Oxygen myelography for cervical spinal cord injuries

Summary Oxygen myelographies were performed on 15 patients with cervical spinal cord injuries, in seven of whom narrowing of the spinal cord was caused by a fracture-dislocation. In eight the fracture was of bursting type, and the neurological involvement in these was more severe than in the former type. The main findings in seven early myelograms were swelling of the cord (3/7) and non-visualization of the spinal canal at the injury level (6/7). The main findings in eight late myelograms were narrowing of the cord (5/8) and anterior stretching of the cord over the obstructing bony ridge.     

Metrizamide myelography.

Complete myelography using metrizamide and a lumbar puncture is described with special emphasis on the cervical region. Good visualization of the cervical region was obtained in 19 of 20 patients using 10-12 ml and iodine concentrations of 250 mg/ml without special techniques or precautions. Possible explanations of failure to visualize the complete subarachnoid space are discussed.     

Morphology of the cervical spinal cord on computed myelography

Summary To ensure adequate use of the technique of computed myelography (CM) it is necessary to have an exact picture of the morphology of the normal spinal cord as demonstrated by this technique. This has been obtained by studying the morphology and measuring the frontal and sagittal diameter of the cervical cord in 20 patients. The normal values are presented. The changes of this morphology in one patient with a tumour, one patient with atrophy of the spinal cord and in some patients with congential malformations are also reported.     

Metrizamide compared with iohexol for cervical myelography: a double-blind study

A double-blind comparative study of iohexol and metrizamide for use in cervical myelography through lumbar puncture was carried out in a group of 30 patients. No difference was found in the quality of radiographic examinations of the cervical or lumbar regions nor in the postmyelographic computed tomographic examinations of the cervical spine. The overall incidence of side effects was significantly higher in the metrizamide group (93.4%) than in the iohexol group (40%) (p = 0.002). The differences in incidence of nausea (53% in the metrizamide group compared with 13% in the iohexol group) and vomiting (46.6% with metrizamide, 6.6% with iohexol) were also significant (p = 0.02). Pyramidal signs and seizures occurred only after metrizamide myelography.     

Metrizamide CT myelography in the evaluation of spinal arachnoid diverticula

An example of a symptomatic intradural arachnoid diverticulum is presented. The usefulness of computed tomographic metrizamide myelography in conjunction with conventional positive contrast myelography in the evaluation of such lesions is discussed.     

颈髓挥鞭样损伤的前路手术治疗

目的 探讨颈髓挥鞭样损伤的受伤特征和前路手术治疗效果。方法 对36例影像学证实伴有急性颈椎间盘突出的颈髓挥鞭样损伤患者行颈前路椎体次全切除、自体髂骨植骨加钢板内固定术，并进行随访。随访时间为36-54个月，平均46．4个月。结果该组患者以交通伤为主，颈椎间盘突出发生在C5-6节段和C4，5节段者最多，突出的椎间盘类型以中央型突出者居多，手术有效率为95％（34／36）。结论 对影像学证实颈髓挥鞭样损伤伴急性颈椎间盘突出症患者，颈前路减压植骨加带锁钢板内固定手术是一种良好的选择。     

Morphology and measurements of the cervical spinal cord in computer-assisted myelography

Summary Thirty-six control subjects had computer assisted myelography (CAM) using the EMI CT 5005 scanner. The normal cervical cord is elliptical, more circular at the upper and lower ends and flatter in the mid-segments. Asymptomatic cord deformities, usually mild, were present in nine subjects (25%). Four measurements, namely, sagittal diameter (APD), transverse diameter (TD), area (a) and circumference (c) were made and two more parameters calcultted i.e. APD/TD ratio and circularity (=4 a/c²). These control values form the basis of qualitative and quantitative assessment of cord deformity. When cord measurements are to be used, control values should be obtained for each scanner and procedures should be standardized     

Metrizamide CT myelography in cervical myelopathy and radiculopathy: correlation with conventional myelography and surgical findings

Conventional myelography, metrizamide computed tomographic (CT) myelography, and surgical findings were correlated in 30 patients with cervical radiculopathy and/or myelopathy. In 60% of patients, metrizamide CT myelography provided significant additional information including better characterization of the abnormality, lateralization if the conventional myelogram was indeterminate, more definitive demonstration of cord atrophy, foraminal narrowing not appreciated on myelography, and demonstration of abnormalities distal to a myelographic block. In no case was a myelographic abnormality not detected on metrizamide CT myelography. In patients with cervical myelopathy, a cross-sectional diameter of the cord equaling less than 50% of the subarachnoid space is predictive of poor patient response to surgical intervention.     

Cervical spinal cord injuries in patients with cervical spondylosis

Eighty-eight patients over age 40 with traumatic cervical spinal cord injuries were clinically and radiographically evaluated, and comparison was made with 35 spinal cord injury patients under age 36. While most older patients sustained obvious bony and/or ligamentous damage commensurate with their neurologic findings, 25 (28%) of the 88 patients had no demonstrable bony abnormalities and 17 (20%) of the 88 patients had only minimal evidence of bony injury. Of particular interest are the patients with severe cord injuries, yet no bony abnormalities, who seem to form a distinct subgroup of the cervical spinal cord injury patient on the basis of radiographic and clinical features. Of these 25 patients, 24 (96%) had severe cervical spondylosis. Fourteen (56%) of the 25 patients were injured in falls, five (36%) of these 14 being of a seemingly trivial nature. Of the 42 patients with minimal or no demonstrable bony abnormalities, 33 (79%) were evaluated with plain tomography and no occult fractures or other significant pathology was demonstrated. Pantopaque myelography in 27 (64%) of the 42 cases revealed no extruded disk or other surgical lesion in any patient. In large measure, these injuries can be attributed to cervical spondylosis, which narrows the canal and makes the cord more susceptible to compression by the bulging ligamenta flava during hyperextension.     

