Journal of craniovertebral junction & spine最新文献

{"title":"Atlantoaxial dislocation adjacent to kyphotic deformity in a case of adult Larsen syndrome.","authors":"Sushanta K Sahoo,&nbsp;Arsikere N Deepak,&nbsp;Pravin Salunke","doi":"10.4103/0974-8237.181869","DOIUrl":"https://doi.org/10.4103/0974-8237.181869","url":null,"abstract":"<p><p>Kyphotic deformity is often seen in Larsen syndrome. However, its progress in adults is not clear. The adjacent level compression in these patients adds to the difficulty regarding the level that needs to be operated. A 56-year-old male presented with neck pain and spastic quadriplegia. Radiology showed kyphotic deformity (sequelae of Larsen syndrome) with atlantoaxial dislocation. Cord compression was apparent at both levels but careful evaluation showed C1-2 level compression and some compression below the kyphotic deformity. The kyphotic spine was already fused and the canal diameter was adequate. The adjacent level C1-2 was fused and he improved dramatically. Correction of long-standing kyphotic deformity may not be necessary, as it unlikely to progress because of its tendency to fuse naturally. Rather, the adjacent levels are likely to compress the cord due to excessive stress. A proper clinical history and a thorough radiological examination help the surgeon to make an appropriate decision. </p>","PeriodicalId":520667,"journal":{"name":"Journal of craniovertebral junction & spine","volume":" ","pages":"109-10"},"PeriodicalIF":1.1,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6e/ba/JCVJS-7-109.PMC4872559.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34512941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of surgical outcome in compressive cervical myelopathy: A novel clinicoradiological prognostic score.","authors":"Rishi Anil Aggarwal,&nbsp;Sudhir Kumar Srivastava,&nbsp;Sunil Krishna Bhosale,&nbsp;Pradip Sharad Nemade","doi":"10.4103/0974-8237.181828","DOIUrl":"https://doi.org/10.4103/0974-8237.181828","url":null,"abstract":"<p><strong>Context: </strong>Preoperative severity of myelopathy, age, and duration of symptoms have been shown to be highly predictive of the outcome in compressive cervical myelopathy (CCM). The role of radiological parameters is still controversial.</p><p><strong>Aims: </strong>Define the prognostic factors in CCM and formulate a prognostic score to predict the outcome following surgery in CCM.</p><p><strong>Settings and design: </strong>Retrospective.</p><p><strong>Materials and methods: </strong>This study included 78 consecutive patients with CCM treated surgically. The modified Japanese Orthopaedic Association (mJOA) scale was used to quantify severity of myelopathy at admission and at 12-month follow-up. The outcome was defined as good if the patient had mJOA score ≥16 and poor if the score was <16. Age, sex, duration of symptoms, comorbidities, intrinsic hand muscle wasting (IHMW), diagnosis, surgical technique, Torg ratio, instability on dynamic radiographs, and magnetic resonance imaging (MRI) signal intensity changes were assessed.</p><p><strong>Statistics: </strong>Statistical Package for the Social Sciences (SPSS) (version 20.0) was used for statistical analysis. The association was assessed amongst variables using logistic regression analysis. Parameters having a statistically significant correlation with the outcome were included in formulating a prognostic score.</p><p><strong>Results: </strong>Severity of myelopathy, IHMW, age, duration, diabetes, and instability on radiographs were predictive of the outcome with a P value <0.01. Genders, diagnosis, surgical procedure, Torg ratio, and intensity changes on MRI were not significantly related to the outcome. A 8-point scoring system was devised incorporating the significant clinicoradiological parameters, and it was found that nearly all patients (97.82%) with a score below 5 had good outcome and all patients (100%) with a score above 5 had poor outcome. The outcome is difficult to predict with a score of 5.</p><p><strong>Conclusions: </strong>Clinical parameters are better predictors of the outcome as compared to radiological findings, following surgery in CCM. A simple scoring system based on clinicoradiological parameters is suggested in this paper to predict the outcome following surgery in cases of CCM.</p>","PeriodicalId":520667,"journal":{"name":"Journal of craniovertebral junction & spine","volume":" ","pages":"82-6"},"PeriodicalIF":1.1,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/42/b4/JCVJS-7-82.PMC4872567.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34512938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}