Cervical Stenosis and Myelopathy
M. J. Rosner
Spinal Canal (16,22,24,36,39,43,45,46,57,59,64,72,81,85,88)
C1 22 mm (20 - 26 mm)
C2 20 mm (18 - 23 mm)
C3-7 18 mm (14 - 22 mm)
Sagittal Cord (24,29,46,56,72)
C1 10.4 mm (7-11 mm)
C2
9 mm (7-10 mm)
C3-7 8.5 mm (6-9 mm)
Transverse Cord
10-14 mm (24,29,39,43,72,81,88)
A-P Compression Ratio (29,34,88,88)
About 0.6 in mid-cervical levels
Increases to about .8-.9 at C1
Spinal Cord Area (24,43,72,88,89)
(24,43,88)Reserve subarachnoid space (12,36)
Vertebral Canal:Vertebral body ratio (22,39)
< 0.9 defines congenital stenosis (55)
Cord:Canal ratio (22)
Neurologic Deficit
Degree of deficit poorly relates to radiographic change (30,57)
Cord area 30-44 mm2 correlated with poor outcome (17)
Cord increases with improvement (47)
Canal of about 12 mm is probably associated with symptoms (53)
Canal of about 15-16 mm usually asymptomatic (53)
Etiology of deficit
Vascular (2,5,5,14,14,15,15,20,20,30,30,57,64,64)
Venous compression (57)
Arterial compression (49,57)
Anterior spinal artery
Arterial fibrosis (5,49)
Vertebral artery (37,41,41,64,71,71,78,78)
Connective tissue (57)
Dural-arachnoid adhesions (14,15,20,80)
Pia-arachnoid adhesions (14,15,20,57,80)
Arachnoid
Denticulate ligaments (11,37,57)
Annulus fibrosis (44,58)
Mechanical (2,45,57,64)
Canal diameter (see above)
Cord area
A-P compression ratio
Hyperextension (see below)
Cervical Extension (2,3,7,13,19,25,33,38,48,53,57,58,62,64,64,65,70,79,83)
Narrows A-P canal by 2-3 mm
Vertebra and lamina approximate
Posterior longitudinal ligament redundant (1,57,70,79)
Ligamentum flavum redundant and infolds (1-3,19,57,64,70,79)
All ligaments hypertrophy with age
Cord shortens by 2.5 cm from flexion to extension (1,40,43)
Clinical Relevance
Central cord syndrome (7,70)
Myelographic block in prone position (1,38)
SCIWORA (3,7,23,32,60,61)
Neuropraxia, commotio spinalis (69,82,83)
“Stinger”
Common Occurrence
Motor Vehicle Crashes
Falls & other trauma
All concussions
Anesthesia (1,28)
Myelography (38,38,57)
Surgical & Dental procedures (1,28,76)
Occupations: Painting, other
Congenital Cervical Stenosis: Does cord respond to decompression?
Congenital Cervical Stenosis
Compression is symmetric
Appears normal to eyeball
Measurements define Stenosis & small cord
Cord expands when decompressed (67)
Basic Rule of Spinal Cord: Lesion may be at, or anywhere above, the lowest level of clinical
involvement by exam. Symptoms and signs may vary spatially and temporally and include:
(4,6,44,47,51,73)
Pain
Motor
Sensory
Reflex
Autonomic
Pain
May or may not be present (1,8,58,73)
Axial Pain
Head/face (44)
Atypical facial pain (44)
Cluster Headaches (44)
Neck pain
70% localize to neck (1,47,90)
May be pain free (45)
Interscapular pain (2787}
Thoracolumbar (44,45,47,52,58,63,73)
Flank/iliac crest (58)
‘Spinal’ pain usually local and due to soft tissue involvement (58)
Appendicular (42,44,47,66)
Upper Extremity (47)
Lower Extremity (44,45,47,52,58,63,73)
Buttock (45)
Thigh (45)
Calves (58)
Ankles (58)
Burning, aching, dysesthetic, electric (1,8,44,45,58,73,82)
Feeling of ‘tightness’ of feet, legs or hands (45)
Lhermitte’s (1,44,45,51,58,63,73)
Associated with tenderness to local palpation
Interscapular (45)
Radiculopathy (44,58)
Usually superficial (44)
Usually dermatomal (44)
Primarily unilateral (44)
Myelopathic (8,35,44)
May be asymmetrical (35)
Often worse with exertion (44)
Worse at night (44,45)
Burning (44,45)
Usually bilateral (44,45,58)
Feeling of ‘tightness’ (45)
Feeling of ‘stiffness’ (58)
Legs about to ‘collapse’ (45,58)
Mechanical Back signs usually absent (44,45)
Feeling of ‘coldness’ of limb—hands or feet (58)
Chest/cardiac (1,44)
Motor
Normal Exam (45)
Numb, clumsy hands (51,73,90)
Intrinsic atrophy (47,73,75,87,90)
C8, T1 ‘Radiculopathy’ by EMG (75)
CTS (73)
Arm--Leg--Leg—arm progression (46)
Hip girdle weakness (1,44,45,73,90)
Foot drop(s)
Any spinal cord syndrome (47,51)
Stiffness, spasticity (58,73)
Drop attacks (58)
Sensory (47)
Normal Exam (44,45)
Any modality
Pin, touch, temperature (1,73)
Proprioception, vibration (73)
May include face (44)
May be dissociated (2704,2696}
Usually bilateral (73)
Usually asymmetrical (73,90)
Often non-dermatomal (90)
Stocking-glove (73,90)
Non-cervical sensory level (73)
Peripheral neuropathy
IQ test
Reflexes
Usually increased (1,47)
May be hypoactive (44)
Combination (44)
May be normal (44,45,73)
Inverted reflexes (1)
Babinski about 50% (47,73)
Hoffman about 15% (21,47,73)
Autonomic Changes (1,6,44,50,86)
Facial (44)
Flushing (44)
Lacrimation (44)
Sweating (44)
Pupillary change (44)
Bladder >10-50% (47,58,74)
Incontinence unusual (6)
Frequency, nocturia common (58)
Hesitancy occasional (1,58)
Bowel (58)
May be precipitous (58)
Retention/constipation (58)
Sympathetic: Frequent
Horner’s
Raynaud’s phenomenon
RSD
Mimics (1,44,44,51,90)
Carpal Tunnel Syndrome (73)
Cluster Headaches (44)
Multiple Sclerosis
Guillian-Barre
Axonal neuropathy
Post-polio syndrome
Brachial Plexitis
Syringomyelia (81)
CFS-CFIDS/Fibromyalgia
Many others
Synergistic
‘Double crush’ (84)
CTS, Ulnar palsy (73)
Peripheral neuropathy
Normal pressure hydrocephalus
Neoplasia
Vertebral atheroma (44)
Vertebral Insufficiency (44)
MS, others
Diagnosis: Often difficult (44,45)
Slowly, variably progressive (73)
Symptoms attributed to other conditions:
‘…my prostate.’
‘...since my babies.’
‘...my arthritis.’
