Effects of Mechanical Stresses on the Spinal Cord in Cervical Spondylosis

Breig, Alf; Turnbull, I. M.; Hassler, Ove

doi:10.3171/jns.1966.25.1.0045

Cited by 319 publications

(114 citation statements)

References 24 publications

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“…The spinal cord stretches with flexionextension. This principle was demonstrated in a classic study by Breig in which he examined the effects of spondylotic bars and positioning of the cervical spine on the spinal cord geometry and blood flow [7]. He demonstrated that extension of the cervical spine causes the cord to relax and shorten.…”

Section: Introductionmentioning

confidence: 98%

“…However, he also demonstrated that the vascular supply of the cord is an important consideration. The arterioles that branch from the anterior spinal artery may be subjected to mechanical compression with flattening of the cord in the sagittal plane leading to ischemia of cord [7]. These phenomena continue to be areas of active research and form much of our modern understanding of the pathogenesis of neuron damage in CSM mediated by both ischemic and mechanical insults to the cord.…”

Section: Introductionmentioning

confidence: 99%

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Cervical Spondylotic Myelopathy: Pathophysiology, Clinical Presentation, and Treatment

Lebl¹,

Hughes²,

Cammisa³

et al. 2011

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

136

111

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Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Cervical Spondylotic Myelopathy: Pathophysiology, Clinical Presentation, and Treatment

Lebl¹,

Hughes²,

Cammisa³

et al. 2011

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

136

111

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show abstract

“…

…”

mentioning

confidence: 99%

Pathophysiology and treatment for cervical flexion myelopathy

et al. 2002

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IntroductionReid [43,44] and Breig and colleagues [3,4], on the basis of a cadaveric study, hypothesized that spinal cord compression by the vertebral bodies and intervertebral discs during neck flexion caused cervical myelopathy. Later, the pincer mechanism of the cervical spine became emphasised, and neck extension was thought to be the predominant pathology of cervical myelopathy [41]. HowAbstract Previous studies have suggested that spinal cord compression by the vertebral bodies and intervertebral discs during neck flexion cause cervical flexion myelopathy (CFM). However, the exact pathophysiology of CFM is still unknown, and surgical treatment for CFM remains controversial. We examined retrospectively patients with CFM based on studies of the clinical features, neuroradiological findings, and neurophysiological assessments. The objectives of this paper are to investigate the pathophysiology of CFM, and to examine an optimal surgical treatment. Twenty-three patients (20 male, three female) with age of onset ranging from 11 to 23 years (mean 15.7 years) were examined for the study. All patients were inspected by magnetic resonance imaging (MRI), myelogram, or computed tomographic myelogram (CTM) of the cervical spine. In eight patients, dynamic motor evoked potentials (MEP) studies were performed. Five patients underwent surgical treatment; two patients had cervical duraplasty with laminoplasty, two patients had musculotendinous transfer, one patient had both of these procedures, and the remaining 18 patients were treated conservatively. Amyotrophy of the hand intrinsic and flexor muscle group of the forearm except the brachioradial muscle was observed hemilaterally in 20 patients and bilaterally in three patients. In three patients, T1-weighted MRI with neck flexion showed linear high intensity regions in the epidural space. In all patients, axial MRI/CTM demonstrated flattening of the spinal cord with the posterior surface of the dura mater shifting anteriorly. The amplitude of MEPs decreased after cervical flexion in two patients with progressive muscular atrophy. In three patients, dysesthesia of the upper extremities disappeared following cervical duraplasty. Musculotendinous transfer for three patients significantly improved the performance of their upper extremity. The findings of this study suggest that degenerative changes of the dura mater may be a characteristic pathology of CFM. Cervical duraplasty with laminoplasty is effective for cases at an early stage, and musculotendinous transfer should be selected in patients at a late stage.

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“…It is observed in 7.6-26% of asymptomatic subjects. 1,2 Numerous factors that contribute to the onset of cervical myelopathy have been reported, including intramedullary ischemia due to mechanical distortion of the spinal cord, 3 a pincer effect, 4 developmental canal stenosis, 5 watershed area of the spinal cord 6 and repeated minor trauma presumed by the pathophysiological similarity to solidtype spinal cord injuries. 7 However, biomechanical influence on the neural tissue damage remains inadequately understood.…”

Section: Introductionmentioning

confidence: 99%

Influence of intramedullary stress on cervical spondylotic myelopathy

et al. 2013

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Study design: A cross-sectional analysis. Objective: To examine whether intramedullary stress is related to the appearance of symptoms in cervical spondylotic myelopathy (CSM). Setting: Japan. Methods: Thirty-three consecutive patients with CSM and 30 consecutive patients without CSM were enrolled. A total of 99 disc levels from C3 to C6 in 33 patients with CSM were divided into two groups: 33 disc levels with high signal intensity (HSI) on T2-weighted magnetic resonance image (HSI group) and 66 disc levels without HSI (Non-HSI group). Ninety disc levels from C3 to C6 in patients without CSM were set up in a control group. Intramedullary stress value at each level was analyzed using the finite element method. Stress was compared among the three groups. A cutoff value of stress to present HSI was investigated from receiver operator characteristics (ROC) curve. Results: In all the patients with CSM, the disc level with HSI presented the highest stress among the three disc levels evaluated. The stress was 3.16 ± 0.86 kPa (mean ± s.d.) in the HSI group, 1.81 ± 0.72 kPa in the Non-HSI group and 1.01 ± 0.37 kPa in the control group. The stress differed significantly among the three groups (Po0.0001). The qualified cutoff value derived from the ROC curve was 2.30 kPa (sensitivity 78.8%, specificity 91.9%). None of the disc levels in the control group exceeded 2.30 kPa. Conclusion: HSI was strongly associated with intramedullary stress. Threshold of intramedullary stress to present HSI that related closely to the symptoms of myelopathy was revealed.

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Effects of Mechanical Stresses on the Spinal Cord in Cervical Spondylosis

Cited by 319 publications

References 24 publications

Cervical Spondylotic Myelopathy: Pathophysiology, Clinical Presentation, and Treatment

Cervical Spondylotic Myelopathy: Pathophysiology, Clinical Presentation, and Treatment

Pathophysiology and treatment for cervical flexion myelopathy

Influence of intramedullary stress on cervical spondylotic myelopathy

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