Spinal cord injury in cervical spinal stenosis by minor trauma

BackgroundThe size of the spinal canal is a factor that contributes to the neurologic deficits associated with cervical OPLL and CSM. We investigate the development of neurologic deterioration after minor trauma and the clinical results of decompressive surgery in cervical spinal stenosis retrospectively.MethodWe treated 200 cases (98 cervical OPLLs and 102 CSMs) of cervical spinal stenosis for 8 years. There were 63 (33.5%) minor trauma cases to the cervical spine in 200 patients. Of these 63 patients, 18 developed myelopathy, 13 showed deterioration of preexisting myelopathy, and no neurologic change was observed in 32 patients. The neurologic status was assessed by the JOA score. The patients were divided into 2 groups according to the residual cervical spinal canal diameter: group I (<10 mm cervical spinal canal) and group II (≥10 mm cervical spinal canal).ResultsNeurologic outcome depended on the diameter of the residual spinal canal; 22 of the 25 patients in group I developed neurologic deterioration, whereas that occurred in 8 of the 38 patients in group II (P < .05). After surgical decompression, 8 patients in group I and 30 patients in group II came out with an improved JOA score of more than 50% (P < .05).ConclusionEven indirect minor trauma to the neck can cause irreversible changes in the spinal cord if there is marked stenosis of the cervical spinal canal. It may be beneficial to check lateral radiograph of the cervical spine as a screening tool for early detection of cervical spinal stenosis especially in Asian people older than 40 years.     

Tonsillar herniation and the cervical spine: a morphometric study of 172 patients

Background When the neck is flexed in patients with Chiari I malformation, herniated tonsils descend, impacting the spinal canal, and the clivus-canal angle changes and compresses the ventral spinal cord. Therefore, we speculated that the existence of tonsillar herniation might have some influence on the cervical spine, such as changes in range of motion, sagittal alignment, and spondylosis. The purpose of this radiological study was to clarify quantitatively the relation between tonsillar herniation and the cervical spine regarding range of motion, sagittal alignment, and cervical spondylotic change. Methods We examined the cervical spine of 609 outpatients with magnetic resonance imaging, and the cerebral tonsils being located below the foramen magnum was defined as tonsillar herniation. Of the 609 patients, 88 (14.4%) had tonsillar herniation. Two of the 88 patients who had complicating osseous anomalies were excluded from this study, and the remaining 86 patients with tonsillar herniation were the subject group (TH group). Of the remaining 521 patients without tonsillar herniation, 86 patients whose age and sex matched those of the TH group were selected at random to be in the control group (Non-TH group). The range of motion, sagittal alignment, and the diameter of the intersegmental dura in the cervical spine in the TH group were compared by age with those in the Non-TH group using a roentgenograph or magnetic resonance imaging. Results The range of motion at C1-C2 was significantly smaller in the TH group (5.4°) than in the Non-TH group (8.4°) in patients over 70 years of age. The level of narrowing of the dura diameter at C5/C6 was significantly higher (P = 0.029) in the TH group (23.3%) than in the Non-TH group (13.4%) in patients over 70 years of age. The cervical alignment was similar in both groups for all age groups. Conclusions The existence of tonsillar herniation was associated with loss of range of motion at the upper cervical spine and progression of spondylotic change, especially in elderly patients.     

先天性颈椎管狭窄与脊髓型颈椎病影像学表现以及预后的关系

目的 探讨脊髓型颈椎病(cervical spondylotic myelopathy,CSM)患者先天性颈椎管狭窄(cervical spinal stenosis,CSS)与颈椎MRI改变及预后的关系.方法 回顾性分析自2006年11月至2009年11月,采用前路、后路或前后路联合手术治疗的286例CSM患者的病例资料,根据患者是否存在CSS将患者分为两组,在MRI T2加权像上评价脊髓高信号的等级以及脊髓受压程度.记录患者日本骨科学会评分标准(Japanese Orthopaedic Associatio,JOA)评分、病程和体征,包括感觉减退或者消失、Hoffman征、Babinski征、腱反射.结果 在CSM患者中CSS的发生率为33.6%,先天性CSS组的年龄、JOA评分、病程均大于无CSS组,术后临床改善率小于无CSS组.两组之间性别的差异无统计学意义(x2=0.006,P=1.00),两组之间的颈椎MRI T2加权像脊髓高信号发生率的差异有统计学意义(x2=-62.396,P＜0.001),CSS组脊髓高信号的发生率为70.8%,无CSS组脊髓高信号的发生率为22.6%.先天性CSS组脊髓受压程度相对于无CSS组严重,且先天性CSS组患者体征的数目相对较多.应用多元线性回归分析法得出术后改善率与CSS、病程、临床体征的数目和年龄有关(R2=0.565).结论 先天性CSS患者出现CSM时往往脊髓受压程度较重、MRI T2加权像脊髓内高信号出现的概率大,病程长且预后较差.

