• Korean Journal of Radiology
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• 제22권7호
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• pp.1163-1171
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• 2021

Objective: To analyze the correlations between intraoperative ultrasound and MRI metrics of the spinal cord in degenerative cervical myelopathy and identify novel potential predictive ultrasonic indicators of neurological recovery for degenerative cervical myelopathy. Materials and Methods: Twenty-two patients who underwent French-door laminoplasty for multilevel degenerative cervical myelopathy were followed up for 12 months. The Japanese Orthopedic Association (JOA) scores were assessed preoperatively and 12 months postoperatively. Maximum spinal cord compression and compression rates were measured and calculated using both intraoperative ultrasound imaging and preoperative T2-weight (T2W) MRI. Signal change rates of the spinal cord on preoperative T2W MRI and gray value ratios of dorsal and ventral spinal cord hyperechogenicity on intraoperative ultrasound imaging were measured and calculated. Correlations between intraoperative ultrasound metrics, MRI metrics, and the recovery rate JOA scores were analyzed using Spearman correlation analysis. Results: The postoperative JOA scores improved significantly, with a mean recovery rate of 65.0 ± 20.3% (p < 0.001). No significant correlations were found between the operative ultrasound metrics and MRI metrics. The gray value ratios of the spinal cord hyperechogenicity was negatively correlated with the recovery rate of JOA scores (ρ = -0.638, p = 0.001), while the ventral and dorsal gray value ratios of spinal cord hyperechogenicity were negatively correlated with the recovery rate of JOA-motor scores (ρ = -0.582, p = 0.004) and JOA-sensory scores (ρ = -0.452, p = 0.035), respectively. The dorsal gray value ratio was significantly higher than the ventral gray value ratio (p < 0.001), while the recovery rate of JOA-motor scores was better than that of JOA-sensory scores at 12 months post-surgery (p = 0.028). Conclusion: For degenerative cervical myelopathy, the correlations between intraoperative ultrasound and preoperative T2W MRI metrics were not significant. Gray value ratios of the spinal cord hyperechogenicity and dorsal and ventral spinal cord hyperechogenicity were significantly correlated with neurological recovery at 12 months postoperatively.

• Journal of Korean Neurosurgical Society
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• 제66권5호
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• pp.591-597
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• 2023

Cervical disc arthroplasty (CDA) has become more widespread and diverges from the conventional technique used in anterior cervical fusion for cervical degenerative disc disease. As arthroplasty has become a popular treatment option, few complications have been reported in the literature. These include subsidence, expulsion, posterior avulsion fractures, heterotopic ossification, and osteolysis. One of the critical complications is osteolysis, but current studies on this subject are limited in terms of not elucidating the incidence, etiology, and consequences. The authors present two cases, who presented with clinical signs of gradually worsening myelopathy induced by posterior vertebral body osteolysis, 2 years after CDA. Subsequently, the patient underwent posterior decompression and fusion without prosthesis removal. Postoperatively, the clinical symptoms gradually resolved, with no severe deficits. The present rare cases highlight the osteolysis that occurs after CDA, which can cause cervical myelopathy, and suggest spine surgeons to be alert to this fatal complication.

• 보험의학회지
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• 제27권2호
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• pp.107-111
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• 2008

The Cervical spondylotic myelopathy (CSM) is degenerative compressive myelopathy which initiation of symptoms seems to be induced by minor cervical trauma or spontaneous event. There was a case of Claim medical examination which was requested to discriminate the cause of ambulatory quadriparesis. Patient asserted that the onset of his myelopathy was followed by minor trauma. The author considered the medical recordings, MRI scan, Claim reports by claim manager. The space available for cord was the smallest at C3-4 level. But on MRI findings, the spinal cord at C3-4 level seemed to be already damaged. There were no recent injury evidences such as hemorrhages, spinal cord contusions, edema, soft tissue hemorrhages. If the space available for cord was small enough to compress the spinal cord, the serious neurologic deficits, non-ambulatory quadriplegia, etc were commonly induced by cervical extension trauma. Patient's asserts did not correspond to his clinical course after cervical trauma. The author reports a case of medical examination for the relationship between symptom onset of cervical spondylotic myelopathy and minor trauma within author's experience.

• Journal of Acupuncture Research
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• 제38권1호
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• pp.79-84
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• 2021

The degenerative spinal cord disease cervical spondylotic myelopathy (CSM), and cervical myelopathy caused by trauma, can result in debilitating symptoms affecting quality of life. This study used acupotomy and other Korean medicine treatments (acupuncture, herbal medicine, and physical therapy) to improve the symptoms of CSM and cervical myelopathy. The visual analog scale, the modified Japanese Orthopaedic Association scale (mJOA scale), the Nurick grading system, and the American Spinal Injury Association impairment scale were used as the evaluation criteria to determine the effectiveness of treatment. The functional status of both patients improved from mild to moderate, with improved gait, local sensation, and level of pain. The degree of spinal cord injury remained the same. The findings of this study suggest that combined Korean medicine treatments including acupotomy may be helpful in the treatment of CSM and cervical myelopathy.

• Journal of Korean Neurosurgical Society
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• 제56권1호
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• pp.55-57
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• 2014

Synovial cysts of the cervical spine, although they occur infrequently, may cause acute radiculopathy or myelopathy. Here, we report a case of a cervical synovial cyst presenting as acute myelopathy after manual stretching. A 68-year-old man presented with gait disturbance, decreased touch senses, and increased sensitivity to pain below T12 level. These symptoms developed after manual stretching 3 days prior. Computed tomography scanning and magnetic resonance imaging revealed a 1-cm, small multilocular cystic lesion in the spinal canal with cord compression at the C7-T1 level. We performed a left partial laminectomy of C7 and T1 using a posterior approach and completely removed the cystic mass. Histological examination of the resected mass revealed fibrous tissue fragments with amorphous materials and granulation tissue compatible with a synovial cyst. The patient's symptoms resolved after surgery. We describe a case of acute myelopathy caused by a cervical synovial cyst that was treated by surgical excision. Although cervical synovial cysts are often associated with degenerative facet joints, clinicians should be aware of the possibility that these cysts can cause acute neurologic symptoms.

