Cervical vertebral erosion due to tortuous vertebral artery

A case of cervical vertebral erosion due to tortuous vertebral artery is presented. This entity is rare and only 11 cases have been reported in the literature. The present case is the first to be demonstrated by magnetic resonance imaging. The importance of considering this vascular anomaly in the differential diagnosis of cervical spinal tumors is discussed.     

Cervical vertebral and spinal cord injury in intensive therapy

24 of 184 patients with vertebro-medullary trauma admitted to the Neurosurgery Clinic of Milan University in the years 1976-1988 have been examined. A common feature of these was a myelic lesion (transverse, complete or incomplete) at cervical level in which respiratory problems had made a period of intensive care indispensable. The purpose of the research was to assess the reliability of certain parameters in establishing patient prognosis. The following parameters were compared: clinical, objective and instrumental examination for a strictly neurological evaluation and for an evaluation of general condition, quantification of the same clinical examination through two scales, the Sunnybrook Cord Injury Scale (SCIS) for the neurological factor and the APACHE II for general condition, the type of treatment, with the same basic medical-resuscitation treatment. The result of the surgery or non-surgery was considered a posteriori. It is concluded that, in the case of the patients considered (high myelic lesion) the prognosis must be split into two different moments that the patient goes through in succession: the acute phase and the stabilisation phase. In the first phase, in which the vital functions are involved, the SCIS and APACHE II scales (with their sum) have great prognostic value; in the second phase, certain values, already considered on the APACHE II scale, are comparable in all patients and the prognostic problem is based on the other scale (SCIS) and on the adjuvant neurophysiological techniques. The very distinction between the two different phases that the patient traverses appears important also for the purposes of surgical indication.2     

单节段椎体自发性融合所致脊髓型颈椎病临床研究

目的：总结单节段椎体自发性融合（SLVSF）所致脊髓型颈椎病（CSM）的临床特点、影像学表现、外科处理及预后。方法回顾性分析2002年7月至2012年6月上海市第十人民医院收治的16例SLVSF患者（SLVSF组）的临床资料,患者均行前路手术,其中Ⅰ型（椎体、椎板和棘突全部融合）11例、Ⅱ型（椎体和椎板融合,棘突各自独立）5例。记录其临床特点、影像学表现、外科治疗方法、功能评分和并发症等,并与38例退变所致CSM患者（退变组）的临床资料进行比较。结果两组年龄、病程比较,差异有统计学意义（P＜0.05）;颈椎长度比较,差异无统计学意义（P＞0.05）。SLVSF组中13例存在融合节段头端水平不稳,但无成角不稳;融合区椎管指数大于其他节段的椎管指数,差异有统计学意义（P ＜0.05）。两组术前Nurick评级、日本骨科学会（JOA）评分比较,差异无统计学意义（P＞0.05）;SLVSF组颈椎功能障碍指数（NDI）高于对照组（P＜0.05）。两组术后1年上述临床指标均优于术前,差异有统计学意义（P＜0.05）。结论 SLVSF患者颈椎长度正常,可与Klippel-Feil综合征相鉴别;其主要临床特点是受累节段椎体和椎间盘发育不良、融合节段头侧水平不稳和颈部疼痛症状较重。前路手术效果良好,但需要注意椎体次全切除的范围。     

Cervical spine fracture patterns predictive of blunt vertebral artery injury

BACKGROUND: Aggressive screening for blunt cerebrovascular injury (BCVI) has uncovered an astonishing incidence of vertebral artery injuries (VAIs) and associated stroke rate. Stroke incidence is reduced with early recognition and prompt anticoagulation. Because of the proximity of the cervical spine and vertebral arteries, we queried whether all patients with cervical spine fractures required arteriography to rule out VAI. METHODS: Four-vessel cerebrovascular angiography remains the standard screening test for patients at risk for BCVI. Patients undergoing angiographic screening for blunt cerebrovascular injuries have been prospectively followed at our regional trauma center since January 1990; however, in January 1996, we began aggressive screening based on injury patterns. RESULTS: Ninety-two patients with vertebral artery injuries were identified during the study period from January 1996 to June 2002. Two patients with vertebral injuries had minor cervical fractures, a C6 body fracture and a C7 spinous process/laminar fracture; both underwent diagnostic angiography for injury mechanism. Of the 21 patients without cervical spine fracture, angiographic screening for BCVI was performed for neurologic symptoms (11 patients), basilar skull fracture (6 patients), or severe facial fractures (4 patients). Cervical spine fracture was the sole indication for VAI in 69 patients. The fracture patterns were subluxations in 38 patients (55%) or extension of the fracture through the foramen transversarium in 18 patients (26%). The remaining injuries (18%) were located in the upper cervical spine: isolated C1 arch in eight patients and C2/3 body fractures in five patients. CONCLUSION: Blunt vertebral artery injury is associated with complex cervical spine fractures involving subluxation, extension into the foramen transversarium, or upper C1 to C3 fractures. Routine screening should incorporate these findings to maximize yield while limiting the use of invasive procedures.     