No single syndrome
Non-quantitative radiology
Red Flag
Onset after surgery, trauma, hyperextension of neck
Hx CTS, ACF other spinal surgery with little change
Prior history of neck or upper extremity numbness, paralysis
Hx of brachial plexitis
Numb, clumsy hands
Hip girdle weakness
Feet burn, other sx at night
Urinary frequency, urgency, nocturia with above
Diagnosis
History, Physical (44,45)
MR: Static, dynamic, quantitative
Plain films
CT/myelogram
Electrical: best for concomitant disease
Hyperextension associated with onset (21)
Suspicious but open mind
Conservative Treatment
Symptomatic
Try to identify hyperextension or flexion & limit neck movement (?collar)
PT: Posture
Posterior neck/shoulder girdle
Abdominal musculature
Balance
Surgical Treatment
Adequate decompression (77)
Posterior Cervical Laminectomy (18,26,27,31,77)
Expansile laminoplasty (54)
Anterior Cervical Fusion(s)
Multilevel Corpectomy (68)
Cervical lordosis key (9,10)
May require combination above
May have to consider posterior fossa
Conclusion: The narrow spinal canal is capable of compromising any or all spinal cord function(s)
to virtually any degree and any combination and, rarely, in near isolation. Because of the dynamic
changes of the spinal canal with movement and other events, the compromise may be variable
producing intermittent, variable symptoms and signs
Reference List
1. Adams RD, Victor M: Principles of Neurology. New York, McGraw-Hill, Inc.:1100-1103, 1993
Reference ID: 2207
Notes: Interesting discussion of myelopathy and related cord compression sx
2. al-Mefty O, Harkey HL, Marawi I, Haines DE, Peeler DF, Wilner HI, Smith RR, Holaday HR,
Haining JL, Russell WF, Harrison B, Middleton TH: Experimental chronic compressive
cervical myelopathy. J Neuosurgery 79:550-561, 1993
Reference ID: 2619
Notes: Hyperextension is prominent in pathophysiology--chronic ischemia central to the
effects of chronic cord compression--symptoms in dogs came on months after initiation of
cord compression
3. Alexander E, Davis CH, Field CH: Hyperextension injuries of the cervical spine. Arch Neurol &
Psychiat 79:146-150, 1958
Reference ID: 2634
Notes: cord injuries with hyperextension have congenital cervical stenosis present-ligamentum flavum infolds and further narrows canal
4. Allen CD: Neurology of cervical spondylotic myelopathy, in Saunders RL, Bernini PM (eds):
Cervical Spondylotic Myelopathy. Boston, Blackwell Scientific Publications:29-47, 1992
Reference ID: 2163
5. Bailey AA: Changes with age in spinal cord. Arch Neurol & Psychiat 70:299-309, 1953
Reference ID: 2627
Notes: Arteries thicken and fibrose with aging--may form the substrate for symptoms,
permanent ischemia
6. Ball PA, Saunders RL: Subjective Myelopathy, in Saunders RL, Bernini PM (eds): Cervical
Spondylotic Myelopathy. Boston, Blackwell Scientific Publications:48-55, 1992
Reference ID: 2124
7. Barnes R: Paraplegia in cervical spine injuries. J Bone & Joint Surg 30:234-244, 1948
Reference ID: 2638
Notes: described 6 patients with hyperextension cord injury without fracture--probably the
first--5 died--SCIWORA
8. Barnett GH, Hardy RW, Jr., Little JR, Bay JW, Sypert GW: Thoracic spinal canal stenosis. J
Neurosurg. 66:338-344, 1987
Reference ID: 2232
Notes: Hypertrophy of the posterior spinal elements leading to compromise of the spinal
canal and its neural elements is a well- recognized pathological entity affecting the lumbar
or cervical spine. Such stenosis of the thoracic spine in the absence of a generalized
rheumatological, metabolic, or orthopedic disorder, or a history of trauma is generally
considered to be rare. Over a 2-year period the authors have treated six cases of thoracic
myelopathy associated with thoracic canal stenosis. In four patients the deficits developed
gradually and painlessly. The three older patients had a clinical profile characterized by
complaints of pseudoclaudication, spastic lower limbs, and evidence of posterior column
dysfunction. Two patients were younger adults with low thoracic myelopathy associated
with local back pain after minor trauma. Both patients also had congenital narrowing of the
thoracic spinal canal. Oil and metrizamide contrast myelography in the prone position were
of limited value in diagnosing this condition; in fact, myelography may be misleading and
result in erroneous diagnosis of thoracic disc protrusion, when the principal problem is
dorsal and lateral compression from hypertrophied facets. Magnetic resonance imaging and
computerized tomography sector scanning were more useful in the diagnosis of this disorder
than was myelography. Thoracic canal stenosis may be more common than is currently
recognized and account for a portion of the failures in anterior and lateral decompression of
thoracic disc herniations
9. Batzdorf U: Considerations of surgical curvature in planning surgery for cervical spondylosis. Jpn J
Neurosurg (Tokyo) 4:85-91, 1995
Reference ID: 2161
10. Batzdorf U, Batzdorf A: Analysis of cervical spine curvature in patients with cervical spondylosis.
Neurosurgery 22:827-836, 1988
Reference ID: 2160
11. Bedford PD, Bosanquet FD, Russel WR: Degeneration of spinal cord associated with cervical
spondylosis. Lancet 2:55-58, 1952
Reference ID: 2632
Notes: Described histologically thickened dentate ligaments in areas of cord compression
and damage and opined that they were involved and contributd to cord damage--described
marked degeneration oof the cord in association with 'fixation' by spurs and thickened
dentate ligaments and hypothesized that the relative inability of the cord to adjust to the
moving neck might potentiate/cause this damage
12. Bhaskar KR, Brown R, O'Sullivan DD, Melia S, Duggan M, Reid L: Bronchial mucus hypersecretion
in acute quadriplegia. Macromolecular yields and glycoconjugate composition. Am
Rev.Respir.Dis. 143:640-648, 1991
Reference ID: 2613
Notes: In acute quadriplegia we have noted that about one in five patients develops
unexplained production of markedly excessive and tenacious bronchial mucus. Spontaneous
recovery from mucus hypersecretion usually occurs within weeks to months. Mucus samples
collected from 12 patients have been found to be abnormal. Macromolecular contents of
single aspirates yielded as much as 500 mg. Analytical ultracentrifuge analysis showed the
mucus to contain considerable epithelial glycoprotein (GP) of typical buoyant density; its
amino acid and carbohydrate compositions were characteristic of the GP from
hypersecretory bronchial mucus such as in chronic bronchitis and cystic fibrosis. In five
patients studied after recovery from hypersecretion, there tended to be relatively less GP.
