RESUMEN
Cervical spondylotic myelopathy (CSM) is the leading cause of acquired spinal cord dysfunction worldwide and may be expected to increase in prevalence due to an aging global population. Clinical features of CSM are highly variable, and chiropractors frequently manage patients with common signs and symptoms of CSM such as neck pain, extremity weakness, and gait imbalances. Early recognition of signs consistent with myelopathy may mitigate future disability and improve quality of life. Key predictors of patient outcome are the age of initial presentation, baseline CSM severity (as measured by mJOA score), and the presence of gait disturbances. This report describes three cases of CSM presenting to a chiropractic clinic. Each case illustrates a unique manifestation of CSM, including myelopathy, myeloradiculopathy, and distal neuropathic pain (funicular referral). In addition, a review of CSM terminology, epidemiology, pathobiology, clinical features, imaging, and management is provided.
La myélopathie spondylotique cervicale (MSC) est la principale cause d'un dysfonctionnement acquis de la moelle épinière dans le monde et sa prévalence devrait augmenter en raison d'une population mondiale vieillissante. Les caractéristiques cliniques de la MSC varient énormément et les chiropraticiens traitent souvent des patients présentant des signes et des symptômes courants de la MSC comme des douleurs cervicales, une faiblesse des extrémités et une démarche déséquilibrée. Une reconnaissance précoce des signes de la myélopathie peut permettre d'atténuer une incapacité future et d'améliorer la qualité de vie. Les principaux signes avant-coureurs des résultats pour le patient sont l'âge de la première manifestation, la gravité initiale de la MSC (mesurée par l'échelle mJOA) et des troubles dans la démarche. Le présent rapport décrit trois cas de MSC soumis à une clinique de chiropratique. Chacun des cas illustre une manifestation unique de MSC, à savoir la myélopthie, la myéloradiculopathie et la douleur neuropathique distale (funiculaire). De plus, une étude de la terminologie, de l'épidémiologie, de la pathobiologie, des caractéristiques cliniques, de l'imagerie et du traitement de la MSC est fournie.
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BACKGROUND: Spinal cord herniation (SCH) remains a challenging diagnosis for neuroradiologists and may require treatment challenging for neurosurgeons. Most cord herniations are usually found at anterior thoracic levels. CLINICAL PRESENTATION: A 28-year-old woman presented at our department with a 7-year history of progressive myelopathy. MR analysis showed a displacement of the spinal cord in a lateral thoracic dural defect. The herniated cord was released using a microscope and the patient significantly recovered 6 months after surgery. CONCLUSION: We present a unique case of pure lateral SCH. In the light of reviewed literature and operative findings, the underlying pathophysiological mechanisms are discussed.
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Enfermedades de la Médula Espinal , Vértebras Torácicas , Adulto , Femenino , Hernia/diagnóstico por imagen , Herniorrafia , Humanos , Imagen por Resonancia Magnética , Médula Espinal/cirugía , Enfermedades de la Médula Espinal/diagnóstico por imagen , Enfermedades de la Médula Espinal/cirugía , Vértebras Torácicas/cirugíaRESUMEN
Radiation-induced myelopathy is a devastating late effect of radiotherapy. Fortunately, this late effect is exceptional. The clinical presentation of radiation myelopathy is aspecific, typically occurring between 6 to 24 months after radiotherapy, and radiation-induced myelopathy remains a diagnosis of exclusion. Magnetic resonance imaging is the most commonly used imaging tool. Radiation oncologists must be extremely cautious to the spinal cord dose, particularly in stereotactic radiotherapy and reirradiation. Conventionally, a maximum dose of 50Gy is tolerated in normofractionated radiotherapy (1.8 to 2Gy per fraction). Repeat radiotherapies lead to consider cumulative doses above this recommendation to offer individualized reirradiation. Several factors increase the risk of radiation-induced myelopathy, such as concomitant or neurotoxic chemotherapy. The development of predictive algorithms to prevent the risk of radiation-induced myelopathy is promising. However, radiotherapy prescription should be cautious, regarding to ALARA principle (as low as reasonably achievable). As the advent of immunotherapy has improved patient survival data and the concept of oligometastatic cancer is increasing in daily practice, stereotactic treatments and reirradiations will be increasingly frequent indications. Predict the risk of radiation-induced myelopathy is therefore a major issue in the following years, and remains a daily challenge for radiation oncologists.
