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Kim SY, Jang JN, Choi YS, Park S, Yi J, Song Y, Kim JW, Kang KN, Kim YU. The cervical ligamentum flavum area: A new sensitive morphological parameter for identifying the cervical spinal stenosis. Medicine (Baltimore) 2023; 102:e36259. [PMID: 38013374 PMCID: PMC10681602 DOI: 10.1097/md.0000000000036259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023] Open
Abstract
Thickening of the cervical ligamentum flavum (CLF) has been considered as a main cause of cervical spinal stenosis (CSS). A previous study reported that cervical ligamentum flavum thickness (CLFT) is correlated with CSS. However, the whole hypertrophy is different from focal thickness. Therefore, to analyze hypertrophy of the CLF, we created a new morphological parameter, called the cervical ligamentum flavum area (CLFA). We hypothesized that the CLFA is an important morphological parameter in the diagnosis of CSS. CLF samples were acquired from 83 patients with CSS, and from 84 controls who underwent cervical magnetic resonance imaging (C-MRI). T2-weighted axial C-MRI images were acquired. We measured the CLFA and CLFT at the C6-C7 intervertebral level on C-MRI using appropriate image analysis software. The CLFA was measured as the cross-sectional area of the entire CLF at the level of C6-C7 stenosis. The CLFT was measured by drawing a straight line along the ligament side towards the spinal canal at the C6-C7 level. Mean CLFA was 25.24 ± 6.43 mm2 in the control group and 45.34 ± 9.09 mm2 in the CSS group. The average CLFT was 1.48 ± 0.28 mm in the control group and 2.09 ± 0.35 mm in the CSS group. CSS patients had significantly higher CLFA (P < .01) and CLFT (P < .01). For the validity of both CLFA and CLFT as predictors of CSS, a receiver operating characteristic curve analysis revealed an optimal cutoff point for the CLFA was 31.66 mm2, a sensitivity of 92.8%, specificity of 88.4%, and an area under the curve of 0.97 (95% CI, 0.94-0.99). The optimal cut off-point of the CLFT was 1.79 mm, with a sensitivity of 83.5%, specificity of 84.5%, and an area under the curve of 0.92 (95% CI, 0.87-0.96). Both CLFT and CLFA were significantly related to CSS, but CLFA was the more sensitive measurement parameter. Therefore, to evaluate patients with CSS, treating physicians should test for CLFA.
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Affiliation(s)
- So Yeon Kim
- Department of Neurosurgery, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Jae Ni Jang
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Young-Soon Choi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Sukhee Park
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Jungmin Yi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Yumin Song
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Jae Won Kim
- Catholic Kwandong University of Korea College of Medicine, Gangneung, Republic of Korea
| | - Keum Nae Kang
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Republic of Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
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Choi J, Park HB, Lim T, Yi SW, Lee S, Park S, Park S, Yi J, Kim YU. Best cutoff score of cervical-pedicle thickness as a morphological parameter for predicting cervical central stenosis. Medicine (Baltimore) 2022; 101:e30014. [PMID: 35984177 PMCID: PMC9388033 DOI: 10.1097/md.0000000000030014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
There are various factors for the cause of cervical central stenosis (CCS), such as osteophyte, cervical-disc degeneration, and cervical ligamentum flavum hypertrophy. However, the pedicle of the cervical vertebra has not yet been analyzed for its relationship with CCS. We created a new morphologic parameter called the cervical-pedicle thickness (CPT) to assess the association between CCS and the cervical pedicle. We obtained morphological cases involving the CPT from 82 patients with CCS. There were also 84 in the normal group who underwent cervical spine magnetic resonance imaging (CS-MR) as part of routine health screening. We obtained the T2-weighted CS-MR axial images from group members, and assessed the CPT at the level of the C6 vertebra on CS-MR. The mean CPT was 3.46 ± 0.57 mm in the normal group, 4.97 ± 0.75 mm in the CCS group, which thus had a significantly higher CPT (P < .01) than did the normal group. For the prognostic value of the CPT as a predictor of CCS, ROC analysis indicated that the best cutoff score for the CPT was 4.18 mm, with 93.9% sensitivity, 92.9% specificity, and AUC 0.97. Greater CPT was highly associated with a possibility of CCS. This conclusion will be helpful for assessing the CCS patients.
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Affiliation(s)
- Jungho Choi
- Department of Internal Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Korea
| | - Hyung-Bok Park
- Department of Internal Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Korea
| | - Taeha Lim
- Department of Anesthesiology and Pain Medicine, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Shin Wook Yi
- Department of Anesthesiology and Pain Medicine, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Sooho Lee
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Korea
| | - Sukhee Park
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Korea
| | - SoYoon Park
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Korea
| | - Jungmin Yi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Korea
- Department of Radiological Sciences, University of California, Irvine, CA
- *Correspondence: Young Uk Kim, MD, PhD, Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary’s Hospital, Incheon, Republic of Korea (e-mail: )
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Kozaki T, Minamide A, Iwasaki H, Yuakawa Y, Ando M, Yamada H. Funicular pain: a case report of intermittent claudication induced by cervical cord compression. BMC Musculoskelet Disord 2020; 21:302. [PMID: 32410709 PMCID: PMC7227285 DOI: 10.1186/s12891-020-03299-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/17/2020] [Indexed: 11/19/2022] Open
Abstract
Background Neurogenic origin intermittent claudication is typically caused by lumbar spinal canal stenosis. However, there are few reports of intermittent claudication caused by cervical spinal cord compression. Case presentation We present the case of a 75-year-old woman who presented with intermittent claudication. She had a history of lumbar spinal fusion surgery, but there was no sign of lumbar spinal stenosis. She also reported bilateral thigh pain on cervical extension. Electromyogram (EMG), posture-induced test, myelogram, and post-myelogram dynamic computed tomography (CT) were performed. Myelography and post-myelogram dynamic CT in the cervical extension position showed narrowing of the subarachnoid space; the patient reported pain in the front of the both thigh during the procedure. We performed an electromyogram (EMG), which implied neurogenic changes below the C5 level. Based on these results, we diagnosed cervical spinal cord compression and underwent laminoplasty at C4–6 including dome-like laminectomy, which significantly relieved the thigh pain and enabled her to walk for 40 minutes. Conclusions In this case, funicular pain presented as leg pain, but was resolved by the decompression of the cervical spinal cord. Funicular pain has various characteristics without any upper extreme symptom. This often leads to errors in diagnosis and treatment. We avoid the misdiagnosis by evaluating post-myelogram dynamic CT compared between flexion and extension. In cases of intermittent claudication, clinicians should keep in mind that cervical cord compression could be a potential cause.