The mucus samples contained a high density glycoconjugate (GC): this had sugars of GP
but also reacted positively with a monoclonal antibody to keratan sulfate. Its amino acid
composition was different from that of GP: threonine was lower and glycine was higher than
in GP. In mucus from one patient who died, chondroitin sulfate ABC and hyaluronic acid
were identified as well. This suggests proteoglycans are involved in the pathophysiology of
mucus hypersecretion. The sudden onset and spontaneous recovery of hypersecretion
suggests that it is not due to gland hypertrophy. We speculate that in acute quadriplegia it is
due to disturbed neuronal control of bronchial mucus gland secretion, perhaps related to
initial disappearance and later reappearance of peripheral sympathetic nervous system tone
13. Bohlman HH: Cervical spondylosis with moderate to severe myelopathy. A report of seventeen
cases treated by Robinson anterior cervical discectomy and fusion. Spine 2:151-162, 1977
Reference ID: 2145
Notes: Described infolding of the posterior longitudinal ligament in cervical extension and
role in 'pinching/compression' of the spinal cord in myelopathy
14. Bradshaw P: Some aspects of cervical spondylosis. Quart J Med 26:177-208, 1957
Reference ID: 2625
Notes: Cervical cord supplied by 2-3 unpaired radicular arteries; 17/78 patients with
cervical spondylosis and cord compression had radiating or burning pain in one or both legs
15. Brain WR, Northfield D, Wilkinson M: The neurological manifestations of cervical spondylosis.
Brain 75:187-225, 1952
Reference ID: 2622
Notes: Vascular factors discussed--8 patients had symptoms precipitated by trauma with 2
deaths
16. Burrows EH: The sagittal diameter of the spinal canal in cervical spondylosis. Clinical Radiology
14:77-86, 1963
Reference ID: 2209
Notes: Mean canal C1--22.9, C2--20.3, C3--18.5, C4--17.7, C5--17.7, C6--17.5, C7--17.3
mm--provide frequency of each measurement--noted that in 24 spondylotics treated with
surgery the median canal diameter was at or above the lower 5% of the canal measurements-also discussed role of ligamentum flavum, and its hypertrophy, osteophytes, etc.--examined
multiple casesof injuries and other presentations with/without clinical signs: concluded that
the difference between those with/without sign-symptoms was the developmental diameter
of the canal--they concluded that normal cord was 10 mm at C1 and 9mm at C7 and felt
10mm was good rule of thumb for normal cord size (did this with air tomography)-17. Casey ATH, Crockard HA, Bland JM, Stevens J, Moskovich R, Ransford AO: Predictors of outcome
in the quadriparetic nonambulatory myelopathic patients with rheumatoid arthritis: a
prospective study of 55 surgically treated Ranawat Class IIIb patients. J Neurosurg
85:574-581, 1996
Reference ID: 2620
Notes: Major predictor or poor outcome was cord area <44 mm2--argued for earlier
decompression before atrophy became severe
18. Casotto A, Buoncristiani P: Posterior approach in cervical spondylotic myeloradiculopathy. Acta
Neurochir.(Wien). 57:275-285, 1981
Reference ID: 2241
Notes: Clinical and radiological data are reported concerning 44 patients suffering from
cervical spondylotic myeloradiculopathy, and operated by the posterior approach; late
results are evaluated. Type of onset, signs and symptoms are specified. Myeloradicular
involvement was present in 52% of cases, medullary in 41%, radicular in 7%. Congenital
stenosis was present in 68% of patients. Laminectomy was performed at 2-3 levels in 4
cases, at 4 levels in 10 cases, at 5 levels in 14, and extended to 6 or more levels in 16
patients. Posterior foraminotomy was performed 28 times. At follow-up evaluation (6
months to 8 years) results were "excellent good" in 46% of cases, "fair" in 34%,
"unchanged" in 9%, and "worse" in 11%. First symptoms appeared more than 2 years before
surgical treatment in 22 patients, between 2 years and 6 months in 15, and less than 6
months before in 7 patients. In this study a statistically significant inverse relation is
demonstrated between: 1. results and duration of the disease, 2. results and gravity of motor
deficits
19. Clarke E, Little JH: Cervical myelopathy; a contribution to its pathogenesis. Neurology 5:861-867,
1955
Reference ID: 2637
Notes: hyperextension and infolding of the ligamentum flavum contribute to the cord
compression of spondylosis1
20. Clarke E, Robinson PK: Cervical myelopathy: a complication of cervical spondylosis. Brain
79:483-510, 1956
Reference ID: 2623
Notes: Vascular factors emphasized--trauma precipitated injury to cord in previously
asymptomatic patients-21. Denno JJ, Meadows GR: Early diagnosis of cervical spondylotic myelopathy. A useful clinical sign.
Spine. 16:1353-1355, 1991
Reference ID: 2219
Notes: This is a retrospective study of 67 patients, seen during a 4- year period, with
cervical pathology requiring surgical correction. The purpose of this study was to evaluate
the usefulness of a new physical finding (dynamic Hoffmann's sign) in diagnosing early
cervical myelopathy or in suggesting a narrow cervical canal clinically. Hoffman's sign was
checked with the head in neutral (static) and during multiple active full flexion to extension
as tolerated by the patient (dynamic). Forty patients had negative Hoffman's signs, 20 had
positive static Hoffman's signs, and 7 had positive dynamic Hoffman's signs. Canal
measurements were made on eight randomly selected negative patients on both plain films
and myelographic studies, and on the seven positive patients. A positive dynamic
Hoffmann's sign was consistent with a narrow sagittal diameter of the cervical canal, and
aided clinically in making the diagnosis of early cervical spondylotic myelopathy or
congenital cervical narrowing
22. Di Chiro G, Fisher RI: Contrast radiography of the spinal cord. Arch Neurol 11:125-143, 1964
Reference ID: 2695
Notes: use oil/pantopaque to measure cord--measurements very similar to ours and
sherman's--clearly shows that the AP cord linearly decreases in size from C1 inferiorly-others have commented upon the same--used post-mortem material--felt formalin would
tend to decrease the sagittal diameter especially--in particular, did detailed study of the ratio
of the SAS and cord--for sagittal and transverse planes: cervical varied froom .7 in mid
region to .67--.59 below and above: transverse was .59 decreasing to .55 (page 132)
23. Dickman CA, Zabramski JM, Hadley MN, et al: Pediatric spinal cord injury without radiographic
abnormalities: report of 26 cases and review of the literature. J Spinal Disord 4:296-305,
1991
Reference ID: 695
24. Elliott HC: Cross-sectional diameters and areas of human spinal cord. Anat Rec 93:287-293, 1945
Reference ID: 2689
Notes: used autopsy material, found that cord shrinkage do to formalin of different strengths
was about .5 mm--used cross product x .78 to calculate area but doesn't mention this in
methods--at C5,6AP=7.9,7.7,7.5,7.8 with overall means of four series=7.7-transverse=13.4,13.2,13.0,13.4 and overall=13.2mm--also had thoracic values at smallest
level (T6) and lumbar at largest (L5)--did not control for spondylosis except to say the
patients did not suffer from neurological disease
25. Epstein JA, Carras R, Hyman RA, Costa S: Cervical myelopathy caused by developmental stenosis
of the spinal canal. J Neurosurg 51:362-367, 1979
Reference ID: 2149
Notes: cases of myelopathy (33% post hyperextension injury, others spontaneous) all with
canal AP diameter < 14 mm--all treated with laminectomy and generally good results--lams
were C1-7, 2-7,3-7, etc.--onset of sc was hrs post extension injury--very asymmetric
findings--burning dysesthetic pain descibed--others with onset of numbness in thighs, hyperreflexia in UEs, but not LEs--plain XR findings were of spinolaminar line nearly adjacent to
the neural arch, poor development of the neural, etc.-26. Fager CA: Management of cervical disc lesions and spondylosis by posterior approaches.