Abstract：

Objective To investigate the relationship between the cervical MR images and pathological changes, prognosis in patients with cervical spinal stenosis and cervical spondylotic myelopathy. Methods From Nov. 2006 to Nov. 2009, 286 patients with cervical spondylotic myelopathy were included through retrospective analysis. All patients were divided into two groups according to whether there was cervical stenosis, the grade of increased signal intensity (ISI) in spinal cord and the degree of spinal cord compression was evaluate in T2-weighted MR images of midian sagittal slices. JOA scale, duration of disease,Hoffmann sign, Babinski sign, sensory loss or hypoesthesia, and lower-extremity/upper-extremity hyperreflexia were recorded. Results The incidence rate of cervical spinal stenosis was 33.6% in patients with cervical spondylotic myelopathy. The study showed that the age was smaller (P＜ 0.001 ), preoperative JOA score was higher(P=0.0018), duration of disease was longer(P=0.009), and the recovery rate was lower(P＜ 0.001 )in cervical spinal canal narrowing group comparing with control group. There was no significant difference between the two groups in gender (x2=0.006,P=l.00). There was significant difference between two groups in the incidence of ISI in spinal cord through x2 test(x2=62.396,P＜ 0.001 ). Multivariate analysis indicated that the likelihood of the recovery rate of cervical myelopathy decreased with the presence of cervical spinal stenosis, duration of dieaase, number of neurological signs, age (R2=0.565). Conclusion Patients with congenitally narrow cervical spinal canal have to suffer severe spinal cord compression and high incidence of ISI in spinal cord. The duration of disease is long, and prognosis is poor.     

Cervical spinal canal narrowing and cervical neurological injuries

Cervical spinal canal narrowing can lead to injury of the spinal cord and neurological symptoms including neck pain,headache,weakness and parasthesisas.According to previous and recent clinical researc...     

CT analysis of developmental spinal canal stenosis

The cervical and the lumbar vertebrae were analyzed by computed tomography in two groups. One group consisted of the patients with developmental stenosis of the cervical spine (the smallest AP diameter of the cervical spinal canal in the lateral view of X-ray was less than 12 mm) and the other was the control group (the smallest diameter was more than 14 mm). The canal to body ratio of the cross-sectional area (CBR), the modified Jones' "canal to body ratio" (JNS) and the flat index of the vertebral canal (FI) were measured at C4,C5, C6, L4 and L5. The shape of the vertebral canal of L4 and L5 was classified according to Baddeley. In the stenosis group, CBR and JNS were smaller at every measured level and FI was smaller at C4, C5 and C6 compared with the control group, Trefoil canals were found more frequently in the stenosis group. There was a clear relationship between the developmental stenosis of the cervical and the lumbar spinal canal. On treating patients with cervical spondylotic myelopathy, one should consider the possibility of pan-spinal canal stenosis.     