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Radioterapia/efectos adversos , Enfermedades de la Médula Espinal/etiología , Médula Espinal/efectos de la radiación , Algoritmos , Humanos , Imagen por Resonancia Magnética , Traumatismos por Radiación/prevención & control , Oncólogos de Radiación , Tolerancia a Radiación , Reirradiación/efectos adversos , Médula Espinal/diagnóstico por imagen , Enfermedades de la Médula Espinal/diagnóstico por imagen , Enfermedades de la Médula Espinal/prevención & controlRESUMEN
Transverse myelitis is a neurological disorder that results in acute focal inflammation of the spinal cord. It can present with a varied spectrum of neurological signs and symptoms which can make diagnosing a challenge, and delayed diagnosis a frequent complication. This is a case of a 61-year-old male who presented with back pain complicated by neurological symptoms that should have warranted immediate referral to a neurologist. It took approximately five weeks from the onset of his symptoms to be referred to a neurologist, and a further four months to the diagnosis of transverse myelitis. The authors hope to stress the importance of thorough evaluations including neurological exams when new symptoms present and to emphasize regular interprofessional collaboration, that may have prevented the delay in diagnosis seen in this case.
La myélite transverse est un trouble neurologique se manifestant par une inflammation focale aiguë de la moelle épinière. Le sujet peut présenter divers signes et symptômes neurologiques qui peuvent rendre le diagnostic difficile. Un diagnostic tardif entraîne de fréquentes complications. Il s'agit d'un homme de 61 ans ayant des dorsalgies et des symptômes neurologiques qui auraient dû justifier son renvoi immédiat à un neurologue. Environ cinq semaines après l'apparition des symptômes se sont écoulées avant le renvoi à un neurologue, et par la suite quatre mois se sont écoulés avant qu'un diagnostic de myélite transverse ne soit établi. Les auteurs de l'étude espèrent souligner l'importance des évaluations poussées, y compris des examens neurologiques lorsque de nouveaux symptômes apparaissent, et l'importance d'une collaboration régulière entre professions, ce qui aurait permis d'éviter le retard de diagnostic dans le cas de ce patient.
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INTRODUCTION: Cervical spinal sarcoidosis can mimic compressive cervical myelopathy leading to potentially harmful surgical procedures before the diagnosis can be made. METHODS: Retrospective description of 3 patients and review of the literature. RESULTS: Twenty-seven patients (16 men/11 women), median age 58 years [range 29-74] were described. Neurosurgical procedures consisted of laminectomy (n=10), laminoplasty (n=15) and anterior discectomy (n=2). Immediately after surgery, 17 patients (63%) worsened or remained disabled. Among the 10 patients who improved, 9 worsened secondarily. The analysis of preoperative MRI showed T2 hypersignal lesions and contrast enhancement in all patients. Neurological symptoms were inaugural in 25/27 patients, and systemic involvement of the sarcoidosis was found after surgery in 15/27 patients. After surgery, all patients received corticosteroids, along with immunosuppressive therapy in 8 cases/27. After a follow-up of 24 [16-72] months; 13 patients were stabilized or worsened, 7 were partially improved. Three died of other cause. Only 5 recovered without sequelae. CONCLUSION: In patients with compressive cervical myelopathy, leptomeningeal contrast enhancement, a T2-weighted hypersignal exceeding the compression level on MRI, and the presence of extraneurological symptoms should point to inflammatory disease. These rare manifestations may be the first symptoms of sarcoidosis and should be recognized to avoid harmful surgical procedures and to provide appropriate medical treatment.