Clin.Neurosurg. 24:488-507, 1977
Reference ID: 2117
27. Fager CA: Posterior surgical tactics for the neurological syndromes of cervical disc and spondylotic
lesions. Clin.Neurosurg. 25:218-244, 1978
Reference ID: 2118
28. Fender FA: A new hazard of cervical laminectomy. JAMA 149:227-228, 1952
Reference ID: 2641
Notes: Warned of neck extension during endotracheal intubation
29. Fujiwara K, Yonenobu K, Ebara S, Yamashita K, Ono K: The prognosis of surgery for cervical
compression myelopathy: An analysis of factors involved. J Bone Joint Surg 71-B:393398, 1989
Reference ID: 2146
Notes: Very poor results related to the number of levels involved, AP compression ratio
correlated poorly with outcome--recovery better when cord area > 30 mm2--however, all
correlations were poor (r=.38 for CSM to .63 for OPLL)--Cord area, age, pre-op exam and
multiple levels all had relation to post-op exam and recovery rate--other variables more
difficult--with greater multiplicity of levels involved, the transverse area decreased implying
cummulative effects of compression upon the cord
30. Girard PF, Garde A, Devic M: Contribution a l'etude anatomique des manifestation medullaires
observees au cours des discarthroses. Rev Neurol 90:481954
Reference ID: 2624
Notes: described ischemic change in cord without overt cord compression
31. Gonzalez-Feria L: The effect of surgical immobilization after laminectomy in the treatment of
advanced cases of cervical spondylotic myelopathy. Acta Neurochir.(Wien). 31:185-193,
1975
Reference ID: 2248
Notes: Surgical immobilization of the cervical spine after laminectomy is proposed for the
treatment of severe cervical spondylotic myelopathy (CSM) occurring with diffuse stenosis
of the spinal canal (congenital or acquired). In 20 consecutive patients showing advanced
CSM and cord compression at various levels, a laminectomy with posterior fixation was
made, in most cases with the aid of a metal plate. In the evaluation of the severity of the
myelopathy a slight modification of the Nurick scale was used. With the exception of three
patients who developed complications unrelated to the technique, the results were very good
as demonstrated by the long lasting improvement in the performance of the patients. The
results emphasize the role which mechanical factors may play both, in the genesis of the
disease and in the failures of the plain laminectomy
32. Grabb PA, Pang D: Magnetic resonance imaging in the evaluation of spinal cord injury without
radiographic abnormality in children. Neurosurgery 35:406-14; discussion 414, 1994
Reference ID: 2128
Notes: Seven children aged birth to 17 years with spinal cord injury without radiographic
abnormality (SCIWORA) were studied with magnetic resonance imaging (MRI) between 3
hours and 16 days after the injury. There were six cervical cord injuries and one thoracic
cord injury. The MRI findings were divided into two groups: extraneural and neural. The
extraneural findings included one case of anterior longitudinal ligament disruption and
anterior C6-C7 disc herniation associated with hyperextension; one case of posterior
longitudinal ligament disruption and C2-C3 disc herniation associated with lateral flexion;
and one case of C6-C7 disc abnormality consistent with increased water content occurring
with hyperflexion. These ligament and disc injuries did not correlate with late instability.
The neural MRI findings included one case of cord transection with rostral cord stump
hemorrhage and one case of hemorrhage involving the majority of the cord's transverse
diameter, both associated with permanent complete cord injuries; one case of hemorrhage
involving a minor portion of the cord and of the brain stem's transverse diameter associated
with a severe partial cord injury but subsequent incomplete improvement; one case of
edema without hemorrhage associated with Brown-Sequard syndrome and subsequent
incomplete improvement; and three cases of normal cord signal and outline. Two of the
latter patients had mild cord injuries that recovered completely. In the third, a child with
complete T12 sensorimotor paralysis at presentation, the normal MRI findings predicted the
subsequent complete recovery. No extraaxial compressive lesion was demonstrated in these
seven children.(ABSTRACT TRUNCATED AT 250 WORDS)
33. Gruninger W, Gruss P: Stenosis and movement of the cervical spine in cervical myelopathy.
Paraplegia. 20:121-130, 1982
Reference ID: 2240
Notes: The width of the spinal canal in 55 patients with cervical myelopathy was compared
to a control group of 225 patients without myelopathy. There was a statistically significant
narrowing of the cervical canal in the patients with cervical myelopathy, especially in men.
Neck movement in the sagittal plane was studied in pantopaque myelograms in 43 patients
with cervical myelopathy. It was found that retroflexion causes the most severe narrowing of
the spinal canal. Patients with congenital cervical stenosis showed the greatest changes.
Sagittal movement of the cervical spine was measured 1--3 years after the Cloward fusion
operation in 38 patients and compared to a corresponding age group of 33 and a younger
group of 26 healthy controls. The fusion of two or more vertebrae leads to considerable
limitation of sagittal movement of the cervical spine on the average of 23,5 degrees in
comparison with 40,6 degrees in the corresponding age control group. With the increasing
age, anteflexion and retroflexion deteriorate equally, whereas the fusion operation restricts
mainly the retroflexion of the cervical spine. In fact, the therapeutic effect of the Cloward
operation seems to lie in the restriction of movement of the cervical spine
34. Hayashi H, Okada K, Hashimoto J, Tada K, Ueno R: Cervical Spondylotic Myelopathy in the Aged
Patient: A radiographic evaluation of the aging changes in the cervical spine and etiologic
factors of myelopathy. Spine 13:618-625, 1988
Reference ID: 2143
Notes: Discusses AP compression ratio vs severity of myelopathy--demonstrates
hyperextended canal diameter in myelopathic patients to average about 13 mm withnonmyelopaths about 2mm greater--compares with larger "static" diameter of 'neutral' position-compared young vs aged myelopathy patients & found no difference in canal size-difference was in location (aged tended to be higher at c3-4, 4-5) and associated with
degenerative changes (osteophytes & disc bulges)--Iwasaki described AP ratio > 45% as
'normal'--degree of compression did correlated with degree of myelopathy, but
correspondence of clinical findings and maximal compression did not
35. Homes G: Pain of Central Origin: Contributions to Medical and Biological Research
Dedicated to Sir William Osler. New York, Paul B. Hoeber, Inc.:235-246, 1919
Reference ID: 2883
Notes: Found pain to be present only on the relatively intact side of those with BrownSequard following cord injury--felt there might be a partial spinothalamic tract lesion cited
by Langfitt (2787)
36. Jauregui N, Lincoln T, Mubarak S, Garfin S: Surgically related upper cervical spine canal anatomy in
children. Spine. 18:1939-1944, 1993
Reference ID: 2180
Notes: Examined upper cervical (C1) anatomy with MR thru 0-17 years--Adult size cord at
C1--9.4+/-0.5 mm--Space available for cord about 20 mm from age 12 on--'free' space about
10-12 mm from age 12--used T1 (TR 200-1000 ms, TE 20-25 nsec)
Abstract: MRI studies of the upper spines of 121 children were evaluated to precisely
define the sagittal anatomy at C1 in the pediatric population. The diameters of the spinal
cord, bony canal, space available for the cord (SAC), dens+atlanto-dens interval (ADI), and
free space were measured. The results demonstrate an accelerated growth in the C1 canal,
dens + ADI, and SAC during the first four years after birth. Steel's rule of thirds was shown
to roughly hold true throughout childhood. Neonates have an average SAC diameter of 12.4