后路选择性扩大减压、侧块螺钉内固定治疗伴有曲度后凸的多节段颈椎病

 目的 探讨后路选择性扩大减压、侧块螺钉内固定治疗伴有曲度后凸的多节段颈椎病的疗效及并发症预防。方法 2008年1月至2011年1月,采用颈椎后路手术治疗的患者43例,年龄42～74岁,平均59.6岁。手术前后采用日本骨科协会评分(Japanese Orthopaedic Association Scores,JOA)判定神经功能,颈椎功能残障指数量表(neck disability index,NDI)评价颈肩轴性痛程度,Ishihara法测定颈椎曲率指数(cervical curvature index, CI),在MRI上测量脊髓扩大和后移程度。结果 43例患者手术平均减压(3.91±0.86)个节段(3～5个节段)。全部病例平均随访38个月(20～60个月)。术后3～6个月复查时颈椎植骨完全融合。术后JOA评分为(14.31±1.33)分,较术前(8.16±1.11)分有明显改善,临床效果优良率为95.34%。术后CI为15.30%±3.18%,较术前7.36%±9.69%有明显改善。术后颈椎中立位MRI显示最狭窄处硬膜囊前后径为(6.10±0.89) mm较术前(2.92±1.49) mm明显增加,较术前增加了108.9%。颈脊髓平均向后漂移(4.59±1.20) mm(2.97～6.68 mm)。术后NDI评分为(4.90±2.46)分,较术前(19.36±8.61)分有明显改善。随访期间均未出现C5神经根麻痹,无内固定松动、脱出、断裂等并发症发生。结论 后路选择性扩大减压、侧块螺钉内固定术治疗伴有曲度后凸的多节段颈椎病,能有效地改善神经功能,恢复和维持颈椎正常曲度,降低轴性症状和C5神经根麻痹发生率。     

A new minimally invasive posterior approach for the treatment of cervical radiculopathy and myelopathy: surgical technique and preliminary results

Degenerative cervical disorders predominantly lead to anterior spinal cord compression (by bony spurs at the posterior margin of the vertebral body or by degenerated disc), which may be central and/or foraminal. In a smaller percentage of cases, there is encroachment of the canal mainly from posterior by bulging yellow ligaments or bony appositions, resulting in compression syndromes of roots or spinal cord. The aim of this work is to present a minimally invasive posterior approach avoiding detachment of muscles for the treatment of cervical radiculopathy and myelopathy. Thirteen patients suffering from cervical radiculopathy (four patients) or myelopathy (nine patients) were operated according to this technique. In principle, the technique secures access to the diseased spinal segment via a percutaneously placed working channel (11 mm outer diameter and 9 mm inner diameter). The cervical paraspinal muscles are not deflected, but just spread between their fibres by special dilators. All further steps are performed through this channel under control of three-dimensional vision through the operating microscope. The mean follow-up period was 17 months (one patient died 9 months postoperatively), and patients were evaluated using a modified version of the Oswestry Index, called the Neck Disability Index (NDI), and the visual analogue scale (VAS) for neck and arm pain. The mean NDI (P<0.0001) improved from 13.2 (preoperatively) to 4.8 (postoperatively). The VAS for arm pain (P<0.001) and for neck pain (P<0.001) also showed marked postoperative improvement. Complete recovery of the preoperative neurological deficit was found in four patients, while the remaining eight patients showed improvement of the neurological symptoms during the follow-up period. There were no intra-operative or postoperative complications and no re-operation. The preliminary experience with this technique, and the good clinical outcome, seem to promise that this minimally invasive technique is a valid alternative to the conventional open exposure for treatment of lateral disc prolapses, foraminal bony stenosis and central posterior ligamentous stenosis of the cervical spine.     

The natural history of asymptomatic lumbar canal stenosis in patients undergoing surgery for cervical myelopathy

We retrospectively examined the prevalence and natural history of asymptomatic lumbar canal stenosis in patients treated surgically for cervical compressive myelopathy in order to assess the influence of latent lumbar canal stenosis on the recovery after surgery. Of 214?patients who had undergone cervical laminoplasty for cervical myelopathy, we identified 69 (32%) with myelographically documented lumbar canal stenosis. Of these, 28?(13%) patients with symptomatic lumbar canal stenosis underwent simultaneous cervical and lumbar decompression. Of the remaining 41 (19%) patients with asymptomatic lumbar canal stenosis who underwent only cervical surgery, 39 were followed up for ≥ 1 year (mean 4.9 years (1 to 12)) and were included in the analysis (study group). Patients without myelographic evidence of lumbar canal stenosis, who had been followed up for ≥ 1 year after the cervical surgery, served as controls (135 patients; mean follow-up period 6.5 years (1 to 17)). Among the 39 patients with asymptomatic lumbar canal stenosis, seven had lumbar-related leg symptoms after the cervical surgery. Kaplan-Meier analysis showed that 89.6% (95% confidence interval (CI) 75.3 to 96.0) and 76.7% (95% CI 53.7 to 90.3) of the patients with asymptomatic lumbar canal stenosis were free from leg symptoms for three and five years, respectively. There were no significant differences between the study and control groups in the recovery rate measured by the Japanese Orthopaedic Association score or improvement in the Nurick score at one year after surgery or at the final follow-up. These results suggest that latent lumbar canal stenosis does not influence recovery following surgery for cervical myelopathy; moreover, prophylactic lumbar decompression does not appear to be warranted as a routine procedure for coexistent asymptomatic lumbar canal stenosis in patients with cervical myelopathy, when planning cervical surgery.     

