly create a wide range of controlled spinal cord hypothermia while preserving normal body temperature warrants wider exploration. The study also indicates that further investigation of the hypothesis that CSF temperature monitoring may be an acceptable surrogate for direct spinal cord temperature monitoring should be pursued.

BACKGROUND: Cervical spinal canal tapering may increase CSF velocities and pressures. One report suggests that the cervical spinal canal tapers more steeply in patients with Chiari I than in healthy subjects. The goal of this study was to test the conclusion by measuring spinal canal tapering in another cohort of patients. MATERIALS AND METHODS: Consecutive patients with scoliosis and MR imaging were selected. The MR images were evaluated for tonsillar herniation and syringomyelia. On a midline T2-weighted MR image, the anteroposterior diameter of the spinal canal was measured at each cervical level, and a linear trend line was fit by least-squares regression. The slope of this line was recorded as the taper ratio in millimeters/level. Patients with >5 mm of tonsillar herniation (with or without syrinx) were compared with those without tonsillar herniation (with or without syrinx). Differences in taper ratios for the 2 groups were tested for significance by the Kruskal-Willis test with significance set at .05. RESULTS: Fifty-four patients with scoliosis were identified; 22 had a Chiari malformation and 32 did not. Syringomyelia was identified in 20 of the patients with Chiari and in 8 of the others. The taper ratios averaged −0.9 mm/level for the patients with a Chiari malformation (with or without a syrinx) and −0.4 mm/level for those without it, significant at P = .035. Syringomyelia did not substantially alter the taper ratio in either group. CONCLUSIONS: Patients with scoliosis with a Chiari malformation have more steeply tapering cervical spinal canals than those without it.