mm, a value less than the 13 mm dimension commonly used to define relative stenosis in
children
37. Kahn EA: Role of the dentate ligaments in spinal cord compression and the syndrome of lateral
sclerosis. J Neurosurg 4:191-199, 1947
Reference ID: 2631
Notes: Felt that the dentate ligaments held the cord bound anteriorly against compressive
lesions and that these should be sectioned at aurgery
38. Kaplan L, Kennedy F: Effect of head position on manometrics of cerebrospinal fluid in cervical
lesions: new diagnostic test. Brain 73:337-345, 1950
Reference ID: 2639
Notes: manometric block occurs in patients with extension and resolves in flexion--the
block also resolves after cervical decompression-7/12 had complete block in extension but
were normal in neutral position; 2/12 had partial manometric block with
hyperextension;1/12 partially blocked in neutral, and completely in extension; 1/12 blocked
in flexion, but not in extension; 1/12 blocked in rotation + hyperextension--all of these were
associated with extrinsic lesions (ie, spondylosis or disc disease)--6/12 had mild to moderate
60->100mg% protein in CSF--in 6/6 of those undergoing repeat post-op tests, results
returned to normal--Queckenstedt
39. Khilnani MT, Wolf BS: Transverse diamter of cervical spinal cord on pantopaque myelography. J
Neurosurg 20:660-664, 1963
Reference ID: 2692
Notes: Feels measurement important when changes are minor--details difficulties of
measurement: failure to fill with contrast, varying magnification, varying angles during
extension of neck, etc.--notes only those cases where the myelograms were 'normal' were
used to study--also did cervical myelograms for sciatica/low back pain and this was the
source for their 'normal' material--did not correct for magnification--calculated the % of
SAS occupied by cord and found it highly variable: C6=67%, C5=68%, C3=63%,
T1=64%: anything more than 80% or less than 50% should be considered enlargement or
atrophy--max transverse diameter at C5 or C6
40. Koschorek F, Jensen HP, Terwey B: The dynamic evaluation of the cervical spinal canal and spinal
cord by magnetic resonance imaging during movement, in Voth D, Glees P (eds): Diseases
in the Craniocervical Junction. Berlin, De Gruyter:1987
Reference ID: 2710
Notes: Cervical spinal cord in anteflexion is 12.69 (10.3-14.6) cm vs 11.5 (9.4-13.4) cm in
dorsiflextion or hyperextension
41. Kremer M: Sitting, standing and walking: part 2. Brit.M.J. 2:1211958
Reference ID: 2875
Notes: Defines 'drop attack' with cervical spondylosis and hyperextension. notes probably
due to cortical spinal tract compression rather than vertebral artery
42. Ladd AL, Scranton PE: Congenital cervical stenosis presenting as transient quadriplegia in athletes.
Report of two cases. J Bone Joint Surg.[Am]. 68:1371-1374, 1986
Reference ID: 2233
Notes: The cases of two patients in whom complete but transient quadriplegia developed
after an injury that was incurred while playing football are presented. Both patients were
found to have a congenitally narrow cervical vertebral canal. Critical stenosis resulting in
the transient quadriplegia occurred after a presumed injury to a cervical disc. In our opinion,
a myelogram should be made for patients with a history of transient quadriplegia, numbness,
or a burning sensation down the back or the lower extremities, even if other radiographic
studies are interpreted as negative. Patients who have stenosis of the cervical spine should
be advised to discontinue participation in contact sports
43. Lang J: Vertebral canal and its contents. New York, Thieme Medical Publishers:79-81, 1993
Reference ID: 2153
44. Langfitt TW: Cervical spondylosis: the neurological mimic. W.V.Med J 65:97-100, 1969
Reference ID: 2814
Notes: clear discussion of myelopathic pain involving the lower extremities, face,
autonomic dysfunction, angina pectoris with good description of burning pain at night:
some detail about VBI and symptoms--mentions the drop attack of Kremer
45. Langfitt TW, Elliott FA: Pain in the back and legs caused by cervical spinal cord compression.
JAMA 200:382-385, 1967
Reference ID: 2787
Notes: 63 female with low back, lower extremity aching , burning leg pain--history of
parlyzed arm years before without diagnosi s and eventual remission--;47 yo male with fall
onto back of head, interscapular pain and bilateral shoulder, arm pain with later
development of intermittent, diffuse le pain of aching but occassionally sharp nature esp to
thighs--feeling of legs ready to collapse from beneath him--exam listed as normal; treated
with posterior cervical lam, dentate section --leg & back pain resolved; 51 yo burning pain
in soles of both feet, tightness in feet, later legs; slower walk. No spine pain; exam normal;
canal measured less than 14 mm; treated with cervical laminectomy with improvement over
next year to only 'soreness' of soles of feet: Specifically chose these patients because the
neurological exam were normal and laminectomy relieved symptoms--also notes that the
critical measurement is the canal diameter, but goes to lengths to make the point that the
exam and history are more important because of the distortion of the cord with chronic
compression--does recommend conservative trial with collar; references both O'Connell and
Holmes in the possibility that tract pain is a partial lesion of the spinothalamic tract and may
represent a 'central phenomenon' of altered sensory input-46. Lowman RM, Finkelstein A: Air myelography for demonstration of the cervical spinal cord.
Radiology 39:700-706, 1942
Reference ID: 2693
Notes: measured cord during air encephalography--AP dia 8-7.5 mm (minimum) from C1C7--Maximum was 11-9 mm; average was 10-9 mm (note their table misplace the decimal
and actual measures are in cm)--described two cases of intradural tumor
(Hodgkins,angioblastoma) with arm-leg progression similar to that described by Symonds-47. Lundsford LD, Bissonette D, Zorub D: Anterior surgery for cervical disc disease. Part 2. J
Neurosurg 53:12-19, 1980
Reference ID: 2705
Notes: also noted that about 60% had recurrent sxdetailes neurologic findings and their
frequency--spincter distrubance in 50%--leg pain in 13%--arm pain 41%--paraparesis 21%,
quadriparaesis10%, hemiparesis 18%, atrophy 13%, ue weakness 31%, Brown-Sequard
10%--Babinski 54%, Hoffman 13%, hyperreflexia 87%--spasticity 54%--gait disturbance
54%--sensory change 41% sensory level, 39% post column, 33% ue dermatomal, 21%
paresthesiae and 15% with Romberg--did not find influence of age, symptom duration,
severity of deficit, number of levels operated or local canal stenosis on outcome; however,
duration of sx (<6mos vs 6-24 mos, vs >24 mos) had p=.06 which was probably a two-tailed
test and would be significant for one-tailed hypothesis--60% developed recurrent symptoms
and 70% had progressive gait disorder: note that this series was using primarily an anterior
cervical technique--also listed surgical complications--cord diameter increased in most
improving patients, and decreased or did not change in deteriorating patients at the p< .05
level--T2 signal also improved in those clinically improving and tended not to change in
those not improving (p<.05)
48. MacNab I: Cervical Spondylosis. Clin Ortho Related Research 109:69-77, 1975
Reference ID: 2151
Notes: Makes specific note of local 'tenderness' to palpation with root lesions such as the
pectoral and beceps tenderness with C6 disease, etc--differentiates referred pain of shoulder
disease from cervical--good description of pathophysiology
49. Mair WGP, Druckman R: Pathology of spinal cord lesions and their relation to clinical features in
protrusion of cervical intervertebral discs. Brain 76:70-91, 1953
Reference ID: 2621
Notes: defined histological changes consistent with ischemia--anterior spinal artery territory
implicated--vessels with advential fibrosis and wall thickening--some round cell infiltrate
