Cervical spinal stenosis with cord neurapraxia and transient quadriplegia

Cervical spinal cord neurapraxia with transient quadriplegia is defined as a distinct clinical entity. The authors identify diminution of the anteroposterior diameter of the spinal canal as the factor that explains the described neurologic picture of the injury. Based on the result of a study of 39,377 athletes, the authors conclude that the prevalence of the injury is high and warrants attention. Given that of the patients interviewed, none recalled prodromal experience of transient motor paresis and none sustained further injury, this injury does not predispose individuals to permanent neurologic injury. No definite recurrence patterns have been established that would warrant the restriction of individuals from further activity. Activity restrictions are called for in the case of individuals with stability or chronic degenerative changes. Individuals with developmental spinal stenosis or spinal stenosis should be treated on an individual basis.     

Cervical spinal stenosis with cord neurapraxia: evaluations and decisions regarding participation in athletics

Cervical spinal cord neurapraxia (CCN) leads to transient episodes ranging from paresthesia to paresis to plegia (complete paralysis), and occurs in athletes with some demonstrable degree of cervical spinal stenosis. Determination of spinal stenosis requires demonstrating a sagittal diameter of the spinal canal less than 14 mm from C4 to C6. Because radiologic techniques vary affecting the accuracy of this measure, a ratio method was developed comparing the spinal canal to the vertebral body width, demonstrating that a ratio of less than 0.8 is indicative of cervical spinal stenosis. Although this has high sensitivity (93%), the low predictive value of 0.2% makes this a poor screening tool for athletic participation. Further complicating the challenge of determining which athletes are at risk for quadriplegia are data showing that athletes who suffered permanent injury did not recall transient episodes of CCN, and conversely none of the athletes with CCN later developed permanent neurologic injury. Nevertheless, 56% of football athletes returning to sport after an episode of CCN experienced a recurrence as determined by survey data. Those with CCN and documented ligamentous instability, magnetic resonance imaging evidence of cord defects or swelling, neurologic symptoms or signs for greater than 36 hours, or more than one recurrence have an absolute contraindication.     

Stingers,cervical cord neurapraxia,and stenosis

The risk of sustaining a stinger, CCN, or a more serious catastrophic injury to the cervical spine increases with increasing stenosis. The RR of a player sustaining a second stinger or CCN increases exponentially when compared with the risk of a player sustaining an initial stinger or CCN. Intravenous steroids have no role in the management of stingers or CCN. Players who remain symptomatic after a stinger, players with persistently abnormal diagnostic studies after a stinger, and any player who experiences a CCN should be excluded from further participation in contact sports.     

Cervical spinal stenosis.

Cervical spinal stenosis occurs at the craniovertebral junction, usually incident to a congenital malformation, or it appears as a developmental defect with diffuse narrowing of the cervical canal. In its acquired form the lesion may be limited to one or two levels, or it may be more extensive and affect three or more segments.     

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.     

Cervical spinal stenosis: determination with vertebral body ratio method

Transient bilateral sensory and motor symptoms after trauma, including complete paralysis, have been identified in patients with cervical spinal stenosis. Radiographs of 23 patient athletes with cervical spinal neurapraxia were used for measurement of the cervical spinal canal. Two methods of measurement were used. In the conventional method, sagittal diameter is measured from the posterior surface of the vertebral body to the nearest point of the corresponding laminar line. In the ratio method, the sagittal diameter of the spinal canal is divided by the sagittal diameter of the corresponding vertebral body. Results indicate the ratio method is reliable for determining cervical spinal stenosis and is independent of technical factor variables.     

Cervical computed tomography in multiple sclerosis with spinal cord involvement.

We present the computed tomography findings in a young man with known multiple sclerosis during an acute phase of recrudescence. An enhancing lesion is demonstrated in the brain with a possibly enhancing focus in the spinal cord.     

Current thinking: Return to play and transient quadriplegia

Athletes that participate in contact and collision sports assume risk of serious injury each time they take the field. For those athletes that have sustained an episode of transient quadriplegia, the decision of whether to return to competition can be a difficult one. Some athletes, realizing how close they may have come to permanent injury, may decide that further participation is not in their best interest. Others may be somewhat undecided, and some may want to return at all costs. As the treating physician, the goal is to identify those athletes who after a single episode of transient quadriplegia are at increased risk for further injury and consequently should discontinue participation in contact sports. Factors that may contribute to that determination include mechanism of injury, prior history of neurologic symptoms or injury, and anatomic features that may predispose to further injury such as disc herniation, fracture, or cervical stenosis.     

