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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Circumferential cervical decompression and fusion (CCDF) is an important technique for treating patients with severe cervical myelopathy. While circumferential cervical decompression and fusion may provide improved spinal cord decompression and stability compared to unilateral techniques, it is commonly associated with increased morbidity and mortality. We performed a retrospective analysis of patients undergoing CCDF at the University of California, San Francisco (UCSF) between January 2003 and December 2004. We identified 53 patients and reviewed their medical records to determine the effectiveness of CCDF for improving myelopathy, pain, and neurological function. Degree of fusion, functional anatomic alignment, and stability were also assessed. Operative morbidity and mortality were measured. The most common causes of cervical myelopathy, instability, or deformity were degenerative disease (57%) and traumatic injury (34%). Approximately one-fifth of patients had a prior fusion performed elsewhere and presented with fusion failure or adjacent-level degeneration. Postoperatively, all patients had stable (22.6%) or improved (77.4%) Nurick grades. The average preoperative and postoperative Nurick grades were 2.1 +/- 1.9 and 0.4 +/- 0.9, respectively. Pain improved in 85% of patients. All patients had radiographic evidence of fusion at last follow-up. The most common complication was transient dysphagia. Our average clinical follow-up was 27.5 +/- 9.5 months. We present an extensive series of patients and demonstrate that cervical myelopathy can successfully be treated with CCDF with minimal operative morbidity. CCDF may provide more extensive decompression of the spinal cord and may be more structurally stable. Concerns regarding operation-associated morbidity should not strongly influence whether CCDF is performed.
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PMID:Successful treatment of cervical myelopathy with minimal morbidity by circumferential decompression and fusion. 1721 28

Diffuse idiopathic skeletal hyperostosis (DISH) is a common but often unrecognized systemic disorder observed mainly in the elderly. DISH is diagnosed when the anterior longitudinal ligament of the spine is ossified on at least four contiguous spinal levels or when multiple peripheral enthesopathies are present. The etiology of DISH is unknown but previous studies have shown a strong association with obesity and insulin-independent diabetes mellitus. DISH can lead to back pain, dysphagia, myelopathy, musculoskeletal impairment and grossly unstable spine fractures after minor trauma. In archeological studies a high prevalence of DISH has been demonstrated in ancient clergymen. The present study describes the pathological changes of human remains excavated from the abbey court (Pandhof) in the city of Maastricht, The Netherlands. Human remains of 51 individuals buried between 275 and 1795 CE: were excavated and examined. The remains were investigated according to a standardized physical anthropological report and individuals demonstrating ossification of spinal ligaments and/or multiple peripheral enthesopathies were included in the study group. The authors reviewed all available material and after reaching consensus, each abnormality found was given a diagnosis and subsequently recorded. After examination, 28 individuals were considered to be adult males; 11 adult females; three adults of indeterminate sex and nine individuals were of sub adult age. The mean age at death for adults was 36.8 years. Seventeen adult individuals (40.4% of all adults), displayed ossifications of at least four contiguous spinal levels and/or multiple enthesopathies of the appendicular skeleton and were therefore, assigned the diagnosis DISH. The mean age of these individuals was 49.5 +/- 13.0 years. In at least three of these individuals, DISH had led to extensive ossification and subsequent ankylosis of axial and peripheral skeletal structures. In this population of (presumably) clergymen and high-ranking citizens, DISH was observed in unusual high numbers at a relatively young age. Some of the examined cases suggest that DISH may be a seriously incapacitating disorder when the more advanced stages of the disease have been reached. It is hypothesized that "a monastic way of life" can predispose to DISH. Present demographic trends in obesity and diabetes mellitus as potential co-factors for the development of DISH warrant further study to investigate its future prevalence.
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PMID:Diffuse idiopathic skeletal hyperostosis in ancient clergymen. 1739 Jan 55

Pediatric basilar invagination and cranial settling have traditionally been approached through a transoral-transpharyngeal route with or without extended maxillotomy or mandibulotomy for resection of the anterior portion of C-1 and the odontoid. The authors hypothesize that application of a recently described endoscopic transcervical odontoidectomy (ETO) technique would allow an alternative approach for the treatment of ventral pathological entities at the craniocervical junction in pediatric patients. The authors performed ETO in a consecutive series of pediatric patients presenting with myelopathy or bulbar dysfunction resulting from basilar invagination or cranial settling. All clinical, radiographic, surgical, and follow-up data were prospectively collected. The initial experience with ETO in the pediatric population is analyzed and outcomes are reported. Three patients required ETO for basilar invagination and 1 required ETO with anterior C-1 arch and distal clivus resection for cranial settling. All patients presented with myelopathy. One patient was wheelchair bound with severe quadriparesis. The mean age was 14 +/- 3 years (mean +/- standard deviation [SD]) in the 2 male and 2 female patients. The ETO and posterior fusion were performed as a 2-stage procedure in 2 (50%) and as a single-stage procedure in 2 (50%) cases. Prolonged intubation or postoperative placement of a gastrostomy tube was not needed in any case. The postoperative hospitalization lasted 9 +/- 4 days (mean +/- SD). At last follow-up (mean 5 months), head and neck pain had resolved and motor strength had improved or stabilized in all cases. All 4 children were independently functioning and ambulatory at the last follow-up. In the authors' initial experience, ETO has allowed ventral brainstem decompression without the need for prolonged intubation, worsening dysphagia requiring enteral tube feeding, or prolonged hospitalization, and has resulted in cosmetically appealing results. The ETO technique allows an alternative approach for the treatment of ventral pathological entities at the craniocervical junction in pediatric patients.
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PMID:Endoscopic transcervical odontoidectomy for pediatric basilar invagination and cranial settling. Report of 4 cases. 1837 13