50. Matsunaga S, Sakou T, Imamura T, Morimoto N: Dissociated motor loss in the upper extremities.
Clinical features and pathophysiology. Spine. 18:1964-1967, 1993
Reference ID: 2171
Notes: Dissociated motor loss occurring in the upper extremities with and without lower
extremity myelopathy was evaluated in patients with cervical spondylosis. The presence of
dissociated motor loss without attendant myelopathy was correlated with selected
compression of the anterior nerve root in the lateral spinal canal, close to the intervertebral
foramen. The clinical and radiologic feature differentiating these two dissociative
syndromes were reviewed
51. Mehalic TF, Pezzuli RT, Applebaum BI: Magnetic resonance imaging and cervical spondylotic
myelopathy. Neurosurgery 26:217-227, 1990
Reference ID: 2249
Notes: Patient 1: numbness in hands, gait ataxia--flexor plantars, no hyperreflexia, normal
sensory exam--decompressed from C3-7--little clinical change--pictures of MRI show the
canal to be narrow at C2 and ?C1--Case 3: burning dysesthesias in upper E's, hypertonia,
hyperreflexia, only one extensor plantar--C3-6 lam with no improvement--development of
bright signal about c5--pictures show the C2 canal and probably C1 to be nearly as narrow
as the lower levels. Case 7: weak left grip, iliopsoas, hypertonia left leg, symmetric
reflexes no comment about plantar reflexes--cord signal improved--similar findings in other
cases--used a 0-4+ scale to grade cord signal changes--felt that cord signal changes
correlated with improvement or its lack--used much more limited lamininectomyin most
patients-52. Middleton GS, Teacher JH: Injury of the spinal cord due to rupture of an intervertebral disc during
muscular effort. Glasgow Med J 76:1-6, 1911
Reference ID: 2878
Notes: describe an individual with rupture of a lower thoracic disc presenting withsevere
back and leg (both) pain followed by paraplegia
53. Murone I: The importance of the sagittal diameters of the cervical spinal canal in relation to
spondylosis and myelopathy. J Bone Joint Surg 56B:30-36, 1974
Reference ID: 2150
Notes: Hyperextension narrows spinal canal about 2-3 mm--also notes that cord
compression may occur when canal is between 11-12 mm in neutral position--average
diameter not associated with compression was 16.5m at C4-7--Japanese have canals which
are about 2.25 mm less than Europeans-54. Nakano N, Nakano T: Clinical results following enlargement of the cervical spinal canal by means of
laminoplasty. Nippon.Seikeigeka.Gakkai.Zasshi. 62:1139-1147, 1988
Reference ID: 2227
Notes: Since 1978, cervical spinal canal laminoplasty has been performed on 75 patients in
our hospital with cervical radiculomyelopathy and followed with studies of from 6 months
to 8 years (average 4 years and 6 months). Overall results: the pre- operative score, using
the Japanese Orthopaedic Association Scoring System, was 7.4 and the post-operative score
was 15.2; the improvement was 81.0%. In congenital spinal stenosis, the average preoperative score was 6.3 while the post-operative score was 14.2; the improvement was
66.9%. The pre-operative score of multiple disc lesions was 7.9 and the post-operative score
was 15.2; the improvement was 82.8%. And the pre-operative score of OPLL was 7.3 and
the post-operative score was 15.3; the improvement was 81.9%. Improvement may be due
not only to the degree of enlargement of the spinal canal, but also to improvement in the
circulation within the spinal cord and nerve roots. No case worsened after the surgery
55. Nakstad P: Myelographic findings in cervical spines without degenerative changes. Special reference
to sagittal diameter of the dural sac. Neuroradiology. 29:256-258, 1987
Reference ID: 2231
Notes: One hundred cervical myelographies in patients without degenerative changes on
plain radiographs were evaluated. Pathologic changes were seen in 75 patients, most of
them with congenital spinal canal stenosis and dural sac stenosis. Normal values for sagittal
diameter of the dural sac from C2 to C6 were established. It was found that a quotient less
than 0.9 between the sagittal diameter of the spinal canal and the midsagittal diameter of the
vertebral body indicated congenital stenosis. It is concluded that plain radiographs of the
cervical spine are unreliable in predicting the diagnostic value of cervical myelography
56. Nordquist L: The sagittal diameter of the spinal cord and subarachnoid space in different age groups.
(A roentgenographic post-mortem study). Acta Radiol 227 (Suppl):1-96, 1964
Reference ID: 2690
57. Nugent GR: Clinicopathologic correlations in cervical spondylosis. Neurology 9:273-281, 1959
Reference ID: 2618
Notes: Found average AP dia of canal to be 14.7 mm--AP distance at level of osteophyte
was 10.9 mm--reviewed other work with canal size defined--Symonds mentioned cord
injury during dental work as did Fender during anesthesia--Nugent clearly defines
hypertrophic ligamentum flavum and its role in cervical extension and feels it is
underestimated--good historical description of vascular and connective tissue involvement
with symptoms--points out that the symptoms have little if any relation to the degree of
radiologic change--describes vessels transitting the subarachnoid space to supply cord
which he referred to as aberrant or abnormal but which may contribute to cord supply when
other vascular factors fail--descibes thickening of pia-arachnoid as a degenerative rather
than inflammatory process with partial obliteration or attenuation of underlying vasculature-notes that equivovcal myelograms should be repeated with the neck in extension, though he
warns of too much extension and cord damage--suggests that infolded ligamentum must be
actively sought on exam of the myelogram--5 of this series became symptomatic after
trauma with three dying after progressive deterioration
58. O'Connell JEA: Involvement of spinal cord by intervertebral disc protrusions. Brit J Surg 43:225247, 1955
Reference ID: 2880
Notes: 50% of patients with cervical spondylosis and myelopathy had back and/or leg
pains--differentiated three types of pain: spinal,root and tract--the latter was usually distal,
occuring in the feet, calves, sometimes alternating side to side--quotes Holmes (1919) who
discussed 'tract' pain after spinal cord injury: usually occured on the more innervated side
of those with Brown-Sequard syndromes--Felt that 'tract' pain represented an alteration in
inflow from affected area and represented a central phenomenon--descibed drop attacks in
two patients-4 patients with 'coldness' of feet/legs (n=14)--good discussion of Lhermitte's
phenomenon and paralleled the discussion with one of 'pain radiating from the back to the
lower limbs with neck flexion'--bowel and bladder disturbance more frequent than other
reports
59. Ono K, Ebara S, Tada K, Yamamoto T: Cervical myelopathy secondary to multiple spondylotic
protrusions. Spine 2:109-125, 1977
Reference ID: 2699
60. Pang D, Pollack IF: Spinal cord injury without radiographic abnormality in children--the SCIWORA
syndrome. J trauma 29:654-664, 1989
Reference ID: 696
61. Pang D, Wilberger JE: Spinal cord injury without radiographic abnormalities in children. J
Neurosurg 57:114-129, 1982
Reference ID: 697
62. Parke WW: Correlative anatomy of cervical spondylotic myelopathy. Spine 13:831-837, 1988
Reference ID: 2147
Notes: detailed discussion of blood supply and the contribution of radicular vessels to ASA
circulation--relation of canal stenosis (esp < 13 mm) and hyperextension potentiates
compression--also discusses relationship of flexion and compression of cord --emphasizes
importance/requirement for congenital narrowing of the canal before most myelopathies