Clinical application of a new plate fixation system in open-door laminoplasty

The purpose of this retrospective clinical series was to evaluate the benefits and complications of plate fixation for open-door laminoplasty in cervical spondylotic myelopathy with multilevel spinal stenosis compared with open-door laminoplasty without fixation. Forty-nine patients underwent open-door laminoplasty for cervical myelopathy with multilevel spinal stenosis with at least 13 months of follow-up. A plate was used as the sole method of fixation between the lateral mass and lamina with 3 screws. Computed tomography scans obtained pre- and postoperatively were assessed for plate complications and spinal canal enlargement. Pre- and postoperative neurological condition was assessed by the Japanese Orthopedic Association (JOA) myelopathy score. Overall cervical spine range of motion (ROM) was measured in full flexion and extension radiographs pre- and postoperatively. No restenosis due to door reclosure was noted, and no plates failed. No screws were backed out or broken. Almost all patients showed neurological improvement. The JOA score increased by 3.9±0.7 points in the suture group and 4.3±0.8 points in the plate group (P>.05). The postoperative increase in mean anteroposterior diameter of the spinal canal from C3 to C7 was 4.5±0.6 mm in the suture group and 5.1±0.5 mm in the plate group. The greater mean anteroposterior diameter increase in the plate group was statistically significant (P<.01). The mean cervical ROM decreased in the plate and suture groups postoperatively (P<.001). No significant difference was found in mean cervical ROM reduction between the groups (P>.05). No difference in axial symptoms was found between the 2 groups.     

Cervical myelopathy in patients with congenital cervical block vertebrae

Summary Thirty-two patients with congenital cervical block vertebrae are reviewed. Twenty-nine patients had single level fusion, one had two-level fusion, and the remaining two had multilevel fusion. Eighteen patients had cervical myelopathy; five of these had related trauma and 13 had no history of trauma. The five patients who had cervical myelopathy following trauma underwent magnetic resonance imaging (MRI); three of them had abnormalities in the spinal cord at the segment adjacent to fusion. In all five patients the symptoms and signs were attributed to the segment adjacent to fusion. Myelography, computed tomographic myelography and MRI were performed in 11 of the 13 patients with cervical myelopathy without trauma. In 9 of them maximum compression of the spinal cord was not seen at the segment adjacent to fusion. The major factor contributing to cervical myelopathy was associated spinal canal stenosis. Seven patients with cervical myelopathy without history of trauma were treated surgically, six of whom had spinal canal stenosis treated by enlargement of the spinal canal: subtotal corpectomy and arthrodesis was performed in three, and open-door expansive laminoplasty in three. Anterior interbody arthrodesis was performed in one patient without spinal canal stenosis. All recovered from the myelopathy postoperatively. When a trauma occurs, it concentrates stress at the segment adjacent to fusion, resulting in possible spinal cord injury. On the other hand, when there is no trauma, spinal canal stenosis is the principal factor contributing to cervical myelopathy.     