Aim of our study was to compare anterior cervical fusion with fusion augmented with dynamic implants and with the first generation-plate. Methods. Patients with radiculopathy and/or myelopathy were included in a prospective cohort study. Clinical outcome was assessed according to the Nurick, Odom, and SF 36 scales. Rotation and translation of screws, and quality of fusion (Tribus) were assessed at the 6-week and 4-year follow-up examinations. Neurodecompression was performed in 81 patients (one-level N = 45, two-level N = 26 and multi-level N = 10) in the period from January 2001 to September 2003. 50 male and 31 female patients were divided into three groups, depending upon type of fusion: 1. Augmented with dynamic implants (N = 33), 2. Augmented with H-plate (N = 33), and 3. Non-augmented (N = 15), one-level. There were no significant differences in clinical outcomes between the groups. Dynamization was detected in both augmented groups: axial in the dynamic implant group (mean translation +/- SD = 2.67 +/- 0.79 mm), and angular in the H-plate group (angle of rotation 7.2 degrees +/- 3.04 degrees). Six-week fusion was significantly better in the dynamic implants and non-augmented groups, as compared with the H-plate group. Two patients in the H-plate group developed pseudoarthrosis, 7 patients in the dynamic implant group had supradjacent segment heterotopic ossification and two of these additional ankylosis. Three patients in the non-augmented group had dislodgement of the bone graft with transient dysphagia in one of them. Our results suggest that selection of implants is not crucial for clinical outcome. Subsidence is allowed with both fixation systems. Fusion is faster and more effective in the axially dynamized group.
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PMID:Axial vs. angular dynamization of anterior cervical fusion implants. 1849 8

Spinal osteochondromas are rare, benign tumors of the bone. These tumors can manifest as solitary lesions or as part of a hereditary syndrome. Most spinal osteochondromas occur in the posterior cervical spine and can cause myelopathy or radiculopathy. Osteochondromas of the anterior cervical spine that cause respiratory or swallowing symptoms are rare. We present the unique case of a solitary osteochondroma of the anterior C1 vertebral arch causing obstructive sleep apnea and dysphagia in a 16-year-old female. The patient underwent resection of the tumor via a left anterior transcervical approach to the spine. The patient's symptoms resolved completely after surgery. To our knowledge, this is the first case of a sporadic osteochondroma arising from the anterior arch of the C1 vertebra causing dysphagia and obstructive apnea in a pediatric patient.
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PMID:Anterior C1-2 osteochondroma presenting with dysphagia and sleep apnea. 1919 92

Anterior procedures in the cervical spine are feasible in cases having anterior aetiologies such as anterior neural compression and/or severe kyphosis. Halo vests or anterior plates are used concurrently for cases with long segmental fixation. Halo vests are bothersome and anterior plate fixation is not adequately durable. We developed a new anterior pedicle screw (APS) and plate fixation procedure that can be used with fluoroscope-assisted pedicle axis view imaging. Six patients (3 men and 3 women; mean age, 54 years) with anterior multisegmental aetiology were included in this study. Their original diagnoses comprised cervical myelopathy and/or radiculopathy (n = 4), posterior longitudinal ligament ossification (n = 1) and post-traumatic kyphosis (n = 1). All patients underwent anterior decompression and strut grafting with APS and plate fixation. Mean operative time was 192 min and average blood loss was 73 ml. Patients were permitted to ambulate the next day with a cervical collar. Local sagittal alignment was characterised by 3.5 degrees of kyphosis preoperatively, which improved to 6.8 degrees of lordosis postoperatively and 5.2 degrees of lordosis at final follow-up. Postoperative improvement and early bony union were observed in all cases. There was no serious complication except for two cases of dysphagia. Postoperative imaging demonstrated screw exposure in one screw, but no pedicle perforation. APS and plate fixation is useful in selected cases of multisegmental anterior reconstruction of cervical spine. However, the adequate familiarity and experience with both cervical pedicle screw fixation and the imaging technique used for visualising the pedicle during surgery are crucial for this procedure.
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PMID:Anterior cervical pedicle screw and plate fixation using fluoroscope-assisted pedicle axis view imaging: a preliminary report of a new cervical reconstruction technique. 1947 35