develop
63. Parker HL, Adson AW: Compression of the spinal cord and its roots by hypertrophic osteo-arthritis.
Surg Gynecol Obstet 41:1-14, 1925
Reference ID: 2879
Notes: patient with severe pain radiating into back and legs with neck flexion--due to high
thoracic spondylosis
64. Payne EE, Spillane JD: The cervical spine: An anatomico-pathological study of 70 specimens (using
a special technique) with particular reference to the problem of cervical spondylosis. Brain
80:571-596, 1957
Reference ID: 2155
Notes: Classic data with regard norms of canal size with/without deficit--vertebral artery
compression by osteophytes--hyperextension causes infolding of ligamentum flavum and
cord compression
65. Penning L: Some aspects of plain radiography of the cervical spine in chronic myelopathy.
Neurology 12:513-519, 1962
Reference ID: 2144
Notes: Noted "pinching" of cord between posterior-inferior lip of vertebral body and
superioranterior margin of lamina with neck extension
66. Phillips WC, Jr., Strauss AJ, Kattapuram SV: Bilateral hand pain. Congenital cervical spinal stenosis
with an associated herniated disc. Del.Med J 58:559-564, 1986
Reference ID: 2235
67. Rosner MJ, Banner SR, Guin S, Oser AR, Johnson AH, Rosner SD, Wadlington V: Response of the
cervical spinal cord to decompression for congenital cervical stenosis. Neurosurgery 1997
Reference ID: 2838
68. Saunders RL: Anterior and middle column decompression, in Saunders RL, Bernini PM (eds):
Cervical Spondylotic Myelopathy. Boston, Blackwell Scientific Publications:166-185,
1992
Reference ID: 2164
69. Scher AT: Spinal cord concussion in rugby players. Am J Sports Med 19:485-488, 1991
Reference ID: 2220
Notes: During an analysis of a group of 40 rugby players who had sustained cervical spinal
cord injury, 9 players were identified who had sustained only transient paralysis. These
players showed no radiologic evidence of any injury to the cervical spine. We did a
retrospective analysis of the clinical and radiological findings in this group of rugby players.
The cervical spine radiographs were analyzed for evidence of spinal stenosis, congenital
anomalies, and degenerative disk disease. Using the ratio method of assessment for spinal
stenosis, we found spinal canal narrowing maximally at C-3 and C-4 in five of the nine
players. In the remaining four players, one showed evidence of osteoarthritic change at two
levels while another had congenital fusion of two vertebral bodies. In two players, no
radiologic evidence of any abnormality was detected. The mechanism of transient
disturbance of the spinal cord function after trauma is discussed here
70. Schneider RC, Cherry GR, Pantek H: Syndrome of acute central cervical spinal cord injury with
special reference to mechanisms involved in hyperextension injuries of cervical spine. J
Neurosurg 11:546-577, 1954
Reference ID: 2636
Notes: Central cord syndrome defined and related to hyperextension type injuries-SCIWORA--also related infolding of ligamentum flavum to narrowing of canal and cord
compression
71. Sheehan S, Bauer RB, Meyer JS: Vertebral artery compression in cervical spondylosis. Neurology
10:968-986, 1960
Reference ID: 2876
72. Sherman JL, Nassaux PY, Citrin CM: Measurement of the normal cervical spinal cord on MR
imaging. AJNR 11:369-372, 1990
Reference ID: 2394
Notes: AP cord decreased linearly from C1 to T3--max cord transverse diameter at C4 with
average of 14+/- 1.1--measurements are within .2- to .5 of our postlaminectomy values
(amazing)--no relation to age, sex or weight as found by Yu et al--also used estimate of cord
area (ap x trans) which gives crude reference--noted that measurements need be made
perpendicular to cord--found their results correlated best with Nordquist's post mortem
study (ref 2690)--noted that any patient may have cord abnormality falling within these
ranges (ie., his cord perhaps should be larger than it is...)--cord areas calculated by Sherman
did not include factor of .7854 to correct for elliptical shape-73. Simmons Z, Biller J, Beck DW, Keyes W: Painless compressive cervical myelopathy with false
localizing sensory findings. Spine 11:869-872, 1986
Reference ID: 2704
Notes: notes had numbness =/- weakness in grip with thoracic sensory level (t5-12),
thoracic and lower extremity dyesthesiae and clumsiness: lumbar workup neg:only 2/5 with
hyperreflexia and Babinski or Hoffman reflex; one with exacerbation of back pain and local
low back tenderness--all with cervical dis disease, one or two with hx trauma, but then
gradual onset of sx
Abstract: Five patients who presented with clearly defined thoracic sensory levels were
found by myelography and follow-up computed tomography (CT) to have cervical spinal
cord compression. None of these patients had pain or an immediate preceding history of
trauma. There is currently no satisfactory explanation for the large discrepancy between the
sensory level and the level of cord compression in such patients. It is crucial that the
clinician recognize the possibility of a cervical cord lesion in patients with such a
presentation so that appropriate radiographic studies can be performed. Failure to appreciate
this syndrome could result in failure to diagnose a treatable lesion
74. Smith AY, Woodside JR: Urodynamic evaluation of patients with spinal stenosis. Urology. 32:474477, 1988
Reference ID: 2229
Notes: Spinal stenosis, which may be congenital/developmental or acquired in origin, is a
narrowing of the spinal canal, nerve root canals, or intervertebral foramina. Compression of
the spinal cord or nerve roots may lead to structural neuronal damage, neuronal ischemia or
edema, and axonal transport block. The most frequent symptom in patients with spinal
stenosis is back pain and some have classic neurogenic claudication. We have performed
urodynamic evaluations in 2 patients with combined cervical and lumbar spinal stenosis. A
girl with achondroplastic dwarfism had urgency incontinence and detrusor hyperreflexia. An
adult man with acquired degenerative spinal stenosis had difficulty voiding and findings
compatible with the cauda equina syndrome
75. Stark RJ, Kennard C, Swash M: Hand wasting in spondylotic high cord compression: An
electromyographic study. Ann Neurol 58-62, 1981
Reference ID: 2152
Notes: Noted nl F-wave latency--increased single fiber density--fibrillations in C7, C8 & T1