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Sarcoidosis/diagnóstico , Sarcoidosis/cirugía , Compresión de la Médula Espinal/diagnóstico , Enfermedades de la Médula Espinal/diagnóstico , Enfermedades de la Médula Espinal/cirugía , Adulto , Anciano , Vértebras Cervicales , Diagnóstico Diferencial , Progresión de la Enfermedad , Discectomía/efectos adversos , Femenino , Humanos , Laminectomía/efectos adversos , Laminoplastia/efectos adversos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Pronóstico , Estudios Retrospectivos , Sarcoidosis/epidemiología , Compresión de la Médula Espinal/epidemiología , Compresión de la Médula Espinal/cirugía , Enfermedades de la Médula Espinal/epidemiología , Resultado del TratamientoAsunto(s)
Calcinosis/complicaciones , Paresia/diagnóstico , Enfermedades de la Columna Vertebral/complicaciones , Calcinosis/diagnóstico , Vértebras Cervicales , Femenino , Humanos , Dolor de la Región Lumbar/diagnóstico , Dolor de la Región Lumbar/etiología , Persona de Mediana Edad , Paresia/etiología , Esclerodermia Localizada/complicaciones , Esclerodermia Localizada/diagnóstico , Enfermedades de la Columna Vertebral/diagnósticoAsunto(s)
Vértebras Cervicales/cirugía , Radiculopatía/cirugía , Enfermedades de la Médula Espinal/cirugía , Tratamiento Conservador , Discectomía , Medicina Basada en la Evidencia , Humanos , Imagen por Resonancia Magnética , Radiculopatía/diagnóstico , Ensayos Clínicos Controlados Aleatorios como Asunto , Enfermedades de la Médula Espinal/diagnóstico , Fusión VertebralRESUMEN
INTRODUCTION: Every year, 240,000 people are struck by lightning worldwide, causing injuries leading to significant handicaps. Most of the symptoms involve brain lesions; neuromuscular sequelae and myelopathy are less common. OBSERVATIONS: We describe five cases of patients struck by lightning with various clinical presentations. The first patient presented painful paresthesias in both upper limbs that disappeared 18 months later; the injury was a plexopathy. The second patient developed proximal weakness in the upper-left limb due to a myopathy. Two patients presented with various motor weaknesses in the lower limbs due to motor neuron disease and myelopathy. The last patient had a transient tetraplegy, which resolved in 5minutes; the diagnosis was keraunoparalysis. DISCUSSION: Lightning injuries can have many consequences depending on the different mechanisms involved. The clinical presentation is often due to a very focal lesion without any secondary extension. Motor neuron disease probably results from post-traumatic myelopathy. We discuss the ALS-electrocution association, frequently described in the literature. CONCLUSION: Various peripheral nerve and spinal cord lesions can be seen in lightning strike victims involving myelopathy, motor neuron, muscle and plexus. Clinical syndromes are often atypical but outcome is often favorable.
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Traumatismos por Acción del Rayo/complicaciones , Paraplejía/etiología , Enfermedades del Sistema Nervioso Periférico/etiología , Traumatismos de la Médula Espinal/etiología , Adulto , Femenino , Humanos , Relámpago , Traumatismos por Acción del Rayo/diagnóstico , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Paraplejía/diagnóstico , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Traumatismos de la Médula Espinal/diagnóstico , Adulto JovenRESUMEN
Cervical spondylotic myelopathy (CSM) is a common condition. Uninstrumented laminectomy may be complicated by postoperative instability, whereas anterior or posterior decompression with fusion may be associated with stiffness and adjacent segment disease. Cervical laminoplasty, initially oriented towards pediatric patients and ossification of the posterior longitudinal ligament, becomes an interesting surgical alternative to decompress and reconstruct cervical anatomy without fusion. Eighteen patients (12 men, 6 women), mean age 64.2 who presented with CSM were treated surgically using multilevel laminoplasty, and reviewed after 1 month, 6 months, 1 year and 2 years. Clinical evaluation was performed based on the Benzel-JOA and Nurick scores. The preoperative mean Benzel-JOA score was 13.55; Preoperative mean Nurick score was 1.88. Preoperative MRI was carried-out in 16/18 patients. Intramedullary hyperintensity in T2 was observed in 6 patients. The operation was performed on 2 levels (4 patients) 3 levels (11 patients) and 4 levels (3 patients). We used the open-door hinged laminoplasty technique, using metallic implants, without bone graft. At one month FU, mean JOA score was 15.44, and Nurick dropped to 1.05. At 6 months, mean JOA was 16.28 and Nurick was 0.71. At one year, the mean JOA score was 16.16, and Nurick was 0.83. At 2 years, mean JOA was 17.5, and Nurick was 0.25. One infection, one dural tear and one transient episode of C5 paresthesia were observed. We conclude that spinal cord decompression by open-door laminoplasty for CSM allows significant clinical improvement observed progressively in the two years following surgery.