颈椎前路减压异体骨笼植入术

目的:评价颈椎前路环钻法减压、异体骨笼植入融合术的临床疗效.方法:采用椎间盘切除、异体骨笼植入治疗颈椎椎间盘病变患者60例,男25例,女35例;年龄37～72岁,平均47岁.并对其治疗结果进行分析.结果:60例患者平均随访23.2个月,不但临床症状得到改善,而且取得了骨愈合,并能维持颈椎解剖关系,无局部及全身异常反应.结论:颈椎前路环钻法减压、异体骨笼植入是具有应用前景的新方法.     

Cervical myelopathy due to compression by bilateral vertebral arteries--case report.

A 69-year-old man presented with progressive cervical myelopathy due to vascular compression of the upper cervical spinal cord. Vertebral angiography and magnetic resonance imaging revealed that the elongated bilateral vertebral arteries (VAs) had compressed the spinal cord at the C-2 level. The spinal cord was surgically decompressed laterally by retracting the VAs with Gore-Tex tape and anchoring them to the dura. The patient's symptoms improved postoperatively. Decompression and anchoring of the causative vessels is recommended due to the large size of the VAs.     

C臂机介入颈椎前径路手术神经联合阻滞

目的采用C型臂介入颈椎前径路手术时的颈部神经阻滞术,降低技术操作难度,提高麻醉效果与安全性。方法两组病人各9例,A组按颈神经阻滞常规操作;B组采用C型臂放射介入进行C4椎体和横突与要手术的颈椎体或椎间隙定位,并引导进行穿刺局部注射麻醉药。结果B组亚甲蓝染色阳性率与麻醉效果优良率均高于A组,但无显著性差异。结论C型臂介入颈部神经阻滞术,解决了颈部转动受限和颈部制动病人带来的定位与操作困难,有利于提高麻醉效果与安全。     

Cervical cord trauma. The relationship between clinical syndromes and force of injury

Several different syndromes, such as central cord, anterior cord, and root, have been described in injuries to the cervical spine. If stress analysis theory is used to analyze the applied forces that cause injury, the various syndromes appear to be interrelated and follow in an orderly progression that depend on the magnitude of the applied force. The modes of injury, either flexion or extension, theoretically produce similar injuries, dependent on the severity of the blow. These applied forces then cause the pathologic changes that have been described. This article applies commonly used principles of engineering design to analyze clinical syndromes and to demonstrate that these syndromes are related in a sequential manner.     

Cervical congenital spondylolytic spondylolisthesis associated with duplication of the vertebral artery: case report

Background contextCervical bilateral congenital spondylolysis with spondylolisthesis is an abnormality both of congenital and mechanical origin, characterized by its primary feature, cervical bilateral spondylolysis. We are unaware of any reports describing cervical congenital spondylolytic spondylolisthesis associated with duplication of the vertebral artery.PurposeTo report the case of a patient affected with cervical bilateral congenital spondylolysis with spondylolisthesis associated with duplication of the vertebral artery.Study designA unique case report from a university hospital and a literature review.Patient sampleAn 18-year-old man who arrived at the emergency department complaining of neck pain starting from a car accident 5 days ago.MethodsNeurologic examination and images taken by ordinary radiographs, magnetic resonance imaging (MRI) scans, ordinary computed tomography (CT) scans, and CT angiograms with three-dimensional (3D) reconstruction.ResultsNeurologic examination did not find evidence of strength deficit in upper extremities. Ordinary radiographs of the cervical spine showed spondylolisthesis of C6 and C7 and a cortical cleft between the superior and inferior articular facets of the C6 vertebra and spina bifida of the C6 and C2 vertebrae and an abnormal appearance of the remnant spinous processes of the cervical vertebrae. Magnetic resonance imaging confirmed the abnormalities that had been noted on the radiographs. Computed tomography scans of the cervical spine showed congenital spondylolytic spondylolisthesis and spina bifida of the C6 vertebra and duplication of the vertebral artery. They also showed double origins of the vertebral artery depicted by 3D angiographic reconstruction. Conservative treatment of wearing a cervical collar and receiving muscle relaxants and anti-inflammatory drugs was effective. With the pain completely subsided, the patient was discharged 5 days after arriving at the emergency department.ConclusionsVascular abnormalities should be suspected and investigated in cases of congenital spondylolysis or spondylolytic spondylolisthesis. We strongly suggest performing angio-CT or angio-MRI and 3D reconstruction in these cases. Awareness of the presence of a duplicated vertebral artery and the course of its limbs could significantly help planning in cases proceeding to surgery.     