We report a 58-year-old woman with adult onset Alexander disease. At the age of 54 she noticed numbness in bilateral legs and at 57 she developed left sided spastic gait. Her walking difficulty was gradually worsened and followed by the development of weakness in left arm, dysarthria and dysphagia. Her mother and elder brother also had similar clinical presentations which suggested an autosomal dominant neurological disorder. With MRI findings showing localized atrophy of medulla oblongata and upper cervical cord with hyperintensities on T2-weighted image, diagnosis of adult onset Alexander disease was made. We performed genetic analysis and found novel variant (S398F) in the glial fibrillary acidic protein gene. In case of slowly progressive myelopathy with bulbar palsy of unknown origin, especially those with atrophy limited to medulla oblongata and upper cervical cord, adult onset Alexander disease should be taken into consideration.
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PMID:[Adult onset Alexander disease with a novel variant (S398F) in the glial fibrillary acidic protein gene]. 1961 46

Sarcoidosis is a chronic disease of unknown aetiology. Neurosarcoidosis is registered in 5% of patients with sarcoidosis. Clinical manifestations of sarcoidosis are numerous and diverse. Manifestation of Neurosarcoidosis includes partial- and grand-mal seizures, low-grade fever, headache, increased intracranial pressure, visual disturbances, diabetes insipidus, amenorrhea- galacterorrhea syndrome and pituitary failure, hypogonadotropic hypogonadism, hyperprolactinemia, unilateral and bilateral facial palsy, infiltration of meninges (aseptic meningitis) and nerve roots, leptominingitis, pachymeningitis with cranial neuropathies, pseudotumor, mild cognitive disorder, psychosis, delirium, dementia, disorientation, amnesia, progressive visual deterioration and proptosis, axonal polyneuropathies, mononeuropathies, chronic polyradiculoneuritis, peripheral neuropathy, cranial nerve abnormalities, radiculopathies, peripheral neuropathy, mononeuritis multiplex, progressive numbness and deep sensation disturbance in bilateral lower extremities, hemiplegia, hyperreflexia with pathological reflexes and hypesthesia, upward gaze palsy, spinal cord compression, dysarthria, dysphagia, weakness, episodes of blurred vision, diplopia, intracerebral hemorrhage, neuro-ophthalmic manifestations, intranuclear ophthalmoplegia, dysorientation, vasculitis presenting with strokes, intracranial hypothalamic lesion, paresthesis, hemiparesis, myelopathy in the cervico-thoracic region, lumbar pain, sensory level and inability of lateral gaze (Tab. 2, Ref. 60).
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PMID:Clinical manifestations of neurosarcoidosis. 1982 43

Although anterior surgical approaches to the cervical spine have become popular and safe in recent years, they also have some complications. We present a case of loss of an anterior cervical plate screw by the natural tracts. The patient was a 47- year-old woman who was operated on for cervical spondylotic myelopathy at another institution. Surgical interference included two levels of anterior discectomy, iliac graft placement and fixation using plate and screws. Two years later, plate dislocation and partial migration of the upper screws were observed. After 7 years the patient complained of dysphagia and she accepted removal of the osteosynthesis. Radiographical examination showed that one of the upper screws was missing and two lower screws were broken. Esophageal perforation was found during the surgery and repaired. Further progress was favourable. Complications associated with esophageal perforation may range from massive infection and death to spontaneous recovery. Erosion of the esophageal wall due to extruded bulky constructs may lead to a persistent fistula, abscess or septic diffusion. Spontaneous perforation of the esophagus and screw loss via the gastrointestinal tract make this case interesting..
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PMID:Cervical screw missing secondary to delayed esophageal fistula: case report. 1984 69

We investigated the outcomes of chordomas of the craniocervical junction after surgery including complication rates, survival, associated adverse factors, and quality of life. We present our results and lessons learned from surgeries performed between 1982 and 2007 in the National Hospital for Neurology and Neurosurgery, London. Patients undergoing transfacial, transoral, and transmandibular surgeries for chordomas of the craniocervical junction were enrolled in this study. Chi-square, Fisher exact tests, and log-rank survival analysis were used to determine significant adverse factors (p < 0.05). In our series, 80 operations were performed in 66 patients; 37 patients were male, 29 female. Age at presentation was commonly 40 to 60 years. After surgery, pain was the same or better in 98.1% of patients; 18.6% of patients presented with myelopathy, of whom 27.8% improved, 44.4% remained unchanged, 27.8% deteriorated. Complication rates were as follows: velopharyngeal incompetence 2%, dysphagia 3%, failure of fixation 2%, sepsis 5%, meningitis 5%, wound infection 3%, chest infection 6%, cerebrospinal fluid leakage 5%. Five- and 10-year overall survivals were 62% and 39%, respectively. Complication rates for these major operations can be minimized in specialist centers, with careful patient selection and counseling. Quality of life and survival are significantly improved after surgery.
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PMID:Surgery for chordomas of the craniocervical junction: lessons learned. 2059 57


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