Roentgenological study of antero-posterior diameter in developmental canal stenosis of cervical spine

Developmental canal stenosis of the cervical spine is an important underlying condition of cervical spondylotic myelopathy. However, the criteria of the degree of narrowing is different among investigators and their rationales are unclear. To clarify this point, the antero-posterior diameter of the cervical spinal canal was measured in groups of normal subjects, patients with neck-shoulder-arm syndrome and cervical spondylosis. The measured values were analyzed statistically. The antero-posterior diameter was the widest in normal individuals and the narrowest in patients with the cervical spondylotic myelopathy. The point of differentiation of developmental canal stenosis was determined as 14 mm for males and 13 mm for females using the mean +/- 2SD of the values in normal subjects. Patients with values lower than this criteria comprised 82% of those with the cervical spondylotic myelopathy. These patients could be further classified into those that also showed clear cervical spondylotic changes and those that did not.     

皮导节段性脊髓诱发电位在脊髓型颈椎病中的应用

本文通过对１０只成兔、 ２０名神经功能正常看、 ３例椎管狭窄症不伴有脊髓功能障碍和 ３０例脊髓型颈椎病者经皮导出的皮导节段性脊髓诱发电位 （ｐｅｒｃｕｔａｎｅｏｕｓ ｓｅｇｍｅｎｔａｌ ｓｐｉｎａｌ ｃｏｒｄ ｅｖｏｋｅｄｐｏｔｅｎｔｉａｌ，ＰＳＳＣＥＰ）进行对比分析研究后，证实了从颈背侧中线皮下导出的Ｐ１、Ｎ１和Ｐ２波不仅能对脊髓型颈椎病做出脊髓功能定位诊断，而且对估计预后和制定正确手术方案都有一定参考和实用价值。     

Clinical studies on the significance of en bloc laminoplasty for cervical compressive myelopathy

The aim of this study was clinical evaluation of en bloc laminoplasty for compressive myelopathy. Subjects were 55 patients with severe myelopathy due to ossification of posterior longitudinal ligament or spinal canal stenosis in the cervical spine. The average age at surgery was 58 years old and average follow-up period 25 months. Stable expansion of the spinal canal was shown and the average extent of the canal enlargement in sagittal diameter was 4.8 +/- 1.8 mm roentgenologically. Symmetrical expansion of the canal, good bony fusion and remodelling of the posterior elements of the spine were observed in CT. No marked malalignment or instability of the cervical spine were found, but limitation of flexion-extension movement was noticed. Neurological recovery was remarkable; 44 patients were rated as excellent or good by Robinson's criteria. The average recovery rate was 76.4 +/- 20.1% according to the evaluation system of Japanese Orthopaedic Association (JOA). En-bloc laminoplasty can accomplish a stable expansion of the canal with adequate decompression of the spinal cord.     

Cervical spinal canal stenosis: the differences between stenosis at the lower cervical and multiple segment levels

The lower cervical segments are commonly the level responsible for cervical spondylotic myelopathy; however, we rarely encounter stenosis at the upper cervical segment in a clinical setting. We assumed that there might be some differences between the pathogenetic mechanisms underlying the development of cervical canal stenosis at different segments. We performed positional MRI in the weight-bearing position for 295 consecutive symptomatic patients. All subjects were classified into four groups (A: normal; B: C3-4 stenosis; C: C5-6 stenosis; D: two-level cervical segments stenosis, stenosis at C3-4 and C5-6). Age, sagittal cervical canal diameter, cervical intervertebral disc degeneration, cervical cord compression, and cervical mobilities were evaluated for each group. Group B showed a narrow cervical spinal canal structure at the C3 to C4 pedicle levels, while groups C and D showed narrow structures at the C4 to C6 pedicle levels in the cervical spine. Additionally, the sagittal cervical canal diameters at all pedicle levels, except C7, in group D were significantly smaller than those observed in group C. We demonstrated the differences in the pathogenetic processes for the development of cervical spinal canal stenosis between C3-4, C5-6, and two-level cervical segments stenosis. Our results suggest that the developmental morphological structure of the cervical spinal canal plays an important role in the development of cervical canal stenosis at different segments. Moreover, individuals with sagittal cervical canal diameters of less than 13 mm may be exposed to an increased risk for future development of cervical spinal canal stenosis at the upper cervical segments following stenosis at the lower cervical segments.     