Cervical spinal cord injury during cerebral angiography with MRI confirmation: case report

We report the first case of MRI-documented cervical spinal cord injury during cerebral angiography. A 54-year-old woman underwent an angiogram for subarachnoid hemorrhage. Her head was secured in a plastic head-holder. At the end of the procedure, she was found to have a left hemiparesis. MRI revealed high signal in the cervical spinal cord. The etiology may have been mechanical due to patient positioning, or toxic, from contrast medium injection in the vessels feeding the spinal cord, or a combination of both. Received: 9 December 1996 Accepted: 28 May 1997     

Upper cervical spinal cord compression due to bony stenosis of the spinal canal

Compression of the upper cervical spinal cord due to stenosis of the bony spinal canal is infrequent. In the first case reported here, stenosis was due to acquired extensive, unilateral osteophytes centered on the left apophyseal joints of C1–C2 in an elderly professional violinist. In the second case, stenosis was secondary to isolated congenital hypertrophy of the laminae of C1 and C2.     

Central spinal cord lesions in stenosis of the cervical canal

Summary 34 patients suffering from cervical spondylotic myelopathy confirmed by myelography were examined by delayed CT 6–10 h after myelography. Twelve patients showed bilateral intramedullary collections of contrast medium, predominantly cranial to the stenosis. In these patients males predominated, the duration of clinical symptoms lasted longer although their age was lower. There was no correlation to the degree and the extension of the narrowing of the cervical spinal canal. Half of 20 patients undergoing consecutive decompressive surgery showed intramedullary contrast enhancement, and this was shown again by postoperative MRI in eight. The postoperative clinical and neurophysiological results revealed no change in the majority of patients, but three patients showing intramedullary contrast medium deteriorated in neurophysiological outcome, while only one of the patients in whom intramedullary contrast medium was not noticed got worse.     

颈椎椎弓根螺钉内固定治疗无骨折脱位型颈脊髓损伤

目的 总结颈椎椎弓根螺钉固定在治疗无骨折脱位型颈脊髓损伤中的疗效.方法 选择2007年9月-2010年3月收治的21例无骨折脱位型颈脊髓损伤合并发育性颈椎管狭窄的患者,行不稳定节段椎弓根螺钉内固定,再将狭窄节段行单开门椎管扩大成形术,观察并总结其治疗效果.结果 对患者进行1～3年的随访.其中,切口浅部感染2例,经换药痊愈;术后1周出现切口内血肿1例,经止血和引流后治愈;再关门1例,但无症状加重.无螺钉穿破椎弓根;无内固定物断裂、松动和移位.颈椎生理弧度较术前明显纠正,较术毕无明显变化.按改良日本骨科学会(JOA)评分,患者由术前的4～15分提高到9～17分,其中13例恢复率≥80％,6例50％≤恢复率＜80％,2例5％≤恢复率＜50％,平均恢复率为75％.结论 在无骨折脱位型颈脊髓损伤并存在发育性颈椎管狭窄患者的治疗中,采用后路椎弓根螺钉固定不稳定节段,既能避免单开门椎管扩大成形术时脊髓再损伤的风险,又能恢复颈椎的生理弧度,为脊髓向后飘移提供坚实的基础,为脊髓功能的恢复创造良好的条件.     

A case of Proteus syndrome with severe spinal canal stenosis,scoliosis, and thoracic deformity associated with tethered cord

Proteus syndrome is a rare, sporadic, hamartomatous disorder manifesting with multifocal overgrowth of tissue. The features seem to develop most often during childhood. Vertebral overgrowth with severe spinal canal stenosis is unusual, although scoliosis with abnormal vertebral bodies is one of the typical features of Proteus syndrome. We report a case of Proteus syndrome with severe spinal canal stenosis, scoliosis, cervical kyphosis, and thoracic deformity with airway obstruction because of asymmetrical overgrowth of vertebrae and ribs associated with a tethered cord, lipomas, strawberry hemangioma, flat nasal bridge, and bilateral hypoplasty of the first metatarsal bones with hyperplasty of soft tissue.     

Lumbar spinal stenosis

Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal with cord or nerve root impingement resulting in radiculopathy or pseudoclaudication. It is a common diagnosis that is occurring with increased frequency in sports medicine clinics. Symptoms include radicular pain, numbness, tingling, and weakness. Peripheral vascular disease presents similarly and must be considered in the differential diagnosis. Imaging for LSS usually begins with plain radiographs, but often requires additional testing with MRI or CT myelography. There are currently limited controlled data regarding both conservative and surgical treatment of LSS. Most physicians agree that mild disease should be treated conservatively with medications, physical therapy, and epidural steroid injections. Severe disease appears to be best treated surgically; laminectomy continues to be the gold standard treatment.