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Laminoplastia/métodos , Procedimientos de Cirugía Plástica/métodos , Compresión de la Médula Espinal/cirugía , Enfermedades de la Médula Espinal/cirugía , Adulto , Anciano , Descompresión Quirúrgica/métodos , Femenino , Humanos , Laminectomía/métodos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Fusión Vertebral/métodos , Resultado del TratamientoRESUMEN
INTRODUCCIÓN. La mielopatía espondilótica es una enfermedad frecuente, que representa la cuarta parte de las paraparesias y tetraparesias no traumáticas. Su diagnóstico se sustenta en los datos clínicos, radiológicos y neurofisiológicos. El objetivo de esta investigación fue demostrar las alteraciones de los parámetros electrofisiológicos evaluados mediante diferentes estudios y describir estas alteraciones, así como correlacionar las alteraciones de los estudios neurofisiológicos con la intensidad de la afectación radiológica. MÉTODOS. Se evaluaron 30 pacientes de uno y otro sexo, con diagnóstico clínico e imaginológico de mielopatía espondilótica cervical. A todos los pacientes se les realizó electromiografía, estudio de conducción nerviosa, onda F, potenciales evocados somatosensoriales y motores. Se aplicaron técnicas de estadística descriptiva a las variables neurofisiológicas y se correlacionaron éstas con el grado de compresión medular apreciable en la resonancia.RESULTADOS. En la mayoría de los casos los potenciales evocados estaban alterados. La electromiografía mostró resultados alterados en todos los casos: en el 72,7 % se observó un patrón neurógeno difuso, mientras que el resto mostró un patrón de irritación radicular. En el 52,1 % de los casos se demostraron alteraciones moderadas a graves en el estudio de conducción del nervio mediano. Existió una correlación estadísticamente significativa entre la anormalidad de los parámetros electrofisiológicos y la intensidad de la compresión medular observada en las imágenes de resonancia. CONCLUSIONES. Los potenciales evocados resultan de gran utilidad para la evaluación neurofisiológica en la mielopatía espondilótica. En la mielopatía espondilótica existe gran asociación entre las alteraciones de los parámetros electrofisiológicos y las imágenes de resonancia
INTRODUCTION. Spondylotic myelopathy is a common disease representing the fourth part of non-traumatic paraparesis and tetraparesis. Its diagnosis is supported by clinical, radiological and neurophysiological data. The aim of present research was to demonstrate and to describe the alterations of electrophysiological parameters assessed by different studies, as well as to correlationate the neurophysiological studies according the intensity of radiolgical affection. METHODS. Thirty patients of both sexes were assessed by clinical and imaging diagnosis of cervical spondylotic myelopathy. All of them underwent electromyography, nervous conduction study, F wave, somatosensory and motor evoked potentials. Techniques of descriptive statistics were applied to neurophysiological variables correlating them with the medullary compression degree according to resonance. RESULTS. In most of the cases the evoked potentials were altered. The electromyography demonstrated altered results in all the cases: in the 72,7 percent there was a diffuse neurogenic pattern, whereas remained showed a radicular irritation pattern. In the 52,1 percent of cases there were moderate to severe alterations in the study of medium nerve conduction. A significant statistical correlation was present between the abnormality of electrophysiological parameters and the medullary compression intensity observed in resonance images. CONCLUSIONS. The evoked potentials are very useful for the neurophysiological assessment in spondylotic myelopathy where is present a strong association among the alterations of electrophysiological parameters and the resonance images
INTRODUCTION. La myÚlopathie spondylique, reprÚsentant la quatriÞme partie des paraparÚsies et des tÚtraparÚsies non-traumatiques, est une maladie frÚquente. Son diagnostic est basÚ sur des donnÚes cliniques, radiologiques et neurophysiologiques. Le but de cette Útude a ÚtÚ de dÚmontrer les altÚrations des paramÞtres Úlectro-physiologiques ÚvaluÚs dans plusieurs Útudes, et de dÚcrire ces altÚrations, ainsi que de mettre en corrÚlation les altÚrations des Útudes neurophysiologiques avec l'intensitÚ de l'affection radiologique. MÉTHODES. Trente patients (tous les deux sexes) ont ÚtÚ ÚvaluÚs et diagnostiquÚs de myÚlophatie spondylique cervicale en clinique et imagerie. Tous les patients ont subi une Úlectromyographie, une Útude de la conduction nerveuse, onde F, potentiels ÚvoquÚs somatosensoriels et moteurs. Des techniques de statistique descriptive ont ÚtÚ appliquÚes aux variables neurophysiologiques, et mises en corrÚlation avec un degrÚ de compression mÚdullaire apprÚciable en RM. RÉSULTATS. Dans la plupart des cas, les potentiels ÚvoquÚs Útaient altÚrÚs. L'Úlectromyographie a montrÚ des rÚsultats altÚrÚs dans tous les cas: Un patron neurogÞne diffus a ÚtÚ observÚ (72,7 percent), tandis que le reste a montrÚ un patron d'irritation radiculaire. Dans 52,1 percent des cas, on a rencontrÚ des altÚrations modÚrÚes Ó graves dans l'Útude de conduction du nerf moyen. Il a existÚ une corrÚlation statistiquement significative entre l'altÚration des paramÞtres Úlectro-physiologiques et l'intensitÚ de la compression mÚdullaire observÚe aux images de RM. CONCLUSIONS. Les potentiels ÚvoquÚs se sont rendus bien utiles pour l'Úvaluation neurophysiologique dans la myÚlopathie spondylique. Dans cette affection, il y a une grande association entre les altÚrations des paramÞtres Úlectro-physiologiques et les images de RM