Cervical root compression by a traumatic pseudoaneurysm of the vertebral artery: case report

We report the case of a patient with cervical monoradiculopathy secondary to a pseudoaneurysm of the vertebral artery caused by a knife wound to the neck.     

Cervical vertebral artery aneurysms and arteriovenous fistulae in neurofibromatosis type 1: case reports

Neurofibromatosis is of particular interest to neurosurgeons because of the various central and peripheral nervous system tumors and, more rarely, cervicocerebral arterial lesions associated with the disease. In the present paper, we report two patients with neurofibromatosis Type 1 (von Recklinghausen's disease) who had anomalies of the extracranial vertebral arteries. A large extracranial vertebral artery aneurysm was incidentally discovered in the first patient, a 43-year-old woman, after rupture of a subclavian artery aneurysm. The second patient, a 28-year-old woman, had an enlarging neck mass and was found to have an extensive extracranial vertebral artery arteriovenous fistula. The vascular lesions associated with neurofibromatosis Type 1 in general and those arising from the extracranial vertebral artery in particular are reviewed.     

Cervical discs are most susceptible to beta 2-microglobulin amyloid deposition in the vertebral column.

Intervertebral discs of 41 chronic renal failure autopsy cases were examined histologically and immunohistochemically to assess the distribution of beta 2-microglobulin-associated (beta 2m) amyloid in the vertebral column. The results demonstrated beta 2m amyloid to appear first in the cervical discs, then in the lumbar and upper thoracic discs, and finally in the middle and lower thoracic discs as the dialysis period is prolonged. The shortest dialysis period for which beta 2m amyloid was detected was one year and seven months. Deposition of beta 2m amyloid was most remarkable in the C4-5, 5-6, and 6-7 levels, which are known to sustain severe mechanical stress in daily life. Thus it is suggested that local mechanical stress accelerates beta 2m amyloidosis. A marked macrophage reaction was observed around the amyloid in cases of severe amyloidosis, the macrophages themselves being immunohistochemically positive for IL-1 beta and TNF-alpha. Amyloid deposition and reactive inflammation mediated by cytokines appear to be closely related to the pathogenesis of destructive spondyloarthropathy.     

Cervical myelopathy from ossification of the posterior longitudinal vertebral ligament. Report of 2 cases]

BACKGROUND AND PURPOSE: Cervical myelopathy due to an ossification of the posterior longitudinal ligament (OPLL) is a rare entity in western countries but frequent in Japan. We report on two Lebaneese patients aged 67 and 72 years respectively, who were twins and presented with OPLL. METHODS: Diagnosis was made on myelography in the first case (1989) and on MRI of the cervical spine in the second case (1994). RESULTS: A wide laminectomy was performed in the first case followed by a marked improvement. In the second case, corporectomy of the third, fourth and fifth vertebra with removal of the ligament followed by bone graft didn't improve the clinical symptoms. CONCLUSION: The cause of OPLL remains unknown: genetic factors and metabolic abnormalities are outlined. Treatment options are discussed.     

Cervical spinal cord injury caused by vertebral body fracture in a patient with concomitant OALL and OPLL

We encountered a case of cervical spinal cord injury associated with cervical vertebral dislocation fracture that occurred in a patient with concomitant ossification of the anterior and posterior longitudinal ligaments. The cervical vertebrae were injured by hyperextension in a car accident. On admission, shearing fracture was noted in the OALL region and vertebral body OPLL region over the posterior column at the fourth cervical level, but no dislocation or neurological findings were noted. Restlessness occurred and caused dislocation several hours after admission, leading to complete injury of the cervical spinal cord. The patient died of complications after 3 weeks. Vertebral body fracture complicated by both OALL and OPLL is very rare, and only four cases have been reported. Since vertebral injury causes delayed fracture/dislocation after a symptom-free interval in cases with ligament ossification, accurate clinical evaluation early after injury and early fixation are necessary.     

Cervical osteochondroma (c2 level) with vertebral artery occlusion and second cervical nerve root irritation

A case of osteochondroma arising from the C2 transverse process, responsible for vertebral artery compression with complete occlusion and C2 nerve root irritation with C2 neuralgia, is reported. Complete surgical removal was achieved via the lateral anterior approach.