Metrizamide myelography and postmyelographic computed tomography: comparative adequacy in the cervical spine

Metrizamide myelography and postmyelographic computed tomography (CT) were evaluated for relative efficacy when correlated with operative findings in a series of 30 patients. Fifty-seven levels were operated on in the 30 patients with 27 patients diagnosed as having diffuse cervical stenosis, hyperostotic spondylosis, or herniated nucleus pulposus. Metrizamide myelography and CT metrizamide myelography were equally useful in providing preoperative diagnostic information at 44 of 57 levels. Both radiographic techniques agreed with the degree of canal and neural forman stenosis found operatively at more than 80% of levels. This study indicates that either metrizamide myelography or CT myelography alone is sufficient, and that both should be performed only if one fails to answer the clinical question or if syringomyelia or cord tumors are suspected.     

Rugby union injuries to the cervical spine and spinal cord

Injuries to the cervical spine are among the most serious injuries occurring as a result of participation in rugby. Outcomes of such injuries range from complete recovery to death, depending on the degree of spinal cord damage sustained. Much information has been gained regarding the mechanisms and frequency of such injuries, from case reports and case series studies. The most commonly reported mechanism of injury has been hyperflexion of the cervical spine, resulting in fracture dislocation of C4-C5 or C5-C6. Tracking both the trends of incidence of spinal injuries, and the effectiveness of injury prevention initiatives has proved difficult because of a lack of properly conducted epidemiological studies. Within the constraints of the research published to date, it appears that hookers and props have been at disproportionate risk of cervical spine injury, predominantly because of injuries sustained during scrummaging. While the scrum was the phase of play most commonly associated with spinal injuries throughout the 1980s in most rugby playing countries, there has been a trend through the 1990s of an increasing proportion of spinal injuries occurring in the tackle situation. The majority of injuries have occurred early in the season, when grounds tend to be harder, and players are lacking both practice and physical conditioning for the physical contact phases of the sport. A number of injury prevention measures have been launched, including changes to the laws of the game regarding scrummaging, and education programmes aimed at enforcing safe techniques and eliminating illegal play. Calls for case-registers and effective epidemiological studies have been made by researchers and physicians in most countries where rugby is widespread, but it appears to be only recently that definite steps have been made towards this goal. Well-designed epidemiological studies will be able to provide more accurate information about potential risk factors for injury such as age, grade, position, gender and ethnicity. Research into the long-term effects of participation in rugby on the integrity of the spinal column is warranted.     

Metrizamide myelography in conjoined lumbosacral nerve roots

Conjoined lumbosacral nerve roots are a congenital anomaly found at 1% of lumbar disc operations. They are usually present at the L5-S1 level and may or may not be associated with herniated intervertebral discs. Previously it had been thought that the preoperative myelogram was not helpful in diagnosis but using metrizamide myelography the diagnosis should be made more often by observing: (a) an asymmetric subarachnoid space, (b) a common axillary pouch exiting between opposite upper and lower nerve root sheaths, (c) a widened axillary pouch, and (d) two or more individual nerve roots in the axillary pouch.     

下颈椎损伤合并颈脊髓损伤的早期外科治疗

回顾性分析36例下颈椎损伤合并颈脊髓损伤患者行手术治疗的临床资料,根据Allen分型指导手术治疗,其中前路11例,后路8例,前后路联合17例。患者术中无大血管、气管、食道、脊髓意外损伤发生,所有患者切口均I期愈合。术后ASIA分级均有不同程度提高（1～3级）。感觉及运动评分较术前均有明显增加（ P＜0.05）。完善术前检查、明确诊断、采取合理的手术方式、尽早手术及重视综合治疗,是取得良好疗效的关键。     

体育运动致颈椎脊髓损伤的几个问题

随着群众性健身体育运动和竞技体育的广泛开展,因缺乏科学训练和防护措施造成人体伤害时有发生,其中颈椎损伤也比较常见.医务人员包括专业医师,尤其创伤医学工作者对此应该有明确的认识.笔者对体育运动造成颈椎脊髓损伤紧急救治的问题进行探讨.     

CT after myelography in complete spinal cord blocks

In each patient (two meningiomas, two lymphomas, one spine fracture) myelography demonstrated only the lower level of the block, but not enough contrast medium leaked past the block to allow myelographic identification of the upper level. On the contrary, thanks to its high power of contrast resolution, CT immediately after myelography clearly outlined the subarachnoid space both below and above the level of the block. Descending myelography was therefore not necessary. Moreover, CT also revealed associated bone and soft tissue lesions, in two cases, providing a more accurate diagnosis. It is therefore concluded that combined myelography+CT can provide complete diagnosis of spinal blocks and any associated lesions.     

Metrizamide myelography: blood and cerebrospinal fluid response

Cerebrospinal fluid and blood were examined for immunologic factors before and after metrizamide myelography in 13 patients who underwent lumbar myelography and seven patients who underwent thoracic myelography. Clinical symptoms were also recorded. The results were consistent with a toxic reaction to the contrast medium, rather than an immunologic one.