• Journal of Korean Neurosurgical Society
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• 제64권1호
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• pp.69-77
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• 2021

Objective : Classification systems for cervical ossification of the posterior longitudinal ligament (OPLL) have traditionally focused on the morphological characteristics of ossification. Although the classification describes many clinical features associated with the shape of the ossification, including the concept of spondylosis seems necessary because of the similarity in age distribution. Methods : Patients diagnosed with OPLL who presented with increase signal intensity (ISI) on magnetic resonance imaging were surgically treated in our department. The patients were divided into two groups (pure versus degenerative) according to the presence of disc degeneration. Results : Of 141 patients enrolled in this study, more than half (61%) were classified into the degenerative group. The pure group showed a profound male predominance, early presentation of myelopathy, and a different predilection for ISI compared to the degenerative group. The mean canal compromise ratio (CC) of the ISI was 47% in the degenerative group versus 61% in the pure group (p<0.0000). On the contrary, the global and segment motions were significantly larger in the degenerative group (p<0.0000 and p=0.003, respectively). The canal diameters and global angles did not differ between groups. Conclusion : Classifying cervical OPLL based on the presence of combined disc degeneration is beneficial for understanding the disorder's behavior. CC appears to be the main factor in the development of myelopathy in the pure group, whereas additional dynamic factors appear to affect its development in the degenerative group.

• Journal of Korean Neurosurgical Society
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• 제60권5호
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• pp.577-583
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• 2017

Objective : Laminoplasty is an effective surgical method for treating cervical degenerative disease. However, postoperative complications such as kyphosis, restriction of neck motion, and instability are often reported. Despite sufficient preoperative lordosis, this procedure often aggravates the lordotic curve of the cervical spine and straightens cervical alignment. Hence, it is important to examine preoperative risk factors associated with postoperative kyphotic alignment changes. Our study aimed to investigate preoperative radiologic parameters associated with kyphotic deformity post laminoplasty. Methods : We retrospectively reviewed the medical records of 49 patients who underwent open door laminoplasty for cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament (OPLL) at Pusan National University Yangsan Hospital between January 2011 and December 2015. Inclusion criteria were as follows : 1) preoperative diagnosis of OPLL or CSM, 2) no previous history of cervical spinal surgery, cervical trauma, tumor, or infection, 3) minimum of one-year follow-up post laminoplasty with proper radiologic examinations performed in outpatient clinics, and 4) cases showing C7 and T1 vertebral body in the preoperative cervical sagittal plane. The radiologic parameters examined included C2-C7 Cobb angles, T1 slope, C2-C7 sagittal vertical axis (SVA), range of motion (ROM) from C2-C7, segmental instability, and T2 signal change observed on magnetic resonance imaging (MRI). Clinical factors examined included preoperative modified Japanese Orthopedic Association scores, disease classification, duration of symptoms, and the range of operation levels. Results : Mean preoperative sagittal alignment was $13.01^{\circ}$ lordotic; $6.94^{\circ}$ lordotic postoperatively. Percentage of postoperative kyphosis was 80%. Patients were subdivided into two groups according to postoperative Cobb angle change; a control group (n=22) and kyphotic group (n=27). The kyphotic group consisted of patients with more than $5^{\circ}$ kyphotic angle change postoperatively. There were no differences in age, sex, C2-C7 Cobb angle, T1 slope, C2-C7 SVA, ROM from C2-C7, segmental instability, or T2 signal change. Multiple regression analysis revealed T1 slope had a strong relationship with postoperative cervical kyphosis. Likewise, correlation analysis revealed there was a statistical significance between T1 slope and postoperative Cobb angle change (p=0.035), and that there was a statistically significant relationship between T1 slope and C2-C7 SVA (p=0.001). Patients with higher preoperative T1 slope demonstrated loss of lordotic curvature postoperatively. Conclusion : Laminoplasty has a high probability of aggravating sagittal balance of the cervical spine. T1 slope is a good predictor of postoperative kyphotic changes of the cervical spine. Similarly, T1 slope is strongly correlated with C2-C7 SVA.

• Journal of Acupuncture Research
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• 제19권6호
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• pp.264-279
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• 2002

Objective : Ossification of the posterior longitudinal ligament(OPLL) is considered kind of degenerative disease usually found in the cervical vertebrae. Most of cases of OPLL have radiculopathy, myelopathy or both of them such as neck pain, numbness, myatonia. These symptoms seems to be similar with those of HIVD(Herniated intervertebral disc), sprain, spondylosis of C-spine. Lost of patients who have those symptoms are visiting oriental medicine hospital, clinic so we thought that making differential diagnosis, treating and prognosing might be needed with acupuncture, Herb medication. Methods : We examined the 3 patients of OPLL who visited Dong-in-dang Oriental Medicine Hospital from 1st November 1999 to 1st February 2002. We treated patients of OPLL with Oriental Medicine care (Acupuncture, Herb medication, Negative treatment) based on oriental diagnosis of neck pain(項强痛), numbness(痺證), myatonia. Results : clinical grade of 3 cases was all Gr III. After treated with oriental medical care, 2 cases were evaluated poor, I cases were evaluated fair and resulted in Clinical grade II. Conclusions : Treating OPLL with oriental medical carte was very difficult to palliate symptoms, to stop progress of OPLL. We might need to reconsider oriental medical care as conservative treatment for OPLL.