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Affiliation(s)
- Takuhei Kozaki
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8509, Japan
| | - Akihito Minamide
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8509, Japan.
| | - Hiroshi Iwasaki
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8509, Japan
| | - Yasutsugu Yuakawa
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8509, Japan
| | - Muneharu Ando
- Department of Orthopaedic Surgery, Kansai Medical University, 2-3-1 Shinmachi, Hirakata City, Osaka, 573-1191, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8509, Japan
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Petrin Z, Freedman M. Persistent knee pain after uncomplicated total knee arthroplasty secondary to undiagnosed spondylotic myelopathy: a case report. Spinal Cord Ser Cases 2019; 5:64. [PMID: 31632722 PMCID: PMC6786408 DOI: 10.1038/s41394-019-0209-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 06/28/2019] [Indexed: 02/08/2023] Open
Abstract
Introduction Knee osteoarthritis and cervical spondylotic myelopathy are both frequent disorders in the aging patient. Total knee arthroplasty is an increasingly common surgical procedure, with approximately 20% of patients describing persistent knee pain after the procedure, for which it is often difficult to find a cause. We review known reasons for pain after total knee arthroplasty and present a new clinically challenging case of persistent knee pain due to previously undiagnosed cervical spondylotic myelopathy. Case presentation Our patient presented with painful knee spasms after an uncomplicated total knee arthroplasty. Her workup revealed cervical spondylotic myelopathy with isolated changes in tone in the affected extremity as well as weakness and atrophy in non-painful limbs. Her clinical status improved after cervical decompression and fusion. We perform a literature review for prior reports of isolated knee pain due to cervical spondylotic myelopathy and find no previous reported association with total knee arthroplasty. Discussion Cervical spondylotic myelopathy is the most common spinal cord disorder in older adults. Incidence increases with age and the clinical manifestations may present with a variety of neurological findings. Careful musculoskeletal and neurologic examination is critical to an accurate and timely diagnosis.
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Affiliation(s)
- Ziva Petrin
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT USA
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An Outcome Study of Anterior Cervical Discectomy and Fusion among Iranian Population. NEUROSCIENCE JOURNAL 2016; 2016:4654109. [PMID: 27635392 PMCID: PMC5007372 DOI: 10.1155/2016/4654109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 07/17/2016] [Indexed: 11/17/2022]
Abstract
Background and Aim. First-line treatment strategy for managing cervical disc herniation is conservative measures. In some cases, surgery is indicated either due to signs/symptoms of severe/progressive neurological deficits, or because of persistence of radicular pain despite 12 weeks of conservative treatment. Success for treatment of cervical disc herniation using ACDF has been successfully reported in the literature. We aim to determine the outcome of ACDF in treatment of cervical disc herniation among Iranians. Methods and Materials/Patients. In a retrospective cohort study, we evaluated 68 patients who had undergone ACDF for cervical disc herniation from March 2006 to March 2011. Outcome tools were as follows: (1) study-designed questionnaire that addressed residual and/or new complaints and subjective satisfaction with the operation; (2) recent (one week prior to the interview) postoperative VAS for neck and upper extremity radicular pain; (3) Japanese Orthopaedic Association Myelopathy Evaluation Questionnaire (JOACMEQ) (standard Persian version); and (4) follow-up cervical Magnetic Resonance Imaging (MRI) and lateral X-ray. Results. With mean follow-up time of 52.93 (months) ± 31.89 SD (range: 13-131 months), we had success rates with regard to ΔVAS for neck and radicular pain of 88.2% and 89.7%, respectively. Except QOL functional score of JOAMEQ, 100% success rate for the other 4 functional scores of JOAMEQ was achieved. Conclusion. ACDF is a successful surgical technique for the management of cervical disc herniation among Iranian population.
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Jo D, Finch PM, Oh J. Epiduroscopic Laser Neural Decompression for Removal of L2-3 Disc Herniation in a Patient with Symptoms Suggestive of L5 Nerve Root Involvement. PAIN MEDICINE 2016; 17:1386-1388. [PMID: 26893111 DOI: 10.1093/pm/pnv118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/13/2015] [Accepted: 12/29/2015] [Indexed: 11/13/2022]
Affiliation(s)
- Daehyun Jo
- *Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
| | | | - Jinyoung Oh
- Department of Promotion of Health, Seosan Public Health Center, Seosan, Korea
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