Treatment of cervical myelopathy in patients with the fibromyalgia syndrome: outcomes and implications

Some patients with fibromyalgia also exhibit the neurological signs of cervical myelopathy. We sought to determine if treatment of cervical myelopathy in patients with fibromyalgia improves the symptoms of fibromyalgia and the patients’ quality of life. A non-randomized, prospective, case control study comparing the outcome of surgical (n = 40) versus non-surgical (n = 31) treatment of cervical myelopathy in patients with fibromyalgia was conducted. Outcomes were compared using SF-36, screening test for somatization, HADS, MMPI-2 scale 1 (Hypochondriasis), and self reported severity of symptoms 1 year after treatment. There was no significant difference in initial clinical presentation or demographic characteristics between the patients treated by surgical decompression and those treated by non-surgical means. There was a striking and statistically significant improvement in all symptoms attributed to the fibromyalgia syndrome in the surgical patients but not in the non-surgical patients at 1 year following the treatment of cervical myelopathy (P ≤ 0.018–0.001, Chi-square or Fisher’s exact test). At the 1 year follow-up, there was a statistically significant improvement in both physical and mental quality of life as measured by the SF-36 score for the surgical group as compared to the non-surgical group (Repeated Measures ANOVA P < 0.01). There was a statistically significant improvement in the scores from Scale 1 of the MMPI-2 and the screening test for somatization disorder, and the anxiety and depression scores exclusively in the surgical patients (Wilcoxon signed rank, P < 0.001). The surgical treatment of cervical myelopathy due to spinal cord or caudal brainstem compression in patients carrying the diagnosis of fibromyalgia can result in a significant improvement in a wide array of symptoms usually attributed to fibromyalgia with attendant measurable improvements in the quality of life. We recommend detailed neurological and neuroradiological evaluation of patients with fibromyalgia in order to exclude compressive cervical myelopathy, a potentially treatable condition.     

Cervical spine stenosis secondary to ossification of the posterior longitudinal ligament

Ossification of the posterior longitudinal ligament (OPLL) is a well-documented cause of cervical spine stenosis and myelopathy among Japanese patients. Reports of OPLL in North Americans are rare. Choices of diagnostic method and treatment for this entity remain controversial. The authors report the results of management of 20 patients in the United States with symptomatic OPLL of the cervical spine. These represented 10% to 20% of patients operated on over the last 3 years for myelopathy secondary to structural spinal compression. Most of these OPLL patients were Caucasian (60%), male (male:female 4:1), and middle-aged (median age 47.5 years). Six had previously undergone laminectomy or discectomy. Cervical roentgenograms and standard myelography occasionally suggested the diagnosis. Axial computerized tomography (CT) metrizamide myelography with small interslice intervals proved invaluable for diagnosis and operative planning. Magnetic resonance imaging was not necessary for diagnosis. Retrovertebral calcification extended over one to five bodies (mean 2.75). The mass ranged in size from 5 to 16 mm in anteroposterior diameter and reduced the residual canal diameter to a mean (+/- standard deviation) caliber of 9.42 +/- 2.41 mm (mean narrowing ratio 0.44 +/- 0.12). Anterior cervical decompression by medial corpectomy and discectomy with fusion uniformly reduced preoperative myelopathy. Complications were limited to transient neurological deterioration in two patients, recurrent laryngeal nerve palsy in one, and halo device pin site infections in two. At a mean postoperative interval of 15 months, improvement was seen in each category of deficit: extremity weakness, hypesthesia, hypertonia, and urinary dysfunction. All fusions produced solid unions. It is concluded that OPLL of the cervical spine is an unexpectedly prevalent cause of myelopathy among patients treated in the United States. Thin-section axial CT metrizamide myelography with small interslice intervals is essential for the investigation of patients who may have OPLL. Anterior decompression and stabilization by medial corpectomy, discectomy, removal of the calcified mass, and fusion is a safe and effective method of treatment.     

颈椎椎管发育性狭窄与脊髓型颈椎病

本文目的探讨脊髓型颈椎病与发育性椎管狭窄在临床发病的关系及其发病因素。报告９６例发育性颈椎管狭窄,发生脊髓型颈椎病。研究结果：发育性颈椎管狭窄是解剖学发育异常,退变后引起椎间盘变性,突出及骨赘形成,并造成脊髓或脊髓血管受压,以脊髓型颈椎病的形式发病。应用前入路直接切除致压物并行植骨融合术,如果椎管后方有致压物,可以有选择地二期施行后路减压。随访优良７５例。     

Cervical spinal stenosis and sports-related cervical cord neurapraxia in children.