muscles in C3-4 and C5-6 cord lesions
76. Symonds C: Interrelation of trauma and cervical spondylosis in compression of cervical cord.
Lancet 1:451-454, 1953
Reference ID: 2640
Notes: Warned of hyperextension cord injuries with general anesthesia and oral/dental
surgery
77. Tarlov EC: Posterior Column Decompression, in Saunders RL, Bernini PM (eds): Cervical
Spondylotic Myelopathy. Boston, Blackwell Scientific Publications:159-165, 1992
Reference ID: 2127
Notes: Specific comments upon narrow canal, posterior lam and its lateral extent
78. Tatlow WFT, Bammer HC: Syndrome of vertebral artery compression. Neurology 7:331-340, 1957
Reference ID: 2877
Notes: Demonstrated vertebral compression with often minimal turning of neck in cadavers
with vert a injected with dye
79. Taylor, A. R. Mechanism of injury to spinal cord in neck without damage to vertebral column.
<None Specified> . 1951. (GENERIC)
Ref Type: Generic
Ref ID: 2635
Notes: described infolding of the ligamentum flava during hyperextension on myelograms
and attibuted cord injury to compression in extension
80. Taylor AR: Mechanism and treatment of spinal cord disorders assoicated with cervical spondylosis.
Lancet 1:717-720, 1953
Reference ID: 2630
81. Thijssen HOM, Keyser A, Horstink MWM, Meijer E: Morphology of the cervical spinal cord on
computed myelography. Neuroradiology 18:57-62, 1979
Reference ID: 2696
Notes: N=20 with concomitant cervical myelogram for lumbar disc disease (similar to Yu et
al)--did tilt gantry to obtain transaxial views perpendicular to disc--generally found about 2
mm smaller measurements than most of the asymmptomatic pts of Sherman--mentions three
patients with dissociated sensory loss in the arms with congenital stenosis (canal 9.5 mm)-mentions molding of the cord with widening of the anterior fissure and dissociated sensory
loss in arms (were worked up for syringomyelia, but not found)
82. Torg JS: Cervical spinal stenosis with cord neurapraxia and transient quadriplegia. Clin.Sports Med
9:279-296, 1990
Reference ID: 2221
Notes: The purpose of this article is to define as a distinct clinical entity, the syndrome of
cervical spinal cord neurapraxia with transient quadriplegia. Sensory changes include
burning pain, numbness, tingling, or loss of sensation, whereas motor changes consist of
weakness or complete paralysis. The phenomenon of cervical spinal cord neurapraxia
occurs in individuals with (1) developmental cervical spinal stenosis, (2) congenital fusions,
(3) cervical instability, or (4) intervertebral disc protrusions when associated with a
decrease in the anteroposterior diameter of the spinal canal. There is no evidence that the
occurrence of cervical spinal cord neurapraxia predisposes an individual to permanent
neurologic injury. However, patients with this syndrome and associated with cervical spine
instability or acute or chronic degenerative changes should be precluded from further
participation in contact sports. Those with developmental spinal stenosis or spinal stenosis
associated with congenital abnormalities should be treated on an individual basis
83. Torg JS, Pavlov H, Genuario SE, Sennett B, Wisneski RJ, Robie BH, Jahre C: Neuropraxia of the
cervical spinal cord with transient quadriplegia. J Bone Joint Surg 68A:1354-1370, 1986
Reference ID: 2148
Notes: Stenosis of lower cervical canal should preclude participation in contact sports due
to risk of extension-flexion injury--surveyed injuries from 503 schools
84. Upton RM, McComas AJ: The double crush in nerve entrapment syndromes. Lancet 2:359-362,
1973
Reference ID: 2698
85. Wolf BS, Khilnani M, Malis L: The sagital diameter of the bony cervical spinal canal and its
significance in cervical spondylosis. J Mt Sinai Hosp New York 23:2831956
Reference ID: 2165
Notes: Measured bony canal on 72" plain films--C1--22 ranged down to 16; C2--20 ranged
to 14 (4 of 1000 measurements)--C3--18 ranged down to about 12--C4 and below was 17
mm with a few out of a thousand as small as 12 mm--noted 1-2 mm further narrowing in
extension--a slight increase in flexion--predict cord compression if canal about 10 mm-further discuss difficulties with plain radiograph interpretation--i.e., cannot tell when bony
canal narrowed by central vs lateral spurs-86. Yap KB, Lieu PK, Chia HP, Menon EB, Tan ES: Outcome of patients with cervical spondylotic
myelopathy seen at a rehabilitation centre. Singapore.Med J 34:237-240, 1993
Reference ID: 2172
Notes: A retrospective study was conducted on 21 patients with cervical spondylotic
myelopathy to study the clinical characteristics of these patients and the influence of surgery
and rehabilitation on their outcome. All the patients were 50 years and above, with a mean
age of 63.6 years. The most common presenting feature was weakness of all the limbs.
Neckache was not a prominent finding. Although only 2 patients complained of bladder
disturbance, 6 other patients were found to have bladder dysfunction after urodynamic
assessment. Clinical outcome after surgery was 50% improved, 28% unchanged and 22%
worsened. Fifty percent of the patients with voiding problems recovered after bladder
training. Rehabilitation was significant in assisting in the recovery of patients after surgery.
One patient had a disabling stroke 4 days after cervical surgery while another died of
urinary tract infection while undergoing rehabilitation
87. Yasuoka S, Okazaki H, Daube JR, MacCarty CS: Foramen magnum tumors. J Neurosurg 49:828838, 1978
Reference ID: 2158
Notes: Notes intrinsic wasting of hand muscles--FM tumors mimic NPH, cervical
spondylosis, MS, syrinx, CTS, intramedullary tumor
88. Yu YL, duBoulay GH, Stevens JM, Kendall BE: Morphology and measurement of the cervical spinal
cord in computer-assisted myelography. Neuroradiology 27:399-402, 1985
Reference ID: 2697
Notes: cord areas very similar to those of ours post op--diameters slightly less----also
calculated AP ratio--note 25% to have 'asymptomatic' distortion of cord--however, his
sample was of 36 (19male, 17 female) patients veing evaluated for lumbar disc disease--i.e.,
not random and with high likelihood of cervical changes
89. Yu YL, Stevens JM, Kendall B, duBoulay GH: Cord shape and measurements in cervical
spondylotic myelopathy and radiculopathy. AJNR 4:839-842, 1983
Reference ID: 2395
Notes: included AP ratio--always above .53 at all lvels and at most was closer to .6--all
forms of cord distortion were associated with AP ratios in the range of .4-.5
90. Yu YL, Woo E, Huang CY: Cervical spondylotic myelopathy and radiculopathy. Acta Neurol
Scand 75:367-373, 1987
Reference ID: 2166
Notes: Review sx/signs of myelopathy--