STUDY DESIGN: Congenital spinal stenosis has been demonstrated to contribute to cervical cord neurapraxia after cervical spinal cord injury in adult athletes. A sagittal canal diameter <14 mm and/or a Torg ratio (sagittal diameter of the spinal canal: midcervical sagittal vertebral body diameter) of <0.8 are indicative of significant cervical spinal stenosis. Although sports-related cervical spine injuries are common in children, the role of congenital cervical stenosis in the etiology of these injuries remains unclear. OBJECTIVES: The authors measured the sagittal canal diameter and the Torg ratio in children presenting with cervical cord neurapraxia resulting from sports-related cervical spinal cord injuries to determine the presence of congenital spinal stenosis. METHODS: A total of 13 children (9 male, 4 female) presented with cervical cord neurapraxia after a sports-related cervical spinal cord injury. Age ranged from 7 to 15 years (mean +/- SD, 11.5 +/- 2.7 years). The sports involved were football (n = 4), wrestling (n = 2), hockey (n = 2), and soccer, gymnastics, baseball, kickball, and pogosticking (n = 1 each). Lateral cervical spine radiographs were used to determine the sagittal canal diameter and the Torg ratio at C4. RESULTS: The sagittal canal diameter (mean +/- SD, 17.58 +/- 1.63 mm) and the Torg ratio (mean +/- SD, 1.20 +/- 0.24) were normal in all of these children. CONCLUSION: Using the sagittal canal diameter and the Torg ratio as a measurement of congenital spinal stenosis, the authors did not find evidence of congenital cervical spinal stenosis in a group of children with sports-related cervical spinal cord neurapraxia. The occurrence of cervical cord neurapraxia in pediatric patients can be attributed to the mobility of the pediatric spine rather than to congenital cervical spinal stenosis.     

颈椎病伴椎管狭窄手术入路的选择

[目的]探讨颈椎病伴椎管狭窄时的治疗策略及手术入路选择，为颈椎病手术治疗提供有益的经验。[方法]通过收集2002年7月～2003年12月间颈椎病伴椎管狭窄经前路减压术后疗效不佳或症状复发的病例，经分析后再次行后路减压手术治疗并观察其近期疗效；同时随机抽取1985年4月～1992年5月间病情相似而行后路减压的一组病例进行远期疗效随访，对比两组术后疗效。[结果]经前路减压术后脊髓功能（JOA）改善率仅为11．7％，但经后路者为70．3％；而前者经后路减压再手术后脊髓功能改善率可提高至52．8％。[结论]颈椎病伴颈椎管狭窄病例经前路减压术后疗效不佳或症状复发的主要原因在于椎管狭窄因素仍然存在，对上述病例行后路减压再手术治疗后，仍可取得一定的疗效；而最初便经后路减压治疗的此类患者则可取得较显著的远期疗效，提示经后路多节段减压可一期有效地扩大颈椎椎管，从而提高手术治疗颈椎病的疗效。     

发育性颈椎椎管狭窄症

测量５０例颈椎骨干标本，确定男１１ｍｍ，女１０ｍｍ以下为狭窄椎管。１０具成人固定标本观察在最大伸、屈位时，脊髓变短，硬膜褶皱，间盘黄韧带截面矢径变小。统计病人１３例，占同期颈椎病性脊髓病的１８．６％；年龄超过５０岁者１０例，９例病程超过半年。首发症状为进行性下肢麻木无力，颈、胸平面以下不同程度痛觉减退，锥体束征阳性。Ｘ线平片测量、脊髓造影、ＣＴ或ＣＴＭ皆示椎管发育性狭窄。行椎板切除１例，后路椎板扩大成形１２例，除椎板切除１例远期效果欠佳外，余皆有明显改进。作者提出了本症的特征及诊断条件，认为确诊后以单开门椎管扩大成形、棘突骨支撑植骨术为佳。